Table of Contents Abstract……………………………………………………………………………3 Introduction……………………………………………………………………......4 Literature Review…………………..…………………………………………..... 7  Complications……………………………………………………………………12 Methodology…………………………………………………………………......23 Inclusion Criteria………………………………………………………………...27 Exclusion Criteria………………………………………………………………..30 Discussion………………………………………………………………………..35 Limitations………………………………………………………………………38 Conclusion………………………………………………………………………44 References………………………………………………………………………53 Abstract Infection with the human immunodeficiency virus (HIV) creates acquired immunodeficiency syndrome (AIDS), which attacks the cells of the immune system, and damages or destroys their function. The virus is spread through immediate contact with an infected mucosal membrane or bodily fluids such as blood, semen, and breast milk.  After an introductory frequently asymptomatic stage, skin predicaments and upper respiratory tract infections occur, and patients start to lose weight. Persistent diarrhea, chronic fever, fungal or bacterial contaminations, and tuberculosis may follow. As the infection advances, the immune system degenerates, gradually losing its strength to fight other infections and diseases, and eventually leading to “immune deficiency”. Immunodeficiency individuals are prone to opportunistic infections and tumors. There is no antidote or vaccine currently ready, but the availability of active antiretroviral treatment has radically lowered mortality and prolonged survival times of HIV-infected individuals in high-income nations. However, antiretroviral medications are usually costly, and access to diagnostic tests and treatments in low- to middle-income class families and third world countries has been inadequate. Over the preceding decade, competition from universal pharmaceutical corporations has dramatically reduced the cost of antiretroviral, although brand-new generation medications continue prohibitively pricey. Most children get HIV through perinatal transmission through pregnancy, childbirth, or while breastfeeding. Prevention programs can decrease the risk of transmission from 30-40% down to less than 5%. Improved admittance to these programs will lead to the higher health of HIV-positive expecting women and lowering numbers of newborns infected. Introduction According to the Centers for Disease Control and Prevention, of all ethnic groups in the United States, African Americans have faced the most challenges and largest burden by the HIV/AIDS epidemic since 1981 (CDC, 2016). Distinguished with various races and ethnicities, African Americans serve a more significant amount of new HIV diagnoses, those existing with HIV, and those ever decided to have AIDS. In 2014, it was reported that 44% (19,540) of newly diagnosed HIV cases were published in the United States were among African Americans, who constitute of 12% of the US population (CDC, 2016). During this same year, it is expected that presently diagnosed HIV cas.

1. Table of Contents
Abstract………………………………………………………………
……………3
Introduction…………………………………………………………
…………......4
Literature
Review…………………..…………………………………………....
. 7
Complications………………………………………………………
……………12
Methodology…………………………………………………………
………......23
Inclusion
Criteria………………………………………………………………..
.27
Exclusion
Criteria………………………………………………………………..
30
Discussion……………………………………………………………
…………..35

2. Limitations……………………………………………………………
…………38
Conclusion……………………………………………………………
…………44
References……………………………………………………………
…………53
Abstract
Infection with the human immunodeficiency virus (HIV) creates
acquired immunodeficiency syndrome (AIDS), which attacks the
cells of the immune system, and damages or destroys their
function. The virus is spread through immediate contact with an
infected mucosal membrane or bodily fluids such as blood,
semen, and breast milk. After an introductory frequently
asymptomatic stage, skin predicaments and upper respiratory
tract infections occur, and patients start to lose weight.
Persistent diarrhea, chronic fever, fungal or bacterial
contaminations, and tuberculosis may follow. As the infection
advances, the immune system degenerates, gradually losing its
strength to fight other infections and diseases, and eventually
leading to “immune deficiency”. Immunodeficiency individuals
are prone to opportunistic infections and tumors. There is no
antidote or vaccine currently ready, but the availability of
active antiretroviral treatment has radically lowered mortality
and prolonged survival times of HIV-infected individuals in
high-income nations. However, antiretroviral medications are
usually costly, and access to diagnostic tests and treatments in
low- to middle-income class families and third world countries
has been inadequate. Over the preceding decade, competition

3. from universal pharmaceutical corporations has dramatically
reduced the cost of antiretroviral, although brand-new
generation medications continue prohibitively pricey. Most
children get HIV through perinatal transmission through
pregnancy, childbirth, or while breastfeeding. Prevention
programs can decrease the risk of transmission from 30-40%
down to less than 5%. Improved admittance to these programs
will lead to the higher health of HIV-positive expecting women
and lowering numbers of newborns infected.
Introduction
According to the Centers for Disease Control and Prevention, of
all ethnic groups in the United States, African Americans have
faced the most challenges and largest burden by the HIV/AIDS
epidemic since 1981 (CDC, 2016). Distinguished with various
races and ethnicities, African Americans serve a more
significant amount of new HIV diagnoses, those existing with
HIV, and those ever decided to have AIDS. In 2014, it was
reported that 44% (19,540) of newly diagnosed HIV cases were
published in the United States were among African Americans,
who constitute of 12% of the US population (CDC, 2016).
During this same year, it is expected that presently diagnosed
HIV cases among African American women represented 26%
(5,128) and 73% (14,305) was that of African American men
(CDC, 2016). Between 2005 and 2014, the CDC (2016) recorded
that the quantity of new HIV diagnoses among African
American women dropped 42%. However, it is still remarkably
compared with women of diverse races/ethnicities.
As of the previous rate of HIV infection among African
American women has transformed into an undeniably
developing epidemic. Among African American women the
fundamental transmission rate is related to having unprotected
sexual relations with their male counterparts of the
corresponding ethnic group (Avert, 2016). Although there have
been multiplied intervention plans executed throughout the
United States, the urgent need for an active women’s
intervention program must be performed in America. By using

4. the Health Belief Model to devise an intervention plan will be
profitable to African American woman living with HIV/AIDS.
Problem Statement
It is necessary for healthcare specialists, especially advanced
nurses and public health specialists in distinguishing the
determinants that add to and are related with taking part in
high-risk sexual relations for African American women of a
feeble to average financial status living in the United States; so
they can implement programs that can reduce the vulnerabilities
of HIV infections within this population, but most importantly
design programs that will educate this population of how to live
with their diagnosis without the feeling of being segregated
against.
Background
Customarily, women have been impacted by HIV/AIDS since
the commencement of the plague. Present, women represent 1 in
5 (20%) new HIV infections in the U.S (FTCA Health Center,
2016). Women of color, especially African American women,
have been especially hard hit and articulate to the lion's portion
of women living with the sickness and women newly
contaminated. As with people with HIV by and large, most
women with HIV are not in universal care and just a quarter are
virally subdued (FTCA Health Center, 2016). Women with and
at risk for HIV encounter a few obstacles to getting the services
and information they need, including financial and social
barriers, for instance, poverty, social inequalities, and sexual
savagery, and women may put the requirements of their families
superior their own.
What is more, women additionally encounter peculiar clinical
side outcomes and complications because of HIV disease.
Notwithstanding this influence, there are encouraging new
symptoms, with information showing that HIV infections are
immediately falling among women, including among African
American, even though they keep on growing among
homosexual men(FTCA Health Center, 2016). The leading cause
of the plague's outcome on women in the U.S., particularly

5. African American women, stays crucial to ensuring that these
empowering models progress.
According to the Florida Department of Health in 2013, 901
African American women account for new HIV cases. As of
January 31, 2014, Miami-Dade County ranks number 1 in the
state of Florida for new HIV cases and AIDS cases. 27,035
people are living with HIV/AIDS in Miami-Dade County
(Florida Department of Health, 2013)
Women are doomed to be infected with HIV through
heterosexual (84% of new infections in 2010), traced by
immersion drug use (16%). This model is constant crosswise
over racial and ethnic groups, albeit heterosexual transmission
represents a more remarkable offer of new HIV epidemics
among African American women and Latinas (87% and 86%,
separately) compared with white women (76%) (Kaiser Family
Foundation, 2016).
Health Promotion- Advanced Practice
The convenience of viable treatment has changed HIV disease
into a continuous condition needing a complicated hybrid of
HIV masterpiece, primary care and preventive medicine best
conducted by a multidisciplinary care group. Superior Practice
Registered Nurses (APRNs) perform a substantial character in
augmenting the viability of the care organization and in giving
quality, financially savvy HIV care in the U.S. Studies confirm
that patients with HIV watched after by APRNs in multi-
disciplinary care settings have functionally indistinguishable
outcomes to patients supervised by doctors (Farley et al., 2016).
The practice scene for APRNs is immediately developing with
numerous states passing legislation that prolong their scope of
practice to mirror their instruction and training and to take care
of the enlarged demand for first care. Substantial portions of the
states with the final practice rules for APRNs additionally have
greater HIV workforce insufficiencies making obstructions to
mastermind that understandable add to HIV well-being
disparities (Farley et al., 2016).
The Health Belief Model

6. The Health Belief Model (HBM) is a psychological model that
strives to clarify and predict wellbeing practices by focusing on
the temperaments and convictions of people. The HBM was
produced in the 1950s as an element of exertion by a social
psychologist in the United States Public Health Service to
clarify the lack of extensive cooperation in wellbeing screening
and prevention programs (Joint United Nations Program on
HIV/AIDS, 1999, p 6). From that point onwards, the HBM has
been modified to investigate a variety of long-and transient
wellbeing practices, including sexual peril uses and the
transmission of HIV/AIDS. The main variables of the HBM are
perceived threats, which consist of two other variables, (1)
observed susceptibility and (2) acknowledged the severity of a
health situation. The perceived susceptibility can be found as
one’s subjective perception of health conditions, and perceived
severity can be seen as feeling enclosed by the seriousness of
contracting a virus (Tarkang & Zotor, 2015). The observed
privilege variable looks at the believed effectiveness of
manipulating that are designed to decrease the threat of disease.
Hence, another variable of HBM is regarded as barriers. This
distinct HBM variable concerns to potential disadvantageous
outcomes that may come about because of taking precise
wellbeing activities, including physical, mental, and money
related inquiries. The last variable of the HBM is a cue of
actions. This variable seems at the events whether bodily or
environmental that would prompt other people to take measures
(Joint United Nations Program on HIV/AIDS, 1999, p 6).
Literature Review
Living with HIV/AIDS as an African American in America;
there are various psychological consequences as well as barriers
that influence them in their life. African American women
living with HIV in America; suffer the same kind of
predicaments in their everyday lives. Their condition
profoundly hinders an analysis by (McIntosh & Roselli, 2012)
stress coping in women. It affected their mental results and
kindled by some constituents to have such an effect on them.

7. Some of the components that the investigation found were the
availability of antiretroviral medication and rejection in the
community. Stress can be a significant barrier for African
Americans who live with HIV in the United States. They have to
develop means through which they can cope with stress in their
daily lives.
Stress, based upon the analysis, could change the
psychological development and functioning of people. African
American women in the study were found to have high-stress
levels which owed to the demands that they had to keep up with
in their lives (McIntosh & Roselli, 2012). Acceptance of their
situation was also another factor as they tried to fit in the
society. The women faced significant problems in mingling with
others and even maintaining the past lives before they were
diagnosed with the virus. It all creates mental hardships which
in turn results to stress and then psychological disorders. As
stated by (McIntosh et al., 2015), the study showed women who
had children experienced more stress. Their children suffered
stress too, according to the women, which was a contributing
factor to the overall level on the mother’s side.
(Ivy, Miles, & Paz-Bailey, 2014) examined sex partner
characteristics, individual risk factors and socioeconomic
factors in 20 cities. Minority populations were one of the areas
that were concentrated on due to its large numbers of African
Americans living with HIV/AIDS. As of 2010, African
Americans constitutes 64% of new infections in women. Of the
3,868 participants in the study, 68% of the women had high
school education, and more than 84% of them lived under the
poverty baseline. The analysis also affirmed that some African
Americans were uninformed that they had tested positive for
HIV. Homelessness amongst the African Americans was of
significant concern as it made it challenging to get medical help
even though they were covered by Medicaid (Ivy et al., 2014).
The behaviors of their current and former sexual partners were a
significant reason for their awareness. African Americans whose
sexual partners used drugs were unlikely to know to consist of

8. 85% of African Americans who were uninformed about the
study. It indicates that women receive delayed medical attention
as they are unaware of their sickness. By this time they will
require many funds, and it will make their socioeconomic
complicated (Ivy et al., 2014). The poverty gap is another
problem that is discussed with most of the African Americans
unable to find medical attention early in progression as they
needed the money.
investigated social support in the issuing of antiretroviral
therapy (Kelly et al., 2014). The critics presume that adherence
to antiretroviral therapy (ART) has not been well studied and
recorded in any settings. 168 African American women who
were recently diagnosed with HIV completed the diagnosis, and
129 other women understood for at least 12 months to monitor
on the progress. It is necessary to follow up after the treatment
on the African Americans to guarantee that it is working
correctly. Not following up and collecting information puts the
African Americans at risk as they might not have enough
control over the virus (Kelly et al., 2014). People who have
undergone the treatment need a follow up to assure that their
response influences them positively and that they can fit back in
the community.
Stigma from the patients is critical and needs a follow-up to
secure that they are physically and mentally steady. According
to (Cutrono et al., 2016), many of the African Americans who
are diagnosed with HIV do not sustain a healthy diet or
robustness. Health and fitness are crucial in assuring that the
body has enough strength for treatment as well as fighting other
illnesses. African American women in the United States do not
recognize the two and end up being frail and overwhelmed by
the HIV. The virus will mainly impact people who lack
nutrients in their bodies as the control treatment is not
supported. Their health declines further, and they are not able to
fight other little complications.
According to (Cutrono et al.,2016), most of these minorities
give up on life after testing positive for the virus and fail to

9. acknowledge a healthy life. More than 80% of minorities are
affected by poverty and stigma. Their relatives abstain from
helping them financially, emotionally, and do not have any
other means that they can use so that they can sustain
themselves. 60% of the minorities in the analysis use the funds
that they get monthly from the government or qualified benefits;
so that they can maintain their upkeep as well as prescriptions.
Stigma and rejection from friends and loved ones or those once
close to them influence 50% of the African Americans as they
lost hope. The family is vital in the process, and the minorities
claim that they have lost their loved ones who left them and
consequently have to fend for themselves. Stress is also a
significant factor that affected 40% of the minorities as they
determined not to keep a healthy diet or fitness. They were
suffering from critical diseases that led them to be either
hospitalized or not interested in leaving their houses.
The report study is on African Americans living with
HIV/AIDS in the United States. Primarily concentrates on
matters that affect them like stress, stigma, health and fitness,
relations with partners or sexual partners and social support.
Most of the African Americans with HIV live under poverty
levels and are not able to fend for themselves financially. They
are rejected and henceforth lack support in preserving their
health which is likely through antiretroviral therapeutics. Most
of the African Americans also cannot furnish the drugs or a
healthy lifestyle to keep healthy bodies that can control the
virus. The study covers some of the predicaments that
minorities have to go through in their everyday lives. Future
analysis should replicate the decisions to assist find better
resolutions for African Americans.
The socioeconomic patterns and practices of the past have
served to reinforce discriminatory beliefs and values as well as
the allocation of resources. From a comprehensive, societal
perspective, this discriminatory suffering adds to poor health
across racial and ethnic borders. Despite increasing interest in
understanding how social determinants drive poor health

10. results, many researchers, policymakers, scientists, elected
officials, reporters, and others responsible for defining and
responding to the public discourse remain unwilling to classify
racism as a root of racial health inequities (Bailey et al., 2017).
Over time, the study has shown that racial and ethnic disparities
in health care subsist even when insurance status, income, age,
and rigor of health are equivalent (Nelson,2002). This is
possible due to the impact of past practices and the influence of
present practices such as institutional racism in both the public
and private area (Bailey et al., 2017).
The establishment by proof that such practices have been and
remain to be buttressed by policies that do not explicitly discuss
“race” but support racist intention or consequences, or both
(Bailey et al., 2017).
Structural Racism
Racial and ethnic disparities, including health disparities, are
well documented in the United States and have been a part of
government statistics since the originating of colonial America
(Bailey et al., 2017). While various controversies propagate
over explanations for these inequalities, it is difficult to release
structural racism as a significant determinant of population
health. Structural racism indicates the totality of forms in which
communities foster racial prejudice through mutually bolstering
systems of housing, education, employment, wages, interests,
credit, media, healthcare, and criminal justice (Bailey et al.,
2017).
Concentrating on the influence of structural racism would offer
a well-defined, practical, and favorable method towards
improving health equity and promotion of population health.
Nevertheless, disparities in an array of health infirmities such
as cardiovascular morbidity, cancer, HIV/AIDS, diabetes,
hypertension, and mental health have contributed to poorer
health results for racial and ethnic minorities (Koh, Graham, &
Giled, 2011). Indeed, the pernicious consequences of race-based
health inequalities have endured for centuries due to repression
and exclusion; however, this complex array of social factors

11. eventually became vital components in the passage of universal
health coverage in 2010 by the United States Congress (Bailey
et al., 2017). Bailey et al.,2017) believe that institutional racism
in one sector reinforces it in other sectors. That is believed to
form a large, interconnected system of structural racism where
discriminatory practices and disparities in the health care and
the criminal justice systems form discriminatory practices and
disparities in the employment and housing markets. That, in
turn, bolsters discriminatory practices and disparities in the
educational system, and so on. Moreover, while the research by
Bailey et al. focused mainly on the activities of African
Americans (since most analysis on racism and health has
concentrated on this group). They also were apt to recognize
that Native Americans and other people of color in the USA
including Hispanics, Asian Americans, and Pacific Islanders
have also been the target of health-harming racial bigotry.
Income Gaps
The measurement of socioeconomic inequalities in health is
critical for several purposes. Health is a crucial aspect of
wellbeing and health inequalities can alleviate any real
differences in wellbeing concerning income. Therefore, some
familiarity with the distribution of health across income
societies can provide a comprehensive picture of how well-
being is distributed across society (Bor, Galea, & Cohen, 2017).
One fundamental factor of racial/ethnic disparity and its
ongoing inter-generational results was the Social Security Act
of 1935. While it formulated an extraordinary system of
employment-based old-age insurance and unemployment
benefit, it also intentionally excluded agricultural workers and
domestic helpers (jobs which were held mainly by African
American men and women) (Bailey et al., 2017). This isolation
afforded the essentially Caucasian recipients additional
possibilities to acquire wealth and pass it on to their offspring.
Those excluded were less able to pass anything on to their
successors and most often become dependent on their children
and grandchildren after retirement (Bailey et al., 2017). The

12. outcome was a further curtailing of the intergenerational
gathering of assets. The net outcome, unfortunately, has been an
entrenchment of racial, economic inequities that continue to this
day.
The record gathered by Buchmueller, Levinson, Levy, and
Wolfe recommends that both before and after the ACA coverage
augmentation went into effect, differences in earnings described
most of the coverage gap between African Americans and
Caucasians; however, it did not describe it all. In 2014, the gap
was only 3.2 percentage points among adults in the lowest
earnings classified, compared with a gap of 9 points among all
adults (Buchmueller, Levinson, Levy, & Wolfe, 2016). Income
may also explain a sizable, although smaller, part of the
coverage gap between Caucasians and Hispanic residents
(Buchmueller, Levinson, Levy, & Wolfe, 2016). By variation,
even within income sections, the coverage gap between
Caucasians and Hispanic noncitizens was huge (Buchmueller,
Levinson, Levy, & Wolfe, 2016). In the lowest earnings
category, the gap was more than 40 percentage points in both
non-expansion and enlargement states.
Stark racial/ethnic disparities exist the HIV prevention and care
continuum (CDC, 2012) simultaneously. The next review
racial/ethnic disparities among Blacks, Latinos, Native
Americans/Alaskan Natives, and Asian Americans of the HIV
prevention and treatment continuation expressed in the model
and address how societal stigma correlates to these disparities.
Notably, analysis on Native Americans/Alaskan Natives and
Asian Americans are more restrained than on Blacks/ African
Americans and Hispanics/Latinos.
Risk
Although racial/ethnic HIV disparities start with risk,
discrepancies in sexual and injecting drug use risk behaviors
amongst races/ethnicities are often little. In nationwide
representative research (Centers for Disease Control and
Prevention, 2002), comparable percentages of Black (46%),
Latino (46%), and White (48%) high-risk heterosexual women

13. describe having various sexual partners. Somewhat lower
percentages of Latino (64%) than Black (75%) and White (69%)
high-risk heterosexual men report many sexual partners. In foil,
lower percentages of Black/African Americans (64%) than
Hispanic/ Latino (71%) and White/ Caucasian (74%) males who
have sex with males record having various sexual partners and
interlocking in risky sexual behaviors (Harawa et al., 2004).
Furthermore, a nationwide survey of injection drug users
discovered that Hispanic/Latinos (38%) were more likely to
share syringes than were Whites/ Caucasians (33%), whereas
Blacks/ African Americans (20%) were inconsiderable possible
(CDC, 2002).
At the structural level, Blacks/African Americans and
Hispanic/Latinos are more likely to exist in risk conditions due
to suburban segregation spaces in which external factors to the
particular increase chances of HIV transmission (Rhodes,
Singer, Bourgois, Friedman, & Strathdee, 2005) such as
neighborhoods that comprise a higher frequency of sexually
transmitted infections including HIV (Krieger, Waterman, Chen,
Soobader, & Subramanian, 2003). Individuals living in a high-
risk environment are not only also likely to acquire HIV, but
they are also more likely to acquire other sexually transmitted
infections, which more enhances their vulnerability to HIV
(Kalichman, Pellowski, & Turner, 2011). Risk environments
also incorporate the criminal justice system, in which Blacks/
African Americans are disproportionately designated, and rates
of HIV, sexual risk, and needle sharing among injection drug
users are more significant than other habitats (Okie, 2007;
Rhodes et al., 2005). Various external risk factors often co-
occur in risk environments, more magnifying the chances of
HIV transmission.
Besides operating at the structural level, medical skepticism
raises the risk for HIV. Among Black/ African American men,
analysis has associated HIV collusion beliefs with
unenthusiastic attitudes towards condoms, which in turn
connected with the lower probability of using condoms

14. consistently (Bogart & Thorburn, 2005). Collusion beliefs may
link to mistrust of data from public health administrators
regarding HIV, including how to decrease the risk of
transmission. Moreover, historical trauma is connected with risk
behaviors such as substance abuse and alcohol misuse in the
midst of Native Americans/Alaskan Natives (Sotero, 2006;
Walters et al., 2011). Substance use can directly raise HIV risk
through injection needle-sharing and indirectly raise HIV risk
by strengthening the likelihood of engaging in unsafe sex.
Stigma manifest at the individual level among targets associated
with expanded HIV sexual risk behavior. For instance,
Hispanic/Latino gay men who regard a stigma connected with
their ethnicity and sexual orientation are more plausible to have
unsafe sex with casual partners (Diaz, Ayala, & Bein, 2004).
Hispanic/Latino gay men may cope with psychological distress
resulting from the perceived stigma affiliated with these
crosscut stigmas by participating in sexual situations that
increase their risk of having unprotected sex (e.g., sex under the
effect of drugs). Additionally, internalized stigma is associated
with sexual risk among gay and bisexual men (Valdiserri,
2002). People who feel internalized stigma may be more likely
to participate in risky sexual conditions as a non-permanent
escape from shame and depression or because they seek self-
validation through sexual contacts.
Stigma manifested at the individual level among aim is further
connected with greater engagement in substance use. (Gibbons
& Co-Workers,2010) found that perceived stigma based on race
is amalgamated with prolonged substance use among Black
teenagers and their parents. Gibbons and colleagues
hypothesized that Blacks/African Americans involved in
substance use in part to cope with stress linked with perceived
stigma and that interactions distinguished by stigma deplete
self-regulatory functioning, which eventually leads to less self-
control to oppose drug use. Additionally, the internalized
stigma allied with race is associated with higher alcohol
consumption among metropolitan Black/ African Americans

15. women (Taylor & Jackson, 1990).
Incidence and Screening
Collocate with disparities in HIV risk, disparities in HIV
incidence are prominent. According to U.S. observation data
(National Center for HIV/AIDS, 2010), although Blacks/African
Americans constitute about 12% of the population in states with
confidential name-based reporting, they accounted for 45% of
all new diagnoses in 2007–2010; Latinos comprised about 16%
of the population but 22% of new diagnoses. In contrast,
although Whites accounted for a more significant percentage of
new diagnoses (29%) than did Hispanic/Latinos, they made up
65% of the population. Furthermore, Black/African American
men who have sex with men bear the highest burden of all
races/ethnicities and transmission groups (i.e., injection drug
use, injection drug use plus males who have sex with males,
heterosexual, and “other”) account for 40% of diagnoses among
men who have sex with men within all races/ethnicities (CDC,
2011). At the crosscut of age, race, and sexual orientation, the
rate of increase in new infections from 2006–2009 – 48% – was
more significant among young Black /African American guys
that have sex with guys than any other racial/ethnic category
(Prejean et al., 2011).
The racial/ethnic disparities also live in HIV screening.
Although Blacks/African Americans (77%) and
Hispanics/Latinos (58%) are more likely to account for having
ever been tested than are Whites/Caucasian (49%) (Kaiser
Family Foundation, 2011), Blacks/African Americans,
Hispanics/ Latinos, and Asians/Pacific Islanders trials at an
afterward stage in the HIV infection continuation (Chen,
Gallant, & Page, 2012). The percentage of Blacks/African
Americans (16%) and Hispanics/Latinos (16%) who tested for
HIV within six months of being infected is decrease than for
Whites/Caucasian (29%) (Schwarcz et al., 2007). The
interchange of race/ethnicity with immigration status may widen
disparities connect to late testing (i.e., receipt of an AIDS
diagnosis during a year after testing). In an analysis of 45 US

16. border communities, people who were foreign-born were most
likely to be late testers (Espinoza, Hall, & Hu, 2009).
Residentiary segregation at the structural level may play a part
in the racial/ethnic disparity in HIV screening: Blacks/African
Americans and Hispanics/Latinos are more likely to stay in
higher HIV prevalence district, which is aimed for receiving
more national HIV prevention funds for testing. Furthermore,
HIV stigma manifested at the individual level among targets
continues to be considered a significant barrier to HIV
screening (Obermeyer & Osborn, 2007). A definite diagnosis
forever marks a person with the stigma of HIV. Individuals who
assume that others will discriminate against them if they test
positive for HIV may avoid testing. Also, people may not test
due to the anticipated stigma associated with risk behaviors or
related stigmas. For instance, guys who have sex with the same
sex, people who employ in sex work, and individuals who inject
drugs may delay testing or not test due to fear that others will
suspect that they engage in a stigmatized behavior. Relatedly,
Hispanic/Latinos who are undocumented may defer testing to
hide their residency condition.
Treatment
Later, in the HIV continuum, racial/ethnic disparities exist in
medical treatment experienced by individuals living with HIV.
Hispanics/Latinos have the huge setbacks between HIV
diagnosis and action in treatment followed by Blacks/African
Americans, with Whites/ Caucasians having the smallest
deferments (Turner et al., 2000). Hispanics/Latinos and
Blacks/African Americans have moderate rates of commitment
to HIV treatment than Whites/Caucasian (Shapiro et al., 1999).
Blacks/African Americans are limited likely to receive
antiretroviral medication followed by Hispanics/Latinos, with
Whites/Caucasians being most likely (Lillie-Blanton et al.,
2010). Blacks/African Americans are less partisan to
antiretroviral treatment than are Whites/Caucasians (Johnson et
al., 2003). The degree to which this disparity exists for
Hispanics/Latinos is unclear; some researchers have discovered

17. that Latinos manifest immeasurable adherence than other
races/ethnicities (Silverberg, Leyden, Quesenberry, & Horberg,
2009), whereas others have shown that Latinos exhibit worse
adherence than Whites (Oh et al., 2009).
At the structural level, living segregation can influence the
availability and quality of attention. Blacks/African Americans
are more likely to live in areas characterized by limited
availability of health care (e.g., fewer physicians and
institutions) and poorer health care quality (White, Haas, &
Williams, 2012). Furthermore, language designates a barrier
among people living with HIV who do not speak English,
reducing the likelihood that they will endeavor medical
attention and increasing the probability of medication errors
when they do (Murphy, Roberts, Hoffman, Molina, & Lu, 2003).
Historical traumatic assaults have disrupted the availability of
common Native medicine services and cultures (Walters et al.,
2011), which may be preferred by some Native
Americans/Alaskan Natives inhabiting with HIV (Duran &
Walters, 2004). Medical mistrust further exacerbates racial
disparities in HIV care and treatment, possibly leading to a
lower likelihood of accessing healthcare (Smedley et al., 2003).
Medical mistrust may also lead to reluctance to adhere to
provider recommendations. For example, Black men living with
HIV who endorse treatment-related conspiracy beliefs, such as
the belief that people who take antiretroviral treatments are
“guinea pigs,” show lower adherence to antiretroviral treatment
(Bogart, Wagner, Galvan, & Banks, 2010).Stigma manifested at
the individual level among perceivers plays a critical role in
racial/ethnic disparities in the treatment of HIV. Accumulating
evidence demonstrates that physicians who hold implicit (i.e.,
unconscious) prejudice towards Black patients also have more
negative stereotypes of and discriminate towards Black patients
by providing them with more poverty-stricken care for a
discussion, see (Dovidio et al., 2008). Within HIV care and
treatment specifically, stigma may affect physician prescription
of antiretroviral therapeutics. (King & colleagues,2004) found

18. that White doctors ordered antiretroviral therapeutics to
Black/African Americans patients much later than to
White/Caucasian patients. Nevertheless, there were no
variations in the period before prescription between
Black/African Americans physicians with Black/African
Americans patients and White/Caucasian providers with
White/Caucasian patients. Provider standardizes partly induce
differences in the medicine of antiretroviral treatment that
Black/African Americans patients will be limited adherent
(Stone, 2005). Several providers also believe that individuals
living with HIV who currently or have in the history abused
liquor or injection drugs, homeless individuals, and parents of
young kids will have poor adherence, possibly influencing
medication.
Stigma manifested at the individual level among targets
moreover undermines care and therapy. When acquiring HIV
care, people living with HIV perceive specific stigma based on
their race and socioeconomic situation (Bird, Bogart, &
Delahanty, 2004) as well as their HIV status (Schuster et al.,
2005). Moreover, Black/African Americans patients record
receiving more poor attention from and having less reliance on
providers who are eminent in specific prejudice (Cooper et al.,
2012). Recognized stigma from physicians is linked with lower
access to treatment (Kinsler, Wong, Sayles, Davis, &
Cunningham, 2007) and prominent possibility of missing
physicians’ appointments (Bird et al., 2004). Individuals living
with HIV who regard stigma from health care providers may
shun health care contexts because they anticipate stigma from
providers. People living with HIV who perceive stigma from
others, in general, are also more likely to miss clinic
appointments for HIV care (Vanable, Carey, Blair, &
Littlewood, 2006). Not obtaining care could help individuals
hide their HIV status. Additionally, internalized stigma is
associated with limited access to treatment (Sayles, Wong,
Kinsler, Martins, & Cunningham, 2009). People with high
internalized stigma may avoid treatment because they feel that

19. they do not earn attention, or because they feel embarrassed to
address their HIV infection or related risk behaviors.
Stigma manifested at the individual level among marks can
damage medication adherence. Research at the cloverleaf of
race, HIV, and sexual familiarization implies that perceived
stigma due to race plays a vital role in antiretroviral adherence.
In a multivariate pattern including the impacts of perceived
stigma due to race, HIV, and sexual bearings, only perceived
stigma due to race was a significant predictor of adherence
(Bogart, Wagner, Galvan, & Klein, 2010). Individuals living
with HIV who have internalized stigma are also more expected
to report suboptimal adherence (Sayles et al., 2009). They may
choose not to take a prescription to avoid speculating about
their HIV status.
Survival
Ultimately, racial and ethnic disparities live at the end of the
HIV continuum in vestige rates of individuals living with HIV
(Simard, Fransua, Naishadham, & Jemal, 2012). Blacks/African
Americans and Native Americans/Alaskan Natives diagnosed
with HIV exhibit much higher mortality rates than
Hispanics/Latinos, Whites/Caucasians, and Asians/Pacific
Islanders, and are less probable to prevail alive nine years post-
diagnosis (Centers for Disease Control and Prevention, 2008,
2011). In a simulation interpretation, Hispanics/ Latinos
diagnosed with HIV were expected to lose more life years from
late antiretroviral regimen introduction and discontinuation
connected to all other races/ethnicities, and Black/African
women were anticipated to waste more years of life due to
delayed beginning and discontinuation than White/Caucasian
women (Losina et al., 2009). However, this course was reversed
for Black/African Americans versus White/Caucasian men,
highlighting the significance of the crossing of race and gender.
Stigma manifested at the structural level may influence the
survival of individuals living with HIV. The concentration of
poverty in residentially segregated circumstances can lead to
susceptibility to raised levels of persistent and acute stressors at

20. the person, household, and neighborhood levels, including
economic catastrophe and criminal victimization. Significant
racial/ethnic differences exist in the vulnerability to various
types of acute and chronic stressors, which add to racial/ethnic
disparities in health (Sternthal, Slopen, & Williams, 2011).
Likewise, historical trauma has been conceptualized as a
persistent stressor that can have adverse health consequences
for Native Americans/Alaskan Natives (Sotero, 2006). Chronic
stress is incorporated with faster HIV disease progression and
shortened survival among individuals living with HIV
(Leserman, 2003).
Perceived stigma and anticipated stigma at the individual level
among marks more act as chronic stressors that can have
devastating physiological (e.g., cardiovascular reactivity),
psychological (e.g., anger, felt stress, anxiety), and behavioral
(e.g., smoking) acknowledgements (Major et al., 2012). People
living with HIV who recognize stigma report great physical
health and mental health symptoms (e.g., HIV symptoms,
depressive symptoms) (Vanable et al., 2006), and those who
internalize stigma report prominent depression, anxiety, and
hopelessness (Lee, Kochman, & Sikkema, 2002).
Methods
Analyzing the data on adults and adolescents, aged 13 years and
older, whose HIV determination had been made during 2005
throughout 2008 and reported to CDC through June 2009. Cases
of HIV infection, unmindful of the stage of illness at diagnosis,
were numbered by year of initially reported the diagnosis. Only
states with private name-based HIV reporting at least six
months before 2005 incorporated in the analysis sufficient time
to allow for stabilization of gathered data to monitor biases.
The following 37 states were included: Alabama, Alaska,
Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia,
Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan,
Minnesota, Mississippi, Missouri, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North
Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South

21. Dakota, Tennessee, Texas, Utah, Virginia, West Virginia,
Wisconsin, and Wyoming. Data adapted for reporting delay by
utilizing a revised semiparametric life-table statistical
procedure and are presented as assessed case counts.
Age groups were based on the individual's age at the date of the
first documented HIV diagnosis. Race and ethnicity were
categorized as White, not Hispanic/Latino (referred to hereafter
as White); Black/African American, not Hispanic/Latino
(referred to hereafter as Black); Hispanic/Latino; and other (to
avoid exhibition of small cell sizes in the groups classified as
other).
Persons classified as Hispanic/Latino can be of any race. Cases
were organized into a hierarchy of transmission sections by risk
factor: male-to-male sexual partner, needle drug use, male-to-
male sexual contact and injection drug use (homosexual)
heterosexual contact (i.e., sexual contact with a person known
to have, or to be at tremendous risk for, HIV infection), and all
other risk determinants combined.
Cases that were reported to CDC without a perceived risk
determinant (42% among persons aged 50 years; 32% among
those aged 13–49 years) were designated a risk determinant by
using various imputations. Multiple imputations is a statistical
approach in which a set of plausible values is generated for each
missing risk factor that represents the uncertainty about the
truth, but missing, value. The plausible values are analyzed
using standard methods, and the outcomes of the analyses are
mixed to produce the ultimate imputed values.
To calculate average yearly rates of diagnosis (per 100 000
persons) for demographic organizations, used population
denominators based on official post-census predicting for 2005
through 2008 from the US Census Bureau. Rates for
transmission sections were not calculated because of the
absenteeism of denominator data. All investigations were
conducted by using SAS statistical software, version 9.1.3 (SAS
Institute Inc., Cary, NC). Stratified multivariate analyses using
log-binomial models were conducted to determine prevalence

22. ratios (PRs) of factors affiliated with late diagnosis of HIV
infection in adult men and women. A diagnosis of HIV was
deemed late if AIDS was diagnosed within 12 months after the
date of HIV diagnosis. The estimated yearly percentage change
(EAPC) was measured by fitting a regression line to the natural
logarithm of the rates (regressor was calendar year). The
standard error, formed from the fit of the regression, was used
to calculate a 95% certainty interval (CI) for the EAPC.
Results
Homosexual and bisexual men are the population most afflicted
by HIV/ Aids in the United States. In 2016, gay and bisexual
men estimated for 67% of the 40,324 current HIV diagnoses in
the United States and six dependent regions. Approximately
492,000 sexually active gay and bisexual men are at significant
risk for HIV;
The NumbersHIV Diagnosed
In 2016, gay and bisexual men estimated for 67% (26,844) of
total HIV diagnoses and 82% of diagnoses amongst males aged
13 and older.
During 2016:
Amid all gay and bisexual men who experienced an HIV
diagnosis in the United States and six vulnerable areas,
blacks/African Americans estimated for the most significant
number n= (10,226; 38%), supported by Hispanics/Latinos
(7,689; 29%) and Whites (7,392; 28%). Other races/ethnicities
estimated for 1,537 (6%) diagnosed amidst gay and bisexual
men.
Gay and bisexual men aged 13 to 34; account for two-thirds
(64%) of HIV diagnoses among all gay and bisexual men.
However, the age pattern changes by race/ethnicity.
Black/African American: 36% (3,720) were aged 13 to 24; 39%
(3,994) were aged 25 to 34; 13% (1,291) were aged 35 to 44;
8% (808) were aged 45 to 54; and 4% (413) were aged 55 and
older.
Hispanic/Latino: 23% (1,751) were aged 13 to 24; 41% (3,181)
were aged 25 to 34; 21% (1,578) were aged 35 to 44; 12% (885)

23. were aged 45 to 54; and 4% (293) were aged 55 and older.
White: 15% (1,095) were aged 13 to 24; 32% (2,340) were aged
25 to 34; 19% (1,414) were aged 35 to 44; 22% (1,598) were
aged 45 to 54; and 13% (946) were aged 55 and older.
Other races/ethnicities: 23% (351) were aged 13 to 24; 41%
(626) were aged 25 to 34; 19% (299) were aged 35 to 44; 11%
(172) were aged 45 to 54; and 6% (94) were aged 55 and older.
From 2011 to 2015:
HIV diagnoses continued steadily at about 26,000 per cycle
among all gay and bisexual men. Bearings for HIV diagnoses
among gay and bisexual men differed by race/ethnicity.
African American: Persisted stable.
Hispanic/Latino: Increased 13%.
Asian: Increased 35%.
White: Decreased 10%.
Other races/ethnicities: Decreased 23%.
Bearings for HIV diagnoses among gay and bisexual men also
varied by age.
Ages 13 to 24: Remained stable.
Ages 25 to 34: Increased 21%.
Ages 35 to 44: Decreased 15%.
Ages 45 to 54: Decreased 14%.
Ages 55 and older: Remained stable.
HIV Diagnoses Among Gay and Bisexual Men
By Age and Race/Ethnicity in the United States and 6
Dependent Areas, 2016
Subpopulations representing 2% or less of HIV diagnoses
among gay and bisexual men are not reflected in this chart.
Source: Diagnoses of HIV infection in the United States and
dependent areas, 2016. HIV Surveillance Report 2017;28.

24. Living With HIV
In the 50 states and the District of Columbia:
Approximated 632,300 gay and bisexual men had HIV at the
conclusion of 2015, representing 56% of everyone with HIV. By
race/ethnicity, 240,900 were White, 201,800 were African
American, 151,200 were Hispanic/Latino, and 38,400 were
different races/ethnicities.
A rated of 83% (526,456) of gay and bisexual men were
knowledgeable of their infection at the close of 2015.
Amongst all gay and bisexual men with HIV in 2015, 62%
underwent some HIV medical attention, 48% were maintained in
HIV care, and 52% had a subdued viral load. A person with HIV
who takes HIV medication as directed and gets and stays virally
contained or undetectable can survive healthily and has
efficiently no chance of sexually transmitting HIV to HIV-
negative companions.
Deaths
During 2015, there was 6,531 mortality among gay and bisexual
men with diagnosed HIV in the United States and six poor
areas. This mortality may be due to any reason.
Prevention Challenges
A much larger balance of gay and bisexual men have HIV
correlated to any other society in the United States. Hence, gay
and bisexual men have an increased possibility of contracting an
HIV-positive companion.
One in 6 gay, and bisexual men with HIV are ignorant they have
it. Individuals who do not recognize they have HIV cannot get
the medications they want to stay healthy and stop transmitting
HIV to their companions. Therefore, they may spread the virus
to others without recognizing it. Among African American gay
and bisexual people who have HIV, a reduced percentage know
their HIV state compared to HIV-positive gay and bisexual men
of some other races/ethnicities.
Largest gay and bisexual men acquire HIV from having anal sex
without utilizing condoms or taking medications to prevent or
tackle HIV. Anal sex is a dangerous type of sex for getting or

25. transmitting HIV. Receptive anal sex is 13 times as dangerous
for getting HIV as insertive anal sex.
According to the Medical Monitoring Project, which
accumulates data about the occurrences and requirements of
people with HIV, 13% of sexually active gay and bisexual men
with HIV contracted in high-risk sex in the past 12 months. Gay
and bisexual individuals are also at heightened risk for other
sexually transmitted diseases (STDs), like syphilis, gonorrhea,
and chlamydia. Condoms can defend from some STDs,
including HIV.
Homophobia, stigma, and discrimination may put gay and
bisexual people at risk for many physical and mental health
difficulties and may change whether they endeavor and can
obtain high-quality health assistance.
Socioeconomic circumstances, such as having insufficient
access to quality health care, lower income earnings and
educational levels, and more substantial rates of unemployment
and incarceration, may set some gay and bisexual men at
tremendous risk for HIV.
HIV Among Pregnant Women, Infants, and Children
Perinatal HIV transmission, also perceived as mother-to-child
transmission, can occur at any time during gestation, labor,
delivery, and breastfeeding. CDC suggests that all women who
are expecting mothers or planning to get pregnant take an HIV
test as quickly as possible before and throughout each
propagation. This is because the earlier HIV is diagnosed and
managed, the more effective HIV medication, called
antiretroviral treatment (ART), will be at stopping transmission
and enhancing the health results of both mom and child.
Advancements in HIV study, prevention, and treatment have
made it likely for many women living with HIV to go through
childbirth without transmitting the virus to their children.
The yearly number of HIV infections throughout perinatal
transmission has decreased by more than 90% since the early
1990s. Now, if a woman takes HIV medicine every day as
prescribed throughout gestation, labor, and delivery and gives

26. HIV medication to her baby for 4-6 weeks after birth, the
chance of transmitting HIV to the child can be as low as 1% or
smaller. When the HIV viral load is not sufficiently decreased,
a Cesarean delivery can also support to prevent HIV
transmission. After birth, a mother can avoid transmitting HIV
to her newborn by not breastfeeding and not pre-chewing her
baby ’s meals.
For infants living with HIV, beginning treatment early is
significant because the disease can advance more promptly in
children than grown-ups. Providing ART first can support
children with perinatal HIV live plentiful, healthier lives.
It is urgent that all women who are expecting or striving to get
pregnant inspire their companions also to get tested for HIV.
Women who are HIV-negative but have an HIV-positive spouse
should talk to their physician about taking HIV medication
every day, called pre-exposure prophylaxis (PrEP), to protect
themselves while attempting to get pregnant, and to protect
themselves and their unborn during pregnancy and while
breastfeeding.
The Numbers
HIV Infections and Prevented Cases of Perinatal HIV
Transmission
HIV Infections and Prevented Cases of Perinatal HIV
Transmission
· Roughly 8,500 women living with HIV give birth yearly
(based on an assessment from 2006, the most current available).
· Within 1994 and 2010, an estimated 21,956 instances of
perinatal acquired HIV infections were averted.
· In 2016, 99 kids under the age of 13 obtained a diagnosis of
perinatal acquired HIV.
Rates of Perinatally Acquired HIV Infections by Year of Birth
and Mother’s Race/Ethnicity, 2010-2014
Monitoring selected national HIV prevention and care

27. objectives by using HIV surveillance data—United States and 6
dependent areas, 2015. HIV Surveillance Supplemental Report
2017;22(2).
Data include only persons born in the United States.
Data accounted for delays between birth and diagnosis, as well
as between diagnosis and reporting.
Rates are per 100,000 live births.
Live-birth data reflect race/ethnicity of the infant’s mother.
Hispanics/Latinos can be of any race.
Diagnoses of Perinatal HIV Infections in the US by
Race/Ethnicity, 2016
Source: CDC. Diagnoses of HIV infection in the United States
and dependent areas, 2016. HIV Surveillance Report 2016;28.
Hispanics/Latinos can be of any race.
Diagnoses of Perinatal HIV Infections in the US, 2011-2015
Source: CDC. Diagnoses of HIV infection in the United States
and dependent areas, 2016. HIV Surveillance Report 2016;28.
Living With HIV
At the completion of 2015, 1,872 children existed with
diagnosed perinatal HIV. Of these 1,206 (64%) were
Black/African American, 279 (15%) were Hispanic/Latino, and
198 (11%) were White.
At the end of 2015, 9,728 grown-ups and youngsters (aged 13
and older) were living with diagnosed HIV contracted via
perinatal transmission. Of these, 58% (5,679) were
Black/African American, 24% (2,380) were Hispanic/Latino,
and 12% (1,125) were White.
Prevention Challenges
Expecting women with HIV may not know they are affected.
CDC urges HIV testing for all women as a component of regular
prenatal care. According to CDC analysis, more women take the

28. prenatal HIV test if the opt-out method is used. Opt-out prenatal
HIV testing indicates that a gestating woman is told she will be
given an HIV test as part of regular prenatal care except she
opts out that is, decides not to have the test In some sections of
the country where HIV among women is more prevalent, CDC
suggests another test during the third trimester of pregnancy. In
2016, the American Medical Association established a new
Common Procedural Terminology (CPT) code that comprises
HIV testing in the Obstetric Panel. This enables prenatal care
providers to require just one panel that incorporates many
standard serologic examinations for pregnant women, including
HIV. Women living with HIV may not be aware they are
expecting, how to prevent or carefully plan a pregnancy, or
what they enable do to decrease the chance of transmitting HIV
to their infant. For women living with HIV, it is essential that
they Visit their health care provider regularly.
· Take HIV medicine as directed for their health and if they
want to get pregnant.
· Take HIV medicine throughout the pregnancy, labor, and
delivery, as ordered.
· Guarantee their newborn gets HIV medication after delivery
Avoid breastfeeding
Avoid pre-chewing meal for an infant, toddler, or anyone else.
To get the complete protective privilege of HIV medication, the
mommy must take it as directed without interference during
pregnancy, labor, and delivery, and give HIV medication to her
newborn. Expecting women living with HIV may have
queasiness during pregnancy that can meddle with taking
medications, and brand-new mothers may not be capable of
seeing their HIV medical treatment provider consistently.
Social and economic circumstances, particularly poverty,
influence access to all health care and disproportionately sway
individuals living with HIV. Pregnant women living with HIV
may encounter more barriers to obtaining medical care if they
also use injection drugs; use other substances, or are homeless,
incarcerated, mentally unhealthy, or uninsured.

29. Discussion
This systematic review of HIV/AIDS included the following
key elements: Socioeconomic differences; income; barriers to
access; medical need; and differences in health care delivery.
The study had two significant limitations. Primarily, there were
comparatively few considerations that recorded racial
disparities in high-risk behavior among women. Secondly, the
investigations that did record racial disparities in behavior
varied considerably regarding study design, sample area, and
population demographics (age, geographic region, and so on).
That makes it very challenging to compare the outcomes of
these studies with one another and draw reliable global
conclusions.
Although, the literature evaluated in this study did present some
unique discovering regarding the four hypotheses that endeavor
to describe the higher incidence of HIV infection among
African-American women. The literature recommends that
African-American women be no more prone to have unprotected
sex, various sexual partners, or abuse substances than women of
other racial/ethnic groups. There is, therefore, inadequate data
that the absence of condom usage, many sexual partners, and
substance abuse are significant causes of the asymmetrical rates
of HIV incidence among African-Americans there is more report
on lack of condom use, multiple sexual partners, or drug use
among African American women that would put them at risk of
HIV/AIDs. To approach one of the key reasons is that AA men
often do not report being bisexual or identify with being gay
and get HIV from their male partners and then transmit this to
their female partners who are unaware that their male partners
had been in a bisexual or gay relationship before.
Based on these conclusions, population-level interventions
provided toward curbing these behaviors in African-Americans
may not be effective in eradicating the racial disparity in HIV
infection among minorities.
Some studies recommend that African-Americans be more
predisposed to have unsafe sexual partners and STDs. The

30. literature also explicated that African-American men who have
sex with men are more inclined to engage in bisexual behavior
and less liable to disclose their same-sex behavior to female
partners. Also, according to national HIV/AIDS monitoring
data, African-American women were more liable to
communicate becoming infected with HIV as a consequence of
sex with a bisexual partner. Therefore, these behaviors could be
adding risk circumstances to the higher rates of HIV infection
among African-American women. It is critical to record,
however, a rigid limitation of the HIV surveillance data. Almost
80 percent of inscribed HIV cases among women between 1999
and 2002 were recorded without a risk factor. Analysis based on
these data, therefore, are subjected to substantial bias due to
lacking data.
Future studies should proceed to explore these risk factors on a
massive scale. That will enable us to decide whether African-
American women are engaging in certain behaviors that put
them at higher risk for HIV infection and thereby promote
active behavioral intervention strategies. Moreover, studies
should concentrate on other social, behavioral, and economic
determinants that could lead to HIV infection such as poverty,
low literacy, and low socioeconomic status as well as childhood
sexual violation to describe racial/ethnic disparities in HIV
incidence. For instance, poverty can lead to limited health-care
access, which can lead to more extended periods of STD
infection, which in change can facilitate HIV infection. Also,
childhood sexual abuse can influence sexual decision-making
and effect in high-risk sexual behavior and drug use to conceal
the anguish of past occurrences.
Literature exhibits that are concentrating on interventions
on specific risk behaviors such as condom usage are not suitable
for the African-American population. African-Americans are at
high risk even when their behavior is deemed low risk, whereas
the Caucasian population’s risk doubles when their behavior is
determined as high risk. Thus, future HIV prevention
interventions should converge on the infection status of the

31. sexual partner by enhancing awareness of and access to testing
for that unknown of their serostatus and decreasing risky sexual
behavior among HIV positive individuals. Future endeavors
should also notify women about risky sexual partners and
address the stigma of homosexuality among the African-
American community. Addressing this stigma may inspire Black
MSM to reveal same-sex behavior to female partners.
Also, future analyses should center on quantifying the
augmentation of each factor to the overall epidemic in African
Americans. That will provide a measure of the possible effects
of interventions aiming these particular sources and provide
scientifically accurate information on which to inform
determinations of prevention resource allocation.
Limitations
It was not possible to study one jurisdiction, and conclusions
may be generalizable only to negligent youth in metropolitan
confinement centers with related demographic organizations.
Although detention was high, decisions on risk behaviors
evaluated at follow-up may have been influenced by missing
report. Some behaviors may present more risk for incurring
STIs with a consequent risk for contracting HIV. No, collected
data on some risk behaviors until partners were youthful adults.
Data are subject to the restrictions of self-report males who
have sex with males that are stigmatized in African American
and Hispanic populations. Therefore, the actual prevalence of
some behaviors may be more substantial than reported.
Eventually, there was no examination on how marital status,
living classifications, or other variables change risk behaviors.
Challenges to Implementing Large-Scale HIV Testing
A national policy to increase the number of people who are
tested for the HIV and admitted to treatment is an essential
element of a national program to prevent and eventually
eradicate HIV/AIDS. However, testing alone will not be
sufficient, and large-scale testing attempts are expected to face
some challenges.
First, as noted in an IOM statement on the Ryan White

32. Comprehensive AIDS Resources Emergency (CARE) Act the
general federal AIDS treatment plan. If testing actions are
thriving in expanding the numbers of people who are diagnosed
and in demand for treatment, there is no assurance that funding
for new treatment slots or prescriptions for low-income patients
will be ready (IOM, 2005; National ADAP Monitoring Project,
2005). Thus, wide-scale HIV testing goals to make Americans
aware of their HIV status could constitute an ethical
predicament. A substantial number of who find out they have
HIV may have nowhere to turn for the medical attention that
can improve chances for survival. Besides, there is the question
of sufficient resources to undertake wide-scale HIV testing.
According to Cohen and colleagues (2005).
The current CDC policy calls for increasing the percentage of
individuals who know they are infected from 75% to 95%.
Accomplishing this aim would demand that an extra 160,000
HIV-positive individuals study of their status. If the prevalence
in the examined population were 13%, then 5.3 -16 million
people would require to be screened more than could be
screened by changing the entire CDC HIV prevention budget to
the four new prevention strategies (Cohen, Wu and Farley,
2005).
Ways to Address the Problem
No known vaccine inhibits HIV infection, and there is no
remedy for AIDS. However, it is likely to protect oneself and
others from infection. That means African-American and
Hispanic youths should train themselves about HIV and
avoiding any behavior that enables HIV-infected fluids blood,
semen, vaginal discharges and breastmilk into their bodies.
To Help Prevent the Spread of HIV.
Teens should encourage the use of condoms. Several youths are
not aware of their partner’s state. In such incidents where they
do not know the HIV status of their partners, they should use a
new condom each time an individual have anal or vaginal sexual
intercourse. Women can use a female condom.
Think of the medicine Truvada. The method of the compound

33. drug emtricitabine-tenofovir (Truvada) can reduce the
likelihood of sexually transmitted HIV disease in those who are
a menace like among the youth. Truvada mixed as an HIV
therapy along with other medications (Truvada, 2012).
When used to support block HIV disease, Truvada is only
relevant if the physician is certain one does not already have an
HIV contamination (Shevell, Meriki, Cho-Ngwa, & Fuller,
2015). The physician should also test for Hepatitis B epidemic.
If one has Hepatitis B, the surgeon should check one kidney
before buying Truvada.
Truvada should be administered daily, exactly as prescribed.
This prescription could be utilized along with other prevention
strategies, such as condom use each time one has sex, as it does
not protect against other sexually transmitted infections, and it
cannot provide total assurance against HIV transmission as
well. If teens are interested in Truvada, they should
communicate with their physicians about the possible risks and
advantages of the drug.
Youths should inform their sexual partners if they have
contracted HIV. It is vital for teens to notify anyone with whom
they have had sexual intercourse with that they are HIV-
positive. Their companions must get tested and to obtain
medical care if they have the virus (Valerio, A., & Bundy,
D.A.P., 2004). They must also know their HIV status so that
they do not affect others.
Drug addicted Hispanic juvenility should practice a clean
needle. If the use a syringe to inoculate drugs, they should make
sure it is sterile and not share it with others. They should take
the comfort of needle-exchange programs in their neighborhood
and consider inquiring help for people with drug use. Expecting
teens should get preventive care right away. It is to guarantee
HIV-positive mothers, do not transfer the infection to their
unborn babies. However, if they receive treatment during
gestation, they can cut their unborn child's chance considerably.
Recommended Action Plan
As the nation’s minor remains to be affected by the HIV/AIDS

34. epidemic, programmatic acknowledgements are required to
maintain control of its expanse. Future endeavors need to
concentrate on promoting sexually active youths to get tested
for HIV or re-tested if the new risk transpires. Ultimately,
prevention plans for infected and high-risk teens should get
elaborate as part of extensive health education curricula that
encourage avoidance, a decrease in the number of sexual
companions, and condom habit for sexually active youngsters
and young grown-ups (Aral, Adimora, & Fenton, 2008).
According to Aral, Adimora, & Fenton, (2008), youth-serving
experts, including teachers and health care providers, should
combine barriers that include HIV, STI and youth pregnancy
prevention among African-Americans and Hispanics in rural
regions in America. Planners can face different funding streams,
complicated administrative systems, lack of knowledge by
faculty and the public, and real division of the fields. Particular
challenges can incorporate the following:
Educational systems and school board commissions should not
force limitations concerning the topics of pregnancy, HIV, and
STIs.
Separate funding rivulets apart from HPP may complicate grant-
seeking, and grant recording and some sources of funding may
restrict or prohibit the use of comprehensive strategies to
preventing reproduction, HIV, and STIs among the African
Americans population (Aral et al., 2008).
HPPG maintains that companies may require financial resources
to address the HIV prevalence sufficiently. The federal
government should intercede in such cases. The organization
may feel distressed about and lack experiences to deal with
behaviors and subjects outside their primary field. Workers may
also worry that integration is a substitution for downsizing
(Aral et al., 2008). Organizations may also face unexpected
competitions for funding, contracts, space(s), or media
recognition. Integration may need a shift or increase in the
target community of the African-Americans and Hispanics in
rural areas of America.

35. The theme recognized that there exist many intervention designs
that collectively would facilitate African Americans to decrease
the rate of infection and their vulnerability to HIV. According
to "Evaluation | Program Resources | HIV/AIDS | CDC", (2015),
the one that the document concentrated on was the utilization of
ABC scheme that stood for self-control when one has no sexual
partner, B stands for being right for that already got into
matrimonies or had relationships, then C stood for condom
usage. The three-dimensional motto had three autonomous
entities that all targets a particular class of people in the
community (CDC, 2015).
Abstinence was a test that required African American women
that had no a particular partner or had not gotten espoused that
they would continue that way till the right time came for them
to get wedded and engage in such kind of actions. Abstinence
decreased the possibility of having more than one sexual
partner, a behavior that is closely connected to contracting HIV,
as one would not tell who among the several partners had the
virus, or if they also had other partners.
Being faithful referred to both the espoused and unmarried
individuals who were in sexually dynamic relationships. Being
married implied that they would sire offspring and the potential
occurrence of unsafe sex. The other level of people targeted by
being faithful was a class of unwed teens or grown-ups that
involved in sexually active relationships amongst themselves
(Rugg et al., 2000).
The last part of the intervention targets the people who would
not hold themselves or get restricted to one sexual partner.
Another set of people that the method targets were women as
sex workers who engaged in sexual activities with many people
whom they could not tell of their HIV status as either positive
or negative. The advantage of using condoms being that it aided
the people in preventing not only Sexually transmitted
infections but also reduced the chances of getting pregnant
when it was initially not planned (Rugg et al., 2000).
ABC intervention scheme aided all women of all stages in

36. life, whether teenagers or in their marriages take care of
themselves to maintain a healthy lifestyle without being at risk
of getting infected with the virus. Women who were in their
teenage years would implement abstinence or remaining loyal to
their partners till they separated. Another category of women
that benefited from the intervention was married couples that
remained faithful to each other throughout their marriages. The
last category were those that had multiple sexual partners
especially the sex workers or female youth that became sexually
active.
Evaluation Plan
As initially stated in the exposition, it is critical to understand
that there exist programs that would get combined within the
intervention plans to authenticate the relevance or usefulness of
the intervention plan or to conclude the outcomes of the
intervention as described in Adimora et al., (2013). The signs
act to determine the level of responsibility and performance of
the programs. The analysis recognized some of these evaluation
programs to determine the regions that besides demanded
considered.
The implementation of evaluation required the support of
several stakeholders in the health sector, from practitioners,
medics, advisers and other neighborhood health staffers as
described in Adimora et al., (2013). Medics that completed the
tests would take the demographic data analyzing it to
correspond it to the preceding ones to determine whether there
had been further developments. A decrease in the number of
infections or a decline in the number that got placed into the
antiretroviral treatment was the direct means of evaluating the
differences. Another notice was checking for an expansion in
the number that got placed into antiretroviral therapeutics,
meaning that the interventions were that not much efficient,
(Adimora et al., 2013).
In Adimora et al.’s, (2013), also stated that counsellors who
went around dispensed free condoms around suburban areas,
joints and clubs took entry of the regularity with which the

37. condoms vendors got used. When the condom dispensers got
empty in a short period, meaning that people took note of the
intervention to exercise safe sex. However, when the
distributors took long without becoming empty, meaning that
people did not make use of the interventions provided to them.
Different evaluation program is through intensification of HIV
prevention outlines. When programs had gotten into place, and
people reacted by taking up the program, meaning there was a
requirement to advance the quality of that service which would,
in turn, decrease the rate of infection of the virus in African
Americans and the rest of the minorities, (Adimora et al., 2013)
Accountability improvement among health administrators and
patients would act as an evaluation scheme when a person
knows that they are accountable for their lives and physicians
help when they get infected by another determinant.
Practitioners and other stakeholders that take part in the
procurement of medical services would guarantee that patients
take the proper prescriptions as directed and that the people
they lived with recognized their status and the threats of HIV
infections (Adimora et al., 2013).
Conclusion
The HIV/AIDS penalty among African Americans, Hispanics
and other minorities are a fatal implication of the health
disparities that exist among this commonality. A few methods of
statistics illustrate that there are various ranges inside this
confinement system in which African Americans are continuing
to succumb ground. African American and the other minority
groups are overrepresented in subgroups of individual
vulnerability agents for HIV transmission, including those
known with sexual conduct, substance control, and sexually
transmitted diseases. The uneven rates of lower financial
situation and neediness in African Americans and other minority
groups in a roundabout way implies an endless loop is
upgrading risk variables for HIV infection furthermore adds to
the possible disparities in access to fitting health care services
for counterproductive action and therapy assets.

38. The need to execute an ABC type intervention program in the
United States of America would support African Americans,
other minority groups , and the youth living with HIV to find
solace in knowing that they have a harbor to become educated
on the danger constituents, diagnosis, medicine and several
other topics that they go through every day. The need for much
more study would be obliged to design a program that would
initiate African Americans efficiently, other minority groups
and teenagers with HIV to come forward and feel to express
themselves and their diagnosis without being segregated against
or having astigmatism associated to having HIV
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First: A Work in Progress: submitting a 1,000 word position
statement in which you declare an epistemological stance, and
draw connections between your position and ideas presented in
course readings and class discussions.
these are the ideas from the whole class, + add some more about
the important of validity and inquiry in research.
Also, declare an epistemological stance as a pragmatism and
subjective researcher, or reflect that I believe I will be a
pragmatist and subjective researcher
Reflection 1:
Education research is defined as the scientific study field that
evaluates education and the process of learning as well as the
human attributes, interactions, institutions and organizations
that determine educational results. Researchers in this field of
study aims at describing, understanding and explaining the
manner in which learning happens throughout the life of an

45. individual as well as how the formal and informal circumstances
affect every form of learning.
As a doctoral student and a future researcher, this class helps
me to understand and look beyond the information that I'm
looking for. To understand the difference between a theory and
facts .to be a researcher in the field of education you have to
understand what educational prospect you have to follow, the
present education, or what the future education will be. The
idea of being a research for me is to add a new thing to the
educational history, to find something that is missing or not
covered the way it should be covered. As a special education
doctoral student, and as a student in the epistemology class, I
understand that my field is not that easy to research about
because in many cases the environment and other factors may
affect my results or it could change during the time.
The human science and the educational field is related
to the human part and what the situation around the study topic
or what the society may reflect on about the topic. In Saudi
Arabia, if we talked about special education, most of the time
we couldn’t find a clear answer for our researchers because of
the society or the families and what they needed or understood,
which lead us to the most important thing. For me what I needed
the most is for the society to understand why we are researching
and why we are looking for an answer or new innovation in the
educational field.
The time is changing and the traditional way of learning is no
longer effective, we need to create new ways to make the new
generation learn and think. As a mission for the educational
researcher, we should be open to other ideas, to look behind the
facts, to read and learn more, this is the way to open up on the
theory of learning and how to encourage ourselves to look more
and discover new things for the future.
Reflection2:
The last couple of classes include to my knowledge a lot, and

46. how to be an outstanding educator. From my point of view, the
last classes were talking about the history of race and feminism.
This history is what we are going to know and gets what we
found it helpful in our days. Moreover, shift the negative effort
that been an issue at that time. Race, gender in education from
my understanding doesn’t matter; what really matter is
obtaining the quality of what the person or educator or scholar
gives to the field. The world is changing but sometimes the
culture and background can affects or thinking; because of the
things that we raise to know or we persuade it of our elder
society members.
Also, I felt proud in the feminist presentation of what my
country becomes in the academic field. I am proud how my
country is trying to become a country with outstanding members
who belong to that country. This presentation comes along with
our 88th national day which makes me proud to represent Saudi
Arabia. What surprises me is that every country they had the
same stereotype of female education and learning and how they
change their perspective regard this matter. The traditional
thinking was constructive at their time, but in our lifetime it’s
something not acceptable; it is no difference between gender or
race or background, it’s what the individual gives to the world.
Science or humanity or any other filed are important to the
future generation. All these fields are part of the ordinary life or
the future life. As an educator, I believe that without all these
fields and researches to get something new for the future. We
should develop the future without placing our attention on
which field is important to the humanity. All of us are working
for a worthier life and that what we should focus on. We can’t
change other people’s attitudes to the others but we can
establish some critical effect for the future.
Reflection3:
From my understanding, I believe that the last two weeks topics
are related, everything happens in the postmodernism is
somehow related to post-colonialism. All of these days

47. changes happen because of some movements that happened in
the past just to devote us the life that we are living it right
now. What we get from postmodernism is something between
the stories that happened in the past and
the history that we want to be proud
of shame of. That improves the way that we look and think
about today’s world.
Traditions keep us related to the past, but it’s not supposed to
keep us away from the future. Post-colonialism indicates us the
political effect on what the world is trying to do to end the
decolonization era. And how
that affect the countries that were under the decolonization from
different prospective; like the language and
the culture thoughts. All these effects become a part of
that country daily life and enhance their current culture. Which
from my point of view could mix the historical traditions with
the decolonization tradition which could makes the recent
generation don’t understand any old culture thoughts.
Postmodernism represent a creative way
to see and interact with the world or to be specific with the
academic field. Students and learners can interact with each
other, or with the new learning
experience. Students can learn from the others and also in more
self-creation
methods. Teachers and learners trying discovering an unfamiliar
way to explore things and gain the knowledge that
they obtain to get. Adolescent children can be more affective
with the Postmodernism method in the academic
field. It gives them the unusual way
to explore and learn. Postmodernism changes the way the
educational guide and rules,
which requires the teachers a researcher to know how
to interact with their student in unusual learning
set. It improves all the educational part to know and explore
more.

48. Reflection 4:
The academic system
supposed to encourage the students to reveal their identity and
learn how to be proud of themselves. As an as an individual;
I need representing myself, represent my values and show
the world who I am. Indigenous does not mean I’m nothing,
or I have to be treated individually. Indigenous doesn’t
mean I’m a minority. I might be from a majority, but not in
this place; however big or small
the place I represent myself. Thinking back about Indigenous
presentation prompts me of the teacher and teaching
values. And how I
should assess and treat my students without taking in what
they are, or which part of the religion they came from.
What I found it related to me during the ecological
class, how we relay in the environment all
the time. How people interact with
their natural and how our natural affects the way we think,
the way we act and the way we respond. My environment is
aggressive, not a green light environment; maybe because of
that, I’m presenting myself through
this natural. I’m presenting myself as a capable woman that
can handle the distance between my home and me.
Learning is always a great thing
and always we can find something in our environment related to
us somehow.
Last but not least, we as researcher, educator, and part of the
academic and learning system supposed to know there is no
ideal
place. Life doesn’t come the way that we want. In addition, we s
hould believe in diversity. So we can accept our students the
way they are, not modifying them according to our thoughts or
the way that we know. Maybe we are wrong from
the beginning, maybe they are the right and all
our values doesn’t mean anything. But everyone

49. must imitate and respect what we believe, we should consider th
at for others also.
Reflection 5:
For me what I got from this experience, I learned that I should
be more careful with my choices especially when talking to
other people. People are entirely different and have different
feelings, thoughts, and understanding of the language, whether
written or oral. As a researcher, I have been able to spend time
with people and understood them well to a point I can write so
much about them. If someone was given a chance to write about
you, how would you want to be described? How would you want
me to define you? And what would you want me to write about
you? These questions must be in mind any researcher before he
starts writing anybody.
The fact is that, no one wants to be misunderstood, this idea
was got from various representatives. The researchers working
in this field are required to fully understand the perspective of
the author, to provide an accurate representation of the same.
Language, therefore, plays the role of a constitutive force
responsible for creating reality. Note well, most writers today
have emphasized the use of scientific conventions in writing
and have managed to identify the lack of style in such tales as a
rhetorical device. I used to be an Arabic writer, and for sure, I
never want anybody to write any false information about me
without them even knowing anything about my thoughts.
Researchers need not be so much away from knowing other
people thoughts before writing about them. The reason as to
why people research, is to be able to put other people's words in
our own words. But keep in mind how other people can read and
understand these words. Statements always have two sides of
the story, and people's interpretation might not be different
from the way you want them to understand.