“Challenges Facing HIV Positive
Africans in Minnesota and The
Way Forward”
by
Omobosola Akinsete, MD, MPH
Health Partners/ Hennepin County
Medical Center/University of Minnesota
Presented at the African World AIDS Day
Event, December 9, 2006
Background of HIV in Africans in
Minnesota
Sub-Saharan Africa


70% of people with HIV/AIDS live in
Sub-Saharan Africa
Anti-retroviral treatment (ARV) is
available to 11% of those affected
(according to WHO 2005)
Some Risk Factors for Acquiring
The Disease in Africa
Driving Factors for HIV in Africa







Ignorance/denial
Fear/silence
Sexual networks
Blood and blood
products
Conflict/displacement of families
Migrant workers
Commercial sex
work




Poverty!!!!- Linked
to most other
factors
Cultural/traditional
practices
Low socioeconomic
status of women
Limited
governmental
support
Large African-born Population in
Minnesota
African-born Residents in the U.S. by State, Census 2000
Number of Persons (Thousands)
140
120
According to the U.S. Census,
Minnesota has the 2nd largest
population of East Africans
in the nation.
100
80
60
Minnesota (10th largest)
40
20
0
NY TX NJ VA FL IL OH WA RI CT TN MO OR WI LA AL SC NE DE SD MS ME ND ID AK MT
State
Source: U.S. Census Bureau, Census 2000 Data
HIV/AIDS in Minnesota:
Number of New Cases, Prevalent Cases, and Deaths by
Year, 1990-2005
HIV (non-AIDS)
AIDS^
AIDS Deaths*
Living HIV/AIDS
5000
400
4000
300
3000
200
2000
100
1000
0
0
1990
1993
*Deaths among AIDS cases, regardless of cause.
1996
1999
2002
Year
^Includes refugees in the HIV+ Resettlement Program diagnosed with AIDS subsequent to their arrival in the United States
2005
No. of Persons Living w/ HIV/AIDS
No. of New HIV/AIDS Cases & Deaths
500
HIV Infections* among Foreign-Born Persons†
in Minnesota by Year of Diagnosis and Region of Birth,
1990-2005
100
Number of Cases
80
60
Region of Birth#
Other
Latin America/Car
40
Asia
Africa
20
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
* HIV or AIDS at first diagnosis
† Excludes persons arriving to Minnesota through the HIV+ Refugee Resettlement Program.
# Latin America/Car includes Mexico and all Central, South American, and Caribbean countries.
HIV Infections* Diagnosed in Year 2005 and General
Population in Minnesota by Race/Ethnicity
HIV Diagnoses
(n = 304)
Population†
(n = 4,919,479)
White
88%
White
51%
Afr Amer
3%
Afr born
1%
Afr Amer
22%
Hispanic
3%
Amer Ind
2%
Other
1%
Asian
1%Amer Ind
1%
Asian
3%
Hispanic
8%
Afr born
16%
* HIV or AIDS at first diagnosis
Population estimates based on 2000 U.S. Census
data.
Data source: Minnesota HIV/AIDS Surveillance System
†
n = Number of persons
Amer Ind = American Indian
Afr Amer = African American (Black, not African-born persons)
Afr born = African-born (Black, African-born persons)
Unique Features of HIV Epidemic in
Minnesota’s African Community
Significant Demographic Diversity



Total Africans living with HIV/AIDS in
2005: 587
Many more are likely undiagnosed
Representing more than 25 different
countries and every region of Africa
Source: Minnesota Department of Health HIV/AIDS Surveillance System
Unique Features of HIV Epidemic in
Minnesota’s African Community
Gender Distribution
African-born Persons
Total Number = 587
Other Minnesota Cases
Total Number = 5,233
Women
18%
Men
47%
Women
53%
Men
82%
Source: Minnesota Department of Health HIV/AIDS Surveillance System, data reflect prevalent cases in 2005
Facts about HIV Positive Africans
in Minnesota



Slightly more women then men
At Hennepin County Medical Center
(HCMC), only 9% of people got routine
HIV test
86% of them acquired HIV through
heterosexual intercourse
Africans Do Not Routinely
Test for HIV

Present to the clinic later in the
disease and usually with an infection
such as TB
Why Do African-born Patients Present Late?
1.
2.
3.
4.
5.
6.
Many Africans do not feel at risk of
contracting HIV- low condom use, stable
relationship, lack of trust
Lack of information about services
Socioeconomic barriers
Immigration barriers
Competing priorities
Psychosocial issues- coping skills, fear
Barriers Accessing HIV Services
Barriers due to:
 Lack of knowledge about services
 Fear of stigma
 Language problems
 Immigration issues
 Lack of insurance
Challenges Within the
HIV Care System





Shock/denial
Insurance
issues/poverty
Interpreters/miscommunication
Competing priorities
Cultural issues





Stigma
Social isolation
Psychosocial issues
Complex forms
Attitudes of providers
Many Family Members and Friends Do Not
Know About The Diagnosis of Each Other
Why?
 Shame
 Fear that they will be left alone
 Fear that others will find out
 Panic
 People will think that
they are bad people
Stigma
What causes stigma?
 Experience in Africa
 Fear
 Shame
 Ignorance
 Association with AIDS
and death
Effects of Stigma
How does stigma affect patient care?
 Late presentation and diagnosis
 Increased transmission
 Poor adherence to medications
 Isolation of patients
Services Provided





Good HIV and primary care
Insurance services
Case managers/social workers
Support groups
Psychological support
How Do Africans in Care Behave?



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Increased knowledge
Good adherence to medications
Trust their providers
More people willing to come out
Increased coping skills
Relatively normal lives
Children
Best ways to teach people in community about HIV
49%
37%
29%
25%
20%
19%
10% 14%
Co
0.5
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
P
T
R
H
S
D
C
mm amp V/ N adio ous tory ram omm
tel
a
un hle at L /Na e
.P
l
ing
an
t la
ity ts
ap
g
ers
ng
f or
um
s
What Is Needed?




Increased funding of sustainable resources!!!!!!!Good response from Minnesota Department of
Health and others - but we need more.
Increased education –culturally appropriate,
within communities, increase numbers of African
trained educators
Involvement of Africans- NGOs,
churches/religious leaders
Counseling/crises centers/hot line
What Is Needed (continued)





Incorporate education/counseling into other
health care- OBGYN, Primary care
Education for refugees
Screening for all as part of health care and
decrease stigma
Interpreters - more/ better trained/discrete
Information pamphlets in various languages,
radio, newspapers and TV
What Is Needed (continued)



Case management/social workers
Support groups for those infected, e.g.
SAYFSM
Affordable drugs for those infected in Africa
The Way Forward

HIV is just a disease!

HIV does not mean you are a bad person!

HIV does not show on your face!

There no cure but there is treatment for HIV!

There is hope for people with HIV!

HIV infected people need support from their
community members!
Acknowledgements

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



Tracy Sides
Keith Henry
Luisa Pessoa-Brandão
Charles Cartwright
Diane Hirigoyen
Christy Boraas
Cynthia Davey
Ellen Kane
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Challenges facing HIV positive Africans in Minnesota