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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



  


 

AIDS/HIV Disease and Socio-Culturally Diverse Populations

 

Summary: Culture embodies the values, attitudes, beliefs and practices of a group as well as its roles and structures, communication styles, technology, art, and artifacts. The numbers of reported cases of AIDS/HIV disease are dramatically increasing in some ethnic and minority groups. The American Nurses Association (ANA) supports the provision of skilled, knowledgeable and compassionate nursing care which respects client conscience and integrity, cultural values, beliefs, relationships and the right to make choices. Comprehensive educational programs that are culturally sensitive must be targeted to diverse population groups to assure that the transmission of the AIDS/HIV epidemic is stopped in all communities. Research which increases knowledge about socio cultural diversity is needed. Continued political action and advocacy is also needed to ensure quality health care for all, regardless of age, color, creed, disability, gender, health status, lifestyle, nationality, race, religion, or sexual orientation.

Background

Culture is transmitted within a group from childhood to death through the family and other major social institutions. Sexual beliefs and practices, drug use, reproductive beliefs and practices, intimacy, family relationships, death and dying involve strong socio-cultural components that may be widely diverse and that certainly affect the spread and course of HIV disease. For instance, socio-cultural beliefs and values affect the use of condoms and abortion. Beliefs about drug use may range from acceptable, immoral or social deviance to illness and may result in practices such as enabling, ostracism, or treatment. Socio cultural attitudes and values may affect whether and which treatment is accepted or rejected and when, where, and how death will occur.

  


Cultural and social diversity, different communication styles and language may result in conflicts or misunderstandings with nurses about treatment methods and the goals of treatment. It may also lead to conflicts or misunderstandings with members of the health care team as a result of differing communication styles and language, and differing beliefs about roles and functions (Flaskerud, Ungvarski, 1992). Examples of this are found with issues of death and dying, HIV disease and mental illness.

One of the most challenging issues in prevention and provision of care to persons with AIDS/HIV disease relates to cultural differences and the difficulties and opportunities these differences may create. Since various cultures have diverse beliefs and attitudes about intimacy, sexuality, health, illness, medical treatment, drug use, and death, the challenge is to understand the nature of the cultural differences of others. Care providers and educators need to be aware of this diversity in order to respond with culturally sensitive behavior (CNA, 1991). The American Nurses Association has a long tradition of respecting socio-cultural differences, the diverse beliefs and practices of its members, as well as those of patients.

Some ethnic and minority groups are reported to have a disproportionate rate of AIDS/HIV disease. The impact of cultural beliefs and practices may be less important in the epidemiology of AIDS/HIV than sociopolitical and economic factors, such as poverty, access to care, and the availability of educational programs (DeSantis, 1992). These sociopolitical conditions seem to interact to influence higher incidence of AIDS/HIV disease: early age of first sexual intercourse, epidemic spread of sexually transmitted diseases, injection drug use, and use of other drugs such as crack cocaine, which can contribute to high-risk sexual behavior and exchange of sex for drugs (Holmes, et al, 1990).

The physical debilitation, economic devastation, and social isolation and stigmatization suffered by person's with HIV/AIDS calls for care modalities outside of the formal health care system. This is where cultural resources within the community or the person's interpersonal/social network are best mobilized and incorporated into community action plans (DeSantis, 1992).

Outreach activities which are culturally appropriate are urgently needed if the spread of AIDS/HIV disease is to be halted. Programs such as the 33 funded in the 1988 Centers for Disease Control five-year grant for HIV prevention efforts by national racial and ethnic organizations, are needed (Holman, et al, 1991).

Mobilizing trust is an important element of a successful community intervention project when addressing complex topics such as AIDS/HIV disease. In addition to creating an atmosphere of trust in multicultural communities, educational programs must be designed to meet the needs of the particular group of people, and they must draw on the strengths of these groups. Written materials should be linguistically and culturally appropriate (Matens, 1991). Successful education programs must include ongoing involvement of community representatives in program design, planning, development and implementation, and involve long-term collaboration among governmental agencies, and community-based organizations (Holman, et al, 1991). Continued funding for these culturally sensitive, social and health education programs is crucial.

  


ANA believes that care, treatment interventions and educational programs should address the needs of the community in which these services are offered. ANA supports :

  • Provision of skilled, compassionate and supportive nursing care to persons with AIDS/HIV disease which respects their conscience and integrity, their cultural values, beliefs, relationships, and their right to make choices;
  • National, regional, and local AIDS/HIV intervention programs that involve representatives from communities, business, church, civic leaders and persons with HIV disease.
  • Education of nurses about the diversities in cultural values, social beliefs and practices that may affect the transmission and course of AIDS/HIV disease;
  • Culturally sensitive education of consumers about the transmission of AIDS/HIV disease;
  • Promotion of nursing research related to HIV disease which increases knowledge about multicultural beliefs and practices, in regard to family relationships, human sexuality, reproduction health and illness, death and dying.
  • Advocacy, policy formulation, and political action to provide high quality health care to all persons with HIV regardless of age, color, creed, disability, gender, health status, lifestyle, nationality, race, religion, or sexual orientation.

Rationale

HIV disease affects people from a wide variety of cultural, social and ethnic groups in the United States. Nurses have a long tradition of respecting socio-cultural differences and the diverse beliefs and practices of people. This commitment to diversity includes the range of effects that various beliefs and practices have on health and illness, including the epidemic of AIDS/ HIV disease.

References

  • Chu, S.Y., Buehler, J.W., Oxtoby, M.J., Kilbourne, B.W. (June, 1991). Impact of the Human Immunodeficiency Virus epidemic on mortality in children, United States. Pediatrics, 87(6), 806-810.
  • California Nurses Association. (1991). Women At Risk Training Manual. III-1-33.
  • DeSantis, L. Personal communication, 1992.
  • Flaskerud, J.H. and Ungvarski, P.J. (1992). HIV/AIDS, A Guide to Nursing Care. Philadelphia: WB Saunders, 2nd Edition.
  • Holman, P.B., Jenkins, W.C., Gayle, J.A., Duncan, C., Lindsey, B.K. (1991). Increasing the involvement of national and regional racial and ethnic minority organizations in HIV information and education. Public Health Reports, Nov-Dec,106(6), 687-694.
  • Holmes, K.K., Karon, J.M., Kreiss, J. (1990). The Increasing frequency of heterosexually acquired AIDS in the United States. American Journal of Public Health, 80(7), 858-863.
  • Matens, R. (1991). Cultural sensitivity in AIDS education for the Hispanic community. AIDS Patient Care. 140-142.
  • Thomas, S.B., Quinn, S.C. ( 1991). The Tuskegee Syphilis Study, 1932 to 1972. Implications for HIV education and AIDS risk education programs in the Black community. American Journal of Public Health, Nov.,81(11), 1498-1505.

Effective Date: April 2, 1993
Status: New Position Statement
Originated by: Council on Cultural Diversity in Nursing Practice, Congress of Nursing Practice, Congress on Nursing Economics
Adopted by: ANA Board of Directors

Related Past Action:
AIDS Testing, 1987 House of Delegates
Advocacy for the Disadvantage and Minorities, 1985 House of Delegates
Position Statement, HIV and Women, 1992
Position Statement, HIV Testing, 1991
Position Statement, HIV Infection and U.S. Teenagers, 1991