The face of the HIV and AIDS crisis is undeniably black.
If current diagnosis rates continue, approximately one in 20 black men, one in 48 black women and one in two black gay and bisexual men will be diagnosed with HIV during their lifetimes, according to Centers for Disease Control and Prevention (CDC) projections.
CDC estimates show that African Americans account for almost half (44 percent in 2010) of all new infections and represent more than one-third (40 percent or 498,400 persons in 2013) of all people living with HIV.
While the disease that emerged in the late 80s as a "white gay male disease" has clearly reached epidemic levels in black and brown communities, one University of Southern California scientist insists that stereotypes -- ones consciously and unconsciously perpetuated by healthcare providers -- can be internalized by members of marginalized groups. Such groups may include people of color, women who seek to have children later in life and older, the poor and LGBTQ people -- and it may literally be making them sicker.
With collaborator Adam Fingherhut, PhD, of Loyola Marymount University, Cleopatra Abdou, PhD, was the first researcher to lead an experimental study about how stereotypes -- specifically "healthcare stereotype threat" -- are directly linked to health outcomes among marginalized groups, including black people.
"Healthcare Stereotype Threats"
“A healthcare stereotype threat,” according to Abdou, “is when individuals with stigmatized identities -- be it about race, socioeconomic status, gender, age, sexual orientation and even weight or maternal age -- worry about being judged by, or about confirming, a widely believed stereotype in healthcare settings. That can cause even greater anxiety than is commonly experienced in medical settings, affecting their experiences with healthcare providers.”
Common stereotypes, Abdou explained, may include beliefs that a particular group tends to engage in unhealthy lifestyle choices or has inferior intelligence, she said. Or there may be negative stereotypes about sexuality and reproduction being perpetuated, often unintentionally, by healthcare professionals, by an unwelcoming medical setting, or even by public health campaigns.
“On the patient side,” Abdou said, “I theorize that, with repeated experiences of healthcare stereotype threat, stigmatized individuals, such as black people, lose trust in physicians or delay seeking healthcare as a way to avoid healthcare stereotype threat.” That can have long-term implications for a patient’s health, she stressed, adding, “It is also possible that healthcare stereotypes become internalized, which is also harmful for health.”
Abdou also emphasized, “The HIV and AIDS epidemic is likely a critically important application of healthcare stereotype threat. Early detection of HIV is hugely important for treatment purposes and also for protecting against the spread of HIV and AIDS. However, if people avoid seeking health care because they are mistrustful of physicians or of the medical community, or simply because they want to spare themselves the anxiety they feel every time they visit a doctor, then HIV and AIDS may not be detected in a timely manner,”
If symptoms are undetected until they “reach the point that they can no longer be ignored,” Abdou continued, “this may make treatment much more complex and also may result in others contracting the disease. It is highly unlikely that it is just a coincidence that the same people who are most susceptible to the experience of healthcare stereotype threat are also at greatest risk for HIV and AIDS.”
Re-Framing the Message
Noting that public health campaigns often reinforce negative stereotypes, Abdou stated that high-risk groups can be educated without stereotyping. “It is absolutely possible. There are definitely real health concerns in specific communities that need to be addressed, but how we communicate those concerns is key; it's all about re-framing the messages, moving away from fear and shame and, instead, focusing on uplifting, positive messages that focus on the potential that is created when we take care of our health.”
For example, she went on, “Instead of a poster showing an older woman with a positive pregnancy test listing all of the alarming statistics about the risks of having children later in life, show the same image with a message that promotes awareness in a positive way, such as, 'Knowledge is power: Learn about your fertility so that you can have the family and the life of your dreams.'”
Abdou concluded, “I want people to know that next time they're in the doctor's office waiting room and experiencing anxiety that it's not necessarily a feeling that is unique to them. Change starts with education. My goal is to transform the way that healthcare is delivered and the way that patients and providers interact with each other in healthcare settings. This is cultural competency redefined.”
Working with Anthem Blue Cross/Blue Shield, Abdou developed an online guide to reducing the stereotype threat in patients. Click here to view the free healthcare stereotype threat curriculum.
Chandra Thomas Whitfield developed this story for the NBC News NBCBLK website for the black community with the support of a journalism fellowship from New America Media, the Gerontological Society of America and the Commonwealth Fund.