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HIV-Positive African American Women Living in Rural Areas


One of the recurrent problems of this time in matters of health is the emergence of the HIV pandemic. Its effects have been felt on all corners of the world. The pandemic has affected most areas of the world. As such, the United States is not an exception. The distribution of the disease is mainly in the female species with some factors being established that predispose them to the infection. Another factor in the spread of the disease is the social and economic status of the population.

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Those people in the lower end of the social-economic status are highly affected. In the US, for example, and North Carolina in specific, the distribution of the infected people is skewed in the direction of the minority populations such as the Black Americans and the Hispanic population. These people are in the lower end of the social-economic status.

Purpose of the Study

With this highlight, the purpose of this study is to show how the Black American women in this state have a higher transmission rate of being infected and are more affected relative to their counterparts in the population. Tackling the subject of infection in this population would have a great effect on the overall rate of infection and the burden of disease in society. It has also been found out that the black American women in the rural areas of North Carolina are more burdened with the disease and that they have a greater challenge relative to their urban counterparts.

Despite the continued assistance from the government and other resources worldwide, African American women have an increased need for other resources to combat the growing number of women infected with HIV. The study aims at showing how strategies such as providing education, emotional support, resource outlet, and counsel can help in lowering the number of people affected with HIV. Specifically, this research paper focuses on the population of African American female minorities in North Carolina from adolescent age up to adulthood who have been affected with HIV. It utilizes two counties (Burke County and Caldwell County) to show the disparities within these areas.

The Burden

The HIV pandemic has had a huge impact on the African American population in North Carolina. This condition has largely been associated with the low social-economic status of the female victims in the rural areas of the state. The North Carolina Department of Health and Human Services (NCDHHS) report indicates that about 26,168 cases diagnosed with human immunodeficiency virus (HIV) are still living (HIV/STD Surveillance Report, 2011).

This figure is a significantly large number for the state since it indicates one of the highest in the United States. The rate of a new infection is also high. The report continues to state that, in the year 2011 alone, there were 1,563 newly diagnosed cases of these women living with HIV (HIV/STD Surveillance Report, 2011). Although all the ethnic groups in the state are affected by the problem, one group that beats the rest in the infection prevalence and the rate of a new infection is the Black American group in the population (Healthy People, 2013).

As stated above, one of the factors affecting the compliance to the treatment and the outcome of treatment in HIV is the social-economic status of the people living with the condition. Hence, the income they earn is significant. The latest available data on the income for the people in the state of North Carolina shows that the average income in Burke County in 2010 was $37, 225. This figure is well below the national level (Census 2010 Data: Population, 2013). In the year 2010, the population of this place was 90,912. Out of these people, the African American population makes up 6.5% by proportion (Caldwell County Quickfacts from the US Census Bureau, 2013).

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Caldwell County, which is closer to the mountains, had an estimated population of 82,395 people in 2011 with this being almost equal to that of Burke County. In this population, African Americans make up 5.2%. This number is also almost compatible with that of Burke in the proportion of them in the population. The data available for this county indicates that the average income in Caldwell County was $45,151 for the same year hence being significantly higher than that of Burke County but close to the national average (Caldwell County Quickfacts from the US Census Bureau, 2013).

In the year 2011, 42 people were living with HIV in Burke County. This figure included the black Americans in the area (Division of Public Health, 2011). On the other hand, there were 91 people diagnosed and living with HIV in Caldwell County in 2011 representing a rate of 1.2 (Caldwell County Quickfacts from the US Census Bureau, 2013). Burke county ranked 90 with a rate of 1.1 (Census 2010 Data: Population, 2013). In the US in general, African Americans represent 68% of all the cases diagnosed with HIV and hence a show of the magnitude of the problem (Division of Public Health, 2011). These cases were reported at a rate of 62.8 per 100,000 populations (Division of Public Health, 2011).

According to Cook, McElwain, and Bradley-Springer, people living with HIV were involved in behaviors, which placed the general population at risk of acquiring the infection (2010, p. 23). This argument only goes to show that increased education is needed to prevent the spread of infection to prevent its spread in the population. The rural areas present a unique challenge in the halting of the spread of the infection, and although several resources are available in these areas that could be used to this effect, the infection rate is still on the rise as the numbers of people being infected increases.

A special group of the population is affected by the conditions existing in the rural areas. Although there has been a continued decline in the number of women living with HIV, there is a need to boost them in the social sectors to ensure that the transmission rate is reduced (Pgdipre, 2011).

There are many barriers in the areas that hinder the compliance of the measures set in place to ensure reduced transmission and or improved quality of life. These barriers as stated above include financial, mental, stigmatism, family issues, lifestyle changes, abuse, education, and transportation (Hurt et al., 2010). All future attempts to tackle the problem must first be focused on understanding the barriers of noncompliance existing in the population. This strategy could then lead to the development of strategies to eradicate HIV infection.

Developing programs to assist minority women with treatment plans will further reduce the number of cases reported. This plan will also reduce the burden of cost to society. These positive behaviors will increase proactive attitudes and ultimately decrease hospital visits, violence, and abuse. A few cost-effective approaches are increased testing for HIV, community efforts to assist in the prevention, and antiretroviral therapy among others. CDC calculated that $16.6 billion were spent on newly diagnosed people with HIV (Center for Disease Control and Prevention, 2013).

There are many excellent programs to assist people living with HIV such as the ‘get real-get tested program’ and prevention programs. Rural areas need more avenues for resources. The purpose of this study is to find funding to develop programming in rural areas to decrease the number of new cases of HIV among African American women. A study done by AWHONN found that resources were available though they were too expensive.

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People lacked insurance coverage or complained of premium increases with the ‘over the counter’ prices of the necessary drugs being expensive and above the reach of the affected women. These and more factors, according to Bingham, play an important role in the increase of HIV (2009). As indicated above, education, counseling, emotional support, and provision of resource outlets are some of the possible ways of reducing the infection rate and prevalence of HIV among the female black American population. These strategies will then be discussed below.

Several studies have shown a relationship between resource allocation and the need in the people living with HIV (Tsai et al., 2013, p. 119). These are important to review, as they provide a means of making conclusions. One such study by Rountree (2008) aimed at establishing whether some races and ethnicities are more tested for HIV relative to others and the regions that are mostly affected. Worth noting in this study is the high testing rates observed in the African American races, which may be a contributing factor to the high-observed incidences of the disease (Lasry et al., 2011, p. 120).

Murri further studied the factors in the adherence of the people affected by the disease. One major cohort that was included in the study was women (Murri, 2009, p. 45). Their preferences in the medication, the physician relationship, and other factors affecting their adherence were discussed. The results indicated that women have more factors affecting their adherence compared to their male counterparts (Murri, 2009, p. 57).

For this study, the researcher who adequately expounded on the topic under discussion was Phillips in his study of barriers to seeking healthcare among African American single women living with their children (2011, p. 61). The women lived in rural areas. They were selected from various areas with the income being defined. Some of the factors established in this study that affected how these HIV affected women sought healthcare included the long distance traveled to get the care, lack of housing, lack of HIV-trained medical practitioners, lack of mental health services, and lack of substance abuse treatment (Philips, 2011, p. 28).

For the HIV-affected black American women in the United States, the above factors play a role in the health-seeking behavior observed among them. Rountree claims that the condition dents the economy besides causing heavy expenses in the health sector (2008). Her study was indeed a pilot study conducted in domestic violence shelters. She used a survey as her sampling strategy (Rountree, 2008, p. 34). Most of the victims were women while the most represented ethnicity and race were African American. In the research, Rountree observed that women had an increased risk of infection due to many variables (2008).

The study emphasized the provision of crucial information to help keep them safe besides lowering the risk of infection. It also provided an insight into the absence of resources in the rural areas where it was conducted and those collaborative efforts are needed to impact disparities (Rountree, 2008: Orne-Gliemann et al., 2010, p. 206).

Murri found major adherence problems in the study population that was selected to established areas that future studies such as the current one should approach for discussion (2009). In the study, “296 patients taking HAART reported optimal adherence, 73 patients reported they had discontinued therapy, and 107 patients took their medication 2 hours before or after ordered time” (Murri, 2009). Another finding was that people who discontinued drugs had a higher CD4 cell count, higher HIV RNA, and was less likely to take non-nucleoside reverse transcriptase inhibitors (Murri, 2009).

This observation was because the people who had their medication discontinued opted for a switch that enabled them to adhere to the medication that was their own choice. This case demonstrates that the freedom of decision-making in treatment for these patients is important (Whiters et al., 2010, p.110: Jacob et al, 2011, p. 900). Strategies that should be employed to reduce HIV infection transmission in North Carolina as per the studies will then be discussed.

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Education is one of the factors that the women in the state have to get to enable them to combat the pandemic. According to the studies done on the social status of the ethnicities in the state of North Carolina, the levels of education are lowest among the ethnic minorities such as the Hispanics and the backs (Rosen et al. 2009). This argument means that black American women are unable to utilize their resources because they do not have the know-how. One factor that determines the effects, the control, and effectiveness of measures in the control of HIV is the level of education of the victims meaning that the authorities in this state have a burden when it comes to tackling the pandemic.

The levels of education can use several ways to improve the lives of persons living with HIV in North Carolina. One of them is the provision of education to the black population among the infected. Rosen et al. (2009) established that the prevalence of the disease is directly proportional to the level of education attained by the individuals. Therefore, education is an important factor to consider as revealed by Rosen et al. (2009).

North Carolina ranks ninth in the rate of infection and the number of people living with the condition. This finding represents a significant population of the US. Among the people affected by the pandemic, black Americans make up 66% of the victims. It is appropriate to indicate that half of these are women. However, this figure is not represented as the number of women affected is far beyond half of the reported number of black Americans. Some of the reasons explained for the differences in prevalence between the sexes in the same race include biological differences, use of drugs, and the relative inability of women to negotiate for safe sexual practices (Thompson, 2011).

The campaigns to promote education should be included in the strategies that the organizations and the government of the state of North Carolina utilize to reduce the prevalence of the disease. It has been found out that the effects of education on the prevalence of HIV are profound and the adoption of health and sexual education in the curriculum especially in the rural schools reduced the chances of increased HIV infection rate, as people can protect themselves.

This issue can effectively be addressed by educating the people who are infected and their counterparts who are not. Sexual partners of the infected black American women are at a high risk of getting the condition. Education would ensure that they protect themselves. Another observation that has been made among this population of people living with the condition is that, despite the provision of resources to curb the condition or even treat the disease, the women are not taught the benefits of the medication (Rosen et al., 2009: Gilbert, & Walker, 2010, p. 144). Hence, they are therefore not compliant. The information that they have is inadequate. Therefore, they are unable to take care of their families based on this information barrier.

Most of the black American women living in North Carolina that are infected with HIV are single mothers with most of them not having a constant level of employment or a source of income. This issue has led to some of them engaging in illegal activities such as prostitution to enable them to provide for their families and themselves. Concerted efforts to reduce the prevalence of the condition are therefore challenged by this factor among others. Education should be provided to this population of people. In fact, its positive effects will be seen in the rate of infection, which will reduce.

Emotional Support

Another important factor in the spread of HIV infection and the outcome for the infected population is the emotional support that is provided to the affected people. In North Carolina, some agencies and organizations are dedicated to the provision of emotional support to the people living with the infection here (Hodder et al., 2013). However, a survey on the emotional support of black American women revealed that they are not able to access the services offered by these organizations especially those living in the rural areas. This argument means that they are unable to acquire the much-desired emotional support. This breakdown may also have negative effects on their condition and the rate of infection in general.

One recognized source of emotional support for patients is their families, which are the first people of contact. For the black American women living with HIV in North Carolina, the high number of patients with no families or are single parents means that the emotional support they get is insignificant or inadequate to enable them to deal with the condition. As Hodder et al. posit, one way of ensuring that this population has emotional support is the creation of groups of patients that can provide emotional support to themselves (2013). The number of such social groupings in the rural areas is low meaning that the infected women in this area are more disadvantaged.

The organizations providing support should therefore facilitate the creation of such social groups for the infected women. This strategy is also a form of group therapy that would be therapeutic. Another effect that the groups would have is the destigmatization of the people living with the condition (Galindo, 2013). In most of the research done on the factors affecting the condition, stigma is one of the recognized negative effects. To deal with it, the government and other organizations offering services to these patients have to encourage the formation of social groups for the infected so that they can share their experiences and or help in the reduction of stigma.


Counseling is another method of combating the prevalence and the high rate of transmission of HIV among women in North Carolina (Mobility and Mortality Weekly Report (MMWR), 2005: JAMA, 2005). Studies done on the effects of counseling indicate that the rate of transmission is reduced by increasing the number of people who are counseled. Some of the things that individuals need to be counseled on include the benefits of using their medication, the means of living positively, and the measures they can take to prevent infection to their partners that are not infected.

The rates of infection are higher in the population that does not counsel its patients. North Carolina should ensure that the black American women in the rural areas living with the disease are adequately counseled. Some of the points in counseling, as advised in the Mobility and Mortality Weekly Report (2005) include the diet that they should have for better health, the sexual behaviors that they should and should not practice, and the stigma that they are likely to face.

Counseling should also be on the interactions with their family, friends, and religious beliefs. They should also be encouraged to live a complete and fulfilled life and that getting the infection is not the end of life. This information will go a long way in ensuring that the infection rates are reduced and that the infected women live a healthy life. The expenses that are incurred in the healthcare accorded to these patients will also be reduced. Consequently, the saved money could be appropriated somewhere else in the economy.


In conclusion, the black American population is greatly affected by the HIV pandemic in the US. This breakout is also apparent in the state of North Carolina. Although the disease has affected a good number of the population in this state, it is surprising to realize that the better portion of the infected and or the affected comprises the women. Many pieces of research have been conducted to unravel the mystery behind this case. Some of the factors that the researchers have considered the cause of the high infection rate among the black American women in the place have also been discussed.

As revealed in the paper, it has been proved that women in this state do not have access to education, which is a strategy that can enable them to understand how to deal with their situation. Moreover, it has been realized that the women here lack counseling and emotional support and hence the reason behind their worsening health. Therefore, the study has sought to present how availing these strategies in the state of North Carolina can help to change the situation.

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