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
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