Running head: COMMINITY SOCIAL WORK AND HIV

Community Social Work and HIV:

The Silent Epidemic of HIV Transmission within Ethnic Minority
Groups in the United States of America
Matthew Wengrowich
SOWK 627
University of Calgary

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Abstract
This paper explores an epidemic in the United States of America (USA) that most are not even
aware exists. When the average person thinks about the Human Immunodeficiency Virus (HIV)
and Acquired Immune Deficiency Syndrome (AIDS) they imagine Sub-Saharan Africa.
However, today in the USA the disease is devastating ethnic minority groups, largely African
Americans and Latino Americans. This paper will explore the role that community social work
practice can play in understanding and addressing this crisis.

COMMUNITY SOCIAL WORK AND HIV

Community Social Work and HIV:

The Silent Epidemic of HIV Transmission within Ethnic Minority
Groups in the United States of America
Often when people imagine HIV and AIDS images of Africa come to mind. Undoubtedly, the
African continent has been hit the hardest by the HIV epidemic, but what about one of the richest
nations in the world with access to incredibly advanced medicine and science? What about the
USA? Surely the United States has managed to curtail this life changing and often life ending
infection. While in many cases great strides have been made in the US fight against HIV there
are still communities in the country where HIV infection is rising and no considerable dent has
been made in stopping the spread of infection. Among ethnic minorities, specifically African and
Latino Americans, the diseases is ripping apart communities and leaving a devastating trail of
destruction. This paper will attempt to analyse some of the contributing factors to the problem,
suggest appropriate strategies based in research to address the issues, and explore how as a social
worker I could contribute to positive change in regards to the HIV epidemic within the
community setting.
According to Davidson (2011) in her review of the current Centre for Disease Control (CDC)
data on HIV in the USA, there are an estimated 40,000 to 50,000 new HIV infections occurring
annually in the United States. These infections cause over 17,000 deaths per year and roughly
only half of those infected are receiving treatment. Even more alarmingly, it is estimated in her
review, that as much as 25% of those who are infected are unaware of their HIV status. Davidson
further highlights that the CDC stated in 2005 that African Americans account for more than half
of all newly acquired infections and that this group is 10 times more likely to be infected

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compared to Caucasian Americans. Latino Americans have the second highest rate of infection
in the USA (Rhodes et al., 2007). According to Rhodes et al., Although Latinos represented
14% of the US population they accounted for 20% of new AIDS cases reported, almost 4 times
greater than that for non-Latino whites.
These numbers are startling. There is obviously a stark difference between ethnic groups in
the USA and the likelihood associated with contracting HIV, but what leads to these differences?
What could possibly be causing Black and Latino Americans to be experiencing such a
dramatically higher rate of infection?
In reviewing the literature, poverty is seems tied to higher risk of contracting HIV (Davidson,
2011). Since poverty is associated with an emphasis on survival, certain high-risk activities can
take place in the search for sustaining basic needs (e.g. sex trade, intravenous drug use, inability
to pay for health care, etc.). Since Black and Latino populations have historically faced higher
levels of poverty this is theorized as one of the major risk factors for this group, but there are
also a host of other issues that have been identified through community-based participatory
research.
Rhodes et al. (2007) conducted a series of focus groups with self-identified Latino men who
spoke little to no English. They were recruited through a local organization and came to some
interesting conclusions about what may be contributing to the spread of HIV in this particular
community. All the men present identified HIV and other sexually transmitted infections as a
major concern/problem within the Latino community. Over the course of the focus groups,
several themes where identified as contributing factors.

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First, a lack of information and abundance of myths about HIV were present. Participants said
that they knew very little about how HIV was transmitted and did not know where to find the
information. Common myths were exposed such as HIV only being a problem for homosexuals,
that HIV could be cured by curanderos (healers using different types of rituals), or that
wearing protective amulets instead of using condoms would protect against HIV.
Since many of the men in the focus group did not have legal citizenship they were afraid to
access health services because they worried about being deported. The men also said they were
worried hospitals would tell their family about test results and there was a fear that the language
barrier would be a problem in accessing services. The participants felt that there would be no
translators or Spanish signs to help them navigate the health systems or community
organizations.
The final major issue to come from the focus groups was beliefs about traditional masculinity.
The Latino men said they felt the need to be hypersexual and have multiple sex partners to prove
their masculinity. Men were not supposed to seek help, such as HIV testing, and if they did they
would not be comfortable talking about these issues with female service providers.
Interestingly Davidsons research (2011) saw beliefs around traditional masculinity to also be
a correlated factor to HIV incidences within black communities. In her article she describes
statistics showing that 46% of Black men who have sex with men (MSM) were HIV positive and
that 67% of those men did not know they were infected. Because of beliefs about masculinity
within the Black community many Black MSM did not identify as gay and had relationships
with women as well. If condoms are not used this becomes an ideal setting for HIV transmission.

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All these factors make it difficult for community organizations to reach Black MSM since many
do not identify as such.
Black and Latino communities have traditionally held high regard for the role of religion,
specifically Christianity, in their day-to-day lives. Miller, Reed, Francisco, and Ellen (2012)
noted that in communities with higher levels of religiosity that funding for HIV prevention
programs often fell and especially if it was tied to programs for Gay or Bisexual men. They
theorized that stigma related to HIV and Gay/Bisexual men led to funding challenges for
organizations dealing with the disease in these communities. Davidson (2011) states that often
Faith Based Organizations (FBOs) struggle with these subjects because they are seen as taboo
and there is worry that talking about it promotes behaviours found immoral. That being said,
Davidson identifies the unique power FBOs have in being able to illicit change because of the
high regard afforded to them. This could potentially be an important place for community based
social work to form partnerships in the fight against the spread of HIV/AIDS.
In his article, Mounting a Social Work Response to the Worsening HIV Epidemic in Black
Communities, Wheeler (2009) suggests that much previous work in HIV prevention has focused
on individual behavioural change models and neglected to assess the environmental, social,
political, and structural forces shaping the effect HIV is having on Black communities. Wheeler
believes that the starting point for change needs to be with social workers studying these larger
macro issues and advancing community policy change. Wheeler (2011) also identifies the unique
role social workers have in being able to unite with other community health workers and help
clients navigate systems in regard to HIV prevention and treatment that may otherwise have
multiple barriers for minorities.

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There is an obvious need to study the larger forces shaping the HIV epidemic and it raises the
question of what has been shown to be effective. Harris (2006) posits that to successfully deal
with the larger social aspects of HIV transmission it is necessary to engage in community-based
collaborative research grounded in respect, equity, and empowerment. Otherwise the researcher
will not be able to have a holistic understanding of the multiple faucets that play a role in the
communities HIV transmission. This may seem obvious, but in my research many of the articles
I encountered took the viewpoint of an expert outsider looking in and applying a solution to
the problem. It would seem like this has been the status quo for sometime and it obviously has
not been effective in helping these communities. It appears self-evident that the insiders to the
issue needs to be involved in any action plans to address it.
Involving the communities affected, acknowledges the varying differences from one space to
the next and that there is no one-size-fits-all solution to the problem. Kippax (2012) puts it very
eloquently when she says:
Achieving effectiveness is not a matter of finding a way over or around social barriers but
rather a matter of engaging with the particular and local social and political lives and contexts
of populations and communities at risk. Effective HIV prevention programs (or interventions)
need to enable people to act in ways that resonate with their sexual and drug injection lives:
what will work for young heterosexuals in KwaZulu-Natal, for gay men in Sydney, for sex
workers in Calcutta or for injection drug users in Ukraine will differ and is likely to change
over time.
Kippax uses the example of Australian MSM where a model of community mobilization and
engagement has dramatically altered the disease progression of HIV in that country. In Australia

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the government made a concerted effort during the outbreak of HIV to engage the MSM
population in conversation around HIV infection. Instead of trying to introduce individual
behavioural changes among the community, namely reducing the number of sexual partners and
forgoing anal sex, the government and agencies in the community started talking about condom
use in a different light. In place of framing condom use as an unpleasant necessity to protect
against HIV, condoms were discussed as part of being a responsible and caring gay man. This
appealed to gay men to care for each other and allowed them to maintain elements of gay culture
(i.e. not asking them to change things that may be central to their identity such as anal
intercourse). The results were dramatic and positive. Today Australian MSM have approximately
half the incidence of HIV infection seen in American MSM. This trend is also seen in other
countries using similar models.
Looking at the previous example in Australia speaks immensely to the role of social workers
engaging the local community to finding internal solutions to slowing the spread of HIV. Having
communities respond with solutions that work for them is crucial to success. So how can
community engagement and mobilization be used to help the Black and Latino communities of
the USA?
Gupta et al. (2008) recommended applying structural changes that encourage or require
community engagement in a way that fits the individual unique scenarios of certain groups. Also
drawing on the Australian success, they point to dedicated and accessible research centres that
encouraged open and collaborative conversations within the community. This empowered
community members to be their own agents of change. A similar option, but suited to the needs
of the Black community is suggested by Davidson (2011) to mobilize and engage African
Americans. She suggests using Faith Based Organizations and Churches as allies in the social

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change needed to impact HIV infection rates. Although some have considered FBOs roadblocks
to managing HIV in the Black community, they could be utilized because of the high importance
they play within the community. Davidson points to examples where this is already happening,
such as The Balm in Gilead, an FBO that trains pastors/ministers in talking to their
congregations and communities about HIV/AIDS.
While changes such as those used by the Australian Government can be helpful, certain
government policies that are meant to help can sometimes do the opposite and it is important to
make sure that structural change encourages community capacity to enact lasting change (Lovell
& Rosenberg, 2009). Integrating structural change in a way that empowers community
organizations is crucial in moving beyond theory to empowering communities (Mykhalovskiy et
al., 2009). To do this, social research needs to be analyzed to give communities the tools to
individualise plans for themselves.
Davidson (2011) suggests one of those tools could be the use of social marketing in
conjunction with local African American community groups and faith organizations. Social
marketing has shown that people are more likely to value things they buy than things they get for
free. Davidson argues that condoms should be sold for low prices at different agencies in the
community instead of being given away for free. The idea would be that charging a nominal fee
makes people more likely to use the condoms.
Another option in the literature is the use of peer educators (Rhodes et al., 2007). Peer
educators would be provided information about HIV and given tools to speak with others in the
community about risks of transmission. One specific example was training peer educators within
Latino mens community soccer leagues. This idea came out of the focus groups discussed

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earlier in the paper and the men were eager to share the knowledge they had gained with their
peers.
Ensuring that social systems provide for the most impoverished in society and meet basic
sustenance needs can also help avoid the problem of people engaging high-risk behaviours.
Community social work can help by lobbying government to ensure that programs provide the
appropriate amount of food and financial support so people do not resort to things such as the sex
trade.
One of the most important things that community social work can do is to start changing the
conversations around HIV and AIDS by discussing risks pertinent to individual communities.
The standardized message around condom use and other risk modification behaviour has not
worked and the message clearly needs to be customized for target audiences.
In reflecting on how I could engage the issue of HIV as a social worker in the community, I
needed to pay credence to my own personal story. I identify as a gay man so I am more than
familiar with how HIV affects my community. As I witness friends contract the virus it is a
constant reminder of the efforts needed by social workers and how far we have left to go. This
being said, despite having witnessed HIVs affect on my loved ones, I am a Caucasian male and
have not witnessed the same amount of transmission that is seen in American Black or Latino
communities. So on one hand I have insider status within the community, but on the other
hand I can never truly know how being a Black or Latino man would change that.
As a social worker it is important for me to explore the lived experience of those directly
involved in the American Black/Latino HIV crisis. I believe that statistics show an immense
crisis but the true phenomenological experience is the stories that arise out of the community.

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The research clearly shows how community mobilization and engagement can reverse the tide in
what seems an impossible battle against a deadly virus.
Community social work has at the very least a responsibility to advocate and help navigate a
system that inherently disadvantages African American and Latino American people. The causes
for this disadvantage are many: poverty/inability to pay for medical services, high-risk behaviour
to meet basic needs, a lack of education, myths surrounding HIV, language barriers, and
dangerous expectations about masculinity. Community based AIDS organizations have the
opportunity to engage the people in a way that is meaningful to them and sometimes these will
involve doing things differently than before. Serious outreach needs to be done within faithbased organizations to reach those at risk of contracting HIV. The current rift between secular or
public health agencies and FBOs needs to evolve into a partnership for the best interests of
African and Latino Americans. If community-based social work can start tailoring HIV
prevention services to ethnic minority groups through services such as peer education, then we
may be able to save the lives of thousands of Black and Latino Americans.

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References
Davidson, L. (2011). African Americans and HIV/AIDS-The Epidemic Continues: An
Intervention to Address the HIV/AIDS Pandemic in the Black Community. Journal of
Black Studies, 42(1), 83-105.
Gupta, G.R., Parkhurst, J.O., Ogden, J.A., Aggleton, P., & Mahal, A. (2008). Structural
Approaches to HIV Prevention. Lancet, 372, 764-775.
Harris, G.E. (2006). Practicing HIV/AIDS Community-based Research. AIDS Care:
Psychological and Socio-medical Aspects of AIDS/HIV, 18(7), 731-738.
Kippax, S. (2012). Effective HIV Prevention: The Indispensible Role of Social Science. Journal
of the International AIDS Society, 15(17357).
Lovell, S.A., & Rosenber, M.W. (2011). Community Capacity Amongst People Living with
HIV/AIDS. GeoJournal, 76, 111-121.
Miller, R.L., Reed, S.J., Francisco, V.T., & Ellen, J.M. (2012). Conflict Transformation, Stigma,
and HIV-Preventive Structural Change. American Journal of Community Psychology, 49,
378-392.
Mykhalovskiy, E., Patten, S., Sanders, C., Bailey, M., & Taylor, D. (2009). Beyond Buzzwords:
Towards a Community-based Model of the Integration of HIV Treatment and Prevention.
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 21(1), 25-30.
Rhodes, S.D., Eng, E., Hergenrather, K.C., Remnitz, I.M., Arceo, R., Montao, J., & AlegraOrtega, J. (2007). Exploring Latino Mens HIV Risk Using Community-based
Participatory Research. American Journal of Health Behavior, 31(2), 146-158.
Wheeler, D.P. (2009). Mounting a Social Work Response to the Worsening HIV Epidemic in
Black Communities. Health & Social Work, 34(2), 156-159.

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Wheeler, D.P. (2011). Advancing HIV/AIDS Domestic Agenda: Social Work and Community
Health Workers Unite. Health & Social Work, 16(2), 157-158.

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