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Multicultural Issues in Treating Clients with HIV/AIDS from the African American, American Indian, Asian, and Hispanic Populations

Freddy A. Paniagua

Department of Psychiatry and Behavioral Sciences University of Texas Medical Branch Galveston, Texas

In the United States, the first description of cases resembling symptoms for the acquired immunodeficiency syndrome (AIDS) was reported in 1981 in a group of homosexual men residing in Los Angeles (California) and New York City (Centers for Disease Control [CDC], 1981a, 1981b). The virus that causes AIDS was first identified in 1983-1984 (Gallo & Montagnier, 1988). This virus has received several names (see McCombie, 1990, p. 12), but the name commonly used in biomedical and social research is "human immunodeficiency virus" or HIV (Flaskerud & Ungvarski, 1999).

In the last 10 years, the biomedical and psychosocial literature on HIV/AIDS indicate three general findings. First, the metaphors "Gay-Related Immune Deficiency" and "Gay Plague" used during the earlier days of the epidemic facilitated the spread of HIV disease because the health-care system in this country failed to identify other risks for HIV disease (in addition to sexual behavior among homosexuals). For example, as noted by Landau-Stanton and Clements (1993) "American researchers initially missed the signs of the disease

Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations Copyright © 2000 by Academic Press. All rights of reproduction in any form reserved.

in intravenous drug users, in recipients of [blood] transfusions, in hemophiliacs, in babies and children, and in women" (p. 5). The current finding is that HIV disease does not discriminate against race, sex, age, or geographical locations around the world (Shannon, Pyle, & Bashur, 1991). Second, in comparison to Anglo-Americans with HIV/AIDS, in this country "HIV/AIDS is a major public problem for racial and ethnic minorities" (Ward & Duchin, 1998). Third, a crucial aspect of HIV/AIDS ignored during the earlier signs of this disease was the psychosocial and social impact of the disease on individuals affected by HIV/AIDS as well as on the family and community structures of such individuals (Hoffman, 1996). Today, the current thought is that HIV is not only a physical entity but also a major psychosocial problem in society. This point led to the development of a biopsychosocial approach specific to the assessment and treatment of persons with HIV/AIDS (Flaskerud & Miller, 1999).

In the biopsychosocial approach toward HIV/AIDS, a crucial factor is the inclusion of cultural similarities and variations across racial groups. These cultural similarities and variations are illustrated in this chapter, with emphasis on four culturally diverse groups in the United States: African American, American Indian, Asian, and Hispanic communities (National Commission on AIDS, 1992; Medrano & Klopner, 1992). The need to emphasize these racial groups was assessed in a study including 2,121 mental health professionals, who were surveyed regarding their opinion about the inclusion of HIV/AIDS topics they would recommend in educational programs targeting this professional group (Paniagua et al., 1998). The inclusion of these four racial groups was among the highest endorsed topic in the "strongly recommended" scale: African American (56.1%), American Indian (44.8%), Asian (43.2%), and Hispanic (54.7%) communities.

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