HIV/AIDS can rightly be called an epidemic in the Gulf States. According to the CDC, in 2010 Louisiana had the second highest rate of reported HIV infection in the nation. The areas hardest hit (by ranking of AIDS cases per 100,000 people) include Baton Rouge and New Orleans, Louisiana; Miami, Florida; and Jackson, Mississippi.
Responding to this crisis requires understanding not only how it has arisen—what attitudes and beliefs contribute to risky behavior—but also how best to marshal various federal, state, and community resources.
RAND researchers have examined attitudes, beliefs, and actions of several ethnic, religious, and socioeconomic populations with regard to HIV and AIDS. RAND has also conducted research on responding to and treating the worldwide HIV/AIDS epidemic. These studies can help Congressional, state, and local policymakers understand how to approach the challenges posed by HIV/AIDS.
See related RAND Blog post
Attitudes and Beliefs About HIV/AIDS
Among racial and ethnic groups, African Americans face the most severe burden of HIV in the United States, according to aids.gov. This population is also highly mistrustful of doctors and may not have access to accurate information before engaging in activities that are more likely to result in infection.
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African Americans have high levels of medical mistrust, including conspiracy beliefs related to HIV, and black men have the highest rates of HIV and AIDS diagnoses in the US. Conspiracy beliefs were associated with high-risk sexual behavior, showing the impact of medical mistrust on outreach and education efforts.
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Many American parents and adolescents do not talk about important sexual topics, including birth control and sexually transmitted diseases, before adolescents' sexual debut. Clinicians can facilitate this communication by providing parents with information about sexual behavior of adolescents.
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Youth who think they are likely to get HIV are at greater risk for later substance abuse problems and risky sexual behaviors, but this perception doesn't cause them to reduce their substance use and change their behavior.
Public health officials have begun to realize the importance of working with community and faith-based organizations when addressing crises such as HIV/AIDS, because of the difficulty reaching those people most at risk. RAND has explored this form of outreach, including the various challenges it can pose.
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Treatment advocacy (TA) programs based in AIDS service organizations and clinics aim to get clients care; advocate for patients; and provide social service referrals. In a non-randomized evaluation,TA clients had higher electronically monitored and self-reported adherence, utilized more social service programs, and had fewer unmet social-service needs.
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Faith-based organizations may frame HIV as punishment for sin, as a call to compassion, or as an opportunity for transformation. The frame affects the kinds of health services that these organizations provide, as well as the messages they convey about HIV to their congregations.
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Content for a toolkit was designed to help community and faith-based organizations take advantage of opportunities presented in the Patient Protection and Affordable Care Act and engage leaders in promoting health in their communities.
Treating HIV/AIDS
A great deal of research and funding has focused on expanding HIV/AIDS treatments to underdeveloped countries. At a Congressional hearing in late May 2012, however, the question arose: Why do American patients pay tens of thousands of dollars each year for HIV drugs that cost just hundreds in Africa?
RAND has explored funding and treatment issues worldwide; our research may be equally helpful in the Gulf States.
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Our Mapping Pathways project, supported by Merck and the NIH and conducted in partnership with the AIDS Foundation of Chicago, was the first study of its kind to synthesise evidence and views about localized antiretroviral-based prevention strategies for HIV/AIDS in diverse global contexts. The project included a thorough review of the social, economic and clinical impact of four treatment regimes. Research, community engagement and policy work took place in three countries, the United States, India and South Africa.
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In this December 2011 Congressional Briefing, Gery Ryan discusses policy options and recommendations on how to most effectively fund HIV treatment initiatives throughout the world.
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Faith-based organizations such as churches and religious relief and development groups can play an important role in the response to HIV and AIDS in Central America, despite the fact that many do not support certain prevention measures such as condoms.
