The epidemiology and demographics of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have evolved over the last 25 years in the United States to include more women and minority populations, especially Latinos and African Americans. In addition, there has been a shift in HIV/AIDS cases from large northeastern and western metropolitan areas to persons living in rural areas and the south. The reasons for the changes and the shift are unclear, but major barriers to primary prevention strategies are most likely sociocultural. This article reviews some of the sociocultural barriers in HIV/AIDS prevention and presents a new approach or framework for addressing these barriers. The framework highlights Stigma, Fear, and Denial as barriers in interventions for HIV/AIDS targeted at African Americans living in rural Alabama. The framework uses a culturally competent, community-based approach. It is hoped that this framework could also be used as a model for addressing HIV/AIDS in other communities, as well as addressing other health disparities where stigma, fear, and denial may play a role, such as cancer, diabetes, heart disease, immunizations, and infant mortality.
From the Department of Community and Rural Medicine, University of Alabama School of Medicine; and the Rural Health Institute for Clinical and Translational Science, The University of Alabama, Tuscaloosa, Ala.
Corresponding author: Pamela H. Foster, MD, MPH, Rural Health Institute for Clinical and Translational Science, The University of Alabama, Box 870326, Tuscaloosa, AL 35487 (e-mail: firstname.lastname@example.org).
The author acknowledges Dr John Stone, formerly of the National Center for Bioethics in Research and Health Care based at Tuskegee University, and Dr Bronwen Lichtenstein, Dr Susan Gaskin, and Leslie Zganjar at The University of Alabama who helped in the editing of this article. Funding for this work was supported by the National Center for Minority Health and Health Disparities through the Tuskegee University/University of Alabama Centers of Excellence EXPORT grant.