Fighting Stigma in The African Caribbean Immigrant Community in The U.S.

Article By Noelle Sewell



In the last year and a half, the “Greater Than AIDS Campaign” an ambitious campaign to raise awareness about HIV/AIDS, reduce the stigma of HIV/AIDS and encourage people to get tested. The campaign’s goal is mainly to reach the African-American community. There is no doubt that HIV/AIDS has profoundly affected the African-American community, but often times African and Caribbean immigrants are included in this population. Unfortunately, they may not respond to the messages that are presented. Those who work with this population call it a “silent epidemic” in the African and Caribbean immigrant community. We need to understand why it is important that we make sure that this population is receiving HIV prevention and treatment information that they can respond to.

African Caribbean Immigrants

Members of the Cardozo African and Caribbean Club at Cardozo Senior High School in northwest DC. Photo courtesy of African Immigrant & Refugee Foundation.

Since the beginning of the HIV/AIDS epidemic, there has been a major focus on the populations in Africa (especially Sub-Saharan Africa) and in the Caribbean. But there has been little focus on African and Caribbean immigrants in the United States.

There have always been a great number of people of African descent in the United States since its formation. That number was mainly as a result of forced migration. While there were a large number of African immigrants in this country by the 19th century, a significant voluntary migration from Africa to the United States did not start until the 1980’s. The Migration Policy Institute report dated July 21, 2011 states that “from 1980 to 2009 the African-born population grew from just under 200,000 to almost 1.5 million.”Also it stated “Africans make up a small, (3.9%) but growing share of the country’s 38.5 million immigrants.” Also, according to the Migration Policy Institute report dated April 7, 2011, “Migration from the Caribbean has increased 17 fold in the last 50 years. In 2009, there were about 3.5 million Caribbean immigrants residing in the United States. Almost three-quarters of all Caribbean immigrants entered the United States between1980-1999.”

With a growing number of African and Caribbean immigrants in this country, there should be more attention paid to the health issues of this population. We hear so much about HIV in sub-Saharan African and to a lesser extent in the Caribbean. However there is almost a deafening silence when it comes to addressing HIV in the African and Caribbean community in Europe and the United States. Even with the United States hosting the International Conference on AIDS, for the first time in 22 years, there was not much attention paid to this population. There is very little data regarding the number of African and Caribbean immigrants living with HIV in the United States and whether the stigma they face is different from the stigma that other groups of people living with HIV face. What is the root cause of the stigma in the African and Caribbean immigrant community and how does it affect this population? The answer may not be very clear cut.

Dr. Cheryl Holder an internist in Miami, who is of Jamaican decent, has provided medical services to the HIV community since 1984. She states that the stigma in the Caribbean community is greatly affected by the country of origin. “In the Jamaican community HIV is mainly associated with homosexuality. In this community no one wants to be open about getting tested and/or their HIV status because they don’t want to be associated with what is perceived to be a deviant lifestyle. On the other hand Haitians mainly associate HIV with being unclean.”

Bisola Ojikutu MD, MPH is an HIV specialist at Massachusetts General Hospital in Boston. She states,

“In our clinic we see approximately 1000 patients living with HIV. Approximately 25% are black and 25% Latino. I believe that around 25% are female which is similar to the national average. In terms of immigrants, unfortunately, we don’t keep accurate records on country of origin. However, at least 25% of my patients are immigrants from sub Saharan Africa or the Caribbean. I believe that most people living with HIV continue to face stigma (both internal and external). By internal stigma, I am referring to feelings of low self worth or shame related to one’s diagnosis. I have many patients who are non-adherent to their HIV medication or don’t come to their appointments because they feel depressed about their diagnosis and don’t want to be reminded that they are HIV positive. By external stigma, I am referring to discrimination from others. I have patients who refuse to tell anyone that they are positive because they fear that people will think poorly of them. I know patients who have not told their family members or sexual partners that they are infected. From the studies that I have conducted there is evidence of lower HIV related knowledge (when compared to other US born blacks) in both African and Caribbean communities. I believe that this has led to misconceptions about HIV infection which has led to increased levels of stigma. In addition, I have found that within African and Caribbean communities sex isn’t openly discussed. When it is discussed it is described as a negative act, something taboo or to be avoided. When people don’t discuss issues related to sex it is more likely that they will have misconceptions and these may lead to stigmatizing beliefs.”

Dr. Helena Kwakwa, who has provided medical care to the HIV positive community in Philadelphia for more than 15 years and is a native of Ghana, believes the stigma of HIV is greater in the African and Caribbean communities. She states,

“I do not know the definitive reasons why, but I think it has to do with the lack of acceptability of the well-publicized modes of transmission, the relative lack of knowledge about HIV and the mysticism surrounding it, the belief that an HIV diagnosis is a reflection of one’s personal worth, and the collectivist nature of many African and Caribbean communities emphasizing the importance of community opinions. I think women are stigmatized to a greater degree. Again I’m not sure why, but it may have to do with their general dependence on men and society, or with the “instinct” in many communities of having women bear all burdens (including blame for all things bad), also perhaps with the relative importance of women being perceived as having to be “pure” and free of HIV-related associations”.

As the number of African and Caribbean Immigrants have increased so has the need for health and social services that are culturally relevant. This was a motivating factor for Asfaha Hadera, an Ethiopian refugee who started African Services Committee (ASC) in his Bronx basement in 1981. Today, ASC is a multiservice agency based in Harlem and dedicated to assisting immigrants, refugees and asylees from across the African Diaspora. In 1992 the organization started providing HIV counseling and testing and connection to medical care. Between the period of March, 2010 and February 2011, 3322 people were tested, of which 45 were positive. In the year 201, they provided services to 461 HIV positive people. Of the HIV positive clients that they served, 38% primary language was English, 18% French, 24% other African languages and 17% Spanish.

African Services Committee (ASC) started the “Why Stand” campaign because they realized there was a lack of focus on one of the main barriers to HIV prevention, testing and treatment: the stigma in the African and Caribbean immigrant community. The organization believes that HIV will never be conquered as long as the stigma that surrounds the disease is not addressed which prevents people from learning their status, protecting themselves and others, and getting into treatment.

Stephanie Kaplan, Communications Director for the organization stated that “the goal of the campaign is to reach African and Caribbean immigrants in an effort to change their perspectives on HIV and the people diagnosed with HIV. Myths and discrimination abound when it comes to the disease, and without educating the public and urging them to accept those who are positive, we will never be able to begin the process of getting more people tested and in treatment.”

The yearly campaign is funded in partnership with the NYC Department of Health and Mental Hygiene. The campaign has received support from Imam Souleymane Konate, Senegalese Association President, Bouna Coundoul and Matel Sow, Miss Senegal USA (all of whom appear in ads for the campaign); as well as, local hospitals and other non-profits that serve the African and Caribbean Immigrant community. The campaign also received coverage from FunTimes magazine which serves Africans and Caribbeans in the Americas, as well as, assistance from FY-Eye. This advertising includes displaying campaign ads on over 100 digital billboards throughout New York City. Despite the fact that the campaign does not have a prominent African actor/actress or singer as its spokesman or a major media outlet or multinational company as a partner, the campaign has had an impact on the African and Caribbean immigrant community.

Although the campaign was funded for only a year, African Services Committee intends to continue the campaign even when the funding ends. Stephanie Kaplan states the “as long as a stigma still exists in the community we serve, we will continue the campaign.”

Noelle Ewanda Sewell
Faith & Knowledge in Action, LLC

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