Barriers to HIV Prevention for the Vulnerable Groups

While anyone who engages in unsafe intercourse is at risk of developing HIV/AIDS, the infection rate in certain groups, such as Infectious Drug Users (IDUs), ethnic minorities (particularly Black Americans), gays, and women, remains high in the United States. According to the Centers for Disease Control and Prevention (CDC), around 1.1 million people in the United States are living with HIV, and one in every seven people are unaware they are infected. After a variety of social groups, including the CDC, launched comprehensive prevention programs, the total rate of new infections fell by 18% by the end of 2015. However, progress in the reduction of new infections has been uneven with diagnoses increasing in the aforementioned groups. Reports on the rate of HIV/AIDs infection in US by CDC showed that gay and bisexual men accounted for more than 82% of the diagnosed male population, heterosexuals were 24% of the overall population, women 19%, and whereas the African American population accounts for only 12% of the US population, they constitute more than 47% of the total HIV/AIDs population. From such information, the research paper seeks to examine the reason HIV/AIDs rates remain high among particular (IDUs, Black American, homosexuals, youth and women) communities.

Prevalence of HIV/AID in the United States

Currently, the United States of America (USA) has at least 1.1 million people that are diagnosed with HIV. Avert.Org(2017) reported that nearly approximately one in every seven individuals do not know that they are already infected either because they are afraid of going for checkup or tested before the end of HIV’s window period that is estimated to be between 2 weeks to around three months. Though the rate of prevalence is low in comparison to the country’s total population, there are specific groups that are more prone to new infections as shown in figure 1. The nation is known for its advocacy in mitigating HIV prevalence through donations particularly to the developing nations, but it is facing an epidemic given that more than 400,000 new infections are reported annually (Avert 2016). Discrimination and stigma towards certain people has hampered progress in eradicating the infection. Additionally, other complex socioeconomic factors that are attributed to the rise in the rate of infections among the groups shown in figure 1 include; poverty, inaccessibility to proper care, sexual associations – people prefer to have sex with people within their community –, and legal barriers.

Figure 1. HIV diagnosis in the United States for the most affected populations (CDC n.p.).

Gays and Bisexuals

Though sexual minorities’ account for just 2% of the USA population, nearly two-thirds of new infection cases come from such a specific group. Moreover, approximately one-half of all the people living with HIV in 2008 were gays. In 2013 also, CDC reported that more than 680,000 men that had sexual interactions with their fellow men were infected with HIV, though 15% of the population are not aware of their HIV+ status (NIH). If the prevailing rate of infection continues, in the long-run, all gays will be infected with the diseases.

One of the major reasons for such high infection prevalence among the gay is most of them do not use condom during sexual interactions. The number of bisexuals having sex without condom increased to 15.7% in 2014 compared to 13% that was recorded in 2008 (CDC 2015). Most gays tend to practice anal sex under the influence of drugs and alcohol thus they are not under proper thinking capacity to use condoms, high number of partners essentially triggered by online transactions, the notion of strategic positioning whereby the infected partner assumes that the other partner will position themselves in a manner that will reduce the chances of being infected, and mutual consent to non-condom use yet the individuals are not aware of their HIV status (Ostergen et al. 126). Such irresponsible behavior among the gay people has led to new cases being reported annually. In addition, the society is yet to universally assimilate the group within the community structures thus most of the people hide when cohabiting making it difficult to seek for condoms due to stigmatization.

Injection Drug Users

Drug use across the American population increased by 63% between 2000 and 2011 as reported by Centers for Disease Control and Prevention (2015). However, the number of people infected with HIV through drug injections declined by approximately 25% owing to the increase in awareness among the drug users. The number ranges between ethnic groups, with the white population accounting for the highest infection rate among the IDU group in comparison to the blacks. The elderly people among the black population are more prone to new infections while the youth are more likely to use heroine and other drugs among the white population.

The attributed cause in the rise of new HIV infections among the drug injectors is that most of them do not use sterilized instruments, with just a quarter of the population asserting that they received the injections from sterile sources. In addition, drug injectors tend to share among themselves without minding the status of the other person, particularly due to the fact that they are usually ‘high’ on the drugs and do not reason properly before and after the injections. Drug users tend to be addicts and they only care about receiving the next dosage to stimulate their bodies, and thus, caring about the source of the injections is usually the last concern. The rate of infection in the IDU group can only be minimized if the number of users reduces.


Most of the women who are infected with HIV obtained the virus through heterosexual relations. In 2010 alone, more than a quarter of the infected people were women. Though the epidemic was more prevalent in Northeastern region of USA, new infections and mortality rate is predominant in the South. Apart from promiscuity particularly among the black women, infection rate is high among the population due to drug injections that mostly take place in private places for fear of intimidation, and trauma from childhood sexual abuse.

Women that are traumatized emotionally and physically are more likely to contract HIV given that they are mentally incapable of making any rational decision, and the fact that they have no self-esteem thus consider extramarital affairs to be remedies to their problems.

African Americans

Of the total population infected with HIV, black people account for the largest population with more than 46% of new infections reported between 2014 and 2015 (NIH). In the population, 57% of the infected people are men who are sexually intimate with men, and 39% are aged 13-24 years (Avert). Though there was substantial decline in the number of new infections among the subgroup by 42% in 2015, compared to other ethnic groups, the rate of prevalence is still high.

The reason for such a high rate of infections in African Americans is the high rate of unprotected sex by the members, lack of adequate healthcare access due to poverty, and stigma surrounding the gays within the population. Additionally, the risk of HIV infection prevalence is increased by the fact that most of the members only have sexual relations within the group.

Also, African Americans have a high rate of sexually transmitted infections (STIs), with some of the infections increasing the chances of contracting HIV when exposed to an infected person (CDC 2016). Another cause for the high rate of HIV infection among the group is that they tend to be diagnosed with the disease at later stages thus end up starting therapy treatments when the infection rate is already high. The members of the group also tend to forgo therapy once they have started which also raises the infectivity rate and causes other health complications.


Compared to other nations around the world, the US has the largest number of people in prisons and other closed settings, at approximately 2.2 million. Among the prisoners, new rate of infections are at 1.5% compared to 0.5% among the free citizens. Reports by CDC indicated that one in eight people infected with HIV go through the prison system annually. Most of these people are either gay or black Americans. The prisons are crowded thus leading to sexual impulses that lead to random sex behavior particularly among men leading to high HIV infection rate (Kann 127).

The Youth

Finally, youth aged between 13-24 years are more likely to be infected with HIV in America, with 22% of the new rates originating from the group. In 2014, more than 23,500 youth did not actually know that they were HIV positive, accounting for the largest undiagnosed group in the USA (Avert).

Most of the young people are rebellious and love trying new things particularly related to sexual activities. Given that today’s youth are millennial who did not witness the high mortality resulting from HIV in the 90s, they tend to be careless and less likely to use condoms. In addition most of the youth experiment drugs and peer pressure cause them to engage in irresponsible sexual behavior leading to high rate of HIV infections (Kann et al 2).

Barriers to HIV Prevention for the Vulnerable Groups

The process involved in addressing discrimination and stigma is a big issue in USA, particularly around the area of misconceptions on how the disease is transmitted. In 2015, a study conducted by CDC established that more than 70% of people living with HIV are stigmatized and discriminated. Though most people say they do not mind interacting with the infected people, majority fear intimate relationships. As such, most people tend hide their status in fear of discrimination leading to more new infections.

Additionally, healthcare is not evenly distributed across the country. Essentially, the black people living in the South produce the highest clinical trials given that majority lack proper access to care and counselling. Though the 2016 federal budget released more than $30 billion towards HIV prevention and treatment, the funds are restricted given that there are controversies towards the people who inject drugs (CDC 2016). For instance, federal funding towards needle exchanges, which have globally proved to reduce HIV transmission through injections, was prohibited until 2009. However, even with the acceptance of the government to fund the initiative in 2009, the budget did not allocate any amount towards the initiative until January 2016 when new infections had already been reported.

Another barrier is in form of legal enforcement. Though under Obama administration the ban on entry into the nation for HIV people was lifted, in 2011 alone, more than 67 laws against HIV people had been instituted across 33 states even though most of the actions stipulated in the legislation do not contribute to HIV transmission (NIH). Enacting laws against the HIV infected people further promotes stigma and thus making it difficult for such groups to come out and seek for care. For instance, the youth fear discrimination and isolation therefore resorting to drug abuse and careless sexual behaviors which in essence lead to new infection rates.


There is hope for the vulnerable population in USA with regards to HIV infection rates after the government revised the national HIV/AIDs strategy by incorporating stigma and discrimination among the transgender, bisexuals, and other risky people to reduce prevalence. Effective reduction in the rate of HIV transmission among the at-risk populations requires impactful targeted campaigns that addresses the specific needs of each sub-group. Increasing the access to testing and awareness can assist in addressing the high infection rate among the groups. Research should focus on establishing the available help strategies and linking them to individual people, and identification of suitable lifestyle changes, acceptable sexual practices and abuse treatments that adhere to the values of each group for more effective outcome.

Works Cited

Avert. “HIV and Aids in the United States of America”, Avert,. 2016, Accessed 7 Aug, 2017.

Center for Disease Control and Prevention. “HIV in the United States: At a Glance. 2017”, CDC, Accessed 7 Aug, 2017.

Center for Disease Control and Prevention. “HIV among African Americans. 2015”, CDC, Accessed 7 Aug, 2017.

National Institute on Drug Use. “Who is at Risk of HIV Infection?”, NIH, 2012, Accessed 7 Aug, 2017.

Kann, Laura, et al. "Youth Risk Behavior Surveillance—United States, 2013." Surveillance Summaries, vol. 63, no. 4, 2014, pp. 1-168.

Ostergren, Jenny E., Rosser, Simon B.R., and Horvath, Keith J. "Reasons for Non-Use of Condoms among Men who Have Sex with men: A Comparison of Receptive and Insertive Role in Sex and Online and Offline Meeting Venue." Culture, Health & Sexuality vol. 13, no. 2, 2011, pp. 123-140.

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