Introduction

Although HIV first affected mainly white men in the USA, the number of cases in African Americans has increased steadily and dramatically. By 1996 in the USA, more cases of AIDS occurred in African Americans than in any other racial/ethnic population. In 1999, almost half the AIDS cases in the USA were African American and in 2001, African Americans accounted for 21 000, or 49%, of the more than 43 000 new adult AIDS cases reported (CDC Fact Sheet). In 2001, African American women accounted for nearly 64% of HIV cases reported in women (CDC Fact Sheet). African American children represent almost two-thirds of all reported pediatric cases (CDC, 2001a). AIDS is the leading cause of death among African American men ages 35–44 and African American women ages 25–34. AIDS is among the top three causes of death for African American men ages 25–54 and African American women ages 35–44 (CDC Fact Sheet). It has become such a serious issue that, in February 2001, there was a call for a Federal State of Emergency for African American Communities and HIV/AIDS.

When working with African Americans, clinicians should remember that they are not a monolithic group. Each person is an individual with his or her own experiences and beliefs. There is no simple model or explanation of community behavior. However, the concepts discussed in this chapter may play some role in patients' life experience and development.