Thanks to a grant from the Susan G. Komen for the Cure Foundation (Houston), Positive Image Productions is proud to present a program that change lives, even save lives.
African Americans Battle Against Breast Cancer is the title of a 30-minute special that will air on television in Houston in October. This program raises awareness of the very serious state African Americans are in, when it comes to breast cancer.
As we began production back in the Spring, we were surprised really, to discover that breast cancer is being called an "epidemic" in the African American community. As the producer/host, I was alarmed to talk to breast health advocates who tell me "fear" is the number one problem in African Americans. Too many black women let fear decide their health, saying "I don't want to know." "I am afraid to die, so I didn't get checked." The consequences of fear are dire. What health experts are seeing in the African American community is a rising death rate of this disease and a trend toward women younger than 40 years old being diagnosed. That is a chilling development, but the good news is, there are steps we can take to fight this disease.
Early detection can save lives. If more African Americans would get mammograms (the recommended age is 40 but women with a family history should get mammograms earlier than age 40), do monthly self checks to become familiar with their breasts so they can report any unusual changes to their doctors and have a physician check their breasts during an annual physical exam, more breast cancer cases can be detected earlier and perhaps more lives saved.
Of course, there are always complications or unforseen circumstances, but we can use the knowledge and tools avaliable to us to fight back against breast cancer. The worst thing we can do is let fear determine our outcome.
So watch the promotional clip. Watch the show when it airs in October. Get educated. Tell a friend and loved one about early detection. It will save lives!
Cynthia Nickerson
Positive Image Productions, Inc.
Yes. Black women and men in the US are hard hit by HIV, and have been since the beginning of the epidemic. In 2006, Black women accounted for 61% of new HIV cases among women, but make up only 12% of US female population.1 The rate of HIV diagnoses for Black women is 15 times the rate for White women.1 Black women also have high rates of sexually transmitted diseases (STDs), which can facilitate transmission of HIV. Among Black women in 2006, the rate of chlamydia was 7 times higher, gonorrhea 14 times higher, and syphilis 16 times higher than the rate among White women.2 These numbers and statistics, however, don’t show the richness and diversity of Black women’s lives. Black women can be White collar and working class, Christians and Muslims. They live in inner-city and suburban neighborhoods, are the descendants of slaves and recent Caribbean immigrants. They work, go to school, raise families, fall in love. HIV among Black women is not simply about individual behavior, but a complex system of social, cultural, economic, geographic, religious and political factors that combine to affect health.3 Having STDs other than HIV, having unprotected vaginal and anal intercourse with an HIV+ person, and sharing injection drug equipment with an HIV+ person are the highest risk factors for HIV transmission for Black women or anyone. Another risk is not knowing your partner’s risks, such as injection drug use, having other current sex partners or unknown HIV status. In 2005, 80% of Black women were infected with HIV through heterosexual contact and 18% through injection drug use.4 Young women and teens are particularly affected. In 2004, HIV was the leading cause of death for Black women aged 25-34 years.5 Black teenagers (ages 13-19) accounted for 69% of new AIDS cases among teens in 2006, but make up only 16% of US teenagers.6 When it comes to having safer sex, women are often more concerned about pregnancy prevention than HIV/STD prevention, and are less likely to use two methods of protection (such as the pill and condoms). Black teenage girls are more likely to use implant and injectable contraception (the patch, Norplant) than White teenage girls, making them less likely to use condoms that protect against HIV.7 Similarly, Black women, especially women living in low income areas, are more likely to use sterilization as contraception.8 HIV prevention often takes a back seat when women are struggling to secure jobs, food, housing or child care. Most HIV/AIDS cases among Black women occur in inner city and rural areas where many women live in poverty and have unstable employment and housing.9 Women in these neighborhoods are more likely to be homeless and trade sex for money or shelter, use substances (alcohol, crack, heroin), be dependent on a man for support, and experience violence or trauma. All of these affect a woman’s ability to refuse sex, use condoms or clean needles and protect herself from HIV. High incarceration rates in the African American community also affect HIV risk. Incarceration decreases the number of men in the community, which disrupts stable partnerships and promotes higher-risk concurrent partnerships (having more than one sexual partner in a given period and going back and forth between them).10 The ratio of men to women is much lower among African Americans than among any other ethnic group in the US. High rates of death among Black men due to disease and violence as well as high rates of incarceration impact the community in many ways, including reducing the number of potential partners. This promotes women with low-risk behaviors partnering with men with high-risk behaviors.3 It’s been reported that many Black women don’t know that they are at risk for HIV, because many women report no or unknown transmission category when testing for HIV. Black communities traditionally have a high degree of social mixing between higher and lower risk individuals,11 which means that Blacks are more likely to know and date a partner with a risk history. Ultimately, it may not be that Black women aren’t aware of their risks, but that risk is more accepted because of this social mixing. Black women understand they are at risk, as shown by HIV testing rates that are higher than any other racial group. Almost two thirds (65%) of Black women ages 15-44 have ever been tested for HIV. Black women are twice as likely to be tested for HIV in the past 12 months (25%) than are White women (13%).12 Because of the disproportionately high rates of STDs and HIV in the Black community, the likelihood of being exposed to an infected person is much higher for Black women and men than it is for people living in other communities. This means that even though Black women are engaging in fewer risk behaviors than White women,3 in order to not get infected, Black women have to do so much more than other women to protect themselves.3 There are currently 11 interventions for Black women and adolescents that have been approved by the CDC as best or promising evidence or are in the Diffusion of Effective Behavioral Interventions (DEBI) project.13 In addition, many agencies across the US provide innovative HIV prevention services with and for Black women that see women as a whole, not just their sex and drug use, and as part of a community. Supporting women with incarcerated partners is important. HOME (Health Options Mean Empowerment) worked with women whose male partner was being released from state prison. HOME trained women visitors to be peer health educators, both for other women visitors and women in their communities. HOME included community-building activities (group lunches for women waiting to enter the prison); general-health workshops (on diabetes, blood pressure, obesity and smoking cessation); sexual-health workshops on HIV/STDs; health fairs; and facilitated community referrals and support services geared to the needs of women who visit men in prison. Women who participated reported decreased unprotected sex, increased HIV testing and increased communication with their partners about HIV-related topics.14 A recent large, multisite trial described the Eban HIV/STD Risk Reduction Intervention, a program for African American couples who are HIV-serodiscordant. Eban addresses individual, interpersonal, and community-level factors that contribute to HIV risk behaviors at mulitple levels in 8 weekly 2-hour sessions. Four sessions focus on communication, problem solving and decision making around safer sex within the couple. Four group sessions focus on changing peer attitudes and norms, de-stigmatizing serodiscordant couples and increasing support for couples in the community.15 To reach Black women in their own communities, many agencies have implemented HIV prevention interventions in beauty salons and nail parlors, which provide a safe environment to access HIV information and condoms. In Durham County, NC, Project StraightTalk has been training barbers and beauticians to educate their clients about STDs/HIV since 1988. The project offers annual trainings, gives condoms and educational materials to each salon twice a month, and produces personalized posters for the salons.16 The African American community will continue to be severely affected by HIV unless prevention and care efforts are combined with efforts to address the root causes of disease.3 Black girls, teenagers and women need to be supported within their social environment to build stronger relationships, families, neighborhoods and communities and reduce their risk for HIV and other diseases. HIV prevention programs for women’s male partners can benefit both men and women. Effective HIV prevention programs should be developed and run by Black women and provide job training, couples counseling, food banks, housing assistance, mental health services, substance abuse treatment and family services. Government and other funding agencies need to understand that all of these things are HIV prevention and should be funded as such. 1. CDC. Subpopulation Estimates from the HIV Incidence Surveillance System—United States, 2006. Morbidity and Mortality Weekly Report. 2008;57;985-989. 2. CDC. Sexually Transmitted Disease Surveillance, 2006. November 2007. 3. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372:337-340. 4. Rose MA, Telfair Sharpe T, Raleigh K, et al. An HIV/AIDS crisis among African American women: A summary for prevention and care in the 21st century. Journal of Women’s Health. 2008;17:321-324. 5. HIV/AIDS among women. Fact sheet prepared by the CDC. August 2008. 6. Black Americans and HIV/AIDS. Fact sheet by the Kaiser Family Foundation. October 2008. 7. Abma JC, Martinez GM, Mosher WD, et al. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. Vital and Health Statistics. 2004;23. 8. Mosher WD, Deang LP, Bramlett MD. Community environment and women’s health outcomes: Contextual data. Vital and Health Statistics. 2003;23. 9. Fullilove RE. African Americans, health disparities and HIV/AIDS. Report prepared by the National Minority AIDS Council. November 2006. 10. Harawa N, Adimora A. Incarceration, African Americans and HIV: advancing a research agenda. Journal of the National Medical Association. 2008;100:57-62. 11. Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the Southern United States: sexual networks and social context. Sexually Transmitted Diseases. 2006;33:S39-S45. 12. Anderson JE, Chandra A, Mosher WD. HIV Testing in the United States, 2002. Advance Data for Vital and Health Statistics. 2005;363:16. 13. Centers for Disease Control and Prevention. Updated Compendium of Evidence-Based Interventions, 2007. 14. Grinstead O, Comfort M, McCartney K, et al. Bringing it home: design and implementation of an HIV/STD intervention for women visiting incarcerated men. AIDS Education and Prevention. 2008;20:285-300. 15. NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Eban HIV/STD Risk Reduction Intervention: Conceptual basis and procedures. Journal of AIDS. 2008;49:S15–S27. 16. Lewis YR, Shain L, Crouse Quinn S, et al. Building community trust: lessons from an STD/HIV peer educator program with African American barbers and beauticians. Health Promotion Practice. 2002;3:133-143. Prepared by Prepared by Pamela DeCarlo and Olga Grinstead Reznick PhD, MPH; CAPS March 2009. Fact Sheet #65E Special thanks to the following reviewers of this Fact Sheet: Victoria Cargill, Deidra Carrol, Marcia Glasgow, Bridget Hughes, Sharon Johnson, Marlene LaLota, Marianne Marcus, Leisha McKinley-Beach, Maureen Miller, Adeline Nyamathi, Tara Regan, Celeste Watkins-Hayes, Wendee Wechsberg. Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. To receive Fact Sheets via e-mail, send an e-mail to listserv@listserv.ucsf.edu with the message "subscribe CAPSFS first name last name." ©March 2009, University of CA.
Are Black women affected by HIV?
Who are the women at risk?
What affects risk?
Do Black women know their risk?
What's being done?
What needs to be done?
Says who?
Food Habits and Their Relationship to Dietary Guidelines Historically, African-American rites revolved around food. The society is based on religious ceremonies, feasting, cooking, and raising food. The popular term for African-American cooking is "soul food." Many of these foods are rich in nutrients, as found in collard greens and other leafy green and yellow vegetables, legumes, beans, rice, and potatoes. Other parts of the diet, however, are low in fiber, calcium, potassium, and high in fat. With high incidence of diabetes, hypertension, heart disease, and obesity, some African-Americans have paid a high price for this lifestyle. Economically disadvantaged families may have no other choice but to eat what is available at low cost. Fresh fruits and vegetables, lean meat, and seafood are not as readily available at low cost. The presenter or educator may want to discuss ways of obtaining quality foods despite economic limitations, such as growing small gardens in community sites; shopping at roadside garden markets; shopping at large supermarkets rather than small corner stores; developing budgeting clubs and food co-ops; and participating in food bank programs. Eating Practices, Food Preferences and Food Preparation Techniques Common ways for African-Americans to prepare food include frying, barbecuing, and serving foods with gravy and sauces. Home-baked cakes and pies are also common. Teaching Implications Educators or presenters should focus on the way food is prepared, encouraging families to provide low-cost, nutritious alternatives by modifying the sodium, fat, and sugar content of traditional foods. Simple changes in diet might include substituting herbs for high sodium seasonings, increasing the amount of vegetables and decreasing the amount of meat, removing the fat and skin from meat, and eating more fresh vegetables and fruits. Cutting calories and eating smaller portions should also be encouraged. Some families may resist change because of family traditions. If this is the case, ask them to submit a list of their favorite foods and recipes and then discuss how to modify them. Any opportunity to include information on exercise and teaching their children and teenagers good nutrition should also be taken. Any stereotyping or assumptions that "all" Black people like the same foods and have the same lifestyle should be avoided. Neither do "all" adhere to poor diets, have no concern about their health, have bad cooking habits, or lack nutritional understanding and health education. Taboos about child rearing and nursing are usually common or adhered to if older grandparents are heads of households. Few teenage African-American mothers breastfeed, but it is common with older mothers. Infant feeding methods vary with pressure from parents when babies are crying. Young mothers might give cereal along with formula because they think the infant is hungry. Custom and Family Traditions Many African-Americans are Protestant and have no specific food restrictions. However, a large number of families are members of religious groups that may have some restrictions or dietary preferences. These may include Seventh-Day Adventists, Muslims, Jehovah's Witnesses, and others. This should be discussed openly. Special Holidays A large selection and variety of food is prepared and much attention is given to individual's favorite dishes. Besides all the formal and traditional American occasions and holidays, a large number of African-Americans observe and celebrate Kwanza, an African-American cultural holiday created by Dr. Maulana Karenga of Southern California in 1965. Kwanza is celebrated December 26 through January 1. Karamu, held on January 31, is celebrated with ceremonies, a buffet, and festive attire. Some Arican-American churches frown on wearing slacks and shorts in the worship area or sanctuary, though wearing them is acceptable in the recreation area. Cultural Diversity: Eating in America Cultural diversity is a major issue in American eating. To fully understand the impact cultures play in American nutrition, one must study both food and culture. This fact sheet on the African-American culture is one of a series of nine developed to address cultural diversity in American eating. This fact sheet is designed as an awareness tool for a novice working with a cultural group previously unknown to them. Given the nature of the variations that exist in each cultural group (i.e. socio-economic status, religion, age, education, social class, location, length of time in the United States, and location of origin) caution needs to be taken not to generalize or imply that these characteristics apply to all individuals of a cultural group. This fact sheet was designed primarily for use in Northeastern Ohio, but may stimulate awareness of differences in these cultural groups in other parts of the country. The goal of this fact sheet is to assist a novice educator in reducing any cultural barriers that may inhibit education. The author strongly recommends continued reading and additional research into the cultural groups in which you work. References Jones, Paul. The Black Heath Library Guide to Heart Disease and Hypertension. Henry Holt and Company, Inc, New York, NY. Additional resources addressing cultural diversity in nutrition education: Cross-Cultural Counseling: A Guide for Nutrition and Health Counselors (FNS 250). U.S. Department of Agriculture and U.S. Department of Health and Human Services. Kittler, P. and Schuer, K. (1989). Food and Culture in America. Van Nostrand & Reinhold, 1989. Nutrition, Food, and Culture. National Livestock and Meat Board, Chicago, Illinois.
Prostate cancer presents a serious problem for all Americans men. However, it is widely recognized that prostate cancer is a particular serious problem for black men: mortality from this disease is higher in black Americans than in all other races. This is due to a higher incidence, more advanced stage at diagnosis, and lower rate of survival. This article will examine each of these factors, and present clinically useful reference ranges for using PSA to diagnose prostate cancer in black Americans.
High Incidence
African Americans have the highest prostate cancer incidence rates in the world. In contrast, the disease is rare in Africa, the Near East, and South America. According to the American Cancer Society, some of the increase in rates may be related to socioeconomic differences reflected in lifestyles behaviors that contribute to cancer risk. This may include a diet high in saturated fats and tobacco and/or alcohol use. Whatever the reason, the incidence of prostate cancer in American Blacks is currently 50% higher than in American whites.
When the National Cancer Institute analyzed black and white cancer rates by socioeconomic status, they found that, in general, cancer incidence was higher in low-education and low-income groups regardless of race. However, the incidence of prostate cancer remained higher among blacks, even after adjustment for income or education.
Late stage at diagnosis
Significantly more blacks than whites are diagnosed with advanced disease. In fact, blacks are more likely than white to have all cancers, regardless of site, diagnosed at a late stage.
Poor Survival Experience
Prostate cancer mortality rates are more that 2 times higher for black Americans than white Americans. Data from the Surveillance, Epidemiologic, and End Results program of the National Cancer Institute indicates that the relative 5-year survival rate of black Americans with prostate cancer is less than that of white American for all stages of disease.
Age and PSA (Prostatic Specific Antigen)
Because serum PSA increases with patien age, primarily due to the increase in prostatic volume with age, the use of age-specific reference ranges may make the test more sensitive in younger men and more specific in older men. Age-specific reference ranges might find more organ-confined, "curable" cancer in younger men, and spare more older men an invasive and costly biopsy. Some urologists recommend using age-specific reference ranges only for patients 40 to 59 years of age, and the conventional range of 0.0 to 4.0 ng/ml for men 60 and older. Age-specific reference ranges for white men have been determined from a study in Olmsted County, Minnesota.
Race and PSA
Subsequent investigations with a Japanese population revealed significantly lower PSA levels than seen in white men. This indicated the importance of considering the patient's race when using PSA to diagnose prostate cancer. A study of military personnel at Walter Reed Army Medical Center became the first to apply, to black men, PSA reference ranges determined from a black population. These values were significantly different from those in white men, but also correlated directly with age.
PSA in Practice
The American Cancer Society currently recommends that every man over 40 have a digital rectal exam as part of his annual physical. In addition, the American Urological Association recommends that annual PSA blood tests also be initiated at age 40 for black Americans or those with a family history of prostate cancer.
The high incidence and mortality of prostate cancer in black men justify aggressive detection using race-specific ranges derived from a black population. This should allow the practicing clinician to detect more clinically significant cancers at an early, potentially curable stage.
The article was originally written by Joseph E. Oesterling, M.D., Professor and Urologist-In-Chief Director, The Michigan Prostate Institute, The University of Michigan, Ann Arbor, Michigan (An educational service of MERCK & CO., Inc.)
