HIV Rates Spur Outreach to African Immigrants

Jeanne Tshibungu, left, and Asheber Gebru, safe sex outreach workers, make a presentation to Cameroonian day laborers in Silver Spring. Disproportionate HIV rates have been found among African immigrants.
Jeanne Tshibungu, left, and Asheber Gebru, safe sex outreach workers, make a presentation to Cameroonian day laborers in Silver Spring. Disproportionate HIV rates have been found among African immigrants. (By Marvin Joseph -- The Washington Post)
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By Karin Brulliard
Washington Post Staff Writer
Tuesday, September 2, 2008

Jeanne Tshibungu imparts her lessons wherever African immigrants agree to listen -- at apartments, hair braiding salons, taxicab stands and, on one particular rainy morning, inside a steamy garage at a Silver Spring day-labor center packed with Cameroonians. Standing with a plastic bag filled with condoms, she began explaining in lilting French how they could contract HIV and especially how not to.

Tshibungu, a Congolese-born HIV outreach specialist, was there to emphasize that the disease that has killed millions in Africa affects Africans in the United States, too. It is a message health researchers say is growing in importance as they become increasingly concerned that the AIDS epidemic ravaging sub-Saharan Africa is following migrants from that continent to America.

Some local studies elsewhere in the United States have found greatly disproportionate infection rates among Africans, and care providers in the Washington region are seeing similar trends. But they are running into a common obstacle as they try to gauge the scope of the problem: Because many health departments do not ask patients where they were born, most HIV-positive African immigrants are typically categorized -- obscured, experts say -- in surveys as "black" or "African American."

African immigrants are a relatively small group. In the Washington region, one of the nation's top destinations for African immigrants, they make up about 3 percent of the population, and those with HIV are a small subset of that group. The danger, experts say, is that outreach efforts are missing immigrants because they are not counted, allowing the problem to grow.

"Quite frankly, many providers don't distinguish between Africans and African Americans," said Garth Graham, deputy assistant secretary for minority health at the U.S. Department of Health and Human Services, which is hosting a seminar this month on Africans and HIV in Rockville as part of a new nationwide initiative. "It doesn't take into account the different cultural backgrounds and perceptions of wellness and disease that these individuals have . . . that's one of the glaring challenges that we're facing."

Providers said the problem is exacerbated by stigma, language barriers and fears of deportation. Many African immigrants are unacquainted with the concept of preventative medicine, providers say -- and don't realize that early diagnosis can mean long life, not a death sentence.

"You have to be sick to go to the doctor in Africa," said Ashenafi Waktola, an Ethiopian-born District physician who treats many HIV-positive patients. "That is disastrous with AIDS."

There are no precise national HIV or AIDS data for African immigrants. But studies in places that include Minnesota and the Seattle area, both home to relatively large African immigrant populations, have found vastly higher rates among Africans, as have surveys in Canada and Europe.

In the Washington region, information on country of birth varies so much by jurisdiction and is so spotty that it provides only a blurry snapshot. But a recent District Health Department survey of groups providing HIV-related services to poor clients in the region found that 10 percent of those clients were African-born.

Of 31,256 AIDS cases reported in Maryland through last September, African immigrants accounted for 716, or 2.3 percent, slightly higher than their percentage of the population, which is about 2 percent. But in Montgomery, 392, or 15 percent, of all reported AIDS cases were among Africans, who represent about 4 percent of the population.

Officials with the state's AIDS Administration are unsure how to explain the disparity between the statewide and Montgomery figures because country-of-origin reporting by health-care providers is "often inconsistent or incomplete," said William Honablew Jr., an administration spokesman. It is possible that health-care providers in Montgomery offer HIV testing to immigrants more routinely and record their national origin more reliably, officials said.

The vast majority of Maryland AIDS cases among African immigrants have been reported in Montgomery and Prince George's counties, a pattern that has prompted the state's AIDS Administration to plan an HIV-prevention program targeting African communities in those counties, Honablew said.

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