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. (By Marvin Joseph -- The Washington Post)
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In Virginia, country of origin was recorded for just 26 percent of 1,062 new HIV infections reported in 2006, according to the state Health Department. Even so, African immigrants, who represent less than 1 percent of the population, accounted for 5 percent of all 1,062 cases. They almost certainly would account for a higher share if national origin were consistently recorded.

In 2003 and 2004, African immigrants accounted for at least 13 percent of the 639 new HIV infections in nine Northern Virginia counties, according to a study by a Seattle-King County epidemiologist, "HIV Among African-born Persons in Selected Areas of the U.S.: A Hidden Epidemic?"

Many providers and researchers interviewed said they thought most HIV-positive African immigrants were infected in their homelands, in part because in many cases the virus is diagnosed in later stages. Studies have found that most African immigrants contract HIV through heterosexual contact.

Tshibungu's organization, the Ethiopian Community Development Council in Arlington, is the main group educating African immigrants in the region about HIV. Its brochures are printed in French and Amharic, and outreach workers speak those languages and others spoken by Africans.

But because few educational materials targeting African immigrants are available, outreach workers sometimes rely on those written for native-born black residents and have little cultural relevance for Africans. Among the English-language stories used to teach the value of protected sex, one begins, "Yo, my name is Tre . . . On the real, I consider myself an equal opportunity lover -- Black, White, whatever." Outreach workers do their best to translate.

The worst obstacle is stigma. African immigrant communities are segmented and tight-knit. Although Spanish-speaking patients often prefer Latino doctors or interpreters, providers say it is just the opposite for Africans. They fear that they would know a doctor or interpreter from the same community and that word of their condition would spread.

At the Inova Juniper program, the largest HIV-AIDS care provider in Northern Virginia, most African clients will communicate through an interpreter only via speakerphone, and many wait for appointments in private rooms because they fear seeing someone they know in the waiting room, said the director, Karen Berube.

One of the program's clients, an HIV-positive Sudanese woman, who did not want her name published, understands such fear. The woman, 36, said she was infected 13 years ago by a Sudanese soldier who raped her. She learned her status a few years later during a medical exam at the Kenyan refugee camp where she lived.

She arrived in the United States in 2001 on a refugee waiver. Now she is a file clerk, and anti-retroviral drugs are keeping her healthy. But a Sudanese social worker who used to visit her stopped after he learned that she was HIV positive, she said. She has told few of her friends and no one at her mosque.

If they knew, "they would stay far away," she said on a recent day, her face surrounded by a black headscarf. "Some people think that just by greeting [you], you can give it."

To even gain access to the various African communities, Tshibungu and her colleagues recruit "gatekeepers" -- volunteers who arrange meetings with people from their native countries, ethnic groups or villages.

At the Silver Spring day-labor center, the gatekeeper was Rabelais Batchaji, one of the many Cameroonians who gather there.

"In my country, to talk about AIDS is not easy," said Batchaji, a tall and affable man who said he has a fondness for community service. "They read it in the paper, but I don't know if they discuss it."