African American women over the age of 49 years old are contracting the HIV/AIDS disease at alarming rates, yet little attention is given towards their prevention needs. HIV/AIDS prevention teaching for postmenopausal black women is imperative to reduce the incidences and the transmission of this disease. Clinicians who provide health services to postmenopausal black women need to be educated on their HIV risk behaviors.
African American women living in minority communities have an overall rate of disease incidence, prevalence and morbidity as compared with the health status of the general population as it relates to HIV/AIDS. HIV is the fourth leading cause of death among black women over 49 years old. Between 1988 and 2001 the rate of HIV infection in women ages 50–59 years old rose from 40% to 56%. In women 60–65 years old, HIV doubled from 24% to 53% and in women over 65 years old HIV more than tripled from 13% to 43%.
Stereotyping postmenopausal women as no longer sexually active often leaves them overlooked in HIV/AIDS prevention teaching, clinical trials and research. The purpose of this article is to encourage all registered nurses working in high-risk HIV communities to include women over 49 years old in their HIV prevention messages.
Surveys reveal that many women over 49 years old do not view themselves as at risk for HIV and therefore do not take necessary precautions to prevent its transmission. Literature also supports that older women are less knowledgeable on how HIV is transmitted.
Vaginal thinning and dryness makes older women particularly susceptible to HIV transmission because of potential skin tears. Psychologically, women who no longer fear pregnancy may be less likely to use condoms and not think of them as a barrier to the HIV virus. Socially, the male/female ratio limits the available men to choose from and some women may engage in high-risk sexual behavior in fear of losing their partner. If they are aware of the necessity of condoms, they may lack the confidence to assert themselves with their partner regarding consistent use. Consistent condom use may also suffer due to a lack of knowledge or experience in proper use. Finally, the older male partner may not achieve a full erection until after initiation of coitus, again putting the woman at risk.
Women should know that this is not just a one-way street either; their partner must be involved in practicing safer sex, such as being supportive of consistent condom use. A sense of self-worth and confidence is essential to achieving this. Not only must your patients be made aware that their bodies still face risks during sexual encounters later in life, they need to feel that their bodies are worth protecting.
A health promotion model of HIV prevention teaching needs a psychological foundation that explains risk behaviors and identifies the best methods to bring about a permanent behavior change. Research has demonstrated that prevention programs work. Persons who are HIV- negative but are at high risk for HIV must be continuously educated and supported at different phases of their lives. Health professionals must encourage women to know their HIV status, regardless of age.
The purpose of patient teaching is to protect, promote and prevent disease occurrence. Pender’s Health Promotion Model is an effective theoretical model to guide patient HIV teaching because the focus is on disease prevention.
In high-risk clinical areas, have teaching tools available that target African American women over 49 years old. Teaching tools are essential for learning. You can modify a “test your HIV knowledge” quiz by using a Center of Disease Control test that is available online. A test is a way for the registered nurse to assess how much a woman knows about HIV. A test may also open up discussion, allowing women to verbalize their concerns for themselves or others. Check out the example on this page of a test your patients may enjoy.
Clinics should also always have easy-to-read HIV prevention pamphlets in sight. Since most prevention pamphlets don’t reflect the face of the middle-aged black woman, nurses can be creative and design their own pamphlets using graphics that are culturally appropriate and effective in getting the prevention message across. For example, consider this simple prevention message:
B Informed about the ABCs of HIV/AIDS Prevention:
C: Use latex condoms to prevent the transmission and contraction of HIV/AIDS.
Again, simple tools like the ABCs and short quizzes like the one to the right can be powerful conversation starters.
Also consider having a list of prevention programs that target black women as a resource for them to share with their communities, church, friends and family. The CDC actually offers several supportive intervention organizations, and you can refer your patients to their website (www.cdc.gov) for further information, including materials for starting local chapters.
SISTA (Sisters Informing Sisters about the Transmission of AIDS) is a gender- and culturally relevant intervention program designed to encourage the use of condoms in African American women. SISTA focuses on building self-efficacy, employing a model that can be adapted to older African American women as well. The group creates a supportive environment and presents relevant information regarding practicing safe sex and fostering a healthy relationship. SISTA groups promote self-worth, validation and personal power—values that must be cultivated in all women, regardless of age.
A similar program, SiHLE (Sistering, Informing, Healing, Living and Empowering) is an intervention program that targets young, potentially sexually experienced girls ages 10–13 for the purpose of reducing sexual risk behaviors. This information is also relevant for menopausal women for learning, as well as teaching children and grandchildren. Like SISTA, SiHLE instills in its participants an invaluable foundation of self-efficacy.
The HIV epidemic has a greater capacity to spread than previous epidemics. With bubonic plague, cholera and smallpox there were signs and symptoms such as boils, dysentery and high fevers that could be identified and isolated, thus limiting the chance of infecting others. With HIV the length of time a person is asymptomatic gives the disease time to spread to vast numbers of people unknowingly. When compounded with a lack of knowledge, this spells disaster for at-risk populations and communities.
The contribution nurses can make by planting the seeds of health promotion and disease prevention blossoms into increased awareness and self-responsibility. A single visit with a nurse can spark the conversation that makes all the difference.
Armed with the weapon of knowledge, and fortified by increased confidence, self-efficacy and feelings of strength and self-worth, African American women over 49 years old can journey into the autumn of their lives without fear of becoming a victim of HIV.
Test Your Knowledge! How much do you know about HIV/AIDS?
TRUE OR FALSE
- I can become infected with HIV by swimming in a pool, sitting in a hot tub or holding hands with someone
with HIV. _______
- I can tell if a person is infected with HIV because they look different from everyone else. _______
- If I were infected with HIV, I would know it because I would feel sick. _______
- Only IV drug users, gay men and prostitutes need to worry about becoming infected with HIV. _______
- If I find a man my age or older and he is in the church I can feel safe that he doesn’t have HIV. _______
-As long as I’m monogamous, I don’t need to be tested for HIV. _______
- The HIV/AIDS epidemic is not as bad as it was in the past because now there is a cure. _______
- I don’t have to worry about HIV because I am a 52-year-old heterosexual woman. _______
- Anyone who has a sexual or drug history is at risk for having HIV. _______
- Women will not get HIV if they use birth control pills and/or a diaphragm. _______
- Natural lambskin condoms are just as effective at preventing HIV infection as latex condoms. _______