AIDS pandemic.)
African American women in particular have special needs. Minority women represent the
fastest-growing segment of the U.S. HIV/AIDS pandemic. One study (Kalichman and
Stevenson, 1997) examined the psychological and social factors related to HIV risk among 153
African American inner-city women. The women completed measures of HIV risk history,
sexual and substance use behaviors, perceived risk for HIV infection, self-efficacy to reduce risk
(i.e., the belief that one can effectively perform specific behaviors), and perceived social norms
supporting risk reduction. Fifty-five percent of the women reported at least one factor that had
placed them at known risk for HIV infection. Results showed that HIV risk history was
associated with a self-perceived risk for HIV infection and low self-efficacy to perform risk-
reducing actions, suggesting that HIV risk-reduction interventions targeting inner-city women
should focus on skills training approaches to build self-efficacy and empower women to adopt
Many African Americans have a deep-seated mistrust of the health system. This dates back to the
pre-Civil War period when, because they were considered property and had no legal right to
refuse, slaves were sometimes used in medical experiments (Gamble, 1997). A collective
memory thus exists among the African American community of their exploitation by the medical
establishment (Gamble, 1997). More recently, the syphilis study performed at Tuskegee
University from 1932 to 1972, during which 400 African American men infected with syphilis
were deliberately denied life-saving treatment, has fostered in some African Americans the belief
that contact with health care institutions will automatically expose them to racist administrators
and policies. Several articles point to the Tuskegee study as a significant factor in the low
participation of African Americans in clinical trials and organ donation efforts and in the
reluctance of many African Americans to seek routine preventive care (AIDS Weekly Plus,
American people that I work with do not trust hospitals or any of the other community health
care service providers because of that Tuskegee experiment. It is like _ if they did it once, then
treatment services among African American, Hispanic, and white substance-abusing arrestees
confirmed that African American substance abusers were more likely than white substance
abusers to hold unfavorable views of treatment. Another study (Gary, 1985) examined the
attitudes of African Americans in a northeastern city toward mental health treatment and found
that only 34 percent of the sample felt positively toward community mental health centers. The
study also revealed that women and married persons demonstrated more positive attitudes than
did men and unmarried persons and that participants with a high tolerance of substance abuse
possessed more negative attitudes than did others.
Counselors should be aware that the issues of slavery and institutional racism are constant and
prevalent facts in the lives of many African Americans and should be addressed early in
treatment so they are acknowledged, validated, and brought into the treatment process (CSAT,
1999A). In order to provide effective substance abuse treatment for African American clients,
providers need to take into account the social, economic, political, and cultural contexts of their
