Executive Summary

Background - During 2000, Saving Lives through Alternate Options (SLAO), a community based organization, with the assistance of the City of Houston, Bureau of HIV/STD, conducted a needs assessment survey in the immigrant community to facilitate understanding of the needs of the African and Caribbean immigrant community. They collected data from 350 individuals during numerous community and social events, and organizational meetings. And while the study forfeited some generalizability due to the data collection methodology, it offers insight into the lifestyles, practices, and beliefs of the African and Caribbean immigrant communities.

Demographics - The majority of respondents (88%) came from 22 countries in Africa, with Nigeria being the most frequently cited. The primary reasons for initially coming to the U.S. were: 1) to study at university or 2) as a refugee. The average length of stay has been 10 years. The majority of respondents were male (55%) and of all respondents, the majority was single or unmarried (53.7%). 52% had an average of 2 children and 85% had a household income lower than the Houston median of $40,974. The majority (64.3%) rent homes, almost twice as many as the general population, and 50.3% had a college or graduate school education compared with 10% of U.S. African Americans; 74% were employed either full- or part-time.

Health Services - 26.3% of respondents use the public health care system with the majority utilizing private physicians or HMO systems. While the majority of individuals have health insurance, only 52% had health insurance coverage for family members.

Unmet Needs - Unmet needs for these respondents were: 1) access to health care, 2) employment opportunities, and 3) help with immigration issues.

Tribal Practices - Circumcision and body scarring were traditional practices for many, and a traditional healer most frequently performed the procedure. Monogamy was reported by the majority of respondents, however 40% accepted polygamy/polyandry as common practice, with no wide disparities in acceptance between men and women.

Condom Use - Over half (58%) reported condom use at least once, and of these 45% reported condom use "almost all of the time" while 24% had discontinued condom use altogether. When compared with knowledge about HIV, there was a statistically significant correlation between history of condom use and HIV knowledge indicating education can affect incidence of condom use.

HIV in the Community - 65% felt HIV was a problem in their community and listed unprotected sex and lack of knowledge about HIV as primary causes of the problem. 44% had known someone with HIV and reported community reactions ranging from fear, avoidance and ostracism to sympathy and concern. About half of the respondents were familiar with HIV services, most commonly (79.5%) with testing and diagnostic services. Self-assessed risk for HIV was low, primarily due to low self-perceived risk. 69% had been tested for HIV at some point and 48% had tested within the preceding 12 months. Of these 94% had received the results of their tests.

2.1 (5) individuals in the study were HIV positive and three of the 5 had been diagnosed within the preceding 3-month period.

Take-home Points

• The population is young and women are in childbearing years.
• University students are a primary population.
• Majority are single households with children.
• Majority are overeducated and underemployed.
• Household income is far below the community norm.
• Primary care, when accessed, is often through private providers thereby reducing accessible public health information.
• Men are more likely than women to receive treatment for STDs.
• Marriage practices may be different and HIV intervention strategies must be tailored to community norms.
• Language and transportation barriers were not addressed in the survey questions and require further investigation.
• Drug abuse was reported by 7% of the study population and it can be reasonably expected that in a randomized study, this percentage would increase.
• About half of the study population was aware of community resources for HIV.
• There was a statistically significant correlation between knowledge about HIV and condom use.

When compared to the Immigrant Service Providers Focus Group sponsored by the Ryan White Planning Council there are areas of commonality in that both groups identified issues of housing, employment and access to health care. The focus group better defined the barriers to healthcare, e.g. language and interpretation. The limitations of the survey, e.g. self-selected participants, lack of questions regarding language, transportation, etc., limited comparisons on some domains.

The survey results do offer insight and provide direction regarding community norms and tailored educational needs.