(Archie-Booker, Cervero, and Langone, 1999) This study concludes that: "...power relations manifested themselves concretely through these factors in the social and organizational context, which by defining African-American learners as generic entities, produced undifferentiated educational programs." (Archie-Booker, Cervero, and Langone, 1999) The work of Gilbert and Wright reports a study conducted through collecting a series of articles in which African-American women were interviewed concerning living with AIDS. They write in their book entitled: "African-American Women and HIV / AIDS: Critical Responses" that: "From the beginning of the AIDS epidemic, the concept of culture has been used to interpret, define and further distance the 'other' or members of groups deemed socially deviant." (2002) They state additionally that African-American women "have long suffered from being defined by mainstream dominant society's cultural characteristics of popular images of them, examining their behavior and creating policies that affected their well-being. Reconstructing realities for HIV-positive African-American women also requires that we hear from them directly, and that we understand the meaning that they attach to this disease." (Gilbert and Wright, 2002)

AFRICAN-AMERICAN WOMEN LIVING WITH AIDS

PART THREE

RACE and GENDER IMPLICATIONS

The work of Andrews and Buchanan entitled: "HIV / AIDS in African-American Women: Implications for Feminist Therapists" relates that the percentage of women with HIV / AIDS has continued to increase, reflecting an ongoing shift in those populations most affected by the epidemic. The HIV / AIDS epidemic has increase most dramatically among women of color. In 2003 African-American and Hispanic women accounted for over 80% of the 11,211 newly reported HIV / AIDS cases among women, though together they represented less than one-fourth of all American women." (Andrews and Buchanan, nd) Since HIV / AIDS disproportionately impact African-American women it is critically important that the factors that make this community "particularly vulnerable to the spread of HIV" (Andrews and Buchanan, nd) are addressed. Andrews and Buchanan state that in particular are: "...contextual factors, such as environmental stress, relationship history, and victimization experience..." (Andrews and Buchanan, nd) Issues such as poverty and disparate educational and economic opportunities also lead to increased rates of unemployment, incarceration and substances abuse, most specifically intravenous drug use which fuels the epidemic in Africa American communities and presents barriers to healthcare. (Andrews and Buchanan, nd; paraphrased)

Andrews and Buchanan report that the factors associated with transmission of the HIV disease include: "...inconsistent use of condoms, multiple sex partners, and other behaviors..." (Andrews and Buchanan, nd) Another factor that affects a young woman's vulnerability to HIV infection is "when her sexual autonomy is comprised. Gendered power relations decrease women's sexual autonomy and therefore increase their risk to HIV infection. According to the dominant female gender roles, particularly in adolescent heterosexual relationships, young women are not supposed to desire sex or to be sexually assertive, and are therefore expected to resist young men's sexual advances." (Andrews and Buchanan, nd) Therefore a young woman who is independent and empowered who "seeks sexual pleasure and sexual safety on her own terms is not a 'normal' feminine woman but often seen as sexually and socially deviant." (Andrews and Buchanan, nd) Negotiating safer sex is a challenge for many women due to "socio-cultural norms that have traditionally fostered female sexual passivity, innocence or ignorance." (Andrews and Buchanan, nd)

Andrews and Buchanan state that African-American women "of all ages are bombarded with 'defeminizing and demonizing' media images of Black women. African-American women are commonly depicted in one of four roles: the asexual and subservient 'caretaker' or 'mammy', the emasculating and assertive 'matriarch', the economically dependent 'welfare mother', of the hypersexualized 'whore' or 'jezebel'." (Andrews and Buchanan, nd) it is related that this type of socialization "can permeate the consciousness and cause some African-American women to internalize these oppressive stereotypes that devalue their bodies." (Andrews and Buchanan, nd) Added to this cultural norms related to power in intimate relationships also tend to shape the sexual behaviors of African-American women with the example given being that "...a woman may feel she has limited options to negotiate or assert protective health measures as a result of unequal distribution of power in male-female relationships." (Andrews and Buchanan, nd) HIV and the associated stigma along with the likelihood of death resulting from the disease "may cause an HIV-infected person and his/her family to experience a wide range of emotional reactions...

Women are at risk of internalizing this stigma which can lead to deleterious psychological effects." (Andrews and Buchanan, nd) Emotions that HIV-infected women may experience include "shock, disbelief, guilt, anger, sadness, and suicide ideation..." (Andrews and Buchanan, nd)
Many times women learn of their HIV-positive status "following pregnancy and/or childbirth and their functioning as a material caregiver may become complicated and/or compromised due to feelings of blame, guilt, anger and shame." (Andrews and Buchanan, nd) Other factors that may exacerbate the woman's psychological reaction to being diagnosed with HIV are lack of knowledge concerning available resources, underemployment, and a fear of stigmatization. (Andrews and Buchanan, nd; paraphrased) the African-American community and families are such that due to the "role flexibility and strong kinship alliances of African-American families, relatives expect and accept reliance on one another in times of need and often live in close proximity to one another. Extended family serves critical support roles in caring for children within the family." (Andrews and Buchanan, nd)

The work of McGoldrick, Giordano and Pearce (1996) state that: "It is not uncommon for a child to be informally adopted and reared by extended family members who have resources not available to the child's parents or who reside in a more 'wholesome' environment." (as cited in Andrews and Buchanan, nd) the work of Gilbert and Wright share another dimension of what the African-American woman faces in the statement "next to racism, substance abuse is the primary health and social problem of the African-American community and cites Watts and Wright 1983, which incidentally is a statement made as pointed out by Gilbert and Wright "before the onslaught of the crack epidemic and obviously before the full impact of AIDS hit home in the African-American community." (Gilbert and Wright, 2002) Gilbert and Wright state that it is not that substance abuse and racism are situated necessarily "next" to one another it is that racism is an underlying cause of substance abuse and "other negative social and psychological outcomes experienced disproportionately by African-Americans." (Gilbert and Wright, 2002)

In order that the "individual behavior and the psychological processes of African-Americans within the context of their historical oppression, we must first as the right questions in our research. Within the Afrocentric paradigm it is related by Gilbert and Wright that the work of Asante 1980 held that actual treatment would be inclusive of elements that would assist these individuals in combating oppressive structural conditions while simultaneously developing and maintaining "a core set of values that are congruent with health cultural identity, and participate in specific culturally congruent rituals. Of these structural "impediments" Gilbert and Wright state that it is these "social, political, and economic forces" in our society that establish and define the reality of certain populations and restrict the options that people can choose as a means of survival. (Gilbert and Wright, 2002; paraphrased)

Lifestyle choices can be said to be dependent on the extent to which individuals have access and personal agency to obtain crucial societal resources such as food, shelter, education, housing and appropriate mental and physical health care - all of which are limited by poverty and social equality, which in turn, impact the effectiveness of AIDS prevention messages." (Gilbert and Wright, 2002) it is just as sure that structural barriers place people in "high risk situation" as stated in the work of Zwi and Cabral (1992) and noted in the work of Gilbert and Wright "where sociocultural forces act in ways to increase individual or group vulnerability to HIV-infection." (Gilbert and Wright, 2002) it is agreed among researchers of HIV / AIDS and policy makers alike that "early prevention strategies have failed to influence African-American communities for two major reasons." (Gilbert and Wright, 2002) the first of these is that prevention messages were not designed for targeting in a culturally specific manner that will reach the African-American community. Furthermore, initial early prevention methods targeted "primarily...White, gay males." (Gilbert and Wright, 2002) the secondary reason is that for African-Americans, HIV / AIDS is woven within the selfsame fabric in the lives of the ethnic minority as are the elements of "poverty, chemical dependency, lack of accessible and affordable health care, mistrust of medical and other institutions, isolation, institutionalized racism and internalized oppression" (Gilbert and Wright, 2002) that comprise the daily lives of these individuals and the families and communities to which they belong.

As stated by Gilbert and Wright the vulnerability to HIV-infection of the African-American woman "includes the entire spectrum of issues that…