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THE DEAF AND HARD OF HEARING AND HIV/AIDS
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On
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| SURVEILLANCE |
According to the National Center for Health
Statistics (NCHS), 3.3 percent of U.S. adults
aged 18 years and over were deaf or had a
lot of trouble hearing without the use of
a hearing aid during the period 2000–2006.1
Deafness or being hard of hearing increased
with age, rising from 0.9 percent among adults
under age 45 to 3.1 percent among adults aged
45–64 and 11.1 percent among adults
aged 65 and over.1 In 2006, 37
million adults in the United States had trouble
hearing (ranging from a little trouble to
being deaf), representing a marked rise from
when 31.5 million U.S. adults reported trouble
hearing in 2000.2,3.
- Because
studies on the deaf or hard of hearing
are limited, it is unclear how many people
in this subpopulation are living with
HIV/AIDS. Estimates fall into a wide range
of 8,000 to 40,000 people, based on two
different studies, one indicating a seroprevalence
rate of slightly less than 1 percent,
and the other of approximately 5 percent.4
A Maryland study based on test results
at federally funded counseling and testing
centers, which historically account for
no more than 12 to 15 percent of all HIV-positive
test results, yielded a 4.3 percent rate.5
- National
AIDS surveillance data do not include
information on hearing status; thus, little
is known about the transmission of HIV
among the deaf and hard of hearing. In
1992, however, 12 years after the onset
of the epidemic in the United States,
experts estimated that the deaf population
was 8 years behind the hearing population
in its knowledge and awareness about HIV/AIDS.6
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| CRITICAL
ISSUES |
| The
NCHS reports that adults with hearing loss
have poorer health and increased risk of engaging
in health risk behaviors than adults with
good hearing.1 The rate of substance
use disorder among deaf or hard of hearing
is higher than among the general population.7
Substance use, in turn, is linked to higher
risk for HIV infection.8
Physically
disabled persons report low discussion rates
with their health care providers on sexuality,
sexually transmitted diseases, contraception,
and reproductive choices.9 A
study in the Annals of Internal Medicine
reported that doctor-patient communication
is severely limited for the hearing impaired,
leading to negative perceptions of the health
care system, difficulty making appointments,
and increasing anxiety and medication dosing
errors.10
Undergraduate
deaf college students scored significantly
lower on the HIV/AIDS Knowledge Index than
hearing undergraduate students.11
This lack of knowledge about HIV disease
contributes to the fact that the deaf are
often not diagnosed with HIV until symptomatic
and die sooner than hearing individuals.6
Many
people erroneously assume that American
Sign Language (ASL) and English are closely
related and that most ASL users have high
English proficiency, but the truth is that
ASL has its own grammar and syntax and communicates
in concepts. As a result, HIV prevention
and treatment materials are often culturally
inappropriate and linguistically incomprehensible
for the deaf and hard of hearing. Developing
communication
methods appropriate for the deaf or hard
of hearing may help reduce health risk behaviors
in this population and ensure equal access
to health services.12,10,1 These
methods may include peer-to-peer communication,
as research suggests that the deaf are more
likely to learn from each other rather than
from formal information sources.13
Deaf gay men report feeling additionally
stigmatized for being “a minority
within a minority.”14 According
to one study, many deaf gay men believe
that HIV infection is inevitable.14
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| HRSA'S
RESPONSE |
| The
deaf and hard of hearing receive services
through all Ryan White HIV/AIDS programs.
Access to services is facilitated by translators,
who can be reimbursed using Ryan White HIV/AIDS
Program funds.
The
HIV/AIDS Bureau publication HIV and
the Deaf Population in the United States
discusses major issues regarding the diagnosis
and care of HIV-positive deaf and hard of
hearing individuals. (For copies, contact
the HIV/AIDS Bureau’s Office of Science
and Epidemiology at 301-443-6560.)
The
Health Resources and Services Administration
(HRSA) took a leading role in the National
Meeting on HIV/AIDS and the Deaf and Hard
of Hearing Community in 2000.
A
follow-up report outlines next steps for
raising awareness of the epidemic among
the deaf and hard of hearing and improving
access to care. (For copies, contact the
U.S. Department of Health and Human Services,
Office of HIV/AIDS Policy, at 202-690-5560.)
HRSA
also published an issue of the HRSA
CAREAction newsletter on HIV/AIDS among
the deaf and hard of hearing (see http://hab.hrsa.gov/publications/hrsa401.htm)
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| END
NOTES: |
| 1 |
Schoenborn
CA, Heyman K. Division of Health Interview
Statistics, National Center for Health
Statistics, Centers for Disease Control
and Prevention. Health disparities among
adults with hearing loss: United States,
2000–2006. Available at: www.cdc.gov/nchs/products/pubs/pubd/hestats/hearing00-06/hearing00-06.htm.
Accessed May 14, 2008.  |
| 2 |
Pleis
JR, Lethbridge-Cejku M. Summary health
statistics for U.S. adults: National
Health Interview Survey, 2006. Vital
Health Stat 10. 2007;(235):1-153. |
| 3 |
Pleis
JR, Benson V, Schiller JS. Summary health
statistics for U.S. adults: National
Health Interview Survey, 2000. Vital
Health Stat 10. 2003;(215):1-132. |
| 4 |
U.S.
Department of Health and Human Services.
Office of HIV/AIDS Policy. Conference
proceedings: National meeting on the
deaf and hard of hearing. Washington,
DC: Author; 2000. |
| 5 |
Maryland
HIV Prevention Community Planning Group.
HIV Prevention Plan for the State
of Maryland Calendar Years 2001–2003.
Report prepared by the Social Work Community
Outreach Service, University of Maryland
School of Social Work. Baltimore, MD:
Department of Health and Mental Hygiene,
State of Maryland; 2000. |
| 6 |
Gaskins
S. Special population: HIV/AIDS among
the deaf and hard of hearing. J
Assoc Nurses AIDS Care. 1999;10:75-8. |
| 7 |
Moore
D, McAweeney M. Demographic characteristics
and rates of progress of deaf and hard
of hearing persons receiving substance
abuse treatment. Am Ann Deaf.
2006-2007;151:508–12. |
| 8 |
HRSA.
HIV/AIDS Bureau. Substance abuse and
HIV. Available at: http://hab.hrsa.gov/reports/report_05_03.htm.
Accessed June 16, 2008. |
| 9 |
Branigan
M, Steward DE, Tardif GS, Veltman A.
Perceptions of primary heathcare services
among persons with physical disabilities.
Part 2: quality issues. MedGenMed.
2001;3:19. |
| 10 |
Lezzoni
LI, O’Day BL, Killeen M, Harker
H. Communicating about health care:
observations from persons who are deaf
or hard of hearing. Ann Intern Med.
2004;140:356–62. |
| 11 |
Heuttel
K, Rothstein W. HIV/AIDS knowledge and
information sources among deaf and hard
of hearing college students. Am
Ann Deaf. 2001;146:280–6. |
| 12 |
Ebert
DA, Heckerling PA. Communication with
deaf patients. Knowledge, beliefs, and
practices of physicians. JAMA.
1995;273:227-9. |
| 13 |
Kennedy
SG, Buchholz CL. HIV and AIDS among
the deaf. Sex Disabil. 1995;13:145–58. |
| 14 |
Mallinson
RK. Perceptions of HIV/AIDS by deaf
gay men. Assoc Nurses AIDS Care.
2004;15:27–36. |
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