The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Chapter 14.26 picasCulture and CareRev Carlos Sandoval, MDINTRODUCTION■ What is culture? Culture refers to learned patterns of behaviors, beliefs and values shared byindividuals in a particular social group. It provides human beings with both their identity and aframework for understanding experience. 1 When we refer to culture in its broadest sense, weusually think about a group of people with similar ethnic background, language, religion, familyvalues, and life views.Culture and nationality, however, are not synonymous. The United States, for example, is a countrymade up of individuals from many countries and traditions, each with a unique culture. Formany years we have viewed this country as the great “melting pot” of the world; however thisvision is being rejected. 2 The truth is that the U.S. is a multicultural or pluralistic society, madeup of members of different ethnic, racial, religious or social groups, living side by side, sharingaspects of the dominant U.S. culture, but maintaining their own values and traditions.Since culture provides individuals with a framework for understanding experience, it is of greatimportance to consider culture in the medical setting. Each cultural group has its own viewsabout health, illness, and health care practices. 3 These views affect how individuals respond toillnesses and their symptoms, including pain; identify and select medical care; and comply with4, 5, 6prescribed care.In his acclaimed book, How We Die, S.B. Nuland saidXIVThere has never been a disease so devastating as AIDS. Medical sciencehas never before confronted a microbe that destroys the verycells of the immune system whose job it is to coordinate the body’sresistance to it. 7As the HIV epidemic enters its third decade, rates of infection continue to rise in much of theworld and in certain minority communities in the U.S. While HIV has only recently ceased to bethe leading cause of death for persons between 25 and 44 in the U.S., 8 this is not the case in manyparts of the developing world, particularly sub-Saharan Africa. In the U.S., HIV is rapidly becominga disease of minorities, particularly African Americans and Hispanics.Considering the impact of culture is very important in managing HIV disease. Today, as earlier inthe epidemic, a diagnosis of HIV infection or AIDS is universally feared. The consequences ofHIV are well known and they are usually associated with increasing debilitation and suffering asthe disease progresses. In addition, HIV often has psychosocial consequences for the patientand can lead to subtle or overt discrimination, abandonment by family and peers, loss of employmentand other negative consequences. In spite of the advances in medical management of HIV,U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 301