Black & White: Death & Dying by Race & Ethnicity

Is health black and white?

Before you answer… Did you know that there are differences in death rates based on race? On average, at birth a white person may expect to live 5 years longer than a black person in the United States. This gap grows to a 10 year difference when comparing life expectancy of white women (81 years) to black men (71 years) [1, 2].

Why is this the case?

Well for starters, the leading causes of death differ down both race/ethnicity and gender lines. For instance, homicide makes the list as one of the top five killers of black men, but does not make the list for white men (nor either group of women). Diabetes makes the list as one of the top five killers of black women, but does not make the list for white women (nor either group of men) [3]. However, when comparing death rates between blacks and whites for the same disease, blacks still tend to have worse health outcomes. In fact, according to 2012 data, the U.S. Department of Health and Human Services Office of Minority Heath states “the death rate for African Americans was generally higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide” [4].

But really, why is this the case?

It comes down to what researchers refer to as ‘social determinants of health’. This term translates into how where you live, work, and play shapes your health. Moreover, these differences may in part be explained by health inequity, “difference or disparity in health outcomes that is systematic, avoidable, and unjust” [5]. For instance, it is common knowledge that many black people in America are living in poverty. This fact is tied to societal oppression dating back to slavery. Poverty manifests in predominately black neighborhoods, leading to limited access to resources such as healthy food, safe environments for physical activity, and quality health care services. As declared by Dr. Martin Luther King Jr., “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” BUT, poverty does not explain it all. Even when a 2015 study compared breast cancer survival rates between low socioeconomic status white women with high socioeconomic status black women, black women still suffered from worse health outcomes [6]. Thus, factors beyond poverty, such as racial discrimination (e.g. subconscious differences in treatment by health care professionals) must be considered.

What can be done?

First and foremost, health education and health inequity awareness must become common knowledge. Children and adults, men and women, black and white must all understand what constitutes health, so that health is not only seen as the physical absence of a pathogen, but more holistic and inclusive of mental, emotional, environmental, and social health. Professionals and patients must work together to actively address gaps in sociocultural competence/humility through being open and honest with each other. Particularly, physicians have a responsibility to treat “humanity as [their] patients” [7]. Thus, systematic discrimination must be deconstructed for the assurance of ‘justice for all’. While health policy should be at the forefront of the conversation to combat these issues of social justice, communities must also consider their power in determining their destiny. Black communities, as they have done in the past, must begin to gather, organize, and mobilize to persevere.

Now, with all of this in mind… you tell me, how long should health continue to be black and white?

Rhoda Moise is a graduate of Pennsylvania State University with a B.S. in Biobehavioral Health and a passion for health promotion. She has been trained to approach health from an interdisciplinary perspective from proteins to people. Through her doctoral studies as a PhD student at The University of Miami, she intends to combat health disparities by conducting research which provides empirical evidence that demands alteration in standing policy.

References

1 http://www.cdc.gov/nchs/nvss/mortality_tables.htm

2 http://www.cdc.gov/nchs/data/dvs/LEWK3_2009.pdf

3 http://www.cdc.gov/nchs/nvss/mortality_tables.htm#lcod

4 http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

5 http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html

6 Keegan, T. H., Kurian, A. W., Gali, K., Tao, L., Lichtensztajn, D. Y., Hershman, D. L., … & Gomez, S. L. (2015). Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. American journal of public health, 105(5), 938-946.

7 http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/declaration-professional-responsibility.page

Black & White: Death & Dying by Race & Ethnicity

Health Isn’t One-Size-Fits-All

By: Delphine Gervais, LCSW

This May will mark five years since my mom was “officially” diagnosed with stage 4 breast cancer and two years since she transitioned.  There were plenty of days that I replayed the rush to the hospital, the exposure of her upper body to the doctors, the shock at what I saw. I remember the doctor questioning my mother, “When did you feel the first lump?”  I remember hearing my mother respond, “four years ago”. (hence my reference to the word “official”).  My mother was a resourceful Haitian woman, who never missed a doctor’s appointment and who never missed out on an opportunity to eat healthy.  Olive oil was a staple in our home.  Processed food was not.  She did everything she knew how to live a fit life.  In her mind, that lump negated every effort,  and it was then that her life completely changed.

For the purpose of conversation, I opt to turn my lense to black women and what their attitudes towards receiving services imply for their ultimate well being.  The stats are not favorable for communities of color.  Heart disease, cancer, hypertension, mental health–people of color lag behind in prevention and are dying at faster rates for lack of both prevention and intervention services.  In the case of breast cancer, although screenings among black women tend to be on level with those of their white counterparts, follow-ups for negative results were much lower.  Death rates among black women are 42% higher than their white counterparts.  It is one thing to schedule and conduct one’s mammogram every year.  Everyone can do that.  It’s another thing to follow up after receiving some not so favorable results.

I didn’t believe my mother loved me and my brother less because she didn’t seek the help she needed.  It couldn’t have been an easy pill to swallow to suffer in silence. Help seeking behaviors among African-American and Afro-Caribbean women have historically been a point of concern among those in the health profession.  The cultural construct surrounding help seeking behavior for physical or mental health concerns boils down to “it’s nobody’s business but mine.” If you couple that with the religious and spiritual impact on decision-making and you likely have a woman who will keep secrets from her loved ones and bear the entire emotional burden of disease.  To say that women of color reject the notion of prevention or intervention services is a fallacy.  It is best to first understand that normalizing health seeking behavior is the first order of business.

Imagine walking into a space where medical jargon is thrown at you left and right.  Machines are beeping.  People hurry about their work day, some stay long enough to inquire as to your well-being, while others just come long enough to poke and prod and leave with nary a word.  A person who speaks the king’s English would have a hard time navigating the health system.  A person who speaks limited or no English would drown in fear and embarrassment.  There is also the matter of inequitable access to services in the communities of color.  Are clinics within walking distance or near a bus stop? Do those who provide services understand the complexities of a person of color coming to their spaces in search for help?  Are they immediately placed at ease?  Are there people present in these spaces who can walk among the emotional minefields of their patient’s mind?

I remembered offering to take my mother to a cancer support group comprised of Haitian women.  The social worker in me thought it would be best for her to be among others who were grappling with similar issues.  She gave me a blank stare and a firm “No”.  I never brought it up again.  At times, we professionals believe we know what’s best for those who need help.   Imposing our norms and expectations lessens the opportunity for the person to establish personal ownership of their circumstances.  They’ve heard about the church member who became ill, went to the hospital and never came back home.  Walking into foreign spaces and experiencing a new normal is difficult for the average human being.  Being a woman of color compounds those feelings of helplessness.  When the strong black woman mystique had been challenged and the figurative “S” was off her chest, my mother didn’t want a support group.  Attendance at weekly church services was support enough.

There cannot be a one size fits all approach to healthcare.  My mother’s doctor knew well enough not to say the big “C” word in sessions.  She was delicate and respectful in her approach, she maintained deference in her tone and she left the hard discussions during one-on-ones with me.  At times she would practice her Creole on my mom.  This would make my mom smile.  The feeble attempts at seeking commonality met with ultimate respect.  For my mom that was enough to keep her committed to returning every month.  Even when the blood work started coming back with less than positive news, she kept her appointments without fail. Being seen by doctors and nurses who knew her name and smiled with their eyes made the trips that much bearable.  Half the battle is won when communities of color are provided with opportunities to maintain their personal dignity while seeking the help they so very much deserve and need.

This is not a mandate to learn a new language or join Doctors Without Borders.  It is however a call to action for professionals in the healing arts to take stock of how they approach their patients of color.  What works for Jane Doe may not work for Marie Pierre and Mary Johnson.  Cultural norms play a big part in how they each approach seeking help.  Knowing Jane’s cultural constructs and not Marie/Mary’s should cause one to pause and assess their effectiveness in providing service.  As the Haitian daughter of a Haitian woman I thought I knew all there was to making sure my mom received the services she needed.  My westernized approach to therapeutic intervention failed miserably.  I should have known that my mother cared less about support groups than ensuring she had a nurse aid to provide meals.  She cared less about the blood work coming back negative and more about when the bus would come to take her to her prayer service.  It didn’t take me long to stop hitting my head against the proverbial wall.  It was less of what I wanted and more about what she needed.  Once I made peace with that, it was smooth sailing.

Delphine is a licensed clinical social worker with experience in education, health, social welfare, community development, and individual/family/group intervention services. Her professional background emphasizes a special focus on community involvement and service; utilizing social networking for the purpose of bridging the gap between those with established needs and those with access to the resources to meet those needs. Read more on her blog.

Source:  American Cancer Society http://www.cancer.org/

 

Health Isn’t One-Size-Fits-All

Sometimes It Is Just Black & White | The Color Wheel

Let’s talk straight no chaser! When it comes to being a black woman in America a mental illness is the last thing that you would also like to have associated with your name. Take myself for instance, I have dealt with Depression for most of my life and it wasn’t until I was 27 years old that I realized how much I needed help. I never thought about telling anyone in my family about my struggles or even my experiences. So when I decided to create a mental health blog showcasing my life, I knew it was going to be seen as an attention seeking affair. Little did I know how much therapy this blog was going to be not only for me, but for other people who looked like me.

In the mental health community there are very few African Americans. From support groups, rallies, speaking engagements and even research centers we are lacking representation. From my experience alone I have always been the only black person and black woman in many support groups, I have never encountered a black mental health professional and I have never met someone who was open and as honest as I am about their illness. Until recently, I thought that it didn’t even matter.

When I began talking to young, black girls about their daily lives, I was shocked to hear that they were open and honest about their emotions, but felt like no one wanted to listen to them. How is that? How can it be that way when you are born to a mother and father? Shouldn’t they want to listen? Aren’t they asking fact finding questions? How are we not showing compassion to our own children?

Let’s get to the facts…

“Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after experiencing a traumatic event, such as a war, hurricane, sexual assault, physical abuse, or a bad accident. Although you are no longer in danger, PTSD makes you feel stressed and afraid. It affects you and the people around you.

Consumers with PTSD can experience a range of emotions such as flashbacks, hallucinations, “going blank”, detachment from events and others, trouble sleeping, nervousness, or being over aware. PTSD can also be accompanied by other mental illnesses such as depression, anxiety, bipolar and schizophrenia.

PTSD does not only effect one age group or race; however, it is proven to be more prevalent in “urban communities”, veterans and patients with other mental disorders. Anyone who has faced a traumatic event like sexual assault, combat, life threatening events  or witnessed others, survivors of natural disasters, unexpected loss of someone or illness that caused severe pain or procedures can develop PTSD”(1).

With adequate treatment including psychotherapy, medications and support from family and friends, PTSD can be managed successfully. However, if left untreated, PTSD can last for months and even years depending on the severity.

In the summer of 2005, I was diagnosed with three different mental illnesses (yes it’s possible). The one I had always heard of was PTSD. Growing up I heard the term being used for survivors of rape, bank robberies and really bad car accidents. The term ” I put it in the back of my mind” was always used to describe what PTSD was and how it can come back to haunt you in the future.

I didn’t even feel like I had been involved in something traumatic enough to be considered a mental illness. So when I got the results from my evaluation, I was shocked. I never told the doctors that I was molested, I used to get bullied and threatened at school or I was in an abusive relationship in high school. So how could they have known about the things I locked away?

As I began thinking about it, I had never been asked how I was feeling or what I was feeling when I was at home. It wasn’t a topic of discussion at the dinner table. It wasn’t even a concern anywhere in my home. And I am sure in any black home we have all heard the ” Shut up. I don’t want to hear anything you have to say. Why are you crying?” Those negative statements which some of us have heard, mold us and begin to create other issues.

If a child has gone through something traumatic like maybe being bullied or threatened at school and has not had an outlet to voice their feelings and experience PTSD can begin to develop. So if you can’t feel safe and supported at home, then where else can you feel comfortable when there is no one that looks like you and shares your experiences in your Insurance Coverage Network?

We don’t see black health advocates on television, we don’t even see black people in medication ads or television shows (other than Andre on Empire). It’s as if black people are Immune to mental illness. The characters are superhuman and forever fearless. They don’t have any duality or vulnerability. When I think about segregation and slavery I always think about the long term psychological effects that it had and is still having on black people. With the current racial situations on the rise, PTSD still has a presence in our community.

I don’t think television is the key to representation or the hear all see all as well. If we don’t have prominent medical professionals, qualified programs and black advocates in our communities, we will continue to sweep mental illness under the rug. Yes it is a black or white thing because let’s be real we all choose what’s comfortable for us. And if you feel as though someone will understand your experience, then you would think they will understand what kind of treatment you need.

My question is who will step up?

Lindsay Anderson is the Editor-In-Chief and Founder of ConsciouslyCoping.org, a Mental Wellness social media site that primarily focuses on educating minorities, underprivileged and lower income based families on healthy approaches of managing Mental Illnesses.

(1) https://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html

Sometimes It Is Just Black & White | The Color Wheel

Superwoman Syndrome and the Millennial Black Woman

To be considered a millennial you would have to be born between the early 1980’s until the early 2000’s. By definition you would be narcissistic, always have a need to be treated special, over confident, extremely pressured, sheltered and conventional. Most of the case studies for Generation X and Y were biased to only affluent white children and when people of color (i.e. Black, Latino or Asian) were asked how these traits pertained to them the response was unrelatable.

Now that we have tackled that terminology…

Year after year black women are faced with some new type of stereotypical hoopla, but the one that has stood the test of time is of course none other than the Superwoman Syndrome. These women are not only the forefront of the household but the rock of our entire community. We raise the children, run the office, console the family, balance the check books, entertain guest and stroke the male ego all in 24 hours. She is known to be fearless and unapproachable, masculine and submissive, all while maintaining a composed and happy demeanor.

So how does a black millennial manage a superwoman personality?

Unlike our white millennial counterparts, we face distinctive defining issues. Take myself, I am a mentally ill black millennial woman, so I rarely feel the need to be narcissistic. I don’t think highly of myself and I was not sheltered growing up. I like many black women was taught to suck it up and don’t cry about everything. Most of my teen days were spent cooking for myself, handling adult issues and worrying about the bills.

My mother always pushed me to be independent, but to think outside of the box at the very same time. She wasn’t a textbook conventional parent. She always reminded me that I would not only have to be 100 times better than the males around me, but I would also have to be 1000 time better than the women around. I was constantly pushed to the limit my education, often being intensely punished for mediocre performance. She taught me to speak my mind and demand respect. She was grooming me to do it all because in her mind there would never be anyone who would support me in doing anything.

By the time I was 18, I was running the show in every organization, I was dismissing men in the blink of an eye and I was overworking myself into a world of anxiety, depression and PTSD. I was so concerned with keeping it so­called together I was falling apart at the seams. I was trying to balance being fearless with the want of being treated specially. Eventually, I broke! And even months later I was back to working 2 jobs, supporting my mother, trying to love emotionally detached men and completely running myself crazy. Just to keep up not with the Joneses, but to follow in the footsteps of some fictional character. So why do we keep doing this to ourselves?

As a black millennial, we are more computer literate, independent, free spirited and on a constant search for love. Which describe the same attributes of the black superwoman. The main issue is the sense of control can not go hand and hand with being emotionally detached. If we’re not in control of every situation there is a sense of it just won’t get done. Whether it be financial, emotional or spiritual. We have to be the driving force of success.

In our society (not community) we are told to be important you have to be everything. You must always follow the invisible instruction manual while conjunctively putting your thoughts, feelings and need last. That the only thing that matters is having the money, the man and the mission to bring you happiness. Yet being a black woman means your journey that happiness can not be attained by help or support. The society is not set up for black women ( especially the black superwoman) to succeed. It has been so well coaxed in our everyday life that our entire community thinks black women are not “real women” if we don’t display these attributes. It is all one huge revolving door. If we are a community then we need to be a community. We need to uplift each other, share stories and help each other thrive not just survive. Being so called strong does not equate to happiness or stress­free. Indeed… it is the exact opposite.

There are many factors and, of course, environmental reasons for every individual case. However, the millennial black woman still wants the American dream. She still wants to be loved and appreciated. The question is after saving Clark Kent, the kids, the family and the corporation where is the time to be one with yourself? When do you say enough is enough and think about your feelings first? How do you separate taking care of and providing for? When is being human simply enough?

This is a guest post by Lindsay Anderson. Lindsay is a Mental Health Advocate, Blogger and YouTube Creator. Originally from Savannah, Ga she is currently residing in Greenville, SC. She is the founder of lindsaywittaa.com a journal website that discusses mental health, open transparency and mental wellness support. When she is not writing she is creating informational mental illness videos on Youtube. You can follow her on twitter @lindsaywittaa or email her at lindsaywittaa@gmail.com. 

Superwoman Syndrome and the Millennial Black Woman

HN Inspiration: Mirna Valerio & the Redefinition of “Looking Healthy”

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Mirna Valerio takes her usual run.

This month’s HN Inspiration is Mirna Valerio, mother, distance runner, and writer of Fat Girl Running. We find Mirna to be an inspiration because she challenges the stereotypes of fitness and health and provides a powerful example to others.


Health Noir (HN): I understand that your weight loss journey began with your doctor issuing you the warning that you would not live to see your son grow up if you didn’t lose weight. Had you thought about losing weight or pursuing a healthier lifestyle before that moment?

Mirna Valerio (MV): About a year before this incident, I lived in Maryland, where I was still adjusting to having to drive everywhere, living and working where I had no family support network (my husband stayed behind in New York to work), where I had a very stressful job, and also where my son spent many days home from school because of asthma and other ailments. I was stressed out. It was also new to me to have to drive absolutely everywhere. I noticed that I was gaining weight fairly rapidly and tried a few times to lose it through exercise and some modifications to my diet. I would go for a few weeks and then my son would be ill again, or I would be ill, or work consumed my life. I decided to move to New Jersey.

This new job was also stressful. My son contracted pneumonia in our first couple of weeks. I was also commuting back and forth to Maryland on the weekends to continue teaching my private voice and piano students. My lifestyle was one of work and family and fitness did not, and as I perceived it then, could not fit into my schedule.

That all changed, of course, after I had been issued what amounted to an ultimatum from my cardiologist.

Health Noir (HN): What would you say is your biggest motivation for staying active? Why did you choose running?

Mirna Valerio (MV): Being active makes me feel good. It really comes down to this. It makes me feel strong, powerful and able to conquer most things. Also, I am a healthier person because I choose to be very active on an almost daily basis. In addition, it is my job to be a positive role model for my son, my family members and my students.

Health Noir (HN): How did you eventually come to accept your body as it is meant to be? What advice would you give to people who haven’t reached the same level of acceptance you have?

Mirna Valerio (MV): I have always accepted my body the way it is. I come from a family full of people who appreciate bodies in whatever size or shape they’re in. Body image has never been an issue for me. This is not to say that I didn’t know that it needed some changing for the better.  There are still things that I’m working on body-wise and spirit-wise. It’s all an incredible, beautiful journey.

We have got to honor and respect our bodies for what they can do RIGHT NOW. Were you able to get up out of bed and walk to the bathroom? Yes? Your body did that? Were you able to walk to your car? Yes? Your body did that. Let’s honor our bodies now, and continue to honor them by doing what we need to keep them.

Health Noir (HN): What is your response to people who think fitness and health are all about aesthetics?

Mirna Valerio (MV): People have vastly different reasons for trying to achieve fitness and health. Some people do it for aesthetic reasons. Some people do it to feel better inside and out. I don’t think there is anything wrong with that.  BUT, people who think that fitness and health are both exclusively about looks are, in my opinion, misinformed about what these things look like in different bodies and in different situations.

Health Noir (HN): Do you pair your physical fitness activities with other mental, emotional, or spiritual health activities? 

Mirna Valerio (MV): Not really, although when I do my longs runs I am usually alone. This gives me much needed space, quiet, and time to focus on what’s going on in my head. I guess you could say it’s a meditative practice.

Health Noir (HN): As an African American woman, you know that we as a community tend to have different perceptions about health and wellness than other communities. Stories like yours are very inspiring and inclusive because they challenge stereotypes that have excluded us for a long time. How do you think we can begin to reframe conversations about health and fitness to improve our health as a community?

Mirna Valerio (MV): I think that women in general, and African American women in particular have this idea that we need to take care of everybody without ever really thinking about or knowing how to take care of ourselves first. We are often guilted by society and ourselves into thinking that we are the sole keepers of our families and the world. This has a tremendously negative effect on our health and wellness. We’ve got to take charge of our own bodies, our own health (emotional, physical, spiritual) and get ourselves out of this kind of destructive thinking. Life doesn’t wait, but death does. I’d rather live my life than wait on death.

HN Inspiration: Mirna Valerio & the Redefinition of “Looking Healthy”

LoveHer: “Allergic to Exercise”

Delicately purposed for the nation’s Black women; brown girls, black girls; light-skinned, brown-skinned, and dark-skinned:

While on a twelve-mile trail, I had no clue that by the two and a half mile mark, exercise would cause me to experience symptoms of an allergy. My thighs and legs started itching and an uncontrollable sensation ran through my body. Before I knew it, my thighs and legs were covered in welts. The sensation in my body felt like the onset of an allergic reaction. After a Google search, I discovered that I had been dealing with symptoms of exercise-induced urticaria. Exercise-induced urticaria is a condition that causes hives and other allergic symptoms during or after exercise. Hives or “welts” are usually raised and can appear on any part of the body.

What was going on with my body to cause such a reaction? Apparently, as my heart rate increased, my blood flowed faster, and the millions of tiny capillaries and arteries in my muscles began expanding rapidly. The capillaries stay open to allow for maximum blood passage when you’re fit, but if you’re out of shape (in my case); your capillaries tend to collapse, not allowing as much blood to pass through. When your capillaries expand, the surrounding nerves become stimulated and send messages to the brain, which reads the sensation as itching.

This experience was definitely an eye-opener and has motivated me to try incorporating some form of exercise into my daily routine. Some days I may choose to take the stairs instead of the elevator or park further from the entrance to stores and buildings. I find that taking little steps to embrace becoming physically fit will make more of a difference, slowly but surely!

Signed,

EnviableZsanai

P.S. Keep reasonable expectations of yourself!

American Academy of Family Physicians. (n.d.). Exercise-induced Urticaria | Overview. Retrieved August 2015, from http://familydoctor.org/familydoctor/en/diseases-conditions/exercise-induced-urticaria.html

POPSUGAR. (n.d.). Why Do My Legs Itch When I Run? | POPSUGAR Fitness. Retrieved August 2015, from http://www.popsugar.com/fitness/Why-Do-My-Legs-Itch-When-I-Run-4514320

LoveHer: “Allergic to Exercise”

LoveHER: The Other Silent Killer of Black Women—Hepatitis C

Delicately purposed for the nation’s Black women; brown girls, black girls; light-skinned, brown-skinned, and dark-skinned:

“It is clear that information about Hepatitis C Virus (HCV) has not effectively reached the majority of African Americans in this country. According to a public awareness poll conducted by the American Liver Foundation, African Americans, when compared to the general public,  are not as aware of the risk factors or symptoms of hepatitis C. Furthermore, a media analysis discovered African American press, a trusted resource which plays a critical role in informing the African American community, features minimal coverage on hepatitis C.

Hepatitis C, the most common blood-borne infection worldwide, is silently killing us, Black women. Like other viruses such as HIV/AIDS, many who are infected are unaware thus, increasing the risk of developing severe liver disease and transmitting the virus to others. According to the Centers for Disease Control and Prevention (CDC), the prevalence of the virus is 3 percent among African Americans, compared to 1.5 percent in the general population.

Within the African American community, chronic liver disease, which is often hepatitis C-related, is a leading cause of death among people between the ages of 45 and 64. About 9.4 percent of African Americans in their 40s are or have been infected with chronic hepatitis C – compared to only 3.8 percent of Caucasians.

In order to raise awareness, connect those affected with treatment, prevent new infections and defeat this silent killer once and for all, we must empower ourselves. As black women, we must make it an effort to get hepatitis C screenings and more importantly know our status.

Signed,

EnviableZsanai

P.S. Click here to take a short Hepatitis C risk assessment!

Centers for Disease Control and Prevention. (n.d.). The ABCs of Viral Hepatitis. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/ABC-Viral-Hepatitis.pdf

Franciscus, A. (n.d.). African Americans and Hepatitis C. Retrieved from http://hcvadvocate.org/hepatitis/factsheets_pdf/African_Americans.pdf

Hepatitis Foundation International. (n.d.). HEPATITIS C: AN EPIDEMIC WITHIN THE AFRICAN-AMERICAN COMMUNITY. Retrieved from http://www.hepfi.org/pdfs/Stakeholders/HFI_African_American_HCV_Disparities.pdf

LoveHER: The Other Silent Killer of Black Women—Hepatitis C