Enhancing Cultural and Contextual Intervention Strategies to Reduce HIV/AIDS Among African Americans

I describe 4 protective strategies that African Americans employ that may challenge current HIV prevention efforts: (1) an adaptive duality that protects identity, (2) personal control influenced by external factors, (3) long-established indirect communication patterns, and (4) a mistrust of “outsiders.” I propose the Sexual Health Model as a conceptual framework for HIV prevention interventions because it incorporates established adaptive coping strategies into new HIV-related protective skills. The Sexual Health Model promotes interconnectedness, sexual ownership, and body awareness, 3 concepts that represent the context of the African American historical and cultural experience and that enhance rather than contradict future prevention efforts.AS THE UNITED STATES enters the third decade of the AIDS epidemic, the rates of new HIV/AIDS cases among African Americans continue to increase compared with those of other ethnic groups.¹ Consequently, the Centers for Disease Control and Prevention has proposed a heightened national response to the HIV/AIDS crisis for African Americans.² Community advocates, including the National Black Leadership Commission on AIDS and the National Medical Association, have called for a state of emergency³ to address disparities in infection rates.Among the population as a whole, evidence-based interventions have achieved some success in reducing HIV-related risks and infection rates.^4–6 Although biomedical and behavioral issues related to the transmission of HIV/AIDS have been well-addressed in these interventions,^7,8 some of the related key culture-bound protective strategies and their historical roots are not routinely included in HIV preventions targeted for African Americans.^2,3,9In the following section, I give 4 assumptions derived from HIV intervention research^4–6 regarding how and by whom HIV prevention messages should be conveyed to those at risk and how decisions are made about behavior change. For each of these 4 assumptions, I describe a culture-bound protective strategy used by African Americans that contradicts it: (1) an adaptive duality that protects identity, (2) patterns of personal control developed in response to external factors such as oppression and gender-based socialization, (3) long-established indirect communication patterns, and (4) a mistrust of “outsiders” that limits acceptance of HIV prevention and care.Finally, I propose the Sexual Health Model—a conceptual framework that addresses these adaptive coping strategies and promotes African Americans'' protective skills. I discuss new methods to aid implementation of this model in future interventions, making HIV prevention research more historically and culturally congruent.     

Operational Fidelity to an Evidence-Based HIV Prevention Intervention for People Living with HIV/AIDS

Evidence-based interventions are often disseminated in public health education with little known about their operational fidelity. This study examined the delivery of intervention components (operational fidelity) of a widely disseminated HIV prevention program designed for people living with HIV/AIDS named Healthy Relationships. Two hundred ninety-nine agencies that had been trained in the intervention by the Centers for Disease Control and Prevention were contacted, and 122 (41%) completed confidential interviews. Among the 93 agencies that implemented the program, 39 (40%) adapted at least one core element activity, and 21 (23%) dropped an activity. Most adaptations were intended to improve the community fit of the intervention. Agencies believed that funders demand that they implement the intervention with fidelity. Models of technology transfer that emphasize behavior change processes rather than specific curriculum content may advance prevention program dissemination.     

Older Adults' Perspectives on HIV/AIDS Prevention Strategies for Rural Kenya

HIV/AIDS is devastating sub-Saharan Africa with great impact in the rural communities. Though prevention is the mainstay of various responses to the epidemic, communication strategies used to influence risk perception and motivate behavior change are culturally inappropriate, hence the lack of success. The bulk of prevention efforts target the 15–49 age group, resulting in limited knowledge and understanding of HIV/AIDS in adults over age 50 who are considered at a lower or no risk of infection. This paper addresses older adults as a key segment of the population in HIV/AIDS prevention given the increasing number that is living with the disease or newly infected. Many older adults are also caregivers of those infected and affected by the disease. As cultural, social, political, and opinion leaders in rural Kenya, older adults are in a position to influence attitudes and behaviors of their community members, but they have not been involved in the current intervention strategies. Through application of a participatory and culture-centered approach, the study sought views of older adults on the factors contributing to the epidemic in rural Kenya and their opinions on effective prevention strategies that are culturally appropriate. Several recommendations are made for a culture-specific HIV/AIDS prevention intervention for rural Kenya.     

HIV/AIDS case profile of African Americans: guidelines for ethnic-specific health promotion, education, and risk reduction activities for African Americans

There are discrepancies in health care services for the poor and ethnic minorities in the United States. Within the past decade widespread concerns regarding the need to reform the nation's health care services, including the problem of human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) among African Americans has continued. These inequalities have been the cornerstone of the U.S. Healthy People 2010 national priority objectives. The objectives focus on health and social outcomes such as low quality of life and mortality rates, poverty, lack of accessibility to and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. The dearth of preventive health services for the high-risk groups, particularly children, adolescents, young adults, and older African American adults undermines early intervention efforts, including prompt HIV/AIDS identification and diagnosis, prevention education, health promotion, effective substance abuse treatment, and counseling services. This work reviews the magnitude of HIV/AIDS among African Americans between 1996 and 1999 by race/ethnicity, gender, and age groups. It also addresses the major factors responsible for the continued upward trend in the distribution and rate of infectiousness of HIV/AIDS among African Americans. The study recommends and discusses culturally sensitive and ethnic-specific intervention strategies for the prevention and control of HIV/AIDS among African Americans.     

广东省艾滋病防治策略分析

目的 了解广东省当前艾滋病防治策略及措施对防治工作方向的指导作用，为适时、有效的防治策略的制定与调整提供依据。方法 回顾性分析自开展艾滋病防治工作以来的历史文献、监测资料和机构发展情况及其相互关系。结果 全省监测网络基本形成，监测系统趋于完善；截至2002年11月底，广东省累计报告HIV感染者3640例，艾滋病患者139例；传播途径的构成中尽管仍以注射吸毒为主(75．7％)，但经性途径感染的比例已开始增加，2002年达4.2％;吸毒、暗娼等高危人群人数持续增加及其危险行为发生率较高。结论 广东省艾滋病流行日趋严重，HIV已经开始从吸毒人群再次进入性乱人群；尽可能地利用和开发政策支持，及时调整防治策略，动员全社会全面开展大范围宣传教育、行为干预活动，积极推广降低危害项目已刻不容缓。     

2014-2018年四川省预防艾滋病经性传播干预实施情况分析

目的分析四川省2014-2018年艾滋病综合防治信息网络直报系统高危人群干预数据,了解艾滋病经性传播高危人群的干预实施情况。方法收集2014-2018年四川省女性性工作者(female sex worker,FSW)、男男性行为者(men who have sex with men,MSM)人群的干预数据,采用历史资料的描述性统计方法分析干预工作各项指标的变化趋势。结果2014-2018年,四川省183个县(区)FSW人群月均干预人数逐年上升;HIV抗体阳性检出率从0.1%升至0.3%;每月每人获得安全套数量仅12个左右,且有减少趋势。MSM人群月均干预覆盖率逐年上升;HIV抗体阳性检出率从3.1%升至3.3%;每月每人获得安全套数量仅6个左右,且有减少趋势。结论四川省183个县(区)FSW和MSM人群干预覆盖面有所提高,仍需进一步扩大;FSW和MSM人群干预工作质量不高,干预效果有待提高;FSW和MSM人群干预形式亟待改变,应充分针对目标人群需求开展干预。     

九江市艾滋病流行现状与预防对策探讨

目的分析九江市HIV/AIDS流行现状、特征和趋势,为制定防治策略提供依据。方法对全市历年来流行病学调查和随访资料、监测哨点资料、特殊人群筛查和相关研究资料进行分析。结果自1998年发现首例艾滋病病毒感染者以来,到2006年10月已累计报告47例,其中艾滋病病人14人,死亡7人。以性传播为主要传播途径,并已出现母婴传播病例,HIV/1B亚型是主要流行株。结论近年来,AIDS流行速度明显加快,在外出打工农民工中存在流行危险,应采取有效健康教育和行为干预措施预防HIV在该人群的流行。     

Impact of HIV/AIDS on African children

In Central and East Africa, pediatric human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasing threats to child health due to the predominance of heterosexual transmission of HIV, high HIV infection rates in women of reproductive age and high birth rates. This paper examines the potential impact of HIV/AIDS on orphanhood and under-five mortality in 10 Central and East African countries. The author estimates that, in the 10 countries studied, HIV/AIDS in children under age five will cause between one-quarter and half a million child deaths annually by the year 2000. Whereas the United Nations estimate (without AIDS) and target for the under-five mortality rate in this 10-country region by the year 2000 are 132 and 78, respectively, HIV/AIDS will cause the under-five mortality rate to rise to between 159 and 189. Increasing HIV/AIDS-related adult mortality is creating a large and growing number of children under age 15 whose mothers have died of HIV/AIDS. During the 1990s, HIV/AIDS will kill a total of between 1.5 and 2.9 million women of reproductive age in this region, producing between 3.1 and 5.5 million AIDS orphans--which means that between 6 and 11% of the population under age 15 will be orphaned. National and international government and nongovernment service providers in Central and East Africa need to recognize this potential impact of HIV/AIDS on children, expand AIDS-prevention efforts, and develop policies and programs to address children's HIV/AIDS-related needs.     

Source Credibility and Evidence Format: Examining the Effectiveness of HIV/AIDS Messages for Young African Americans

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source—physician or minister—that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.     

Source credibility and evidence format: examining the effectiveness of HIV/AIDS messages for young African Americans

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source--physician or minister--that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.     

女性高危人群预防HIV/AIDS知识的认知调查

目的通过对女性高危人群预防HIV/AIDS知识的认知调查,以保护妇女健康,防止HIV和性传播疾病在社会上的流行和蔓延。方法以云南省某女子劳教所劳教人员为对象,运用社会学的个案研究、问卷调查,以及开展预防HIV/AIDS知识的培训。结果女性高危人群大多数受教育程度低,初中文化程度以下的人群占89.66%,无职业者占82.7%,她们对艾滋病的病因、症状和预防方法等问题不是很清楚,只有25%的人对HIV的传播途径有所认识。结论通过对女性高危人群进行预防HIV/AIDS感染健康教育的培训后,女性高危人群对艾滋病的病因、传播途径、初期症状、HIV所需的检测时间,以及感染艾滋病高危行为等知识的认知度明显提高,93.10%的人表示赞成预防HIV首先从自己做起。     

Congregation-Based Programs to Address HIV/AIDS: Elements of Successful Implementation

Religious organizations may be uniquely positioned to address HIV by offering prevention, treatment, or support services to affected populations, but models of effective congregation-based HIV programs in the literature are scarce. This systematic review distils lessons on successfully implementing congregation HIV efforts. Peer-reviewed articles on congregation-based HIV efforts were reviewed against criteria measuring the extent of collaboration, tailoring to the local context, and use of community-based participatory research (CBPR) methods. The effectiveness of congregations’ efforts and their capacity to overcome barriers to addressing HIV is also assessed. We found that most congregational efforts focused primarily on HIV prevention, were developed in partnerships with outside organizations and tailored to target audiences, and used CBPR methods. A few more comprehensive programs also provided care and support to people with HIV and/or addressed substance use and mental health needs. We also found that congregational barriers such as HIV stigma and lack of understanding HIV’s importance were overcome using various strategies including tailoring programs to be respectful of church doctrine and campaigns to inform clergy and congregations. However, efforts to confront stigma directly were rare, suggesting a need for further research.     

Spiritually Based Intervention to Increase Colorectal Cancer Awareness Among African Americans: Intermediate Outcomes From a Randomized Trial

Colorectal cancer screening, while effective for reducing mortality, remains underutilized particularly among underserved populations such as African Americans. The present study evaluated a spiritually based approach to increasing Health Belief Model–based pre-screening outcomes in a Community Health Advisor–led intervention conducted in African American churches. Sixteen urban churches were randomized to receive either the spiritually based intervention or a nonspiritual comparison of the same structure and core colorectal cancer content. Trained Community Health Advisors led a series of two educational sessions on colorectal cancer early detection. The educational sessions were delivered over a 1-month period. Participants (N = 316) completed a baseline survey at enrollment and a follow-up survey one month after the first session. Both interventions resulted in significant pre/post increases in knowledge, perceived benefits of screening, and decreases in perceived barriers to screening. Among women, the spiritually based intervention resulted in significantly greater increases in perceived benefits of screening relative to the nonspiritual comparison. This finding was marginal in the sample as a whole. In addition, perceived benefits to screening were associated with behavioral intention for screening. It is concluded that in this population, the spiritually based was generally as effective as the nonspiritual (secular) communication.     

人本主义对艾滋病防控策略的影响

艾滋病是全球面临的一个重大公共卫生问题和社会问题。对艾滋病感染者和艾滋病病人的歧视,必然导致这部分人不敢公开到正规机构接受咨询检测和治疗,从而成为潜在的传染源,造成艾滋病的扩散蔓延。在艾滋病的防控策略中引入人本主义精神,能够营造全社会关注、支持与参与艾滋病防控的良好氛围,最终实现控制艾滋病的目标。     

艾滋病母婴传播健康教育预防对孕妇艾滋病知识知晓率的干预效果研究

目的探讨艾滋病母婴传播健康教育预防对孕妇艾滋病知识知晓率的干预效果。方法选择2013年2月至2014年2月期间我院收治的孕妇200例为研究对象,按照入院先后顺序分为两组各100例,其中给予对照组常规干预,观察组在对照组的基础上再给予艾滋病母婴传播健康教育,对两组的干预效果进行对比分析。结果干预前,两组的艾滋病母婴传播知识知晓率和艾滋病一般预防知识知晓率对比差异无统计学意义(P>0.05);干预后,观察组对二者的知晓率均明显优于对照组(P<0.05)。观察组的产妇满意度显著高于对照组,差异有统计学意义(P<0.05)。结论在对孕妇进行常规护理的基础上,再给予艾滋病母婴传播健康教育,一方面可以使孕妇正确认识艾滋病,提高关于艾滋病知识的知晓率和认识率,另一方面还能降低出现艾滋病的几率,避免艾滋病母婴传播,在一定程度上对改善母婴预后有着极其重要的意义,值得推广应用。     

Recommendations for increasing the use of HIV/AIDS resource allocation models

Background

Resource allocation models have not had a substantial impact on HIV/AIDS resource allocation decisions in spite of the important, additional insights they may provide. In this paper, we highlight six difficulties often encountered in attempts to implement such models in policy settings; these are: model complexity, data requirements, multiple stakeholders, funding issues, and political and ethical considerations. We then make recommendations as to how each of these difficulties may be overcome.

Results

To ensure that models can inform the actual decision, modellers should understand the environment in which decision-makers operate, including full knowledge of the stakeholders' key issues and requirements. HIV/AIDS resource allocation model formulations should be contextualized and sensitive to societal concerns and decision-makers' realities. Modellers should provide the required education and training materials in order for decision-makers to be reasonably well versed in understanding the capabilities, power and limitations of the model.

Conclusion

This paper addresses the issue of knowledge translation from the established resource allocation modelling expertise in the academic realm to that of policymaking.

     

Adherence to World Cancer Research Fund/American Institute for Cancer Research Lifestyle Recommendations Reduces Prostate Cancer Aggressiveness Among African and Caucasian Americans

The effect of adherence to the World Cancer Research Fund (WCRF) lifestyle recommendations on cancer aggressiveness is unknown. We examined associations between adherence to recommendations and risk of highly aggressive prostate cancer in research subjects enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). We examined associations between adherence to WCRF recommendations and risk of highly aggressive prostate cancer among 2212 newly diagnosed African Americans (AA) or Caucasian Americans (CA) aged 40–70 years in PCaP. Prostate cancer aggressiveness was based on Gleason scores, serum prostate-specific antigens, and TNM stage. Adherence to WCRF recommendations was based on point scores and odds ratios estimated. Results showed that adherence to recommendations was significantly and negatively associated with risk of a highly aggressive prostate cancer. Each additional point in the total adherence score corresponded to a 13% risk reduction. Total adherence score <4 predicted increased risk in both AA (OR = 1.36; 95% CI = 1.01–1.85) and CA (OR = 1.41; 95% CI = 1.01–1.98). Consumption of <500 g red meat per week or ≤125 total kcal/100 g solid food per day is a statistically significant protective factor in the overall cohort. Recommendations aimed at preventing all cancers also may reduce risk of highly aggressive prostate cancer.