Voices Less Heard

ABSTRACT

Asthe HIV infectionrate among African American women steadily increases, the body of research focusing on the lives, health, and concerns of HIV-positive African American women remains insufficient. Through primarily qualitative techniques, this study aims to gain insight into the health issues and concerns of HIV-positive African American women. Focus groups with small numbers of HIV-positive African American women were conducted to understand what factors strengthen and weaken medication adherence for women, determine what women's needs are about these issues, and to find out how medical community and service providers can help meet women's needs about adherence. Results from a series of face-to-face interviews with 98 HIV-positive African American women provided insightson how women with HIV and AIDS take care of themselves, and to what extent various life experiences and events influence self-care and adherence. Focus group findings identified factors that weaken and strengthen current medication adherence. Focus group participants also made several recommendations for future adherence strategies and tactics. Face-to-face interviews demonstrate the impact of substance use and past sexual abuse upon women's efforts to adhere to medication and treatment regimens. Implications and recommendations derived from the analysis provide suggestions for enhancing medication adherence strategies. Enhancing methods of increasing adherence rates for medical and human service professionals can improve support services for African American women living with HIV and AIDS.     

"We're going to have to cut loose some of our personal beliefs": barriers and opportunities in providing HIV prevention to African American men who have sex with men and women

In the United States, there is an urgent need to provide HIV prevention services to African American men who have sex with men and women (MSMW) but who do not identify as gay or homosexual. Engaging these men in HIV prevention has historically been challenging. This study used qualitative methodology to explore the beliefs and experiences from community-based service providers (n = 21) and from African American MSMW (n = 21) regarding the provision of HIV prevention education and counseling to these men. Data analysis revealed that (a) African American MSMW who do not identify as gay can challenge service providers' assumptions about sexual behavior and sexual identity; (b) service providers' attitudes toward these men can be affected by ambivalent or negative beliefs that pervade the general community; (c) African American MSMW need safe and nonjudgmental spaces that offer HIV risk reduction, but they also might experience anxiety about disclosing same-sex behaviors to counselors. Findings highlighted the complexities related to culture, masculinity, and sexuality as determinants of HIV risk in African American MSMW, and findings also revealed tensions between these factors that may affect the quality of HIV prevention services. Service providers may need additional training to provide appropriate and non-judgmental HIV prevention counseling and education.     

HIV/AIDS Knowledge and Perceptions Among African American Male and Female College Students at a Historical Black University

Abstract

With the incidence of HIV/AIDS infection continuing to increase among young, African Americanmen andwomen, it is necessary to examine the breadth of their knowledge on HIV prevention strategies.

This study assesses the reported knowledge, attitudes, and behaviors of students attending a Southern urban commuter campus at a Historically Black University. Major differences among males and females, as well as factors influencing testing, issues of safer sex, and perceptions of being HIV infected are examined. The cross-sectional survey data was collected using a self-administered instrument with 238 African American female and male students. Knowledge of transmission was relatively accurate. The majority of students were aware of testing services available to them, though less than 50% of the students reported using services on campus or in their community. There were several significant genderdifferences in attitudes and knowledge about social supports and condom use. The findings are important for social service providers to consider when developing and/or integrating HIV prevention into a culturally responsive service delivery approach.     

Gender and Racial/Ethnic Disparities in the Impact of HIV Prevention Programming in Substance Abuse Treatment

Objective: The objective of the study was to evaluate the capacity of HIV prevention programs offered in substance abuse treatment to reduce HIV-related risk behavior for women and men and for Black, Latino, and White groups. Methods: Prospective data was collected at intake, discharage, and 12 months post-treatment from 1992 to 1997 for the National Treatment Improvement Evaluation Study with a sample consisting of 3,142 clients from 59 service delivery units: 972 females, 1,870 males, 1,812 Blacks, 486 Latinos, and 844 Whites. Results: Study findings show that receipt of HIV prevention programming as part of substance abuse treatment services resulted in reductions in HIV-related risk behavior for the sample overall and for women as well as men. However, although Blacks received more prevention services than Latinos and Whites, the significant positive effect of HIV services on reduced HIVrisk behavior held only for Whites. Conclusions: Racial/ethnic disparities exist in the capacity for HIV prevention programming offered as part of substance abuse treatment to reduce HIV-risk behavior. The findings highlight the need for the development of culturally competent service delivery strategies to enhance the impact of these services for all groups.     

Family, cultural and gender role aspects in the context of HIV risk among African American women of unidentified HIV status: an exploratory qualitative study

This was an exploratory, qualitative study of contextual cultural and social realities of the sexual interactions of a representative sample of African American women of unidentified HIV status. The study expanded our understanding of family and gender role variables by exploring influences of family of origin and idealistic perceptions of roles on sexual relationships. Data was collected on 51 African American women who were recruited through probability sampling. Between 39% and 70% of study participants reported at least one of the following HIV risk factors: low condom use, substance use during sex, partner's incarceration and history of abuse. Nonetheless, all women in our study perceived their chances of HIV infection to be almost non-existent, despite a fairly good knowledge of HIV/AIDS modes of transmission including that anyone could become HIV infected, knowing somebody with HIV/AIDS and acknowledgment, among some, of their partner's infidelity and risk behaviors. Our analysis revealed that parental communications about sexuality in relationships focused largely on trust (being mistrustful of men) and women's control of their sexual impulses. Trust was also emphasized (desired) by women in the discussions of gender roles. Women reported a strong reliance on God and made frequent references to the role of the church in HIV prevention. Our findings offer suggestions for HIV prevention for the general population of African American women. HIV-prevention messages that consider their views of relationships, gender roles, sexual abuse history and the role of the church are suggested.     

HIV and Violence

ABSTRACT

Many men and women living with HIV/AIDS are also dealing with current or past violence. HIV/AIDS services agencies would benefit from understanding the relationship and impact of violence and abuse on their specific client population. AIDS Project Los Angeles (APLA), an HIV prevention, advocacy and service agency for those living with and at risk of HIV, decided to investigate client intake questions regarding violence to determine if there were any behavioral patterns associated with those clients who stated they had or were currently living with violence. Substance abuse was an issue in many of those with a history of domestic violence. The implication of this study is that substance abuse, domestic violence and HIV/AIDS programs need to work collaboratively to address these intertwined issues.     

HIV testing among racial and ethnic minority adolescents living in an urban community

ABSTRACT

This study examined the factors that influence HIV testing among a sample of African American and Hispanic/Latino adolescents (N?=?747) living in an economically disadvantaged community in the Northeastern United States. The majority of sexually active participants in our study (77%) have never been tested for HIV. However, youth engaging in risky sexual behaviors, interacting in positive peer networks, and having access to sources of prevention information were more likely to seek HIV testing services. Our findings underscore the importance of developing multifaceted HIV/AIDS prevention protocols that provide direct education and skill-building activities, leverage peer education as a means to disseminate health-related information, and deliver broad-based prevention messaging that is both culturally-tailored and gender-specific.     

Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homophobia: perspectives of providers

HIV-related stigma, discrimination, and homophobia impede community-based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles, California, from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a 2-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: (1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; (2) recasting HIV prevention messages in a broader social or health context; (3) developing culturally appropriate HIV prevention messages; (4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and (5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs.     

African American Women,AIDS, and Resiliency

ABSTRACT

Ongoing shifts in the populations affected by the AIDS epidemic are reflected in the increasing proportion of AIDS cases in women-particularly women of color. While African American women represent approximately 13% of the U.S. female population, in 2000, 63% of all reported AIDS cases in women in the United States were among African American/non-Hispanic women. Despite these statistics, relatively few studies in the area of HIV research target African American women exclusively. As part of a larger study, we asked 105 African American women to describe in their own words how their lives have changed since becoming HIV positive. Despite multiple past and current stressors, the majority of participants provided responses that were decidedly positive. Clinical implications as well as future research directions based on these findings are discussed.     

Southern Rural African American Faith Communities' Role in STI/HIV Prevention Within Two Counties

Abstract

Purpose:Because of the faith community's historical response to HIV/AIDS, some religious leaders, local community activists, and public health professionals are challenging this institution to get involved in the struggle against HIV especially among adolescents. The paper reviews the historic process and reports findings from a study, which assess Southern Rural Florida pastors' perception of and involvement in STI/HIV prevention education of their adolescent members.

Method:Surveys were administered to 43 African-American pastors of three denominations to describe existing STI/HIV prevention efforts targeting adolescents within their churches and pastors' perceptions of the STI/HIV and drug prevention needs of their adolescent members.

Results:Forty-two percent of the churches had existing educational prevention discussions focused on condom use, pregnancy and STI/HIV prevention, and what constitutes appropriate sexual behavior, while 58% did not. Pastors with program (83%) and without program (64%) desired specifically designed formal prevention programs. All pastors desired program content consistent with abstinence while 50% and 39% desired additional content on condom use and negotiating safer sex behavior, respectively.

Conclusion:The existence of faith-based prevention programs offers hope as churches assume a facilitator role in prevention services; however, their rather narrow and conservative agenda may be perceived as a barrier to effective intervention prevention.     

Friendship and encouragement of safe-sex practices among African-American college women

ABSTRACT

This study explored HIV prevention and prevalence knowledge, awareness and utilization of testing services, factors encouraging testing, perceptions of risk for HIV/AIDS, whether friends discuss and encourage safe-sex practices among African-American women (n?=?176) at a historically black university. In this cross-sectional survey, participants attended a 90-minute HIV informational session before being administered a questionnaire. A majority of participants agreed their sexual behaviors increased their risk for HIV infection, and approximately one-fourth considered themselves at high risk. Participants reported that friends discuss and encourage safe-sex practices. Friendship may be a mobilizing component of HIV prevention among female African-American college students.     

Rural HIV/AIDS Services

Abstract

An exploratory study to investigate the needs of those living with HIV disease to determine related service challenges was conducted in 1997 and replicated in 1999. This study utilized qualitative and quantitative measures, surveyed both individuals who are living with HIV disease and HIV/AIDS service providers in predominately rural counties of a midwest -ern state with a low incidence of HIV infection. Respondents' perceptions were solicited regarding existing services in the areas of: (1) awareness; (2) satisfaction; and (3) gaps and barriers. Findings indicate: (1) the critical role AIDS service organizations have in rural service delivery; (2) service awareness is much stronger among those living with HIV disease than HIV/AIDS service providers; (3) satisfaction with available services is growing; and (4) there is a widening gap between important needs and available services.     

HIV Prevalence and Risk Behaviors Among African American Women Who Trade Sex for Drugs Versus Economic Resources

Trading sex for money, drugs, goods, services, or a place to stay is prevalent among women who use drugs and has been associated with women’s risk of HIV acquisition. There is evidence that trading sex for drugs only may be associated with elevated risk of HIV compared with trading sex for money. The purpose of this study was to assess whether HIV risk behaviors and HIV prevalence differ among African American drug using women (N = 92) who traded sex for drugs only, traded sex for economic resources (defined as money, shelter, or other resources) only, or traded sex for both economic resources and drugs. In this study, lower rates of condom use and higher rates of HIV were found among women who traded sex for drugs only compared to women who traded sex for economic resources or for economic resources and drugs. These findings suggest that African American women who trade sex for drugs only represent an understudied yet highly vulnerable group.     

“Getting tested is almost like going to the Salem witch trials”: discordant discourses between Western public health messages and sociocultural expectations surrounding HIV testing among East African immigrant women

Washington, DC, has the highest AIDS diagnosis rate in the USA, and Black women are disproportionately affected. Although HIV testing is the first entryway into vital treatment services, evidence reveals that foreign-born blacks have a lower rate of recent HIV testing than US-born blacks. To date, however, there are no studies that examine the culture-specific perceptions of HIV testing among East African immigrant women (who comprise a large share of Black Africans in DC) to better understand their potential barriers to testing. Adopting the PEN-3 cultural model as our theoretical framework, the main objective of this study was to examine East African women's HIV testing perceptions and partner communication norms. Between October 2012 and March 2013, trained interviewers conducted a total of 25 interviews with East African women in the Washington, DC, metropolitan area. For triangulation purposes, data collection consisted of both in-depth, semi-structured interviews and cognitive interviews, in which participants were administered a quantitative survey and assessed on how they interpreted items. Qualitative thematic analysis revealed a systematic pattern of discordant responses across participants. While they were aware of messages related to Western public health discourse surrounding HIV testing (e.g., Everyone should get tested for HIV; One should talk to one's spouse about HIV testing), divergent sociocultural expectations rooted in cultural and religious beliefs prevailed (e.g., Getting an HIV test brings shame to the person who got tested and to one's family; it implies one is engaging in immoral behavior; One should not talk with one's spouse about HIV testing; doing so breaks cultural norms). Implications of using a culture-centered model to examine the role of sociocultural expectations in HIV prevention research and to develop culturally responsive prevention strategies are discussed.     

Barriers to Care and Unmet Needs for HIV-Positive Women Caring for Children

ABSTRACT

Grounded theory was used to explore barriers to care and unmet needs for HIV-positive women caring for children under 18 years of age. The main study group consisted of 40 HIV-positive women caring for children. There were 21 Latinas, 11 Euro-Americans, 6 African Americans, and 2 participants from other ethnic groups. In addition, 5 providers of HIV services were interviewed to ensure trustworthiness of the data. The main findings identify and discuss needs for: (1) mental health and addiction services, (2) a better understanding of professional and paraprofessional roles, (3) improved privacy and confidentiality, (4) improved cultural sensitivity, and (5) other support service gaps are outlined and discussed in this study.     

Predictors of HIV sex risk behavior among women in US drug treatment programs: NIDA CTN trial results

Abstract

HIV prevention for women with substance use disorders is a public health priority. To identify characteristics associated with sexual risk among women in outpatient substance abuse treatment we categorized 809 screened women into three groups: (1) sexually inactive, (2) sexually active with consistent condom use, and (3) sexually active with inconsistent condom use. Multinomial logistic regression analyses were used to examine demographics, substance use and treatment characteristics, and regional HIV seroprevalence as predictors of sexual risk behavior. Younger age and attending psychosocial (PS) treatment were significantly associated with being at higher HIV risk. HIV prevention should be tailored to address HIV risk in younger women in PS treatment.     

Risk Factors for HIV/AIDS Among American Indian/Alaska Native Women

Abstract

This article illuminates the main risks that American Indian/Alaska Native women face for contracting the human immunodeficiency virus, and their challenges in living with HIV disease, by presenting a case study of one Native woman's experiences. The woman, a member of a Midwestern Indian tribe, was a participant in a larger in-depth qualitative longitudinal study of 55 women living with HIV. The findings about her path to healing provide insights for understanding and serving this neglected ethnic population, and her words eloquently articulate the struggles of women of color living in dignity with HIV. The article explores potential venues for reaching Native women with culturally relevant prevention and intervention methods, emphasizing the importance of Native culture and Spirituality.     

HIV Services Utilization in Los Angeles County, California

Recipients of HIV/AIDS prevention services in Los Angeles County California were surveyed in 2004 by 220 HIV prevention service provider staff from 51 agencies funded by the Office of AIDS Programs and Policy. This resulted in 2,102 usable surveys for cluster analysis purposes. This Countywide Risk Assessment Survey assessed demographics, sexual history, substance use, perceptions regarding HIV/AIDS, and use of 18 different services at both the agency administering the survey and at other agencies. The 36 types of service use data were subjected to a cluster analysis that found five clusters. These service pattern clusters differed from each other on proportion HIV positive, HIV testing history, history of abuse, education, type of residence, type of funding, intervention type, and ethnicity. The analysis also suggests that domestic violence services availability and utilization should be examined more thoroughly in the future for HIV infected/affected populations.     

Boston Consortium of Services for Families in Recovery

SUMMARY

Through collaboration among the service agencies collectively known as the Boston Consortium of Services for Families in Recovery, the Boston Public Health Commission implemented an integrated model of trauma-informed services that is culturally and linguistically appropriate to its service population of primarily poor urban Latina and African American women. The enhanced intervention was implemented in five Consortium-affiliated alcohol and drug addiction treatment programs providing outpatient, residential, and methadone services. Programs adopted trauma-informed service system enhancements and offered study participants a package of trauma-specific and trauma-informed clinical services. The assessment and consensus-building processes, enhanced model components, implementation process, challenges and lessons learned are described.     

Ethnicity,Serostatus, and Psychosocial Differences in Sexual Risk Behavior Among HIV-Seropositive and HIV-Seronegative Women

Childhood sexual abuse and related life traumas, and other psychosocial variables were investigated as contributors to ethnic differences in sexual risk behaviors among women who differed in HIV-serostatus. A multiethnic sample of 457 HIV-positive and HIV-negative women residing in Los Angeles county was recruited and studied over 2 years as part of the UCLA–Charles R. Drew University Women and Family Project (WFP) study. Comprehensive interviews were administered to participants by ethnically- and linguistically matched interviewers. Data on demographic information, sexual trauma, substance abuse/dependence, psychiatric distress, and sexual history and risk behaviors were collected. The sample for these analyses consisted of 155 African American, 153 European American, and 149 Latina women, and nearly two-thirds of the sample was HIV-seropositive. HIV-positive women were significantly more likely to report more posttraumatic stress, chronic stress, negative health behaviors, drug use, and psychiatric history than HIV-negative women. European American and African American women were more likely to report a history of sexual trauma than Latina women. Finally, Poisson regression analyses revealed that history of trauma, ethnicity, drug and alcohol use, homelessness, and being HIV-positive were associated with greater likelihood of engaging in high-risk sexual behaviors, with history of trauma increasing the likelihood of engaging in high-risk behaviors by 5.1%. These findings highlight important differences among women as a function of ethnicity and HIV status, and underscore the need for special services for HIV-positive women that address the risk-enhancing effects of substance abuse/dependence, homelessness, and sexual trauma.