Incarceration, African Americans and HIV: advancing a research agenda

Incarceration is a crisis among African Americans, and the prevalence of HIV/AIDS in incarcerated men and women is 3-5 times that of the general population. We explore the potential implications of the widespread incarceration of African Americans on HIV risk and HIV outcomes in: 1) the current and formerly incarcerated, 2) their sexual partners, and 3) the communities impacted by incarceration. We set forth a research agenda for understanding and ameliorating the negative impacts incarceration and conclude that the African-American population's ability to successfully address the HIV/AIDS epidemic requires a coordinated and evidence-based response to the challenge of effectively preventing, managing and treating HIV in populations affected by incarceration.     

Relative rates of AIDS among racial/ethnic groups by exposure categories

The relative rates of acquired immunodeficiency syndrome (AIDS) were calculated among racial/ethnic populations using Centers for Disease Control and Prevention HIV (human immunodeficiency virus)/Surveillance reports assuming that racial/ethnic distributions reflect that of the US Census Data from 1990. For comparison, a rate of 1 was assigned to whites in each calculation. The overall relative rates were whites--1, African Americans--4.7, Hispanics--3, Asian/Pacific Islanders--0.4, and Native Americans--0.5. Acquired immunodeficiency syndrome surveillance data show higher rates of AIDS for African Americans and Hispanics compared with whites, Asians/Pacific Islanders, and Native Americans. The relative rates for African Americans and Hispanics compared with whites were highest for injecting drug users, heterosexual contact, and pediatric patients. These results led us to explore possible explanations for increased AIDS reporting in African Americans and Hispanics. We then explored available national datasets regarding those variables. The analyses indicate that variables such as access and receptivity to HIV prevention and treatment efforts, race/ethnicity, sexual behaviors, sexually transmitted diseases, socioeconomic status, and substance abuse interact in a complex fashion to influence HIV transmission and progression to AIDS in affected communities.     

The tragedy of AIDS in Black America

Statistics reveal that while African Americans comprise only 13 percent of the population, they account for 56 percent of reported HIV cases nationwide. The nation's near disregard for health issues related to African Americans coupled with their communities being left poor, politically weak, and ignored has contributed to allowing diseases, some of which are curable, to reach epidemic proportions. African Americans most at risk for HIV are mired in poverty. African American leaders have called for a national "State of Emergency" on HIV/AIDS to provide quick emergency financial intervention to follow the AIDS epidemic and meet the needs of impacted African American communities. In 1998, $171 million was appropriated to be disbursed through grants from the Centers for Disease Control and Prevention (CDC) to community-based service organizations (CBOs). These CBOs will develop and implement HIV prevention programs. Funding for HIV/AIDS through other government agencies will also be distributed to African American communities.     

Assessing the attitudes, knowledge, and awareness of HIV vaccine research among adults in the United States

OBJECTIVES: To assess HIV vaccine research attitudes, awareness, and knowledge among adults in the general US population, African Americans, Hispanics, and men who have sex with men (MSM). METHODS: Applying results of focus groups and a media content analysis, a survey was designed and conducted to validate key HIV vaccine research themes and messages identified by focus groups and a media content analysis. Between December 2002 and February 2003, 3509 telephone interviews were conducted, including 2008 randomly selected from the general population, and 501 population-specific samples of African Americans and Hispanics, and 500 from MSM. RESULTS: Although the majority of each population believes that an HIV preventive vaccine is the best way to control and end the global AIDS epidemic, only 34.9% of African Americans and 28.8% of the general population are supportive of someone they know volunteering for an HIV vaccine trial. The study also found that 47.1% of African Americans, 26.5% of Hispanics, and 13.4% of MSM believed an HIV vaccine already exists and is being kept secret, and 78.0% of African Americans, 57.5% of Hispanics, and 68.0% of MSM did not know or incorrectly believed that the vaccines being tested could cause HIV infection. A subanalysis of the general population also found that women generally had less knowledge of or a decreased awareness about HIV vaccine research. CONCLUSIONS: Awareness, knowledge, and attitudes toward HIV vaccine research vary by population and these issues must be addressed to ensure an adequate number of volunteers for future domestic HIV preventive vaccine clinical trials. In some populations, barriers such as misinformation and distrust must be targeted to increase support for HIV vaccine research.     

The Four Cs of HIV Prevention with African Americans: Crisis,Condoms, Culture,and Community

HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.     

HIV / AIDS and STD prevention in Surinamese prisons

The Suriname National AIDS Program (NAP) developed an education and support program involving activities for prison inmates, staff, and non-prison personnel and organizations. Male inmates and prison warders were selected for training as peer educators. Male inmates formalized their status by forming the Boma AIDS Education Collective (BAEC). Female inmates were not included in the training because most of them served short sentences and were instead involved in educational sessions which focused on sexual and mother-child transmission of STDs. BAEC produced AIDS education leaflets in three languages (Dutch, English, and Sranan Tongo) for new and discharged inmates at the prison and also for all prisoners in Suriname. The leaflets were then pre-tested and modified based on comments from 17 inmates. The Program was officially introduced in April 1992 when BAEC organized an AIDS/STD week. The week's activities included AIDS educational sessions, video shows, discussions, and HIV testing. A permanent AIDS/HIV counseling system, which specifies that among other things HIV testing must be done on a voluntary basis, was implemented at Santo Boma prison for both male and female inmates. A manual was produced for peer educators, and AIDS/STD education has since been included in the prison warder training curriculum. A number of collaborative activities with non-prison organizations were organized to demonstrate that prisoners are part of a wider community concerned about HIV/AIDS. However, some prisoners are against condom distribution in the prisons, because they feel that it would encourage homosexual contacts. Prison authorities have not yet approved official condom distribution.     

State of emergency: HIV/AIDS among African Americans

HIV medical care has improved the health and the quality of life for many people with HIV, but African Americans are not experiencing the full benefits of these advances. AIDS is still the leading cause of death in African Americans between the ages of 25 and 44, and African American women account for 56 percent of the cumulative total of women with AIDS. African American children represent 58 percent of pediatric cases. There have been some success stories in HIV prevention, notably the use of Zidovudine (AZT) to radically reduce perinatal transmission rates, although the majority of these cases still occur among African Americans. They are also subject to higher rates of AIDS from injection drug use and increasing rates of other sexually transmitted diseases. The National Minority AIDS Council's (NMAC's) recommendations for serving this population are described.     

Optimizing treatment for African Americans and Latinos with HIV/AIDS

HIV/AIDS is a disease that has a disproportionate negative impact on the African-American and Latino communities when compared with the general population. African Americans account for more than 50% of new AIDS cases, though they comprise only 12% of the general population. More than one-third of AIDS-related deaths in the United States have been among African Americans. Many factors contribute to the HIV/AIDS healthcare disparities seen in the African-American and Latino communities. These factors include medical issues (such as resistance to antiretroviral therapy, toxicities of medications and hepatitis-C coinfection) and social factors (such as a lack of faith in the healthcare system, cultural circumstances and poor access to healthcare services). Healthcare providers can take steps to improve HIV care for African Americans and Latinos. Distrust of the medical establishment can be addressed by increasing the number of culturally sensitive healthcare providers. Communication is the first step toward establishing the trust of patients and minimizing the devastating effects of perceived institutional bias that may lead many HIV patients to be diagnosed late in the course of the disease. Medical and cultural issues faced by African Americans and Latinos should also be addressed in treatment guidelines. When healthcare providers take steps to overcome the medical and cultural issues facing African Americans and Latinos, HIV patients will have access to more effective disease management.     

Characteristics and knowledge about HIV/AIDS and drug abuse associated with inmates education level within prison populations in Singkawang, West Borneo in 2006

AIM: to identify the characteristics and knowledge of inmates within prison population in Singkawang city about HIV/AIDS and drugs associated with their education level. METHODS: a cross-sectional study with 240 respondents was conducted in Singkawang City, West Borneo. The subjects were inmates of prison population. They were interviewed by co-assistant doctors who completed the questionnaire forms about various aspects of knowledge about HIV/AIDS and drugs, including the application of standardized scales on subject characteristics. Data was prepared by using Microsoft Excel 2000 and all data were evaluated by univariate and bivariate analyses. The presentation will be shown in table. RESULTS: at the end of 2006, 91.25% respondents were male and mostly were Malay ethnic group. Moreover, 32.08% of them had formal educational background of Senior High School. Approximately 83.33% of respondents had discovered their status of HIV/AIDS by voluntary counseling and testing (VCT). Their level of knowledge about HIV/AIDS issue particularly that AIDS is caused by HIV was 90.42%. Approximately 48.33% respondents agreed that the risk factor for drug abuse was living with a family member who had taken up smoking and alcoholic consumption. CONCLUSION: our data indicate that higher education level has better contribution to the better knowledge about HIV/AIDS and drugs.     

Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?

OBJECTIVES: This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans. METHODS: We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States. RESULTS: A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociode-mographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, men's attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior. CONCLUSIONS: HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.     

Comorbidities and Challenges Affecting African Americans with HIV Infection

The significant disparities in health outcomes that exist among racial minorities in the United States are clearly evident in the HIV epidemic. HIV disproportionately affects minorities, African Americans in particular. Current treatment of HIV/AIDS is complicated by medical problems such as hepatitis, diabetes and dyslipidemia, which also disproportionately affect African Americans and can significantly impact the complexity of clinical care. In addition, untreated psychological problems such as depression and societal barriers to adequate medical care may decrease treatment adherence and increase HIV-related morbidity and mortality among African Americans. Consideration of these issues by healthcare providers is necessary to optimize care and improve treatment outcomes for African Americans with HIV infection.     

Incarceration and risk for HIV infection among injection drug users in Bangkok.

OBJECTIVE: To assess potential multiple relationships between incarceration and HIV infection among injecting drug users (IDUs) in Bangkok. Previous cross-sectional studies have shown strong relationships between incarceration and HIV infection but have not been able to assess potential causal pathways. METHODS: Injection drug users seen at methadone treatment programs in Bangkok were screened during 1995 to 1996 for enrollment into the study. With informed consent, 1,209 seronegative IDUs were enrolled in a cohort study to determine HIV incidence and identify factors associated with incident infections. Follow-up visits were conducted every 4 months, with HIV testing and assessment of risk behaviors. RESULTS: Overall incidence rate was 5.8 per 100 person-years (95% confidence interval [CI], 4.8-6.8) of follow-up. A four-step "injection risk" scale was constructed that included less frequent than daily injection, daily injection, daily injection with reported sharing of injection equipment, and injection while incarcerated. This scale was strongly related to HIV incidence, with incidence approximately doubling for each step in the scale. Incidence rate for follow-up periods that contained drug injection while incarcerated was 35/100 person-years at risk. In multivariate analyses, incarceration was related to incident HIV infection in multiple ways: previous incarceration and recent incarceration without drug injection, and the injection risk scale were all independently predictors of incident HIV infection. CONCLUSIONS: Incarceration is related to incident HIV infection through multiple pathways. Previous incarcerations are likely to serve as markers for unmeasured high-risk behaviors, and it is also highly likely that HIV is transmitted during periods of incarceration. Programs to reduce HIV transmission in jails and prisons, including drug abuse treatment of inmates and programs to reduce the likelihood of incarceration of IDUs, are needed urgently. Given the current diffusion of injecting drug use, of HIV infection among drug injectors, and of the common policy of incarcerating drug users, it is very likely that the problem of HIV transmission in jails and prisons is increasing in many countries throughout the world.     

HIV/AIDS and the African-American community: a state of emergency

HIV and AIDS disproportionately affect African Americans more than any other racial or ethnic group in the United States. Representing only 13% of the U.S. population, African-American adults and adolescents comprise more than half of all HIV/AIDS cases reported to the Centers for Disease Control and Prevention. The present incidence and prevalence of HIV/AIDS in the black community in the United States is of crisis proportions. The situation as it stands today is tantamount to a state of emergency for African Americans.     

Challenges of a hidden epidemic: HIV prevention among women in the United States

HIV/AIDS trends in the United States depict a concentrated epidemic with hot spots that vary by location, poverty, race/ethnicity, and transmission mode. HIV/AIDS is a leading cause of death among US women of color; two-thirds of new infections among women occur in black women, despite the fact that black women account for just 14% of the US female population. The gravity of the HIV epidemic among US women is often not appreciated by those at risk and by the broader scientific community. We summarize the current epidemiology of HIV/AIDS among US women and discuss clinical, research, and public health intervention components that must be brought together in a cohesive plan to reduce new HIV infections in US women. Only by accelerating research and programmatic efforts will the hidden epidemic of HIV among US women emerge into the light and come under control.     

PERCEPTION OF ELIGIBLE BLACK MEN AS A CONTEXT FOR HIV‐RELATED RISK BEHAVIOR AMONG BLACK WOMEN

African American women are leading in number of newly diagnosed HIV cases, which is a cause for alarm and has a deleterious effect on families and communities. Research suggests the gender‐ratio imbalance as a contextual factor leading to increases in high‐risk sexual behavior and subsequent increases in the rates of HIV infection among African American women. The current study examines correlates of consistent condom use among 213 single, heterosexual, African American women in the community, on probation, and incarcerated who believe it is difficult to find an eligible Black man. Results of this study reveal that drug‐using women and incarcerated women were less likely to use condoms consistently. In addition, after controlling for drug use and criminal justice status, age emerged as significant. Specifically, older African American women were less likely to use condoms consistently. Community‐level implications and targeted prevention efforts are discussed.     

Epidemiology of hepatitis C virus infection in Australia.

BACKGROUND: Since the discovery in 1989 of hepatitis C virus (HCV) as the infectious agent responsible for the vast majority of post-transfusion non-A non-B hepatitis the patterns of transmission and clinical consequences of this highly prevalent flavivirus have been widely studied. OBJECTIVE: This paper reviews available evidence on the epidemiology of HCV infection in Australia, including HCV notification data obtained through public health surveillance systems, HCV seroprevalence surveys among high risk populations, and models for estimating and projecting HCV transmission and long-term consequences of chronic HCV infection. RESULTS: Over the period 1990-2000 approximately 160,000 notifications of HCV infection were received by State and Territory health jurisdictions making it the most commonly notified communicable disease in Australia. Approximately 210,000 people are estimated to be living with HCV infection in Australia, with an estimated 80% having acquired their infection through injecting drug use. Less than 500 cases of newly acquired HCV infection are notified each year, however, an estimated 16,000 new infections occur annually. Despite the widespread introduction of needle and syringe programmes in the late 1980s, HCV transmission continues at high levels among current injecting drug users (IDUs) with incidence and prevalence estimates of 10-20/100 person years and 50-55%, respectively. Levels of HCV transmission are particularly high in both younger and incarcerated IDUs. In contrast to HCV infection, prevalence of HIV among current IDUs has remained below 2% since 1995. Although a small minority of people with chronic HCV infection will develop liver failure or hepatocellular carcinoma, the incidence of these advanced disease complications is estimated to double over the next decade. CONCLUSION: The epidemic of HCV infection continues to escalate in Australia, predominantly through transmission related to injecting drug use. As the population of people with chronic HCV infection and progressive liver disease expands the public health burden of advanced disease complications will be considerable.     

Reducing HIV/AIDS transmission among African-American females: is the female condom a solution?

Rates of HIV/AIDS have increased at an alarming rate among minority women, especially African-American women. Suggestions that have been presented to decrease HIV/AIDS transmission among African-American women include promoting abstinence and the use of the male condom. Little recognition and support have been given for promoting the female condom as a viable solution to combating the HIV/AIDS epidemic.     

Barriers to safer sex practices among African American college students

African American college students are among the age group of African Americans with significantly higher heterosexual transmission of HIV. It has been projected that young African Americans of college age will be the next group to be affected by the HIV/AIDS epidemic. The goals of this research were to identify barriers to African American college students engaging in safer sex behaviors; determine whether barriers to safer sex differ for African American men versus African American women; and use the findings to help identify strategies likely to promote safer sex practices among African American college students. The Nominal Group Technique (NGT) was used to collect the information. The results yielded the following themes. For males and females, the combined themes, negative views of condoms were ranked the most important with a score of 70. Trust issues were ranked the second most important with a total score of 47. The third highest ranked theme was living for the moment with a total score of 43. The fourth highest ranked theme was feeling invincible with a total score of 42. The authors provide a number of recommendations for consideration in the development of HIV prevention programs for African American college students.     

Perception of reliability of human immunodeficiency virus/AIDS information sources

The sources of human immunodeficiency virus (HIV)/AIDS information as well as the perception of reliability of information from these sources may have a significant impact on the effectiveness of HIV risk reduction messages in reaching high risk populations. We examined the sources of HIV information and the perception of reliability of information from these sources among African Americans (n = 441), Hispanic Americans (n = 456), and whites (n = 297), in Houston, Texas. The data revealed that African Americans and Hispanics were most likely to receive their HIV/AIDS information from the "media" compared with whites who received most of their information from "government agencies and professionals." Information from "family, friends and schools" were regarded as the least reliable by respondents from all three ethnic groups. The data also showed that perceptions of reliability of information sources were influenced by level of educational attainment. Implications for designing target audience-specific intervention strategies for the prevention of the spread of HIV disease are discussed.