HIV risk behaviors in African American males.

Human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) infection is the fifth leading cause of death for people who are 25-44 years in the United States, and is the leading cause of death for African American men ages 35-44. The incidence rates for HIV among African Americans are steadily increasing, despite wide-spread campaigns to educate the public about the disease. The purpose of this article is to review the epidemiology and statistics related to HIV/AIDS, as well as changes in the epidemic among African American males. A review of the literature was conducted which specifically focused on HIV risk behaviors, changing patterns of behavior, and risk modification among African American males. Opportunities for future research are also detailed.     

Adaptation of an HIV prevention curriculum for use with older African American women.

Although African American women over 50 years of age represent the fastest growing group with HIV infection, little attention has been given to their HIV risk reduction needs. This study adapted an HIV risk reduction curriculum for use with older African American women based on input from a sample of women from the target population. Four focus group interviews were conducted with 30 African American women from three churches regarding adaptation of the Sisters Informing Sisters on Topics about AIDS (SISTA) curriculum for older women and the feasibility of implementing the curriculum in a church setting. From these focus group interviews, the authors identified modifications that could be used to adapt the curriculum for older women. After examination of the curriculum, the women expressed increased knowledge of HIV, a sense of bonding with other participants, and willingness to use churches as venues for HIV prevention. Nurses can build upon the study's recommendations to ensure successful implementation of church-based sexuality programs for individuals of all ages.     

Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

PURPOSE: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. METHODS: The sample included 343 opioid-dependent patients enrolled in two national multi-site studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV) risk, and quality of life were examined. RESULTS: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems. CONCLUSIONS: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.     

HIV/AIDS among midlife African American women: an integrated review of literature

HIV occurs among African American women at rates exceeding those among White women, and the prevalence of HIV/AIDS is rising disproportionately among African American adults over 40. The literature between 1987 and 2003 was reviewed for data on prevention and risk taking behavior regarding HIV transmission among midlife African American women. A search of relevant databases revealed four reports specifically targeting African American women aged 40-65. Five reports including this population also included men and other ethnic/racial groups. Content analysis revealed that factors related to risk for HIV included socioeconomic factors, knowledge, perceived vulnerability, sexual assertiveness, and risk taking behavior. Findings suggest that further research on the relationships between sociocultural variables and individual factors may explain prevention and risk taking behaviors in midlife African American women.     

Challenges and opportunities for HIV prevention and care: insights from focus groups of HIV-infected African American men.

Given the inordinate burden of HIV illness borne by African American men, investigations of HIV prevention and care in this population are urgently needed. In this qualitative study, a sample of 20 HIV-infected African American men participated in two focus groups in which they exchanged experiences and ideas about living with HIV. They shared details about how they were personally impacted by HIV, and together they constructed a perspective on the larger societal context in which the HIV infection rate among African American men continues unabated. The men focused on growing complacency about HIV/AIDS in the United States, underfunding of supports and services, stigmas operative in African American communities, and differential care based on race, gender, and diagnosis. They saw opportunity in personal strategies that help individual men infected with HIV to take a more empowered stance to deal with the disease and improve their health but looked for changes undertaken by African Americans at the community level to make a real difference in the epidemic. Their vision included enhanced support for HIV prevention and care from influential community institutions like Black churches, more open dialogue about drugs and sexual behavior, and capacity-building for families whose members are HIV-infected or at risk for HIV.     

Promoting African American women and sexual assertiveness in reducing HIV/AIDS: an analytical review of the research literature

African American women, including adolescents and adults, are disproportionately affected by the transmission of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). HIV/AID is a health disparity issue for African American females in comparison to other ethnic groups. According to data acquired from 33 states in 2005, 64% of women who have HIV/ AIDS are African American women. It is estimated that during 2001-2004, 61% of African Americans under the age of 25 had been living with HIV/AIDS. This article is an analytical review of the literature emphasizing sexual assertiveness of African American women and the gap that exists in research literature on this population. The multifaceted model of HIV risk posits that an interpersonal predictor of risky sexual behavior is sexual assertiveness. The critical themes extracted from a review of the literature reveal the following: (a) sexual assertiveness is related to HIV risk in women, (b) sexual assertiveness and sexual communication are related, and (c) women with low sexual assertiveness are at increased risk of HIV As a result of this comprehensive literature, future research studies need to use models in validating sexual assertiveness interventions in reducing the risk of HIV/AIDS in African American women. HIV/AIDs prevention interventions or future studies need to target reducing the risk factors of HIV/AIDS of African Americans focusing on gender and culture-specific strategies.     

Utility of the AIDS risk assessment for crack cocaine and sex risk behaviours among homeless persons addicted to crack undergoing behavioural day treatment

The primary aim of this study was to assess the impact of an HIV and drug addiction intervention on reported sexual transmission HIV risk and drug use among homeless persons in two treatments for cocaine addiction. The ARA‐C study (n=104) included 74 (71.2%) men and 30 (28.8%) women with an average age of 37.8 (SD=6.9) years. Most participants were African American (90, 86.5%) and the remainder were Caucasian (14, 13.5%). All participants met criteria for homelessness, nonpsychotic mental distress, and admitted to smoking crack cocaine within the 2 weeks prior to treatment. It appears that, overall, behavioural day treatment for cocaine disorders among homeless persons can have a short‐ and long‐term impact on the reduction of sexual transmission HIV risk among this population with a minimal sexual transmission HIV risk intervention. The causal factors of this outcome still remain unclear. Treatment group differences did not sufficiently explain sexual transmission risk reductions and the impact of the HIV risk education programme was impossible to explain because it was provided to all participants and was only a small part of the overall programme. There did seem to be a small contribution of drug abstinence in the reduction of sexually transmitted risk, but this was at one time point for the Sex and Crack subscale only. This study demonstrates that there may be promise in providing drug addiction treatment combined with sexual transmission HIV risk reduction prevention programming for this extremely vulnerable group, and that future interventions should be better designed and tested using more robust research.     

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.     

Two-year follow-up of AIDS education programs for impoverished women

The long-term effects of two culturally competent AIDS education programs with different content on the risk behavior and AIDS-related knowledge of 410 homeless African American women 2 years after program completion were examined. Participants were members of a larger cohort of impoverished African American and Latina women recruited in Los Angeles from 1989 to 1991. Of a subsample of 527 African American women selected randomly for a 2-year follow-up interview, 410 (78%) were located and agreed to participate. Women participating in both AIDS education programs reported reduced HIV risk behaviors and demonstrated greatly improved AIDS knowledge at 2-year follow-up (p < .001). Women in a specialized program were less likely than those in a traditional program to report noninjection drug use at 2 years. Women in the traditional program had significantly better AIDS knowledge at follow-up (p < .001). These findings suggest that educational programs can produce sustained benefits among impoverished women.     

HIV health crisis and African Americans: a cultural perspective.

While incidence of new HIV infections have decreased in the overall population, the numbers continue to rise in African-Americans creating a serious health emergency. Studies seem to imply that part of the rise is due to HIV beliefs and high risk behaviors among African Americans. Due to certain societal factors, African Americans appear to be at greater risk for contracting the virus. This article will examine these critical social factors and their impact on this current state of emergency in the African American community using Leininger's theory of Culture Care and Universality. Implications for health providers are also addressed.     

Influence of communicator's race on efficacy of an HIV/STD prevention intervention among African American and Caucasian college students

ABSTRACT Objectives: The present research examined the influence of communicator's race on the efficacy of intervention videos in the reduction of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among African American and Caucasian college females.
Design: Experimental HIV/STD prevention digital versatile disks (DVDs) featured a White female as a primary or a secondary communicator relative to a Black female, while a control DVD featured 2 Black females. Respondents watched 1 DVD and completed questionnaires before and after viewing the DVD as well as 2 and 4 weeks later.
Sample: 79 African American females and 88 Caucasian females participated.
Measurements: Perceptions of the DVDs, HIV/STD risk, intentions to use condoms, and number of condoms purchased after viewing the videos were assessed.
Results: The intervention was effective in increasing intentions to use condoms with a current partner across the follow-up periods. There was no effect of race of communicator on any variable for African American or Caucasians.
Conclusions: While communicator's race did not affect this intervention, more research is necessary. Future studies should use multiple Black and White communicators to isolate the role of race and should be conducted where larger samples of African American college students can be recruited.     

Parent communication and sexual risk among African Americans

African American adolescents and young adults disproportionately experience adverse sexual health outcomes, including HIV, other sexually transmitted infections, and unintended pregnancy. Despite the diversity of the African American population, many studies of sexual risk are limited to inner-city and clinic samples. The purpose was to examine the influence of parent-teen sexual risk communication on the sexual risk attitudes, beliefs, and behaviors of 488 African American college students from a historically Black university and document the psychometric properties of the Parent-Teen Sexual Risk Communication Scale (PTSRC-III) when used with this population. The PTSRC-III demonstrated excellent internal reliability and construct validity across all four parent-teen communication dyad categories (e.g., mother-son, mother-daughter, father-son, father-daughter). PTSRC was associated with students' reports of more conservative sexual attitudes and beliefs and greater perceived ease of sexual communication with partners. PTSRC with mothers was also associated with fewer sexual risk behaviors and pregnancies among the female students.     

Internet chat rooms: connecting with a new generation of young men of color at risk for HIV infection who have sex with other men.

The purpose of this study was to explore the use of gay-related Internet chat rooms by young men who have sex with other men of color (YMSMC) in a specific catchment area. Participants were 104 YMSMC age 18 to 24 (M = 21.56) who were encountered in two gay-related Internet chat rooms during April 2005. Participants were mainly African American (53.7%, n = 56), HIV-negative (57.6%, n = 60), and online looking for some type of sexual encounter (80.7%, n = 84). The results of this study support the need to develop specific culturally appropriate HIV prevention Internet outreach protocols targeting YMSMC at risk for HIV infection. Lessons learned while conducting this study and recommendations are also discussed.     

An expansion and modification of the information, motivation, and behavioral skills model: implications from a study with African American girls and their mothers

African American females make up a disproportionate number of adolescent HIV cases. Focus groups were conducted to investigate sexual communication between 11- to 14-year-old girls and their mothers. Twenty-eight African American mother-daughter dyads from inner-city community centers participated. Implementing an intervention for families with children requires the use of a framework that is amenable to the development of intervention strategies as well as taking a family approach. The focus of the study was to adapt a leading theory used in interventions for HIV risk reduction at the individual level to be employed with a dyadic relationship between mother and daughter. Following qualitative analysis, data were reexamined according to an expanded and modified version of the Information, Motivation, and Behavioral Skills (IMB) Model. Each of the constructs was represented in the data, and insights for intervention strategies were obtained. However, the IMB model restricted an understanding of the dynamic relationship and the mother-daughter interactions with the community.     

African American adolescent perceptions of vulnerability and resilience to HIV.

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.