Disclosure decisions of rural African American men living with HIV disease.

A qualitative study was conducted to explore disclosure decisions of rural African American men living with HIV disease. The sample consisted of 20 HIV-infected African American men living in the rural South who had been diagnosed with HIV for at least 6 months. Audiotaped semistructured interviews were used for data determination. The men were questioned about who they had told about their disease, reactions to their disclosures, and their advice to others about disclosing. Results showed that initially the men did not disclose their disease to others, and many of them continued not to disclose. They were concerned about negative consequences such as rejection, fear of contagion, and the recipients telling others. If and when they disclosed, it was likely to be to sexual partners, immediate family members, and health care providers. Their decision not to disclose protected them from the possible negative reactions, but it also limited the amount of social and emotional support they received related to their HIV disease.     

African American caregivers and HIV/AIDS formal resources.

The African American community continues to be disproportionately affected by the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in many ways. In addition to the prevalence rates of the disease in the community, caregivers of people living with HIV/AIDS continue to be challenged as they strive to provide care and support to love ones. The purpose of this pilot study is to explore how African American caregivers of adults living with HIV/AIDS engage available formal resources within their community. African American caregivers (N = 10) were recruited from Long Island, New York and interviewed using unstructured and semi-structured questions. The caregivers' use of community resources were associated with circulating communication within the community about the resource. For example, formal (health & social) resources were recommended and/or accessed if the resource had a positive, historical past of rendering culturally sensitive and medically competent care to the African American community. Recommendations for further study and community- level implications for health care professionals are suggested.     

HIV/AIDS among African Americans and US women: minority and young women

The HIV/AIDS pandemic continues to be a major health crisis facing the African American community. Although African Americans make up only about twelve percent of the U.S. population, they accounted for half of the new HIV infections reported in the United States in 2001. Numerous studies suggest that many new infections occur among young African Americans. In the early 1980s, HIV/AIDS was considered mostly a gay white male disease in the United States. Today, the pandemic has expanded and the disease is also a major health problem in the African American community, where men and women of every age and sexual orientation are affected.     

Understanding the HIV risk reduction needs of heterosexual African American substance-abusing men.

With the increasing prevalence of HIV/AIDS, nurses find themselves caring for diverse populations at risk for HIV. One subpopulation at risk is African American men with a history of substance use. To better understand the risk reduction needs of these men, a focus group was conducted with 16 African American men attending an outpatient drug treatment program in Philadelphia. The purpose was to identify perceptions of HIV risk, engagement in HIV risk behaviors, and barriers to condom use in order to generate recommendations for risk reduction programs tailored to the needs of this population. Results revealed that African American substance-abusing men perceive themselves to be at risk for HIV infection and other adverse health outcomes yet lacked adequate information related to HIV prevention. The need for culture- and gender-specific interventions to reduce HIV-related risk behaviors among African American substance-using men is discussed.     

Reaching African American men: a qualitative analysis

African American men are disproportionately affected by most illnesses and associated complications. These men are also less likely to participate in primary and secondary prevention interventions. Little is known about reaching them. The purpose of this study(1) was to explore factors associated with effectively reaching African American men. Ethnographic methods were used. Key and general informants from an urban Northeastern community were recruited for this study. The data revealed 3 major themes as essential to reaching African American men: a trusted and respected community member providing the outreach, a perceived safe and caring environment during outreach, and a perceived benefit from participating in the outreach. The findings from this study provided a foundation for designing community interventions that will increase participation among African American men. Future research efforts should focus on operationalizing these findings in the community.     

Recruitment,enrollment and retention of young black men for HIV prevention research: Experiences from The 411 for Safe Text project

ObjectiveThere is abundant evidence of the HIV crisis in the black community, yet African Americans—and African American men in particular—are consistently under-represented in research on HIV prevention. The purpose of this paper is to describe the methods used to recruit and retain young black men in Philadelphia for an HIV prevention intervention.MethodsWe formed a partnership between community members, Media Education Entertainment (MEE) Productions, Inc., and academic researchers of the Colorado School of Public Health (CSPH). Recognizing the core principles of community-based participatory research (CBPR), face-to-face recruitment was first conducted by MEE with the assistance of their community partners; subsequent enrollment and data collection were conducted over the telephone by staff in Colorado.ResultsWe enrolled 58% of the young black men recruited, retained 77% of the young men for a follow-up survey at three months, and 65% of the initial enrollees were retained for the six-month follow-up survey. Enrollment staff in Colorado reported initial challenges because of time elapse between recruitment and enrollment as well as participants' unfamiliarity with the enrollment staff. Subsequently, MEE recruitment staff emphasized the telephone area code and specific names of Colorado enrollment staff who would call.ConclusionOur results demonstrate the importance of the community–academic partnership formed and adherence to the principles of CBPR in carrying out this work. Despite challenges in recruitment of racially and ethnically diverse participants for research, we successfully recruited, enrolled, and retained young black men in an HIV prevention program.     

African American women and breast cancer: notes from a study of narrative

Survival after breast cancer and after all cancers is significantly worse for African American women than for others. Although many reasons have been proposed, no studies have explored the reception of messages about breast cancer by African American survivors of this disease, and how public images and discourses about breast cancer affects both their perceived risk for this disease and their experiences of illness. Narrative accounts of their lived experiences with breast cancer were collected from 23 African American survivors of breast cancer. Three themes have emerged: (a) Breast cancer is perceived to be a white woman's disease; (b) cancer is caused by experiences of repeated traumatic heartbreak; and finally, (c) there is a perceived lack of social support and understanding for the unique life experiences of the African American survivor of breast cancer. Nurses are on the front line of patient care. In the context of the managed care environment, they spend more time with patients than other health care providers and are soundboards for many patient concerns. As such, they can use the information provided in this study to inform high-risk women, current patients, partners, and other individuals in the medical community of how African American women might inaccurately access their personal risks for breast cancer, despite the public emphasis on this disease. Through the use of culturally sensitive pamphlets, nurses and other medical practitioners can also open discussions with underserved and minority patients as a means of realistically addressing some of these women's fears about breast cancer. These fears are barriers to effective cancer prevention because these individuals may consciously or unconsciously link a diagnosis of breast cancer, or even behaviors related to cancer prevention, to a potential death sentence.     

HIV infection and community nursing staff in Scotland--2. Knowledge and attitudes

Findings from a survey of community nursing staff in Scotland reveal that there is limited knowledge about many aspects of HIV infection. Respondents were concerned about their lack of experience and knowledge as well as the in-service education that they had received. A substantial minority of community nursing staff felt that they should have the right to refuse to care for HIV-infected patients and those whose lifestyle put them at risk of HIV infection. A majority of staff felt that health professionals who are most at risk of contact with HIV-infected materials should be informed of patients' HIV-antibody status without their consent. There were also some indications of a lack of confidence in service managers and recommendations are made regarding ways of increasing both the knowledge and confidence of front-line staff.     

Understanding the health needs of incarcerated men living with HIV/AIDS: a primary health care approach

Nearly 20% of American men with HIV/AIDS pass through a correctional facility each year. As these men pass through the criminal justice system, discontinuation of health care access and nonadherence to prescribed treatments often occur. Men who are not engaged in health care during and after incarceration are at risk for treatment interruption and disease progression. Correctional facilities are therefore important sites for secondary prevention of HIV/AIDS. Unprecedented scientific attention and resources are currently directed at detecting and treating HIV in the criminal justice system. To support these efforts to increase health care access, we must have a better understanding of the cultural and situational factors that structure opportunities for secondary prevention during incarceration and during the transition from correctional facilities back into the community. This article presents a timely review of the literature on the health needs of incarcerated men living with HIV/AIDS. The author uses the primary health care framework to describe the movement of HIV-positive men through the criminal justice system as a series of strategic opportunities to initiate and establish a process of care. The author concludes that although we understand many of the challenges of providing care to men who become incarcerated, and have evidence of effective health-promoting services, we are only beginning to understand how to make health care services accessible and acceptable to HIV-positive male inmates, and we have not yet used some proven HIV prevention tools.     

Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System

OBJECTIVE: To identify patterns of health behaviors and health outcomes among a sample of American Indian men with spinal cord injury. DESIGN: Telephone interviews with all participants, except those who did not have telephones (they returned materials by mail). SETTING: Large rehabilitation hospital in the Western mountain region of the United States. PARTICIPANTS: Seventy-six American Indian men with traumatic SCI of at least 1 year in duration. MAIN OUTCOME MEASURE: Selected health-related behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) were used to assess health behaviors and general health outcomes among the American Indian SCI sample and to compare findings with those from American Indian men without SCI based on nationwide BRFSS data. RESULTS: The study participants reported lower overall health and satisfaction with health care than the non-SCI BRFSS group. They also reported a different pattern of health behaviors, including a greater frequency of inoculations for flu and pneumonia but a lower rate of HIV testing and cholesterol screening. A smaller percentage of American Indians used alcohol, but those who did reported more heavy drinking. CONCLUSIONS: American Indians with SCI are more likely to receive health care consistent with the prevention of secondary conditions of SCI (eg, pneumonia), but less likely to receive basic health screens intended to prevent chronic health diseases.     

Knowledge and attitudes toward HIV/AIDS and risky sexual behaviors among Caribbean African American female adolescents.

The incidence of HIV/AIDS among African Americans in culturally blended south Florida constantly challenges the health care community to reconsider prevention efforts. Very few studies examine the Caribbean population. This study was performed to identify and describe knowledge and attitudes toward HIV/AIDS and risky sexual behaviors in Caribbean African American female adolescents. Three focus group sessions were conducted using a sample of 22 adolescents. The questions included, "What do you know about HIV/AIDS?" "How would a friend's diagnosis of HIV affect your friendship?" and "Why do your peers engage in risky sexual behaviors?" Adolescents abstained from sexual activity mainly because of parental fear and church teachings. Some had accurate knowledge of HIV/AIDS, but all expressed reluctance to share space and personal items with an HIV/AIDS-infected friend. Sharing personal items with a close friend is a common Caribbean practice. This unwillingness suggests a need and direction for further inquiry.     

HIV infection and community nursing staff in Scotland--1. Experience, practice and education

To assess the effects of human immunodeficiency virus (HIV) for the work of community nursing staff, and to find out how community staff regard their contribution to the prevention of HIV infection, the care of people with AIDS and their preparation for this role was ascertained in a postal survey of one in five field staff carried out in Scotland. The 1,205 respondents represent an 85% response rate. While only 3% of respondents had experience of patients with AIDS, 11% had been involved with known asymptomatic HIV infection and 30% had encountered those they considered to be at high risk of infection. While the workload generated by HIV-infected patients for individual nurses at this time was small, there were variations in the proportions of staff involved according to type of staff and employing health board. Only one-fifth of those who had encountered HIV-positive patients had offered them health education, and fewer had referred patients to their general practitioners or offered counselling. However, community nursing staff do consider that they have a role to play in health education, counselling and terminal care, but feel ill equipped to carry out this role. There is an urgent need for policies which clearly specify the roles that community nursing staff should be playing and for in-service education programmes which assist them to draw on the knowledge and skills that they have to enable them to apply them to help patients with HIV infection.     

Health beliefs and high-risk sexual behaviors among HIV-infected African American men.

The purpose of this study was to describe whether the health beliefs of HIV-infected African American heterosexual men and men who have sex with men predict condom use during anal, vaginal, and oral sex. The sample consisted of 130 HIV-infected African American men with a mean age of 46 years. Multiple logistic regression analysis showed that the odds of noncondom use during anal sex was highest among heterosexual men and those with perceived barriers to condoms. Furthermore, participants without a relationship and those not discussing safe sex with their partners were more likely not to use condoms during vaginal sex.     

Parenting and Child Outcomes of HIV-Infected African American Mothers: A Literature Review

Parenting young children while living with HIV is an important public health concern. This article reviews maternal HIV and the impact it has on the parenting experience of African American mothers. Because living with HIV has been considered a family illness, the Family Systems Model provided a framework for this article. The model demonstrated an important link between maternal HIV and its impact on the health and wellbeing of not only the mother and her children, but her parenting and family roles as well. Research has documented an association between maternal HIV and negative parent–child outcomes among African American mothers. I examined studies on parenting and child outcomes among African American mothers living with HIV. The review assists in conceptualizing parenting with HIV as an area of increasing importance in health services delivery to HIV-infected African American mothers who are caring for young children.     

An HIV self-care symptom management intervention for African American mothers

BACKGROUND: Human immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes. OBJECTIVE: This study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV. METHOD: Women caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function). RESULTS: Regarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group. CONCLUSIONS: The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.     

Factors influencing HIV-risk behaviors among HIV-positive urban African Americans.

Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions.