Risk behavior, perceptions of HIV risk, and risk-reduction behavior among a small group of rural African American women who use drugs.

HIV/AIDS is a health crisis for African Americans. African American women are exposed to HIV primarily through sexual behavior, which is an increased risk for women who use drugs. The study design was a mixed method consisting of an ethnography with ongoing participant observation and in-depth interviews and a questionnaire. The purpose of the questionnaire component was to explore drug use, sexual behavior, health history, and perceptions. The questionnaire was administered at months 6 and 18. Data for this report were derived from the first questionnaire with 30 respondents. The majority of respondents (82.7%) used polysubstances consisting of cocaine, marijuana, and alcohol. Between 33% and 50% exchanged sex for drugs or money, with less than half ever using condoms. About 37% perceived that they had no risk of acquiring HIV, whereas 52% perceived a 25% chance. The pattern of HIV testing in which 33% of the women were tested 10 times or more was unexpected because of the low perception of risk. The principal conclusion was that there is great need to intervene with prevention efforts targeting rural women who use drugs in an attempt to curb increasing rates of sexually transmitted infections including HIV.     

Promoting sexual health in black African women who have HIV

There is an upwards trend of HIV infection in women and in particular women from sub-Saharan Africa. The clinical nurse specialist has a pivotal role in promoting sexual and reproductive health and must educate and discuss how transmission risks can be reduced, particularly for those in relationships where only one partner has HIV.     

HIV risk reduction strategies for low-income African American women

Intervention strategies from the Health Education Reaching Out into the Community project that can be used in the clinical setting to assist low-income African American women adopt sexual behavior that is low risk for human immunodeficiency virus are discussed. These strategies include allocation of adequate time, the nurse practitioner's acceptance of the client, the use of adult learning principles, and active client participation through discussion, return demonstration, role play, and promotion of the client's ownership of the information learned.     

The measurement of HIV risk level in African American women who dwell in the Southeastern United States.

African American women are the group most heavily afflicted with heterosexually transmitted HIV. The southeastern United States suffers a disproportionate degree of this burden. The purpose of this study was to present the psychometric testing of the HIV Risk Behavior Questionnaire, which was designed and tested for use in this population. The instrument, initially comprised of 32 items, was screened for face validity by experts in the field. This resulted in a revised 28-item instrument. Internal consistency was tested in 74 subjects and yielded Cronbach's a of 0.74. High interitem correlations coupled with similarity between the items resulted in the elimination of three additional items. The final 25-item instrument was then administered to 304 subjects, with Cronbach's a of 0.82. Factor analysis yielded a four-factor solution: barrier/fluid avoidance modalities, survival sex, sexual communications, and factors that increase sexual risk. This indicated the complex multidimensional variables that affect sexual risk. Construct validity was then established through correlation with existing instruments of assertiveness and personal control, using an additional sample of 131 subjects.     

Preconception care & pregnancy planning: voices of African American women

PURPOSE: This study aimed to investigate the intersection of women's pregnancy planning beliefs with preconception care barriers. We assessed the meaning of "planned pregnancy" for African American women and explored its connection to preconception experiences. The role of race and economics as contextualizing women's experiences was considered. STUDY DESIGN/METHODS: African American women (n = 168) recruited from health department sites discussed the following questions: "What does the term 'planned pregnancy' mean?" "Would you describe your most recent pregnancy as planned?" Substantive themes were extracted using phenomenological methodology. RESULTS: The following themes emerged: (1) Preconception care: An unfamiliar concept; (2) Planning for pregnancy: A continuum of responses; (3) The psychology of conception: Attitudes, beliefs, and behaviors; (4) The shared nature of pregnancy: It takes two to plan; (5) Birth control: The means to the end; and (6) The context of preconception care: The big picture. CLINICAL IMPLICATIONS: Nurses who care for women in the childbearing years should understand that planning for pregnancy is not a simple cognitive process, and that race and economics play a role in women's beliefs about pregnancy. Preconception care also encompasses the contexts of family, public health, and society. Linking preconception care with all medical encounters is an important but insufficient approach. Nurses should apply their understanding of the biopsychosocial dimensions of health in support of the goals of preconception healthcare. Holistic nursing and public health perspectives should be considered to broaden the scope of preconception interventions and more effectively address social factors that influence preconception care.     

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.     

From their own voices: the lived experience of African American registered nurses.

This phenomenological study described the lived experience of African American registered nurses providing nursing care to individuals, families, and communities in southeast Louisiana. Data were collected from 13 African American registered nurses using semistructured interviews and a focus group. Analysis of the phenomenological data revealed two essential themes, (a) connecting with the patient and (b) proving yourself; and four incidental themes, (a) a fulfilling dream, (b) being invisible and voiceless, (c) surviving and persevering, and (d) mentoring and role modeling. The findings revealed that the general perception among participants was that they were not fully accepted as equal professionals by their Caucasian nurse colleagues, other health care providers, and sometimes patients. The findings of the study indicate the immediate need to address and resolve the issues of diversity within the nursing profession. Nursing will also have to reform its system and practices to embrace and support diversity.     

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.     

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.     

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.     

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.     

Reducing substance use and risky sexual behavior among young, low-income, Mexican-American women: comparison of two interventions.

A pre-posttest, randomized pilot study evaluated the effect of two selective prevention interventions on knowledge, attitudes, intentions, and behaviors to prevent and/or reduce substance use and risky sexual behaviors among 50 predominantly Mexican-American, low-income young women. Women were randomly assigned to either a risk and resilience workshop or a health information correspondence course. Comparison tests using t tests and chi-square analyses were conducted to determine the baseline equivalence and pre- and posttest effects of the interventions. Both interventions had consistently similar effects. Neither significantly decreased use of alcohol or cigarettes. Both interventions significantly improved attitude, sexual self-efficacy, and resilience scores. Contraceptive use increased among women in partnered relationships, and both condom use and contraceptive use increased among sexually active, single young women. Both interventions also had significant positive effects on reported ability to discuss precautions to prevent human immunodeficiency virus/acquired immunodeficiency syndrome with sexual partners. Study limitations and implications for clinical practice and future research are provided.     

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.     

Prenatal care utilization among low-income African American women

The purpose of this study was to assess prenatal care utilization among low-income African American women, examine the relations of demographic and other selected variables to the adequacy of prenatal care utilization, and to describe the women's positive and negative experiences with prenatal care. The sample consisted of 126 African American women who had a child 1 year old or younger. A structured interview developed by the investigator was used. Adequacy of prenatal care utilization (APNCU) was calculated using Kotelchuck's index (Kotelchuck, 1994b). The findings indicated that 13% of the women did not receive any prenatal care and that only 50.8% of the women had adequate utilization of prenatal care. Women who perceived prenatal care as important utilized the services significantly more than other women, chi 2(1, N = 126) = 8.04, p = .01. Demographic variables, presence of health problems during pregnancy, and whether or not pregnancy was planned were not significantly related to APNCU. Several positive aspects of prenatal care were expressed by the women, and 24% of those who obtained care stated that there was nothing negative about it. The negative experiences mentioned by some women were clinic waiting time, waking up in the morning, transportation difficulties, having morning sickness, and disliking seeing a doctor.     

Condom use predictors for low-income African American women

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.