In our grandmother's footsteps: perceptions of being strong in African American women with HIV/AIDS

One of the most significant challenges facing the health of black women in the 21st century is the growing numbers of human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) infections. An ethnographic study of African American mothers living with HIV/AIDS revealed that they believed in a tradition and heritage of strength that fostered their survival during difficult life experiences such as living and mothering with HIV/AIDS. They enacted this strength in culturally significant ways. This article discusses the importance of recognizing and supporting cultural strengths of African American women to help manage illness, while remaining cognizant of the context of oppression, discrimination, and stigma that distort cultural traditions and instead penalize women when they are ill.     

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.     

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.     

Social roles and health in women living with HIV/AIDS: A pilot study.

The purpose of this report is to share results from a pilot study about the social role experiences and health of women living with HIV/AIDS. This pilot was designed as part of a larger study undertaken to ensure cultural competence of measures and methods proposed for testing a model of role quality and health in culturally diverse low-income women. Thirteen women participated in the study (69% African American; 77% less than dollar 10,000 annual income; range of years since HIV diagnosis, 3-21). Measures of physical health, role quality, and psychological well-being previously used to test relationships among the variables in women with chronic illness were administered using a face-to-face interview format. Results indicated that the women experienced a number of HIV symptoms and coexisting health problems, moderate physical limitations, positive perceptions of their roles, moderate levels of well-being, and high depression scores. The pilot study represents the first step in the development of a theory-based approach to understanding linkages among health and role quality in women with HIV.     

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.     

The politics of invisibility: HIV-positive women who have sex with women and their struggle for support.

HIV-positive women who have sex with women (WSW) have been routinely overlooked by government researchers, health care providers, and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income African American and Latina HIV-positive WSW in particular face culturally based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work, and abuse. By analyzing 16 intensive interviews with low-income HIV-positive WSW of color, the author examined the physical, emotional, and psychological needs of this population and their methods of coping with HIV. Also examined were the participants' perceptions of available support networks, which were examined in order to raise awareness of the complex battle fought by these women against HIV and homophobia in the face of greater social, cultural, and economic strife.     

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.     

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.     

The practices of mothering in caregiving an adult son with AIDS

One invisible and silent phenomenon associated with the acquired immune deficiency syndrome (AIDS) epidemic is the return of mothers to care for their adult sons who are dying of the disease. This article presents an emergent fit of data from an interpretative study with 14 such mothers into Leonard's practices of mothering framework. Conceptualizing mothering as a practice rather than a technical skill provides a context for understanding nurture and care. The mothers' stories reveal moral content of mothering that is centrally important to cultural life, as well as implications for nursing practice.     

Our Children,Our Hope: Voices of African American Mothers Living with HIV and Rearing Uninfected Children

Parenting school-aged children while living with HIV has been associated with significant consequences for African American mothers. This article presents and discusses the results of a qualitative study that examined the parenting experiences of HIV-infected African American mothers rearing young children. A sample of 8 inner-city, African American mothers of uninfected preschool-aged children were interviewed individually. Interview guide questions explored day-to-day childcare activities from the mothers’ perspective. Five themes emerged: role of mothering, doing it all, less time for self, fear, and hope. Findings can be used to guide the development of programs to support HIV-infected mothers rearing young children.     

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.     

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.     

Rural nursing students' knowledge, attitudes, and beliefs about HIV/AIDS: a research brief.

The purpose of this study was to explore rural student nurses' knowledge, attitudes, and beliefs about caring for people with HIV/AIDS. The results from this study were consistent with other past studies where judgmental attitudes toward patients with HIV/AIDS were demonstrated. Data indicate that nursing students' attitudes, beliefs, and knowledge about HIV/AIDS have not changed over the past decade. Based on these findings, many implications for nurse educators exist. Nurse educators need to examine approaches to teaching about HIV/AIDS that can increase knowledge and influence the actual treatment of individuals who have this disease. In addition, the focus for rural nursing programs should be on increasing the understanding of the impact of HIV/AIDS on rural communities and to help project future needs for HIV/AIDS-related services.     

Investing in self-care: a midrange theory of self-care grounded in the lived experience of low-income HIV-positive white women

Little is known about the types of interventions that invite low-income women into partnerships that motivate self-care practices when living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The increasing incidence of HIV infection in low-income women with histories of inattention to self-care calls for nursing theories that address self-care practices. The purpose of this article is to describe a midrange theory developed from grounded theory research and to discuss implications of theoretical construction for future knowledge development. For the 12 women in this study, self-care practices developed over time and through four categories: focusing self, fitting resources, feeling emotions, and finding meaning. The core category, investing in self-care, linked the categories and carried explanatory power for developing midrange theory. Implications for nursing knowledge development through partnerships with low-income women are discussed.     

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.     

The impact of HIV/AIDS on the African American woman and child: epidemiology, cultural and psychosocial issues and nursing management.

The approach to understanding the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) must include the African American woman and children as persons at high risk. This information must be documented in all epidemiology, cultural and psychosocial aspects of care, and nursing management reports. Approximately twenty years after it was first recognized, AIDS is still traveling across the globe at full speed, with very little brake power. In the United States, the African American heterosexual woman continues to be the fastest growing group of persons with the acquired immunodeficiency syndrome. The proportion of cases increased drastically in the period from 1993 to October 1995, with women totaling 18 percent of the total cases (Newman & Wofsy, 1997). The impact that cultural and psychological issues have had on women and children living with HIV or AIDS is immense, involving not only the potential burdens of physical deterioration, but also the stress of accompanying lifestyle and role changes. These issues involve processes in adjusting and adapting to HIV infection that are important not only because of their centrality to the coping individual, but because they directly affect the success of treatment and prevention (Jaccard, Wilson & Radecki, 1995).     

African American mothers use stories for family sexuality education

PURPOSE: To examine the sexual knowledge and cultural values transmitted by stories from African American mothers to their adolescent daughters. METHOD: Narrative analysis. Stories from 11 mothers were recorded and transcribed by entering interview narratives into Qualpro, a computerized data management program, and examined using a narrative analysis method. RESULTS: Analysis revealed that mothers used story telling as a strategy for family sexuality education. The mothers used stories from their own experiences to accomplish socialization/enculturation and to discourage their daughters from making the same mistakes that they reportedly made (such as becoming pregnant during the teenage years). Findings supported the fact that stories served as cultural artifacts that describe the cultural pathways of a group of African Americans mothers and daughters. IMPLICATIONS: It is important for nurses to have an awareness of the importance of ethnocentric models for community health nursing practice and culturally sensitive assessment tools for adolescent sexuality education programs.     

Taking action in communities: women living with HIV/AIDS lead the way

For the past 5 years, a successful collaboration of a medical center, a community-based HIV/AIDS service organization, a university school of nursing, and women living with HIV/AIDS in an inner city community resulted in a series of educational programs1 for women living with HIV/AIDS, their family, friends and caregivers. These programs were intended to provide inner-city women who were living with HIV/AIDS with knowledge and new insights from the voices of their peers. Topics focused on their self-care and empowerment so that they could take control of their wellness and their health care while remaining in their community. The efforts made in launching the collaborative educational series created trusting relationships between academic, clinical, and community service agencies, professional caregivers, and the recipients of their care. The most significant contribution belonged to the women living with HIV/AIDS themselves: After the programming they turned their health and life experiences into "action" by planning a research project that will test the efficacy of an intergenerational HIV prevention program for adolescent women of color in their community in the future.     

Role of spirituality in HIV-infected mothers

The purpose of this study was to describe the processes by which HIV-infected mothers manage mothering. A semi-structured guide was used to facilitate discussion from a convenience sample of 15 mothers. The core category was "The Process of Living for My Children." "Leaning on God" was a part of "Taking Care of Myself" and reflected the ways in which the mothers used spiritual aspects to manage mothering and live with HIV infection. Leaning on God was an important tool in managing mothering and self-care. Health care providers can enhance this tool by being aware of their own values and beliefs.