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.     

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.     

A prevalence study of faith-based healing in the rural southeastern United States

BACKGROUND: Although prayer and other spiritual practices are common among residents of the rural south, the use of faith-based healers (FBH), or healers who use prayer as their primary healing modality, has not been explored in this population. METHODS: Secondary data analysis from a random digit dialing telephone survey of rural adults in eight southern states. RESULTS: Our overall response rate was 51% and 193 subjects (4.1%) had seen an FBH practitioner within the previous year. FBH use was significantly more common among younger respondents (OR 7.21, 95% Ci 2.00, 25.94), women (OR 1.49, 95% CI 1.03, 2.14), those reporting poorer health (OR 1.83, 95% CI 1.19, 2.83), and those who believed in avoiding physicians (OR 1.82, 95% CI 1.24, 2.67). A relationship between FBH use and delayed or foregone medical care, and cost as a barrier to obtaining care was not statistically significant after controlling for other factors. CONCLUSIONS: Prevalence of FBH use is low, but is significantly related to younger age, female gender, poorer health status, barriers to medical care and devaluing medical care. Clinicians may consider exploring FBH usage with their younger, female patients, and those in poorer health. Policy makers should consider how FBH usage is related to various indicators of health care services demand, utilization and access.     

Pemphigus in the southeastern United States

BACKGROUND: Our purpose was to review the course and management of pemphigus treated at a tertiary care center in the southeastern United States. METHODS: We describe 30 patients seen at the Emory Clinic from January 1992 to July 1999. RESULTS: Equal numbers of men and women from different ethnic backgrounds were affected. Pemphigus vulgaris was more common than pemphigus foliaceous. Pain, sore throat, and pruritus were the most common presenting symptoms. The mean diagnostic delay was 6 months in patients with pemphigus foliaceous and 4.5 months in patients with pemphigus vulgaris. Hospitalization was required in 47% of patients. Adjuvant therapy in addition to systemic orticosteroids was required in 93%. Herpes gingivostomatitis occurred in 33%. Clinical or total remission was obtained in 33%. CONCLUSIONS: Pemphigus occurs in multiple ethnic groups in the southeastern United States. Appropriate treatment is frequently delayed by lack of prompt diagnosis. The complications of pemphigus and its therapy were significant.     

A portrait of HIV infection among men in the United States.

HIV/AIDS has been a major public health problem in the United States for over 25 years and has significantly contributed to morbidity and mortality among men. At the onset of the HIV/AIDS epidemic, White men were predominantly affected, representing 95% of the cases in 1982. Over time, the burden of disease shifted from White men to Black and Hispanic men. Currently, Blacks and Hispanics represent 64% of the men living with HIV. AIDS is the sixth leading cause of death for Black men and the tenth leading cause of death for Hispanic men. Because the transmission of HIV is predominantly behavior-driven, it is imperative that nurses have open, honest discussions with clients about their behaviors.     

Sledding injuries in the southeastern United States

BACKGROUND: Heavy ice and snow accumulation combined with record low temperatures in Chattanooga, Tennessee, from February 2-6, 1996, contributed to many sledding injuries. METHODS: We retrospectively reviewed medical records of emergency visits to seven area hospitals from February 2-6, 1996. We further reviewed sledding injury records. Sledding was defined as sliding on snow or ice using any device except skis. RESULTS: Of 2,134 emergency room visits, 241 patients had 310 sledding injuries. Ages of patients ranged from 3 to 53 years (mean, 18.9; median, 16). One hundred twenty-eight injuries were severe. These included extremity injuries (65), head injuries (28), chest injuries (10), intra-abdominal injuries (10), vertebral column fractures (11), and pelvic fractures (4). Thirty-six patients required inpatient hospitalization; 18 had surgery. The minimum healthcare costs associated with these injuries were estimated at $220,000. CONCLUSIONS: Major trauma potential is associated with sledding, especially where significant winter storms are uncommon. Level I trauma centers should seasonally incorporate sledding safety into community-wide injury prevention programs.     

Mycobacterium xenopi pneumonia in the southeastern United States

Mycobacterium xenopi (M. xenopi) is a slow-growing, nontuberculous mycobacterium (NTM). This organism is found in fresh water and has been isolated in water samples collected from water systems in homes and hospitals. Before the acquired immunodeficiency syndrome epidemic, M. xenopi infection was infrequent and occurred in clusters; however, M. xenopi is now a recognized cause of pulmonary infection in immunocompetent patients with preexisting lung disease. The classic chest x-ray appearance is cavitary apical pulmonary disease, which mimics tuberculosis. M. xenopi is currently one of the most common NTM pathogens in parts of England and Canada and has been reported in parts of the northeastern United States. Whether the isolation of M. xenopi from our patient in Tennessee represents a new geographic distribution of this organism or technologic advancements that now allow for reliable identification is debatable. This case serves as a reminder to clinicians that the incidence of NTM infection is rising in the United States and that unusual NTM are capable of causing disease even in patients who are not immunocompromised.     

African American women's coping with health care prejudice

African American clients have reported racism and prejudice in health care; yet there is limited documentation of the strategies used to cope with these experiences. This study describes African American women's perceptions of prejudice in health care and the strategies used to cope with the experiences. This qualitative study used the constructivist perspective of interpretive interactionism for paradigmatic and methodological guidance. Participants were 20 women ranging from age 26 to 74 years with 50% having a high school education. Individual interviews consisting of five areas were conducted with three instruments measuring ethnic identity, socioeconomic status, and general demographics. The analyses provide two themes: experience with the "White health care system" and strategies for coping with the prejudice, which included getting angry, learning to unlearn, being assertive, and walking away. Consistent with the discussions of race in the United States, racism in health care has become a subtle entity that infuses health care relationships.     

Nurses' agricultural education in the southeastern United States

The number of nurses across the United States with expertise in agricultural health nursing is unknown, yet as many as 8,000 are needed. This article describes agricultural health content in nursing programs in the southeastern United States. Agriculture is primarily family based but ranks among the top three most hazardous industries in America. Nurses in the southeastern United States serve more than 541,000 farm families, more than a quarter of the nation's agricultural population. A 15-item survey was mailed to 185 nursing schools located within 13 southeastern states. Information was requested about undergraduate and graduate curricula that included information about agricultural health and safety. Surveys were returned from 113 programs (61.1%). Schools with larger percentages of rural students were more likely to include mention of agricultural health; however, scant attention was given to any rurally focused content. In 27.4% of the schools, no mention of agricultural health issues was made, and 54.0% of nursing faculty who completed the survey were not aware of the need for nurses with agricultural health expertise. Results suggested that, when agricultural health topics were presented in class, student interest in the topic increased. Given the occupational hazards faced in agriculture and the region's economic dependence on agriculture, increased attention should be focused on agricultural health content within nursing programs.     

HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States

This article reviews 35 U.S. studies on the intersection of HIV and adult intimate partner violence (IPV). Most studies describe rates of IPV among women at risk or living with HIV/AIDS and identify correlates, using multiple types of convenience samples (e.g., women in methadone treatment, women in shelters or clinics), cross-sectional designs, and self-reported risk behaviors. HIV-positive women appear to experience any IPV at rates comparable to HIV-negative women from the same underlying populations; however, their abuse seems to be more frequent and more severe. The authors found only four relevant interventions and none addressed sexually transmitted HIV and partner violence risk reduction simultaneously. There is a critical need for research on (a) causal pathways and cumulative effects of the syndemic issues of violence, HIV, and substance abuse and (b) interventions that target IPV victims at risk for HIV, as well as HIV-positive women who may be experiencing IPV.     

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.     

The experience of African American women living with HIV: creating a prevention film for teens.

The personal and social costs of HIV are well documented. What remains unknown is the effect of public disclosure of HIV status on the individual who is doing the disclosing. This study describes the experience of four African American women living with HIV who participated in the development of an intergenerational education intervention for African American adolescent girls. These women suggested that they be filmed discussing the "dark side" of HIV in an effort to create an intergenerational education intervention that would alter the risk-taking behavior that they observed in young women in their community. After a rough cut of the film was completed, these women viewed the film and participated in a focus group during which they discussed what it was like to reveal and revisit their own painful experiences associated with becoming infected and then living with HIV. Findings from content analysis of transcribed dialogue included the following positive themes: (a) self-acceptance by telling one's own story and hearing the stories of the other women, (b) a sense of liberation by disclosing publicly one's image and message and letting go of others' judgments, (c) feeling supported by meeting other women who share the same experience, (d) value of using the film to impact or save young people from the pain one has experienced. A negative theme emerged related to personal pain in reliving the individual's history with HIV.     

Physical and mental health in African American mothers with HIV.

This article examines the physical and mental health of African American mothers during a 2-year period following the birth of an infant seropositive for human immunodeficiency virus (HIV). Participants were 34 African American mothers enrolled when the infants were approximately 3 months of age and reinterviewed when the infants were 6, 12, 18, and 24 months. Three self-report questionnaires were used to assess physical health (perception of health, activity limitation, and physical symptoms) and mental health (depressive symptoms and stigma). Health symptoms most often reported were infections, problems thinking and remembering, low energy, and gynecologic problems. Moderate levels of perceived stigma were reported. Depressive symptoms were high; a large number of women at each data point had depressive symptom scores above the cutoff, indicating risk for depression. There were significant correlations between depressive symptoms and health, suggesting a link between mental and physical health. These findings have significance for the health of the mother and the parenting of her infant. Attention should be paid to the mental and physical health of mothers with HIV, especially during the first 2 years after the birth of a child.     

Equity of African American Men in Headache in the United States: A Perspective From African American Headache Medicine Specialists (Part 2)

In part 1 of this opinion piece, we described inherent and potential challenges of the equity of African American (AA) men in headache medicine including headache disparities, mistrust, understudied/lack of representation in research, cultural differences, implicit/explicit bias, and the diversity tax. We shared personal experiences related to headache medicine likely faced due to the color of our skin. In part 2, we offer possible solutions to achieve equity for AA men in headache including: (1) addressing head and facial pain disparities and mistrust in AA men; (2) professionalism and inclusion; (3) organizational/departmental leadership buy-in for racial diversity; (4) implicit/explicit and other bias training; (5) diversity panels with open discussion; (6) addressing diversity tax; (7) senior mentorship; (8) increased opportunities for noteworthy and important roles; (9) forming and building alliances and partnerships; (10) diversity leadership training programs; (11) headache awareness, education, and literacy with a focus to underrepresented in medicine trainees and institutions; and (12) focused and supported the recruitment of AA men into headache medicine.