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.     

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.     

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.     

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.     

Self-care and mothering in African American women with HIV/AIDS

African American women are the most rapidly growing group of people in the United States diagnosed with HIV/AIDS. The purpose of this study was to explore experiences of self-care and mothering among African American women with HIV/AIDS. It is important to recognize how culture affects illness management, childrearing, and daily living to design culturally appropriate nursing interventions for African American women. Critical ethnography was used to study 10 African American mothers from the rural Southeast who were HIV positive and mothered children who were HIV positive. Domains derived from the research were disabling relationships, strong mothering, and redefining self-care. The cultural theme was creating a life of meaning. African American mothers with HIV/AIDS in the rural Southeast used culturally specific self-care and mothering strategies reflective of cultural traditions. This study acknowledges strengths of African American women and generates theory that will enhance nursing care to this population.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.     

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.     

Toward an Understanding of the Context of Anal Sex Behavior in Ethnic Minority Adolescent Women

Understanding the context of anal sex behavior among ethnic minority adolescent women has public health implications for behavioral sexual health promotion and risk reduction interventions. African-American (n = 94) and Mexican-American (n = 465) women (14–18 years of age) enrolled in a clinical trial completed semi-structured interviews to assess psychosocial and situational factors and relationships to sexual risk behavior, substance use, sexually transmitted infection/HIV acquisition, and violence. Bivariate analyses with comparisons by anal sex experiences identified differences by ethnicity and higher self-reported histories of sexual risk behaviors, substance use, violence, and stressful psychosocial and situational factors among adolescent women experiencing anal sex. Predictors of anal sex identified through logistic regression included Mexican-American ethnicity, ecstasy use, methamphetamine use, childhood sexual molestation, oral sex, and sex with friends for benefits.     

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.     

THE CONTEXT OF SEXUALLY TRANSMITTED DISEASE: LIFE HISTORIES OF WOMAN ABUSE

Approximately 25%-50% of women with sexually transmitted diseases (STDs), including AIDS, are involved in abusive relationships. Numerous characteristics associated with a past history of abuse are also risk factors for STD infection, including multiple partner relationships, substance abuse, early age at first coitus, and partner control of the relationship. Research has identified psychological effects of previous abuse, including depression, minimal control in relationships, and decreased self-efficacy. These effects may prevent abused women with STDs from making behavioral changes to prevent recurrence and transmission of disease. Life history methodology was used to understand the context of the interrelationships between STD and woman abuse in 30 Mexican American and African American women's lives. A focus on the context of abused women's partner relationships and aspects of personal control within these relationships may facilitate effective behavioral change, risk reduction, and subsequent decrease in incidence of STDs and woman abuse.     

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.     

HIV in women in the sex industry and/or injection drug users

Women working in the sex industry are at risk for HIV infection acquired through intravenous drug use or sexual practices with steady sex partners, but there is no evidence that they are transmitting the virus to their customers. Most HIV infection in women in the United States is related to injection drug use (personal or that of a partner). Scapegoating and prejudice toward prostitutes and IVDUs is widespread. Services must be provided with attention to unique social and psychological concerns. Both educational and medical interventions must be sensitive and accessible, and, at times, must be provided outside traditional health care settings.     

The relationships among sexually transmitted infection, depression, and lifetime violence in a sample of predominantly African American women

This study was a secondary analysis of the relationships among lifetime experiences of violence, depressive symptoms, substance use, safer sex behaviors use, and past-year sexually transmitted infection (STI) treatment among a sample of 445 low income, primarily African American women (257 HIV-, 188 HIV+) reporting a male intimate partner within the past year. Twenty-one percent of HIV- and 33% of HIV+ women reported past-year STI treatment. Violence victimization increased women's odds of past-year STI treatment, controlling for HIV status and age. Depressive symptoms increased, and use of safer sex behaviors decreased, women's odds of past-year STI treatment. Results suggest that positive assessment for violence and/or depression indicates need for STI screening.     

Role of women in prevention and control of AIDS

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.     

HIV Infection in Inner-City African American Women: The Role of Optimism in Predicting Depressive Symptomatology

This study examined the role of optimism in longitudinally predicting depressive symptomatology. Participants were 160 inner-city African American women, 96 who reported no history of HIV infection and 64 who reported current HIV infection. HIV-infected women, relative to the women without a history of HIV infection, were less optimistic and had higher levels of depressive symptomatology based on both self-report and interviewer rating. Consistent with the proposed hypothesis, a curvilinear relationship emerged between optimism at Time 1 and depressive symptomatology at Time 2 in both samples. However, the shape of the curve differed substantially for the two samples. As predicted, therewas a U-shaped curve for the noninfected women; however, for the HIV-infected women the curve had an inverted U-shape. We discuss these findings in lightof previous conceptualizations of optimism and psychological functioning, the contextual environment in which the participating women live, unique contributions of HIV to the optimism–depressive symptomatology, and the implicationsfor infected women.