Supporting South Asian carers and those they care for: the role of the primary health care team.

BACKGROUND: Demographic and socioeconomic changes have increased policy interest in informal carers. However, despite the multicultural nature of British society, most research in this field has been in majority communities. AIM: To explore the role of the primary health care team (PHCT) in supporting carers from British South Asian communities. DESIGN OF STUDY: Qualitative study. SETTING: Four South Asian communities in Leicestershire and West Yorkshire. METHODS: Focus groups and in-depth interviews were used to assess male and female carers, supported by a literature review. RESULTS: Failure to recognise carers' needs, gaps in service provision, and communication and language issues compromised carers' ability to care. While some carers were positive about the PHCT role, the main weaknesses concerned poor consultation, PHCT attitudes towards carers, and access to appropriate services. CONCLUSION: South Asian carers' experiences largely parallel those of others, but there are some issues that are distinct, namely, language and communication barriers, culturally inappropriate services, and implicit or explicit racism. The multi-ethnic nature of Great Britain requires that professional practice enhances the ability of minority ethnic communities to provide informal care. The findings underline the important role of the PHCT in ensuring that carers' needs are taken seriously and that appropriate services reach them.     

Issues of human rights and HIV. Guest commentary

The AIDS pandemic has not spread in a social and economic vacuum. Indeed, HIV and AIDS have spread in the context of widespread poverty, sexism, racism, homophobia, and heterosexism throughout most nations of the world. Globally, communities have been allowed to reject or ignore that the spread of HIV/AIDS is symptomatic of underlying social injustices. It is, however, extremely difficult to combat AIDS in the context of poverty, gay bashing, low women's status, and overt violence against HIV-seropositive individuals, notably in Russia, Mexico, and the US. It is clear even at the policy level that countries around the world are still ignorant about HIV/AIDS and violate the human rights of infected individuals. US immigration and entry restrictions against HIV-seropositive individuals is but one example of such policy. Discrimination also extends down to the fundamental need for and provision of health care to people with AIDS. These individuals are stigmatized by health care workers, discriminated against when receiving treatment, or simply denied health care services. Shapiro et al's study found that 23% of young American medical residents would not care for AIDS patients if they had a choice. The study also found that 39% of surgeons or other medical specialists have refused care to at least one of the HIV-infected patients in the respondent physicians' care. Governments must act to ensure that such discrimination is eradicated. Each country must reassess its laws which directly affect the lives of people who are most at risk, eschewing anti-gay rights initiatives and the criminalization of prostitution.     

RACISM IN ORGANIZATIONS: THE CASE OF A COUNTY PUBLIC HEALTH DEPARTMENT

Racism is part of the foundation of U.S. society and institutions, yet few studies in community psychology or organizational studies have examined how racism affects organizations. This paper proposes a conceptual framework of institutional racism, which describes how, in spite of professional standards and ethics, racism functions within organizations to adversely affect the quality of services, the organizational climate, and staff job satisfaction and morale. Grounded in systems theory and organizational empowerment, the framework is based on data that describe how racism was made manifest in a county public health department. The findings highlight the importance of understanding how organizations are influenced by external forces and can negatively affect clients, communities, and their own staff members.     

Perceptions of racism by black medical students attending white medical schools

Thirty-one black medical students attending five white medical schools were seen in individual interviews of one to two hours to evaluate their perceptions of racism in their medical school education. The interviews focused on racism experienced in high school, college, and medical school. Over one half of the population experienced racism during their high school and college education, while 30 of 31 subjects reported racist experiences in their medical school education. The students reported a variety of methods of coping with racist experiences and emphasized the importance of fellow minority students, faculty, and the minority office in coping with the stresses of racist experiences. Those offering counseling services to minority students should recognize the reality of racist experiences in medical education.     

Comparing the epidemic in U.S. and Britain

Cultural differences between the United States and Britain influence how the AIDS/HIV epidemic is being addressed and why AIDS rates are smaller in the United Kingdom. The author proposes that highly diverse and racist societies, like in the United States, may cause distrust among different groups in the effort to challenge the spread of HIV/AIDS, leaving people to fend for themselves. Because of racism and distrust between ethnic and racial groups, as well as differences in financial resources between groups, the AIDS epidemic in the United States is being fought on too many fronts without the benefit of a uniform response. Ironically, this problem has also spurred a greater ability among US AIDS service providers to work with diverse communities during the course of the epidemic.     

HIV/AIDS and the Black Church: what are the barriers to prevention services?

The HIV/AIDS epidemic continues to have a devastating impact on the black community in the United States. Trusted community institutions within the black community--the Black Church among them--have often been reluctant to respond to the epidemic in a manner commensurate with the scope of the problem. The aim of the current study was to understand the barriers to HIV/AIDS prevention services offered by black churches in a northeastern metropolitan area by surveying the ministers who lead the churches. METHODS: The study team constructed a 25-item questionnaire that asked questions about the ministers' and congregational demographics as well as general health and/or HIV/AIDS prevention services offered by the churches. The overall response rate was 82% (N=18). RESULTS: 83.3% (N=15) of the ministers surveyed reported financial barriers as reason for not providing HIV/AIDS prevention services. A majority of the ministers also perceived HIV/AIDS to be a problem in their communities. DISCUSSION: The resource-related nature of the barriers and the eagerness of the ministers to get more involved suggest that fostering creative partnerships between AIDS service organizations and churches may encourage more churches to offer HIV/AIDS prevention programming in a culturally acceptable manner.     

Combating effects of racism through a cultural immersion medical education program.

The purpose of this paper is to provide a perspective from New Zealand on the role of medical education in addressing racism in medicine. There is increasing recognition of racism in health care and its adverse effects on the health status of minority populations in many Western countries. New Zealand nursing curricula have introduced the concept of cultural safety as a means of conveying the idea that cultural factors critically influence the relationship between carer and patient. Cultural safety aims to minimize any assault on the patient's cultural identity. However, despite the work of various researchers and educators, there is little to suggest that undergraduate medical curricula pay much attention yet to the impact of racism on medical education and medical practice. The authors describe a cultural immersion program for third-year medical students in New Zealand and discuss some of the strengths and weaknesses of such an approach. The program is believed to have great potential as a method of consciousness raising among medical students to counter the insidious effects of non-conscious inherited racism. Apart from the educational benefits, the program has fostered a strong working relationship between an indigenous health care organization and the medical school. In general, it is hoped that such programs will help medical educators to engage more actively with the issue of racism and be prepared to experiment with novel approaches to teaching and learning. More specifically, the principles of cultural immersion, informed by the concept of cultural safety, could be adapted to indigenous and minority groups in urban settings to provide medical students with the foundations for a lifelong commitment to practicing medicine in a culturally safe manner.     

HIV/AIDS behind bars: an avenue for culturally sensitive interventions.

The prevalence of HIV infection and the incidence of AIDS are higher among prison inmates compared to the general population. Although African Americans and Hispanics constitute approximately 13% and 12.5% of the population, respectively, they are over-represented among the prison population. The current trend in the adult/adolescent AIDS cases among African Americans and Hispanics outpaces that of the white population. The sociodemographic data of HIV/AIDS looks similar to the sociodemographics of U.S. prisons. This suggests that there may be a link between HIV transmission in prison and the current AIDS epidemic in the community. In addition, this high incidence is also a reflection of the high-risk lifestyle of the incarcerated population. High-risk behavior common among the incarcerated and inner city minority communities includes injection drug use, sharing of drugs and drug paraphernalia, and multiple sex partners. HIV transmission risk-reduction efforts such as mandatory screening of inmates, preventive HIV/AIDS education, and appropriate and adequate therapeutic management are essential to curtail the epidemic. However, any HIV/AIDS reduction program for minority communities must include culturally sensitive interventions.     

Racism, psychosis and common mental disorder among ethnic minority groups in England

BACKGROUND: The aim of this study was to explore the relationship between risk of psychosis, common mental disorder (CMD) and indicators of racism among ethnic minority groups in England and how this relationship may vary by particular ethnic groups.METHOD: A multivariate analysis was carried out of quantitative, cross-sectional data from a nationally representative community sample of people aged between 16 and 74 years from the largest ethnic minority groups in England: those of Caribbean, Indian, Pakistani, Bangladeshi and Irish origin.RESULTS: Experience of interpersonal racism and perceiving racism in the wider society each have independent effects on the risk of CMD and psychosis, after controlling for the effects of gender, age and socio-economic status. There was some variation in the findings when they were conducted for separate ethnic and gender groups.CONCLUSIONS: An understanding of the relationship between racism and mental health may go some way towards explaining the ethnic variations found in both CMD and, particularly, psychosis.     

Urban health: a look out our windows.

Approximately 80% of Americans live in cities or immediately adjacent communities. Such urban environments are complex amalgams of people of disparate backgrounds, economic status, and expectations, with extraordinary disparities in health status and outcomes between groups just blocks apart. Urban health as a framing paradigm is of recent vintage and offers a perspective on health and disease that integrates clinical medicine and public health and draws on the social and political sciences to seek understanding of the impact of cities on the health of populations and individuals. Ironically, disparate outcomes and increased mortality among poor minority populations in cities are not primarily related to the consequences of the urban epidemics of drugs and violence but rather are due to the increased prevalence and severity of common diseases such as asthma, cardiovascular disease, diabetes, and kidney disease. Several factors may be responsible for such disparities, including stress, racism, perceptions of deprivation, economic inequalities, and lack of access to quality health care. It is time for leaders in medical education and health care delivery to focus on the populations that surround their institutions in order to study urban health and meet the challenge of caring for all the residents of our cities.     

Community health workers and home-based care programs for HIV clients

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections.     

Depression in multicultural Australia: Policies,research and services

Background

Depression is one of the leading causes of disability in Australia. The cultural and linguistic diversity of the Australian population poses a significant challenge to health policy development, service provision, professional education, and research. The purpose of this study is to explore the extent to which the fact of cultural and linguistic diversity has influenced the formulation of mental health policy, the conduct of mental health research and the development of mental health services for people with depression from ethnic minority communities.

Methods

The methods used for the different components of the study included surveys and document-based content and thematic analyses.

Results

Policy is comprehensive but its translation into programs is inadequate. Across Australia, there were few specific programs on depression in ethnic minority communities and they are confronted with a variety of implementation difficulties. The scope and scale of research on depression in Ethnic minority communities is extremely limited.

Conclusion

A key problem is that the research that is necessary to provide evidence for policy and service delivery is lacking. If depression in Ethnic minority communities is to be addressed effectively the gaps between policy intentions and policy implementation, and between information needs for policies and practice and the actual research that is being done, have to be narrowed.

     

北京市项目社区男性生殖健康状况的调查

目的调查北京市项目社区男性计划生育生殖健康的现状,为政府和主管部门关注男性生殖健康和加强开展社区计划生育生殖健康服务的决策提供依据。方法采用意向性、抽样典型调查方法,对项目社区806位男性生殖健康状况及相关知识进行问卷调查。结果806位男性中,对艾滋病相关知识了解程度显示,回答正确率户籍为本市者高于外地为87%-97%。对于性交传播艾滋病的问题,年龄〈25岁组回答正确率仅有55.9%。关于预防艾滋病的知识调查显示,回答使用避孕套可防止艾滋病者达到75.6%,而回答防止共用针头者仅占14.1%。年龄〈45岁组男性性生活满意度为58.3%,年龄〈45组为41.7%。对配偶更年期等问题调查显示男性对配偶关心不够。结论社区男性对生殖健康知识了解匮乏,对于预防艾滋病相关知识有比较广泛的了解,随着年龄的降低,回答正确率有下降的趋势。绝大多数男性均有规律性生活,但是性生活满意度低。研究提示,政府应加强对于男性生殖健康的关注,加强科普宣传工作,更好的发挥社区医疗卫生机构的作用。     

Trends in AIDS incidence and survival among racial/ethnic minority men who have sex with men,United States, 1990-1999

OBJECTIVES: We describe trends in AIDS incidence, survival, and deaths among racial/ethnic minority men who have sex with men (MSM). METHODS: We examined AIDS surveillance data for men diagnosed with AIDS from 1990 through 1999, survival trends from 1993 through 1997, and trends in AIDS incidence and deaths from 1996 to 1999, when highly active antiretroviral therapy (HAART) was introduced. RESULTS: The percentage of racial/ethnic minority MSM with AIDS increased from 33% of 26,930 men in 1990 to 54% of 17,162 men in 1999. From 1996 through 1998, declines in AIDS incidence were smallest among black MSM (25%, from 66.2 to 49.5 per 100,000) and Hispanic MSM (29%, from 39.3 to 27.8), compared with white MSM (41%, from 17.9 to 10.5). Declines in deaths of MSM with AIDS were also smallest among black MSM (53%, from 39.7 to 18.6 deaths per 100,000) and Hispanic MSM (61%, 21.6 to 8.4), compared with white MSM (63%, 12.3 to 4.5). Survival improved each year for all racial/ethnic groups but was poorest for black MSM in all years. CONCLUSIONS: Since the introduction of HAART, a combination of factors that include relatively higher infection rates in more recent years and differences in survival following AIDS diagnosis contribute to observed differences in trends in AIDS incidence and deaths among racial/ethnic minority MSM. Increased development of culturally sensitive HIV prevention services, and improved access to testing and care early in the course of disease are needed to further reduce HIV-related morbidity in racial/ethnic minority MSM.     

COVID- 19 Vaccination: Potential Challenges and Reforms

Minority groups continue to suffer disproportionately from COVID-19's impact, with Blacks and Hispanics three times more likely to die from the disease than their White counterparts. The COVID-19 vaccine roll out has the potential to provide relief to these most adversely impacted communities. However, historic mistrust within racial minority communities threatens to derail the effective implementation of a vaccination program. The origin of this mistrust is multifactorial. Current day experience with structural racism and research abuses like Tuskegee Study collectively influence our perception of biased healthcare system. We outline issues and propose solutions that must be addressed to achieve a successful vaccination agenda. Mishandling of public expectations at any point may lead to an avalanche of vaccine opposition which might be unrecoverable.     

Health Literacy: Impact on the Health of HIV-Infected Individuals

Health literacy is known to affect vulnerable communities such as persons living with HIV/AIDS. The purpose of this review was to provide a current summary of research on the impact of health literacy on the health of persons living with HIV/AIDS and to address future areas of need. Contemporary studies focused on expanding the reach of health literacy in HIV/AIDS to retention in HIV care, use of technology for assessing and intervening to improve health literacy, and health literacy across the globe, for example. A number of studies did not find health literacy to explain health behaviors whereas other studies supported such a relationship. Future issues relevant to health literacy in HIV/AIDS include the aging of the HIV population and associated comorbidities, studies to understand the role of health literacy in specific populations affected by HIV/AIDS, and the continued need to refine the definition and measurement of health literacy.     

PVO / NGO initiatives,Africa. Women Fighting AIDS in Kenya (WOFAK)

Women Fighting AIDS in Kenya (WOFAK) was founded in order to improve the effectiveness of existing AIDS services delivered to women in Kenya. Founded by both seropositive and seronegative women, WOFAK is unique in that it is the only AIDS support organization (ASO) in Kenya run by and for women. WOFAK contributes to the empowerment of HIV positive women and girls by assisting them in gaining control over their own health and serostatus, to live positively with the infection, and to protect their families and communities from becoming infected. WOFAK founders feel that existing ASOs address women's issues as only a small part of their programs and that most existing programs aimed at women focus on commercial sex workers. Whenever possible, WOFAK provides psychological and material support for women affected by HIV/AIDS. They conduct training in home-based care techniques and visit hospitalized members to offer counseling and support. WOFAK conducts HIV/AIDS education and outreach in schools, churches, commercial centers, and rural areas. All activities center around a network of positive women from all parts of society responding to the community and advocating for stronger responses by the government and other agencies providing HIV/AIDS prevention and care services. They stress the basic human rights of HIV positive women such as their right to marriage and reproduction, proper medical care, housing, and jobs. For more information, please contact Dorothy Odhiambo, WOFAK, PO Box 58428, Nairobi, Kenya; tel: +1 254 2 217039; fax: +1 254 2 243164.     

Toward eliminating health disparities in HIV/AIDS: the importance of the minority investigator in addressing scientific gaps in Black and Latino communities

Dialogue in the medical and public health communities has increasingly focused attention in the area of health disparities. We believe that the elimination of health disparities in the United States will require a multipronged approach that includes, at the very least, new approaches in both biomedical and prevention interventions. We also believe that since health disparities primarily affect communities of color, a model which fosters the development of junior scientists, clinicians and researchers of color who serve these communities will yield important progress in this field. The Minority HIV/AIDS Research Initiative at the Centers for Disease Control and Prevention (CDC) is a program that, through targeted research, aims to address health disparities in HIV/AIDS. Although the program is disease specific, there are a variety of lessons learned from its inception and implementation that can be useful throughout the scientific, medical and public health communities.     

Leveraging the private health sector to enhance HIV service delivery in lower-income countries

Evidence that the private health sector is a key player in delivering health services and impacting health outcomes, including those related to HIV/AIDS, underscores the need to optimize the role of the private health sector to scale up national HIV responses in lower-income countries. This article reviews findings on the types of HIV/AIDS services provided by the private health sector in developing countries and elaborates on the role of private providers of HIV services in Ethiopia. Drawing on data from the nation's innovative Private Health Sector Project, a pilot project that has demonstrated the feasibility of public-private partnerships in this area, the article highlights the potential for national governments to scale up HIV/AIDS services by leveraging private health sector resources, innovations, and expertise while working to regulate quality and cost of services. Although concerns about uneven quality and affordability of private sector health services must be addressed through regulation, policy, or other innovative approaches, we argue that the benefits of leveraging the private sector outweigh these challenges, particularly in light of finite donor and public domestic resources.     

Coping with racism: a selective review of the literature and a theoretical and methodological critique

Racism is a stressor that contributes to racial/ethnic disparities in mental and physical health and to variations in these outcomes within racial and ethnic minority groups. The aim of this paper is to identify and discuss key issues in the study of individual-level strategies for coping with interpersonal racism. We begin with a discussion of the ways in which racism acts as a stressor and requires the mobilization of coping resources. Next, we examine available models for describing and conceptualizing strategies for coping with racism. Third, we discuss three major forms of coping: racial identity development, social support seeking and anger suppression and expression. We examine empirical support for the role of these coping strategies in buffering the impact of racism on specific health-related outcomes, including mental health (i.e., specifically, self-reported psychological distress and depressive symptoms), self-reported physical health, resting blood pressure levels, and cardiovascular reactivity to stressors. Careful examination of the effectiveness of individual-level coping strategies can guide future interventions on both the individual and community levels.