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.     

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.     

HIV/AIDS among African Americans and US women: minority and young women

The HIV/AIDS pandemic continues to be a major health crisis facing the African American community. Although African Americans make up only about twelve percent of the U.S. population, they accounted for half of the new HIV infections reported in the United States in 2001. Numerous studies suggest that many new infections occur among young African Americans. In the early 1980s, HIV/AIDS was considered mostly a gay white male disease in the United States. Today, the pandemic has expanded and the disease is also a major health problem in the African American community, where men and women of every age and sexual orientation are affected.     

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.     

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.     

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.     

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.     

Transmission of HIV/AIDS among African American intravenous drug users: implication for public health policy.

According to recent research, Baltimore City has one of the highest HIV/AIDS (Human Immunodeficiency Virus), (Acquired Immunodeficiency Syndrome) infection rates in the state of Maryland. Intravenous drug use (IDU) in persons who are infected with HIV, is identified as the critical link to the spread of this disease in Baltimore. Substance abuse programs are insufficient to aid the city in helping to fight the warfare on HIV/ AIDS. The City Council, citizens and community based organizations must play a non-judgmental role in obtaining legislation to address the issues. Adequate substance abuse programs will greatly enhance educational and prevention strategies among African Americans who are already disproportionately affected by HIV/AIDS and IDU. Efficient, effective, equal, legal, political acceptance, and improvement would be included in the criteria of policy options.     

Effectiveness of a cardiovascular health promotion education intervention on the attitudes of urban African American school-age children

African American children are at risk for high rates of morbidity and mortality associated with cardiovascular (CV) disease as they become adults, yet little is known about the effectiveness of CV risk-reduction interventions in African American children. This study explored the effectiveness of a concentrated CV health promotion educational program on health-related attitudes of 76 African American children enrolled in a mid-southern school system. The Children's Cardiovascular Health Promotion Attitude Scale was used to examine differences in attitude prior to and 2 weeks following a focused health education intervention. Results demonstrate that children have preconceived attitudes regarding practice of health behaviors and that these attitudes are modifiable with age and developmental level specific educational interventions. Findings indicate the need for health care providers to assume more active roles in reducing the risk of future CV disease and death in African Americans through health promotion education of individuals who influence the development of children's attitudes.     

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.     

Factors influencing HIV-risk behaviors among HIV-positive urban African Americans.

Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions.     

Recruiting Chinese American adolescents to HIV/AIDS-related research: A lesson learned from a cross-sectional study

The purpose of this article was to report identified barriers and challenges experienced in the recruiting process of Chinese American adolescents to a cross-sectional HIV/AIDS-related study. Snowball sampling method was used to recruit Chinese American adolescents from Chinese American communities in a U.S. Midwestern state. Barriers and challenges to recruitment were reviewed and analyzed from Chinese cultural perspectives in the hope of aiding researchers and health care providers understand and facilitate future recruitment of Chinese Americans for HIV/AIDS prevention studies. Barriers to recruitment were found related to the taboo topic of sexual issues in Chinese culture, unawareness and denial of HIV/AIDS risks, authoritarian parenting style in Chinese culture, and the required active consents. Facilitating factors of recruiting Chinese American adolescents to future HIV/AIDS prevention research or intervention programs are discussed. Information provided in this article may increase nurses' awareness of various barriers that they might encounter when they conduct research or address HIV/AIDS-related topics of Chinese American adolescents.     

Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life among adults in opioid detoxification: results from the National Drug Abuse Treatment Clinical Trials Network

PURPOSE: Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study examined clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. METHODS: The sample included 343 opioid-dependent patients enrolled in two national multi-site studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from 12 addiction treatment programs across the nation. Gender and racial/ethnic differences in addiction severity, human immunodeficiency virus (HIV) risk, and quality of life were examined. RESULTS: Women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems and report poorer health-related quality of life and functioning. Whites and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine and to have more severe alcohol and employment problems. CONCLUSIONS: Women and whites show more psychopathology than men and African Americans. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanisms and to reduce their risky behaviors.     

Ecological influences of sexuality on early adolescent African American females

African Americans make up the greater proportion of AIDS cases in adolescent girls but little is understood about the development of sexual risk behaviors during the early adolescent years. This article will explore ecological factors influencing adolescent sexual risk behaviors. In the focus groups, which were conducted using 28 African American mothers and their early adolescent daughters, 2 major themes emerged: exposure and support systems. Mothers described the impact community had on their daughters and how monitoring and support systems worked together to control exposure. The girls detailed the different ways they were impacted by the community. Attitudes the girls adopted from their exposures resulted in risk-taking behaviors or a determination to positively impact the community. Community was shown to be the context of the acquisition of sexual knowledge and attitudes. These findings support the development of interventions to address the impact of community on the participation of sexual risk behaviors.     

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.