HIV/AIDS and the African-American community: a state of emergency

HIV and AIDS disproportionately affect African Americans more than any other racial or ethnic group in the United States. Representing only 13% of the U.S. population, African-American adults and adolescents comprise more than half of all HIV/AIDS cases reported to the Centers for Disease Control and Prevention. The present incidence and prevalence of HIV/AIDS in the black community in the United States is of crisis proportions. The situation as it stands today is tantamount to a state of emergency for African Americans.     

African-American sexuality and HIV/AIDS: recommendations for future research

HIV/AIDS continues to create a significant health crisis in African-American communities and health disparities within the United States. Understanding African-American sexuality within a culturally congruent and ethnocentric approach is critical to decreasing the HIV infection and transmission rates for African Americans. This brief discusses two major factors: 1) confusion about race-based stereotypes; and 2) historical health disparities and mistrust, which have influenced our understanding of African-American sexuality despite that fact that very little research has been conducted in this area. This paper discusses the limitations of what is known and makes recommendations for research surrounding sexuality and HIV/AIDS. Research trainings for new and established investigators and collaborations among health, community, religious, political organizations, and historically black colleges and universities are needed to disseminate relevant HIV prevention messages. Conducting research to better understand African-American sexuality will facilitate the development of behavioral interventions that address health, HIV and mental health risk reduction within the context of African-American life.     

Characteristics of African-American college students with HIV/AIDS.

This article examines the risky sexual behaviors, condom and drug usage, sexually transmitted diseases (STDs), and attitudes of African-American college students with the human immunodeficiency virus (HIV), which is the precursor of the acquired immunodeficiency syndrome (AIDS). A total of 408 (199 males, 209 females) African-American college students, representing 75% of the students enrolled in a southern university, were surveyed. The results revealed that 3.18% of the students reported having HIV/AIDS. The students with HIV/AIDS exhibited significant deficits in AIDS knowledge, particularly information concerning the transmission of HIV/AIDS. While subjects with HIV/AIDS did not differ from subjects without HIV/AIDS with regard to their perceived risk of being exposed to AIDS or their attitudes about using condoms, a significantly larger percentage of subjects with HIV/AIDS reported that they "always" used condoms with their partner. Nevertheless, subjects with HIV/AIDS were more likely to engage in anal intercourse, experience sex with prostitutes, and use drugs. Sexually transmitted diseases were more prevalent among subjects with HIV/AIDS, and syphilis was found to be the best predictor of HIV/AIDS.     

Building collaborative networks for HIV/AIDS vaccine development: the AVIP experience

The need for an effective HIV/AIDS vaccine is imperative to halt a pandemic that involves more than 40 million individuals worldwide as of 2005 and is causing enormous socio-economic losses, especially in developing countries (DC). The overall failure of more than two decades of HIV vaccine research justifies the demands for a concerted effort for the rapid development of new and efficacious vaccines against HIV/AIDS. In this context, building international collaborative networks is a must for speeding up scientific research and optimizing the use of funding in a synergistic fashion, as resources for HIV/AIDS are limited and do not involve most of the biggest Pharmas that are more interested in drug discovery. The AIDS Vaccine Integrated Project (AVIP) consortium is an example of synergistic partnership of international European Union and DC experts with a common research goal. AVIP is a European Commission-funded (FP-6), consortium-based, 5-year program directed to the fast development of new HIV/AIDS vaccine candidates to be tested in phase I clinical trials in Europe for future advancement to phase II/III testing in DC. To ensure their rapid development, AVIP novel combined vaccines include both regulatory and structural HIV antigens, which have already been tested, as single components, in phase I clinical trials. In particular, such combination vaccines may be superior to earlier vaccine candidates, the vast majority of which are based only on either structural or regulatory HIV products. In fact, the generation of immune responses to both types of viral antigens expressed either early (regulatory products) or late (structural products) during the viral life cycle can maximize immune targeting of both primary or chronic viral infection. Further, the rational design of combined vaccines allows exploitation of immunomodulatory functions of HIV regulatory proteins, which can improve immunity against structural vaccine components. The building of the AVIP consortium and its scientific strategy will be reviewed in this paper as an example of the establishment of a consortium regulated by a specific intellectual property agreement.     

Home care for persons with HIV / AIDS: the Rwanda model

The majority of people with AIDS are cared for at home by their families. Home care will become even more important in coming years as more HIV-infected people develop AIDS. This paper describes the Rwanda Home Care Model developed in Rwanda by the Rwanda Red Cross with support from the Norwegian Red Cross. In this model, Red Cross volunteers go to the homes of people who are chronically ill from AIDS where they provide education and emotional support to infected individuals and their families. This program operates outside of the health care system and sends volunteers to homes regardless of whether or not individuals have sought health care. The program started September 1990 and has trained 66 volunteers, of which half remain active. In 1992 and 1993, active volunteers reported making 810 home visits to families caring for a chronically ill person and teaching 18,834 people about AIDS. The community-based approach has proved to be sustainable, capable of reaching target audiences over wide geographic areas, and reduces community fears and prejudices about AIDS. Volunteers in the Rwanda Home Care Model reach as many people as possible with minimal support and improve the quality of life of people living with AIDS and their families living with the problems. Sections describe the program design and addressing the HIV/AIDS stigma.     

Overlooked role of African-American males' hypermasculinity in the epidemic of unintended pregnancies and HIV/AIDS cases with young African-American women

This article looks at multiple lines of converging evidence relevant to the 72% unintended pregnancy rate, and recently emerged heterosexually-based HIV/AIDS epidemic with young African-American women. Evidence recently reveals a convergence of these epidemics, in a vulnerable subpopulation segment of African-American women. Overlooked, as a unique contributing factor in these epidemics is the hypermasculine behaviors of African-American males. Among the risky behaviors linked with this hypermasculinity are a greater tendency with African-American males to have more multiple sexual partners, and a stronger aversion to condom use than other male ethnic groups. As a contributing factor in these epidemics, African-American males' hypermasculinity has several implications for intervention strategies to reduce the epidemics, which are discussed.     

Attitude of Lesotho health care workers towards HIV/AIDS and impact of HIV/AIDS on the population structure

Background

The impact and management of HIV/AIDS in Lesotho in the context of disaster management was investigated.

Objectives

Lesotho health care workers'' perception on HIV/AIDS progression, whether HIV/AIDS was managed as a disaster, and the impact on the demographic profile was investigated.

Methods

The empirical investigation included a literature study, and primary and secondary data analyses. Questionnaires (n=116) determined health care workers'' perception of HIV/AIDS. Interviews with officers of Lesotho Disaster Management determined how HIV/AIDS was managed as a disaster. National population censuses and data from surveys were summarised to describe the impact of HIV/AIDS on the population structure.

Results

Respondents'' modal age group was 25 to 39 years, 28.4% viewed HIV/AIDS related deaths as very high and perceived that HIV/AIDS changed the age composition, sex and dependency ratio of the population. Although HIV/AIDS was declared a disaster, the Lesotho Disaster Management Authority only aided the National AIDS Commission. There was evidence that HIV/AIDS caused the population pyramid base to shrink, and an indentation in the active population.

Conclusion

Health care workers attributed HIV/AIDS to changing the demographic profile of Lesotho, also reflected in the population pyramid. Lesotho Disaster Management Authority played a supporting role in HIV/AIDS disaster management.     

Knowledge, attitudes, and behavior of homeless African-American adolescents: implications for HIV/AIDS prevention

The purpose of this pilot study was to describe the knowledge of HIV/AIDS, attitudes about condom use, and the sexual behavior of African-American adolescents who reside in a children's emergency homeless shelter. The Attitudes Toward Condom Usage Questionnaire, the AIDS Knowledge and Attitude Survey, and a Perceived Risk of HIV/AIDS Scale were modified and administered to 37 African-American male and female adolescents who reside in an emergency shelter. HIV/AIDS knowledge and attitudes about condoms among these respondents were comparable to those of other adolescents described in the literature in that there was a strong knowledge of HIV/AIDS, although sexual behavior and attitudes toward condoms were not consistent with this knowledge. Significant differences between male and female respondents were only found on three items of the Attitudes Toward Condom Usage Questionnaire and on the Perceived Risk of HIV/AIDS Scale at the 0.05 level. The knowledge, attitudes, and sexual behavior of homeless, African-American adolescents should be examined to develop and implement appropriate programs to address the specific needs of this population. Further research should focus on this population and expand on this preliminary data.     

A way forward: the National HIV/AIDS Strategy and reducing HIV incidence in the United States

In July 2010, the Obama Administration released a National HIV/AIDS Strategy for the United States to refocus national attention on responding to the domestic HIV epidemic. The goals of the strategy are to reduce HIV incidence; to increase access to care and optimize health outcomes among people living with HIV; and to reduce HIV-related disparities. The strategy identifies a small number of action steps that will align efforts across federal, state, local, and tribal levels of government, and maximally impact the domestic HIV epidemic. In this article, we outline key programmatic and research issues that must be addressed to accomplish the prevention goals of the National HIV/AIDS Strategy.     

Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education

African Americans are disproportionately affected by acquired immunodeficiency syndrome (AIDS). New treatments that slow the progression of human immunodeficiency virus (HIV) infection offer hope for individuals living with HIV/AIDS, but lack of access to care and poor treatment adherence remain significant obstacles to HIV treatment. This study investigated the association between education literacy to HIV treatment adherence and barriers to care among African Americans living with HIV/AIDS. A community-recruited sample of 85 African-American men and 53 women receiving HIV treatment completed measures of health literacy, health status, treatment adherence, emotional well-being, and barriers to care. Nearly one-third (29%) of the participants had < 12 years of education or were functionally illiterate, and those with low-education literacy were less likely to be adherent to HIV medications within the previous two days. Lower-education literacy also was related to reasons for missing medications and barriers to accessing medical care. Individuals of law-education literacy also were more emotionally distressed, lacked social support, and were less optimistic than those with higher education. These results indicate that education and health literacy are important factors in HIV-treatment adherence and access to medical care. Interventions are needed for improving treatment adherence among law-income minorities, and such interventions will need tailoring for individuals with limited reading ability.     

Pattern of pediatric HIV/AIDS: a five-year experience in a tertiary hospital

OBJECTIVES: to determine the mode of transmission, clinical presentation and the outcome in children with HIV/AIDS at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. METHODOLOGY: a five-year retrospective study of children with HIV/AIDS from January 2001 to December 2005. Screening was based on World Health Organization criteria. Confirmation of HIV seropositivity was from a positive ELISA and then a western blot assay. RESULTS: 10,107 children were admitted over the said five-year period; 1,359 died, giving a mortality rate of 13.5%. Eight-hundred-forty (8.3%) of the admitted children had HIV/AIDS; 305 (36.3%) died. Mother-to-child transmission accounted for the highest mode of transmission, 794(94.5%). There were 44 (5.3%) cases of unidentified route of infection and two (0.2%) cases of sexual abuse in males aged 11 and 13 years. Fever (81.3%), diarrhea (75.0%), vomiting (41.4%), difficulty in breathing (39.8%) and refusal of feeds (39.8%) were the commonly encountered clinical features. Septicemia (49.5%) and acute respiratory tract infections (40.9%) were the major admitting diagnoses and major causes of deaths. Deaths from HIV infection accounted for 22.4% of the total deaths for the study period. CONCLUSIONS: Mother-to-child transmission of HIV is still high in the area of study, and pediatric HIV/AIDS remains a significant cause of childhood morbidity and mortality. Present efforts to strengthen and sustain prevention of mother to child transmission are highly encouraged. Advocacy for protection of children against sexual abuse should be strengthened.     

An integral care telemedicine system for HIV/AIDS patients

OBJECTIVE: In this article we will describe a new approach to improve the quality of care of chronic HIV/AIDS patients, combining the integral care approach with a telemedicine system. METHODS: Following the integral care approach, we included the patient in a multidisciplinary care team, covering the whole process of care with a telemedicine system that allows the patient to improve his/her self-care and to be remotely followed-up by the healthcare professionals. RESULTS: This challenge has been met by the creation of the "VIHrtual Hospital" project. Its main goal is the definition, development, clinical routine installation and evaluation of a telemedicine service that complements standard care with a telecare follow-up for treating stable HIV infected patients, in a chronic stage of their disease, and study if that improves the quality of assistance and the expense per patient compared to the conventional control (without telemedicine service) that patients usually have. Although the study is not yet finished, in the discussion the main benefits and drawbacks of this telemedicine system are described. CONCLUSIONS: The main conclusion of the article is that a new home telecare model for chronic HIV/AIDS patients has been created and has been implemented through the "VIHrtual Hospital" in the Clinic Hospital in Barcelona (Spain). The architecture of this web-based system fulfills the demanding security and integration requirements of the IT department of the hospital. An easy-to-use graphical interface for both patients and professionals has also been developed. The low costs of the system allow us to cover a wide range of patients and promising results are being obtained regarding the use of telemedicine systems for improving the follow-up care of chronic HIV/AIDS patients and for creating a new care model for this disease.     

Exploring the relationship of conspiracy beliefs about HIV/AIDS to sexual behaviors and attitudes among African-American adults

Conspiracy beliefs about HIV/AIDS have been endorsed by significant percentages of African Americans in prior research. However, almost no research has investigated the relationship of such beliefs to behaviors and attitudes relevant to HIV risk. In the present exploratory study, 71 African-American adults (aged 18-45; 61% female) in the United States participated in a national, cross-sectional telephone survey examining the relationship of HIV/AIDS conspiracy beliefs to sexual attitudes and behaviors. Results indicated significant associations between endorsement of a general HIV/AIDS government conspiracy and negative beliefs regarding condoms and greater numbers of sexual partners. Endorsement of HIV/AIDS treatment conspiracies was related to positive attitudes about condoms and greater condom use intentions. Findings suggest that conspiracy beliefs have implications for HIV prevention in African-American communities.     

Clinical experience of HIV/AIDS in a municipal hospital in Taiwan

To describe the spectrum of epidemiological and major clinical manifestations of patients infected by human immunodeficiency virus type 1 (HIV-1) in a municipal hospital, a retrospective review was done of 53 HIV-1-infected patients who had been admitted to Taipei Municipal Jen-Ai Hospital between January 1990, and July 1996. The majority (94.3%) of the patients in the cohort were male. Peak incidence was found in the fourth decade (28.3%). Forty-four (83%) patients presented in the first hospital stay with acquired immunodeficiency syndrome (AIDS). The mean duration between establishment of diagnosis of HIV-1 infection and that of AIDS was 11.2 (0-84) months. Heterosexual transmission accounted for 54.7% of the infections in the study group, and bi-/homosexual men made up another 32%. Psychosis of new onset was noted in two patients. In all AIDS indicator conditions, Pneumocystis carinii pneumonia (PCP) was the leading opportunistic infection among AIDS patients. PCP was also on the top of initial manifestations of HIV-1 infection. One patient with Penicillium marneffei infection was diagnosed to have AIDS. The mean CD4 count at admission of AIDS patients was much lower than that of non-AIDS patients (32 vs. 297/microliter, p < 0.0005). During the follow-up period 24 of 53 patients died. Mean survival time of 23 expired patients after establishment of diagnosis of AIDS was 6.4 (0-29) months. The results indicated that males outnumbered females greatly in the number of cases. Sexual activity remained the most important route of infection. Psychosis of new onset may be an early manifestation of HIV-associated encephalopathy and requires more attention. In addition, the outcome was poor as most patients in this area did not become aware of risk of HIV-1 infection until they were seriously illed with full-blown AIDS that they would seek medical help. PCP was the most common incentive for medical consultation. Penicillium marneffei infection is endemic in southeast Asia, and should be classified as an AIDS indicator condition in Taiwan.