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AIDS - References J Am Med Womens Assoc 1999 Summer;54(3):126-8 Creating a new framework for promoting the health of African-American female adolescents: beyond risk taking.Roberts LUrban Public Health Program, Hunter College, New York City, USA. African-American female adolescents bear a disproportionate burden of poor health outcomes compared to young white women. The racial and gender disparities in adolescent health are readily apparent in the reported rates of human immunodeficiency virus (HIV) infection, poor nutrition, victimization and exposure to traumatic violence, incarceration, and mortality among young African-American women, especially those who are poor and living in inner cities. Risk behavior, the dominant construct explaining adolescent morbidity and mortality, is inadequate because it assumes that all adolescents develop similarly when, in fact, gender, race, and socioeconomic status force different developmental patterns and health outcomes. The author calls for interdisciplinary collaborations examining the structural inequities and combined consequences of sexism, racism, and inner-city poverty for young women of color in order to inform public health interventions to improve the health of African-American female adolescents. MeSH Terms:
Am J Kidney Dis 1999 Aug;34(2):254-8 Familial clustering of end-stage renal disease in blacks with HIV-associated nephropathy.Freedman BI, Soucie JM, Stone SM, Pegram SInternal Medicine/Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA. bfreedma@wfubmc.edu Human immunodeficiency virus-associated nephropathy (HIVAN) develops more often in HIV-infected blacks than whites. Blacks also show marked familial clustering of other causes of end-stage renal disease (ESRD), particularly diabetes mellitus-, hypertension-, and systemic lupus erythematosus-associated ESRD. We compared the family history of ESRD in 201 blacks with ESRD caused by HIVAN (cases) to that of 50 HIV-infected blacks without renal disease (controls) to determine whether HIV-associated ESRD shows familial aggregation. Cases were identified using the Southeastern Kidney Council/ESRD Network 6 Family History of ESRD database. Cases initiated dialysis between September 1993 and October 1998. Controls were consecutively identified, HIV-infected blacks with serum creatinine concentrations of 1.3 mg/dL or less and no proteinuria, treated in an infectious disease clinic during September 1998. Cases and controls had similar mean ages and family sizes. First- or second-degree relatives with ESRD were reported by 24.4% of the cases compared with 6% of the controls (P = 0.004). Logistic regression analysis, controlling for sex, family size, and age, showed cases were 5.4 times more likely than controls to have close relatives with ESRD (P = 0.007). The 49 HIVAN cases who reported a positive family history had a mean of 1.2 additional relatives with ESRD per case (60 total relatives with ESRD). HIVAN was not listed as the cause of ESRD in any of the 27 relatives who underwent dialysis in Network 6 facilities. We conclude that ESRD clusters in the families of nearly 25% of blacks initiating renal replacement therapy for HIVAN. This familial aggregation of ESRD appears to be independent of HIV infection. Although environmental factors cannot be excluded, it is possible an inherited susceptibility to renal failure is present in many blacks with HIV infection who subsequently develop nephropathy. MeSH Terms:
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J Acquir Immune Defic Syndr 1999 Jul 1;21(3):189-93 CCR5 genotype and resistance to vertical transmission of HIV-1.Philpott S, Burger H, Charbonneau T, Grimson R, Vermund SH, Visosky A, Nachman S, Kovacs A, Tropper P, Frey H, Weiser BWadsworth Center, New York State Department of Health, Albany 12208-2022, USA. A human gene has been identified that affects susceptibility to HIV-1 infection. The gene codes for CCR5, the coreceptor for macrophage-tropic strains of HIV-1. Individuals who are homozygous for a deleted, mutant form of the gene, delta32, display a high degree of natural resistance to sexual and parenteral transmission of HIV-1. To investigate whether delta32 plays a role in vertical transmission, we determined the CCR5 genotype of 552 children born to infected mothers in the United States and correlated the genotypes with HIV-1 infection status. Of these children, 13% were white, 30% Latino, and 56% African American, reflecting the ethnic makeup of infected women in the United States. The delta32 gene frequency varied among these groups, ranging from 0.08 in whites to 0.02 in both Latinos and African Americans. Approximately 27% of the children in each ethnic group were infected. Four children were identified as delta32 homozygotes, two uninfected whites (3.77%) and two uninfected Latinos (1.68%). None of the infected children displayed the delta32 homozygous genotype. Among Latinos and whites, the number of uninfected children who carried the homozygous delta32 mutation was significantly greater than that predicted by the Hardy-Weinberg equilibrium (p < .001 for Latinos, p = .044 for whites). This association was noted in Latino and white children whose mothers were either treated or untreated with zidovudine. These data document the occurrence of the homozygous delta32 genotype among children of HIV-1-infected mothers and suggest that this mutant genotype may confer protection from mother-to-child transmission of HIV-1. They also suggest that sexual, parenteral, and vertical transmission all involve processes that use CCR5 as a coreceptor for primary HIV-1 infection. Therefore, blocking the CCR5 receptor may provide an additional strategy to prevent HIV-1 vertical transmission. MeSH Terms:
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AIDS Educ Prev 1999 Jun;11(3):243-61 This is my story: a descriptive analysis of a peer education HIV/STD risk reduction program for women living in housing developments.Downing M, Knight KR, Vernon KA, Seigel S, Ajaniku I, Acosta PS, Thomas L, Porter SDepartment of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco 94105, USA. Descriptive, qualitative data was collected from 30 women who participated in the Centers for Disease Control and Prevention-funded Perinatal HIV Reduction and Education Demonstration Activities (PHREDA) Project. Women were primarily heterosexual, welfare-dependent, African-American mothers. Staff trained women to conduct HIV/STD education as peer volunteers. The theory-based educational components consisted of role model stories developed by women about their experiences with HIV/STDs and discussion groups to build behavioral and communication skills. Women were given role-model stories and safer sex supplies to initiate conversations about women's health and sexual safety in their communities. PHREDA groups allowed women to identify their risk reduction, sexual, and family issues. Role model stories provided a validating medium through which high-risk women explored reproductive health risk and planned steps toward behavioral change. Descriptive data from peer volunteers can provide an important perspective on small group, peer-based community HIV/STD reduction interventions. MeSH Terms:
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J Am Soc Nephrol 1999 Jul;10(7):1566-74 Hepatitis C virus-associated glomerular disease in patients with human immunodeficiency virus coinfection.Cheng JT, Anderson HL Jr, Markowitz GS, Appel GB, Pogue VA, D'Agati VDDepartment of Medicine at Harlem Hospital Center, New York, New York 10037, USA. jc31@columbia.edu Chronic infection with hepatitis C virus (HCV) has been linked to the development of glomerular disease. HCV infection is highly prevalent among intravenous drug users, a population that is also at risk for HIV coinfection. This study reports the clinical-pathologic features and outcome of HCV-associated glomerular disease (HCV-GD) in 14 patients with HIV coinfection. All were intravenous drug users and all but one were African-Americans. Renal presentations included renal insufficiency, microscopic hematuria with active urine sediment, hypertension, and nephrotic syndrome or nephrotic-range proteinuria without hypercholesterolemia. Hypocomplementemia and cryoglobulinemia were present in 46 and 33% of patients, respectively. The predominant renal biopsy findings were membranoproliferative glomerulonephritis type 1 or type 3 (Burkholder subtype) in 79% of patients and membranous glomerulopathy with atypical features in 21% (including overlap with collapsing glomerulopathy in one patient). The clinical course was characterized by rapid progression to renal failure requiring dialysis. The overall morbidity and mortality were high with median time of 5.8 mo to dialysis or death. Although most patients died in renal failure, cause of death was primarily attributable to long-term immunosuppression and advanced AIDS. Patients with AIDS had shorter survival than those without (median survival time of 6.1 mo versus 45.9 mo, log-rank test P = 0.02). Only two patients were alive with stable renal function at follow-up of 28.5 mo. In patients with HCV-GD, coinfection with HIV leads to an aggressive form of renal disease that can be easily confused with HIV-associated nephropathy. Although hypocomplementemia, cryoglobulinemia, and more prominent hypertension and microscopic hematuria may provide clues to the presence of HCV-GD, renal biopsy is essential to differentiate HCV-GD from HIV-associated nephropathy. MeSH Terms:
Ethn Health 1998 Nov;3(4):283-99 The Health Belief Model and HIV risk behaviours: a causal model analysis among Anglos, African-Americans and Mexican-Americans.Neff JA, Crawford SLUniversity of Tennessee College of Social Work-Nashville Branch, USA. A causal model of the Health Belief Model (HBM) is empirically evaluated which emphasizes possible indirect paths linking distal demographic and seriousness/susceptibility variables to HIV risk behaviours among Anglo, African-American, and Mexican-American adults. A specific focus of the paper is upon alcohol-related expectancies (anticipation of disinhibitory effects of alcohol upon sexual behavior) as a 'barrier' to preventive behaviours. Ethnic comparisons stem both from the paucity of available research on the HBM in minority populations and from recent questions regarding the applicability of rational models such as the HBM among minority groups. Analyses of data from a community sample of 1390 adults indicate relatively consistent direct effects of barriers for males and benefits for females upon HIV risk behaviors. The analyses suggest distinct paths operative among males and females. The susceptibility-barriers-risk behaviours path among males may suggest that alcohol-related expectancies (barriers in this model) may be more strongly related to risk behaviours among males than minority females. MeSH Terms:
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Drug Alcohol Depend 1999 Jun 1;55(1-2):177-82 Level of education and injecting drug use among African Americans.Obot IS, Hubbard S, Anthony JCDepartment of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
[Medline record in process] Drawing upon a nationally representative survey sample of African American (AA) drug injectors and non-injectors, this study tests for a suspected causal association between dropping out of school and the occurrence of injecting drug use (IDU), which remains a major cause of human immunodeficiency virus (HIV) transmission in this population. The data are from public use files of the National Household Surveys on Drug Abuse (NHSDA) conducted between 1991 and 1995. From within the NHSDA's nationally representative sample of adult household residents, a total of 389 AA adults with a history of IDU were matched on neighborhood of residence with 2253 AA adults with no history of IDU. The conditional form of multiple logistic regression was used to estimate the relative risk of having injected a drug for school dropouts relative to a reference category of AA who received the high school diploma but did not go to college. AAs who dropped out of high school were an estimated two times more likely to have injected drugs. With statistical adjustment for age, sex, and Hispanic background, the estimated association was 1.9 (95% confidence interval (C.I.) = 1.3-2.6, P<0.001). Contrary to our advance hypothesis, earning the graduate equivalency certificate (GED) did not seem to affect the magnitude of excess risk for having started IDU (adjusted odds ratio (aOR) = 2.3, 95% C.I. = 1.4-3.8, P<0.001). Hence, school dropout prevention might reduce the risk of IDU per se, in addition to the many other general benefits of educational attainment. The issue of GED-associated reduced risk of IDU remains open for future study. Grant support:
J Natl Med Assoc 1999 Jun;91(6):343-8 A preliminary study of African-American physician involvement in the care of HIV-infected patients.Rawlings MK, Grimes RM, Easling ICommunity-Oriented Primary Care Program, Parkland Health and Hospital System, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, USA. In 1995, questionnaires were sent to the mailing list of the National Medical Association (NMA). The mail responses were supplemented by questionnaires distributed at the NMA annual meeting. Of the 709 respondents, approximately 63% were primary care providers, pediatricians, or obstetrician-gynecologists; 72% were treating from zero to 10 human immunodeficiency virus (HIV) patients while 9% were treating > 90 HIV patients; and 12% had been treating HIV patients > 10 years. The majority of these patients were African American; male-to-male sex and injecting drugs were the two major risk factors. Complexity of HIV care and lack of reimbursement were the principal barriers to providing HIV care. The burden of providing HIV care is borne by a relatively small number of physicians, and African-American physicians are actively involved in this care. Programs are needed to increase the number of African-American providers treating HIV patients and to provide appropriate reimbursement for providing this care. MeSH Terms:
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Clin Pediatr (Phila) 1999 Mar;38(3):184-7 Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents.Braverman PKSt. Christopher's Hospital for Children. Publication Types:
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J Am Diet Assoc 1999 Jun;99(6):735-7 Ethnic differences in body image attitudes and perceptions among women infected with human immunodeficiency virus.Clark RA, Niccolai L, Kissinger PJ, Peterson Y, Bouvier VHIV Outpatient Program, New Orleans, LA 70112, USA. MeSH Terms:
Science 1999 May 7;284(5416):919-21 Uses and abuses of Tuskegee.Fairchild AL, Bayer RProgram in the History of Public Health and Medicine, Division of Sociomedical Sciences, The Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032-2625, USA. alf4@columbia.edu Publication Types:
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Ethn Dis 1999 Winter;9(1):132-9 Do patients' ethnic and social factors influence the use of do-not-resuscitate orders?Thompson BL, Lawson D, Croughan-Minihane M, Cooke MDepartment of Medicine, University of California, San Francisco, USA. OBJECTIVES: To determine whether ethnic and other social factors affect how frequently do-not-resuscitate (DNR) orders are written, the timing of DNR orders, or patient involvement in the DNR decision. DESIGN: Retrospective cohort. METHODS: Patients who died in one urban teaching hospital on the medicine, cardiology, or family practice service during 1988 were eligible; 288 were included in the analyses. Chi-square tests and logistic regression were used to examine frequency of DNR orders and patient involvement; analysis of variance and linear regression were used to examine timing of the DNR orders. RESULTS: Non-whites were more likely than whites to have DNR orders (OR 1.76; 95% CI, 1.09-2.84) but timing of the DNR order did not vary significantly by race/ethnicity. Patients who spoke English fluently were more likely to be involved in the DNR decision than those who did not (OR 1.28; 95% CI, 1.01-1.61). Patients with documented human immunodeficiency virus were more likely than uninfected patients to have DNR orders (OR 3.51; 95% CI, 1.36-9.02), to be involved in the decision (OR 10.11; 95% CI, 4.87-21.00); and to have DNR orders written earlier (P = 0.02). Alcoholic patients were more likely than non-alcoholics to have DNR orders (OR 1.17; 95% CI, 1.04-1.33). CONCLUSIONS: Ethnic and other social factors do appear to play a role in DNR decisions. It needs to be determined if these differences are due to patient preferences or clinician characteristics. MeSH Terms:
Prev Med 1999 May;28(5):451-7 Do blacks believe that HIV/AIDS is a government conspiracy against them?Klonoff EA, Landrine HBehavioral Health Institute, California State University, 5500 University Parkway, San Bernardino, California 92407, USA. eklonoff@csusb.edu BACKGROUND: We present the first study to explore the possibility that blacks believe that the human immunodeficiency virus was developed by the federal government in order to exterminate the black population. METHODS: Five hundred twenty black adults sampled door to door in 10 randomly selected census tracts completed a written survey in exchange for $10. They indicated their degree of agreement with the statement, "HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people." RESULTS: Twenty-seven percent of blacks held AIDS-conspiracy views and an additional 23% were undecided. Endorsing AIDS-conspiracy beliefs was not related to blacks' age or income but was related to higher levels of education. Blacks who agreed that AIDS is a conspiracy against them tended to be culturally traditional, college-educated men who had experienced considerable racial discrimination. CONCLUSIONS: The prevalence and health-related implications of blacks' AIDS-conspiracy beliefs must be fully investigated, and such beliefs must be addressed in culturally tailored, gender-specific AIDS prevention programs for blacks. Copyright 1999 American Health Foundation and Academic Press. MeSH Terms:
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Violence Vict 1998 Winter;13(4):377-93 Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department.El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura S, Witte SSColumbia University School of Social Work, New York, NY 10021, USA. This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1%, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships. MeSH Terms:
Appl Nurs Res 1999 May;12(2):91-100 The experience of relapse to unsafe sexual behavior among HIV-positive, heterosexual, minority men.Sherman DW, Kirton CADivision of Nursing, New York University, New York 10012, USA. The purpose of this qualitative study was to examine the phenomenon of relapse to unsafe sexual behavior in human immunodeficiency virus (HIV)-positive, heterosexual, minority men. In-depth interviews were conducted by using a purposive sample of 18 HIV-positive, heterosexual, minority men who were recruited from an outpatient acquired immunodeficiency syndrome (AIDS) clinic in upstate New York and a community-based HIV/AIDS service organization in New York City. All participants expressed concern about the seriousness and health threat of unsafe sexual behaviors. The perceived benefits and barriers to unsafe sexual practices were identified. Content analysis revealed the following themes related to relapse to unsafe sexual behavior: drug and alcohol use, state of mind, "looking good" and "helping" fallacies, male-female relationship issues, influence of friends, weighing the risks, sexual preparation, uncontrollable sexual urges, and the symbolic meaning of condoms. Clinical implications related to health assessment, interventions, and health education and prevention programs for HIV-positive heterosexual, minority men and their sexual partners are presented. MeSH Terms:
Epidemiology 1999 May;10(3):282-7 Predictors of urinary tract infection at the first prenatal visit.Pastore LM, Savitz DA, Thorp JM JrDepartment of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, 27599-7400, USA. We identified maternal demographic, behavioral, and medical history factors that predict bacteriuria (that is, symptomatic and asymptomatic urinary tract infection) at prenatal care initiation. We applied logistic regression modeling to data from all prenatal care recipients who delivered during 1990-1993 and resided in selected North Carolina counties (N = 8037), omitting those with diabetes mellitus, human immunodeficiency virus, or structural urologic abnormalities. The two strongest predictors of bacteriuria at prenatal care initiation were an antepartum urinary tract infection prior to prenatal care initiation (for whites, adjusted prevalence odds ratio (POR) = 2.5, 95% CI 0.6-9.8; for blacks, POR = 8.8, 95% CI 3.8-20.3) and a pre-pregnancy history of urinary tract infection (POR = 2.1, 95% CI 1.4-3.2). For white women only, education beyond high school and age > or =30 years were inversely associated (POR < or = 0.6). Sickle cell hemoglobin nearly doubled the prevalence odds for bacteriuria among African-Americans (POR = 1.9, 95% CI 1.0-3.5), whereas African-Americans with normal hemoglobin had reduced prevalence odds compared with whites (POR = 0.6, 95% CI 0.4-0.9). This study suggests predictors not considered before, including race controlling for sickle cell disease or trait and antepartum urinary tract infections prior to prenatal care. MeSH Terms:
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J Infect Dis 1999 Jun;179(6):1395-404 Natural history of primary Epstein-Barr virus infection in children of mothers infected with human immunodeficiency virus type 1.Jenson H, McIntosh K, Pitt J, Husak S, Tan M, Bryson Y, Easley K, Shearer WDepartment of Pediatrics, University of Texas Health Science Center, San Antonio, TX 78284-7811, USA. jenson@uthscsa.edu The natural history of Epstein-Barr virus (EBV) infection in 556 infants born to 517 human immunodeficiency virus (HIV) type 1-infected mothers was studied in a prospective, multicenter, cohort study. HIV-1-infected children had a cumulative EBV infection rate similar to HIV-1-uninfected children at age 3 years (77.8% vs. 84. 9%) but had more frequent oropharyngeal EBV shedding (50.4% vs. 28. 2%; P<.001). The probability of shedding decreased with longer time from EBV seroconversion and was similar to that of HIV-1-uninfected children 3 years after seroconversion. HIV-1-infected children identified as rapid progressors shed EBV more frequently than nonrapid progressors (69.4% vs.41.0%; P=.01). HIV-1-infected children with EBV infection had higher mean CD8 cell counts. EBV infection did not have an independent effect on mean CD4 cell counts, percent CD4, IgG levels, HIV-1 RNA levels, lymphadenopathy, hepatomegaly, or splenomegaly. Early EBV infection is common in children born to HIV-1-infected mothers. Children with rapidly progressive HIV-1 disease have more frequent EBV shedding. Publication Types:
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Kidney Int 1999 Apr;55(4):1491-500 Up-regulation of Duffy antigen receptor expression in children with renal disease.Liu XH, Hadley TJ, Xu L, Peiper SC, Ray PEResearch Center IV, Children's Research Institute, Children's National Medical Center, George Washington University, Washington D.C., USA. BACKGROUND: The Duffy antigen chemokine receptor (DARC) is a promiscuous chemokine receptor that binds chemokines from the C-X-C and C-C families. DARC was initially described on red blood cells, but subsequent studies have demonstrated DARC protein expression on renal endothelial and epithelial cells, even in Duffy-negative individuals whose red cells lack DARC. Because approximately 68% of African Americans lack the Duffy/DARC on their red cells, we carried out experiments to identify the specific renal cells expressing DARC protein and mRNA in African American children and to define whether DARC expression was altered in renal inflammatory processes. METHODS: Immunohistochemistry and in situ hybridization studies were done in 28 renal sections from children with each of the following diagnoses: HIV nephropathy (HIVAN), HIV-associated hemolytic uremic syndrome (HIV-HUS), HIV infection without renal disease, HIV-negative children without renal disease, and Argentinean children with classic HUS. RESULTS: The predominant localization of DARC mRNA and protein was found in endothelial cells underlying postcapillary renal venules in all patients studied. However, DARC mRNA and protein were significantly up-regulated in peritubular and glomerular capillaries, collecting duct epithelial cells, and interstitial inflammatory cells in children with HIVAN, HIV-HUS, and classic HUS. CONCLUSION: These findings support the notion that the renal DARC is linked to the inflammatory cascade and that African American children may be at risk of accumulating chemokines in renal tissues. MeSH Terms:
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Ann Pharmacother 1999 Mar;33(3):294-300 Nonprescription and alternative medication use by individuals with HIV disease.Smith SR, Boyd EL, Kirking DMDivision of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy, University of North Carolina at Chapel Hill 27599, USA. OBJECTIVE: To examine the strength of the associations between predisposing, enabling, and need-for-care variables and the self-treatment of HIV disease; and to compare sociodemographic and illness-related factors associated with the use of vitamins, nonprescription medications, herbs, and recreational substances among HIV-infected individuals. METHODS: Data were derived from 7887 interviews conducted as part of the AIDS Cost and Services Utilization Survey. The conceptual framework was the Andersen Behavioral Model of Health Services Use. Factors associated with nonprescription and alternative medication use were assessed using logistic regression. Generalized estimating equations were applied to adjust variance estimates for within-person correlations of drug use over time. RESULTS: After adjusting for perceived health status, T cell count, and stage of disease, the results indicated that African-Americans were less likely to use nonprescription drugs (odds ratio [OR] 0.65, 95% CI 0.52 to 0.81), vitamins (OR 0.59, 95% CI 0.48 to 0.73), and herbs (OR 0.41, 95% CI 0.22 to 0.76), compared with non-Hispanic whites. Similarly, Hispanics were less likely to report use of herbs (OR 0.58, 95% CI 0.34 to 0.98) or recreational drugs (OR 0.34, 95% CI 0.15 to 0.76) than were non-Hispanic whites. Oppositely, individuals who had a college education were more likely to use vitamins (OR 1.26, 95% CI 1.05 to 1.50) and herbs (OR 2.47, 95% CI 1.56 to 3.91). Enabling variables such as insurance status and income were generally associated only with use of recreational drugs. Need-for-care variables were generally associated only with use of nonprescription drugs and vitamins. CONCLUSIONS: Predisposing, enabling, and need-for-care variables from the Andersen Behavioral Model were significantly associated with the use of four categories of drugs to self-treat HIV disease. However, there was not a consistent pattern across the drug categories. MeSH Terms:
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J Rural Health 1997 Summer;13(3):226-36 Delivering care to rural HIV/AIDS patients.Topping S, Hartwig LCCecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27599, USA. With HIV/AIDS on the rise in rural areas, health care providers must find ways of delivering care with little or no increase in resource support. This paper examines the evolution of a rural HIV/AIDS alliance using a life cycle model to identify each stage of the alliance development and the specific issues associated with each stage. The data were collected through structured interviews and by review of background materials, including budgets, grant proposals, and program reports. The findings identify alliance strategies that can be used in other rural communities facing the challenge of serving an increasing number of HIV/AIDS patients with limited resources. Differing from other models, this rural HIV/AIDS alliance emerged from local government and community support into an independent, nonprofit organization operating through a network of interorganizational relationships. Comments:
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Sex Transm Dis 1999 Mar;26(3):121-6 The epidemiology of syphilis in the waning years of an epidemic: Houston, Texas, 1991-1997.Risser JM, Hwang LY, Risser WL, Hollins L, Paffel JSchool of Public Health, University of Texas-Houston Health Sciences Center, 77225, USA. BACKGROUND: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs. GOALS: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997. STUDY DESIGN: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services. RESULTS: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993. CONCLUSION: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis. MeSH Terms:
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J Natl Med Assoc 1999 Feb;91(2):92-100 HIV risk differences between African-American and white men who have sex with men.Heckman TG, Kelly JA, Bogart LM, Kalichman SC, Rompa DJDepartment of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53226, USA. African-American men who have sex with men remain at disproportionately greater risk for contracting human immunodeficiency virus (HIV) infection. While high HIV seroincidence has been documented among homosexual African-American men, behavioral research has rarely studied the HIV risk issues confronting these men. This study assessed a sample of 253 men who have sex with men to determine if African-American (n = 79) and white (n = 174) men report different rates of HIV risk behaviors and differ in characteristics indicative of risk. African-American men who have sex with men were more likely to be HIV-seropositive, to report past treatment for gonorrhea and syphilis, and to have a recent unprotected sex partner known or believed to be HIV-seropositive. Multivariate analyses of covariance, controlling for group differences in age, education, and income, revealed that African-American men who have sex with men were less open about their sexual orientation, scored lower in HIV risk behavior knowledge, had more female sexual partners, and more frequently used cocaine in association with sex relative to white men who have sex with men. Human immunodeficiency virus prevention programs tailored to the needs and risk issues of African-American men who have sex with men are needed. MeSH Terms:
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AIDS Educ Prev 1999 Feb;11(1):38-52 Correlates of condom use stage of change: implications for intervention.Polacsek M, Celentano DD, O'Campo P, Santelli JDepartment of Family and Community Medicine, University of New Mexico, Albuquerque, USA. A telephone survey was used to collect data on attitudes, beliefs, and practices concerning condom use among 812 African Americans with regular sex partners and of reproductive age in Baltimore. Condom use was "staged" according to Prochaska's model of stage of behavioral change. Characteristics of the respondents' sexual relationships, peer characteristics, and demographic and psychosocial characteristics were examined for their association with the stage of condom use. Multiple logistic regression analysis revealed that a partner's reaction to condom use, condom use self-efficacy with the partner, condom use outcome expectancy with the partner, perceived partner risk, length of relationship, sterility, cohabitation, perceived vulnerability to HIV infection and perceived peer norms about condom use were each independently related to staged condom use. Gender differences in the relationship of these independent variables with stages of change were found. Implications for intervention include differential treatment by gender and stage of change. Couples should also be considered for intervention. MeSH Terms:
J Natl Med Assoc 1999 Jan;91(1):17-24 Relative rates of AIDS among racial/ethnic groups by exposure categories.Haverkos HW, Turner JF Jr, Moolchan ET, Cadet JLNational Institute of Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA. The relative rates of acquired immunodeficiency syndrome (AIDS) were calculated among racial/ethnic populations using Centers for Disease Control and Prevention HIV (human immunodeficiency virus)/Surveillance reports assuming that racial/ethnic distributions reflect that of the US Census Data from 1990. For comparison, a rate of 1 was assigned to whites in each calculation. The overall relative rates were whites--1, African Americans--4.7, Hispanics--3, Asian/Pacific Islanders--0.4, and Native Americans--0.5. Acquired immunodeficiency syndrome surveillance data show higher rates of AIDS for African Americans and Hispanics compared with whites, Asians/Pacific Islanders, and Native Americans. The relative rates for African Americans and Hispanics compared with whites were highest for injecting drug users, heterosexual contact, and pediatric patients. These results led us to explore possible explanations for increased AIDS reporting in African Americans and Hispanics. We then explored available national datasets regarding those variables. The analyses indicate that variables such as access and receptivity to HIV prevention and treatment efforts, race/ethnicity, sexual behaviors, sexually transmitted diseases, socioeconomic status, and substance abuse interact in a complex fashion to influence HIV transmission and progression to AIDS in affected communities. MeSH Terms:
Health Serv Res 1999 Feb;33(6):1611-38 Incidence and duration of hospitalizations among persons with AIDS: an event history approach.Crystal S, Lo Sasso AT, Sambamoorthi UAIDS Research Group, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903, USA. OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses. MeSH Terms:
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J Trauma Stress 1999 Jan;12(1):41-58 Victimization experiences and HIV infection in women: associations with serostatus, psychological symptoms, and health status.Kimerling R, Armistead L, Forehand RStanford University Medical Center, CA 94305, USA. The present investigation evaluates the relationship between HIV infection and victimization with regard to the interplay of these two factors as they relate to mental and physical health. Eighty eight inner-city low income African-American women who are HIV-infected and a demographically similar comparison group of women who were not HIV-infected were assessed for victimization experiences (rape, physical assault, robbery/attack) via interview. Additionally, the psychological symptoms and health status correlates of victimization within the HIV-infected group are delineated. Results indicated that women in the HIV-infected sample were significantly more likely to report a victimization experience. Additionally, within the HIV-infected group, victims reported higher levels of global psychological distress, depressive symptomatology, and greater distress regarding physical symptoms than nonvictims. Furthermore, HIV-infected victims were diagnosed with higher rates of AIDS-defining conditions than HIV-infected nonvictims. These results underscore the importance of acknowledging the experience of violent victimization in the prevention and treatment of HIV infection in women. MeSH Terms:
Patient Educ Couns 1998 Oct;35(2):127-37 Model for using hip-hop music for small group HIV/AIDS prevention counseling with African American adolescents and young adults.Stephens T, Braithwaite RL, Taylor SEDepartment of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. tstephe@sph.emory.edu Currently little attention has been directed, with the exception of peer education efforts, to constructively develop new and innovative ways to promote HIV/AIDS primary prevention among African American (AA) adolescents and young adults. With this in mind, the aim of this conceptual effort is to present a HIV/AIDS preventive counseling protocol developed for use with AA young adults that makes use of hip-hop music, a form of music popularized by young AAs. The author contend that an increased understanding of the relationships that many AA young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about protective factors for HIV. Making use of hip-hop music is one strategy for integrating counseling in prevention and health maintenance. The overall implications of using hip-hop music in health promotion are unlimited. First, this method makes use of cultural relevant materials to address the educational and health needs of the target community. Second, it is grounded in an approach that serves to stimulate cooperative learning based on peer developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. The authors contend that such an approach holds heuristic value in dealing with HIV/AIDS prevention among AA young adults. Additional testing of the intervention is warranted in the refinement of this innovative intervention. MeSH Terms:
J Health Care Poor Underserved 1999 Feb;10(1):45-71 The three leading causes of death in African Americans: barriers to reducing excess disparity and to improving health behaviors.Feldman RH, Fulwood RDepartment of Health Education, University of Maryland, College Park 20742, USA. African Americans suffer disproportionately from several major health problems associated with high morbidity and mortality. The 1985 DHHS Secretary's Task Force Report on Blacks and Other Minorities identified six major disease categories of excess deaths for African Americans compared with whites by applying the lower death rate for whites to the American population. The report provided a stimulus for public and private action to begin to address the health disparities between minority and nonminority populations. This article examines three of the leading causes of death for African Americans and assesses the extent to which the health disparity between African Americans and whites has been reduced. The three leading causes of death for African American males are diseases of the heart, cancer, and HIV infection/AIDS. The conditions are the same for African American females except stroke replaces HIV infection. Three health outcomes measures are discussed: life expectancy, excess death rates, and years of potential life lost. A widening of the gap between the races was found for diseases of the heart and HIV infection for males and for cancer for females. An extensive list of barriers to reducing the disparity are presented from the scientific literature and strategies for reducing the three health problems are recommended. MeSH Terms:
Am J Public Health 1999 Feb;89(2):176-81 The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.O'Donnell L, Stueve A, San Doval A, Duran R, Haber D, Atnafou R, Johnson N, Grant U, Murray H, Juhn G, Tang J, Piessens PEducation Development Center, Inc., Newton, MA 02458, USA. lodonnell@edc.org OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs. Publication Types:
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J Assoc Nurses AIDS Care 1999 Jan-Feb;10(1):42-50 Spirituality, psychological well-being, and HIV symptoms for African Americans living with HIV disease.Coleman CL, Holzemer WLDepartment of Nursing, University of Southern California, Los Angeles 90033, USA. The purpose of this descriptive cross-sectional study was to explore the contribution of spiritual well-being and human immunodeficiency virus (HIV) symptoms to psychological well-being measured by depression, hope, and state-trait anxiety in a sample of 117 African-American men and women with a mean age of 38 years living with HIV disease. Of the respondents, 26% had acquired immunodeficiency syndrome (AIDS), and 74% were HIV seropositive. Each participant completed a sociodemographic questionnaire, the Sign and Symptom Checklist for Persons with HIV Disease, the Spiritual Well-Being Scale, the Nowotny Hope Scale, State-Trait Inventory, and the Beck Depression Inventory. The findings suggest that existential well-being, a spiritual indicator of meaning and purpose, more than religious well-being, was significantly related to the participants' psychological well-being. In addition, HIV symptoms were found to be significant predictors of psychological well-being. These findings support the need for nurses to continue exploring ways to integrate and support spirituality within the domains of clinical practice. MeSH Terms:
J Acquir Immune Defic Syndr Hum Retrovirol 1999 Jan 1;20(1):85-92 Effect of race on insurance coverage and health service use for HIV-infected gay men.Kass N, Flynn C, Jacobson L, Chmiel JS, Bing EGDepartment of Health Policy and Management, Johns Hopkins School of Public Health and Bioethics Institute, Johns Hopkins University, Baltimore, Maryland 21205, USA. nkass@jhsph.edu OBJECTIVE: To determine whether race is associated with health insurance coverage and health service use among gay and bisexual men in the Baltimore center of the Multicenter AIDS Cohort Study. METHODS: Data from eight semiannual study visits between 1991 and 1996 were used. Descriptive, stratified, and logistic regression analyses were conducted to determine whether race is associated with insurance coverage, medical, or dental service use, after controlling for socioeconomic variables. RESULTS: No difference was found between blacks' and whites' likelihood of having health insurance, private insurance, using inpatient, emergency department services, or antiretroviral medications. Whites were more likely to use outpatient services, particularly if CD4 cell counts were high, and were more likely to use dental services, although blacks were more likely to have dental insurance. CONCLUSIONS: Further research must be conducted to examine cultural, social, and psychological factors that help explain why white gay men use more outpatient and dental services, when other service use is unrelated to race. Investigators should be precise when using race as a variable in health services and epidemiologic research, emphasizing when racial differences truly exist versus when the variable race is a surrogate for another factor. MeSH Terms:
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J Acquir Immune Defic Syndr Hum Retrovirol 1999 Jan 1;20(1):67-72 Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City.Des Jarlais DC, Friedman SR, Perlis T, Chapman TF, Sotheran JL, Paone D, Monterroso E, Neaigus ABeth Israel Medical Center, New York, New York 10003, USA. OBJECTIVE: To examine HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. DESIGN AND METHODS: Cross-sectional surveys of injecting drug users (IDUs) recruited from a large detoxification treatment program (n=2489) and a street store-front research site (n=2630) in New York City from 1990 through 1996. Interviews covering demographics, drug use history, and HIV risk behavior were administered; serum samples were collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting through 3 years) and recent initiates (injecting 4-6 years); and long-term injectors (injecting > or = 7 years). RESULTS: 954 of 5119 (19%) of the study subjects were newer injectors, essentially all of whom had begun injecting after knowledge about AIDS was widespread among IDUs in the city. New injectors were more likely to be female and white than long-term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; compared with median age at first injection for long-term injectors, 17 years). The newer injectors generally matched the long-term injectors in frequencies of HIV risk behavior; no significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among the very recent initiates and 18% among the recent initiates. Among the new injectors, African Americans, Hispanics, females, and men who engaged in male-male sex were more likely to be infected. CONCLUSIONS: The new injectors appear to have adopted the reduced risk injection practices of long-term injectors in the city. HIV infection among new injectors, however, must still be considered a considerable public health problem in New York City. MeSH Terms:
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Sex Transm Dis 1999 Jan;26(1):17-25 Sexual experiences and condom use of heterosexual, low-income African American and Hispanic youth practicing relative monogamy, serial monogamy, and nonmonogamy.Norris AE, Ford KSchool of Nursing, Boston College, Chestnut Hill, Massachusetts 02167, USA. BACKGROUND AND OBJECTIVES: To describe (a) demographic characteristics, (b) sexual history, (c) perceived HIV susceptibility, and (d) current sexual behavior, condom use, and alcohol and marijuana use of heterosexual, low-income African American and Hispanic youth categorized as relatively monogamous (n = 577), serial monogamous (n = 171), or nonmonogamous (n = 278). STUDY DESIGN: Data were drawn from personal interviews with a probability sample of low-income youth, age 15 to 24 years, conducted in Detroit in 1991. RESULTS: Many group differences were found. For example, relatively monogamous youth were most likely to be female and Hispanic and to have engaged in unprotected intercourse. Serial monogamous youth were younger and most likely to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier and were most likely to have experienced oral and anal intercourse and to have used alcohol and marijuana. CONCLUSION: Risk reduction programs may need to be tailored differently to accommodate the needs of these three distinct subgroups of youth. MeSH Terms:
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J Calif Dent Assoc 1998 Sep;26(9):652 HIV spread drops in some, but increases in others.Publication Types:
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J Consult Clin Psychol 1998 Dec;66(6):967-78 Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: implications for intervention development.Stark MJ, Tesselaar HM, O'Connell AA, Person B, Galavotti C, Cohen A, Walls CMultnomah County Health Department, Portland, Oregon, USA. mike.j.stark@state.or.us This study examined the prevalence of consistent condom use among inner-city women at risk for HIV, measured the distribution of these women across the stages of change for condom use, determined psychosocial factors associated with the stages, and suggested intervention strategies based on the results. The 5-city sample of women aged 15-34 years consisted predominantly of African Americans. Only 18% reported consistent condom use with main partners and 45% with other partners. Logistic regressions compared women in each stage of change with those in higher stages for each partner type. Results indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and indicate that people important to them favored condom use. Intervention approaches are suggested for women in different stages of change for condom use. MeSH Terms:
W V Med J 1998 Nov-Dec;94(6):320-5 Utilizing an epidemiological profile for HIV prevention community planning in West Virginia.Foglia G, Farr RWSection of Infectious Diseases, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, USA. An epidemiologic profile revealed that approximately 1,000-1,600 persons in West Virginia are living with HIV, and that it is the 5th leading cause of death among persons ages 25-44. HIV is also the leading cause of death in black males ages 25-44 in WV, and blacks are disproportionately affected by HIV/AIDS (composing about 3.1% of the general population and 17% of the AIDS population). This is most marked in Kanawha, Raleigh, and McDowell counties. The predominant mode of exposure reported from 1984-1993, and more recently from 1991-1993, has been men having sex with men (MSM), accounting for 57% of all AIDS cases. A substantial proportion of all cases (13%) were attributed to injecting drug use (IDU), especially in Public Health District 1 where 63% of women infected with HIV reported IDU as a risk behavior. It is difficult to draw conclusions about populations at risk in WV because of the large proportion of HIV cases reported without risk behaviors (26.5%). However, among men, most cases initially reported without risk are eventually reclassified to the MSM and IDU categories. Among women, most cases first reported without risk are eventually changed to the IDU and heterosexual contact categories. Map analyses by Public Health District and county suggest some clustering of cases in the southern region of the state which may be secondary to racial/ethnic and sociodemographic factors. MeSH Terms:
Am J Community Psychol 1998 Oct;26(5):705-43 Culturally sensitive AIDS educational videos for African American audiences: effects of source, message, receiver, and context.Herek GM, Gillis JR, Glunt EK, Lewis J, Welton D, Capitanio JPPsychology Department, University of California, Davis 95616-8775, USA. The importance of using culturally sensitive educational materials in HIV-related interventions with racial and ethnic minority groups is widely recognized. However, little empirical research has been conducted to assess the relative effectiveness of different techniques for creating culturally sensitive AIDS educational videos. Two field experiments with three samples of African American adults (N = 174, 173, and 143) were conducted to assess how source characteristics (race of communicator), message characteristics (multicultural message vs. culturally specific message), and audience characteristics (racial distrust and AIDS-related distrust) influence proximate (perceptions of the message's credibility and attractiveness) and distal (AIDS-related attitudes, beliefs, and behavioral intentions) output variables for AIDS educational videos. In Study 1, an AIDS video with a culturally specific message was rated as more credible, more attractive, and of higher quality than was a video with a multicultural message. The multicultural message was rated less favorably when delivered by a White announcer than when the announcer was Black. In Study 2, the same pattern was replicated with a second community sample and a campus-based sample. Study 2 also indicated that a multicultural message might be more effective if delivered in a culturally specific context, namely, after audience members watch a culturally specific video. Minimal changes were observed in distal outcome variables. It is argued that influencing proximate output variables is necessary, though not sufficient, for effecting long-term change in AIDS-related attitudes, beliefs, and behaviors. MeSH Terms:
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Public Health Rep 1998 Jun;113 Suppl 1:107-15 Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City.Hartel DM, Schoenbaum EEMontefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. works@mhv.net OBJECTIVE: We undertook a study of the role of methadone maintenance in protecting injecting drug users (IDUs) from human immunodeficiency virus (HIV) infection from the earliest days of the HIV epidemic in New York City to the present. The historical context of the epidemic in the Bronx is discussed. METHODS: For close to two decades, we have been tracking changes in injecting drug use and HIV infection levels in a Bronx cohort study of IDUs. An initial sample of 622 IDUs was recruited from a methadone treatment program in 1985, with historical data going back to 1978. Behavioral interviews and HIV testing were performed and methadone treatment program records (urine toxicology and methadone dose history) were reviewed. We examined both prevalent and incident HIV infections. The sample included African Americans (24.3%), Latinos (50.3%), and white non-Latinos (24.4%). The average methadone dose was 64 milligrams (mg) per day with an average time in treatment of five and a half years. RESULTS: We found a very low rate of incident infection of 1.7 per 100 person-years observation since 1986. Because of this low rate of infection, we were unable to determine the association between methadone treatment factors and HIV seroincidence. We found that our prevalence data on the 622 IDUs enrolled from 1985 to 1988 yielded strong findings on the role of methadone maintenance in a period when most infections occurred in this population. HIV seroprevalence was 42.9%. Logistic regression analysis revealed associations of methadone dose > or = 80 mg (adjusted odds ratio = 3.07/yr, 95% confidence interval (CI): 1.23-7.68) and last year entered methadone treatment (adjusted odds ratio = 1.22/yr, 95% CI: 1.06-1.41) to HIV infection, independent of year of last cocaine injection, needle sharing in shooting galleries, number of IDU sex partners, low income, and African American of Latino ethnicity. CONCLUSIONS: Properly dosed, long-term methadone treatment was found to be a central protective factor in preventing HIV infection from the earliest days of the epidemic in New York City. It is crucial to have high quality drug treatment programs in place before an epidemic draws our attention to the inadequacies through excess and unnecessary morbidity and mortality. MeSH Terms:
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Psychosom Med 1998 Nov-Dec;60(6):714-22 Stressful events, pessimism, natural killer cell cytotoxicity, and cytotoxic/suppressor T cells in HIV+ black women at risk for cervical cancer.Byrnes DM, Antoni MH, Goodkin K, Efantis-Potter J, Asthana D, Simon T, Munajj J, Ironson G, Fletcher MADepartment of Psychology, University of Miami, Coral Gables, Florida 33124, USA. OBJECTIVE: This study examines whether stressful negative life events and pessimism were associated with lower natural killer cell cytotoxicity (NKCC) and T cytotoxic/suppressor cell (CD8+CD3+) percentage in black women co-infected with human immunodeficiency virus Type 1 (HIV-1) and human papillomavirus (HPV), a viral initiator of cervical cancer. METHOD: Psychosocial interviews, immunological evaluations, and cervical swabs for HPV detection and subtyping were conducted on 36 HIV+ African-American, Haitian, and Caribbean women. RESULTS: Greater pessimism was related to lower NKCC and cytotoxic/suppressor cells after controlling for presence/absence of HPV Types 16 or 18, behavioral/lifestyle factors, and subjective impact of negative life events. CONCLUSIONS: A pessimistic attitude may be associated with immune decrements, and possibly poorer control over HPV infection and increased risk for future promotion of cervical dysplasia to invasive cervical cancer in HIV+ minority women co-infected with HPV. MeSH Terms:
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J Acquir Immune Defic Syndr Hum Retrovirol 1998 Dec 1;19(4):413-20 Sociodemographic and behavioral characteristics of African-American women with HIV and AIDS in Los Angeles County, 1990-1997.Wohl AR, Lu S, Odem S, Sorvillo F, Pegues CF, Kerndt PRHIV Epidemiology Program, Los Angeles County Department of Health Services, California 90005, USA. African-American women have the highest AIDS rate of any racial/ethnic group of women in both Los Angeles County (LAC), California and in the United States. Limited population-based epidemiologic studies of African-American women with HIV and AIDS describe this group and examine the factors associated with the excessive rates. Interview data collected from 1990 to 1997 on a population-based sample of AIDS cases and a group of HIV-infected women in LAC were analyzed to highlight the sociodemographic and behavioral characteristics of African-American women. This group of African-American women with HIV or AIDS in LAC were unemployed (88%), single mothers (64%), living on public assistance (86%) with annual household incomes <$10,000 U.S. (76%). A history of crack use predominated (50%). Compared with women of other races with HIV and AIDS, African-American women reported more sexual partners; reported more infections with sexually transmitted diseases; sought treatment for their HIV infection later; were more likely to trade sex; and were almost five times more likely to have ever used crack cocaine. HIV prevention for African-American women in LAC should focus on improving self-esteem and negotiation skills within the context of the crack cocaine culture and the disadvantaged social and economic situation described. MeSH Terms:
J Acquir Immune Defic Syndr Hum Retrovirol 1998 Dec 1;19(4):350-60 Factors associated with HIV-infected patients' recognition and use of HIV medications.Jeffe DB, Meredith KL, Mundy LM, Fraser VJDivision of Health Behavior Research, Washington University School of Medicine, St. Louis, Missouri 63108, USA. djeffe@imgate.wustl.edu In 1996, we interviewed 224 HIV-infected patients (54% men, 63% African American) receiving HIV medical care in St. Louis, Missouri about their recognition, prior use, and current use of HIV medications. Of 221 respondents who had heard of at least one antiretroviral drug, only 2 respondents reported they had never taken antiretroviral drugs. Multivariate logistic regression among respondents with CD4 counts <500 cells/mm3 identified sociodemographic variables (gender, race, education, and site of care) that were significantly (p < .05) associated with never having heard of, never having used, and not currently using specific antiretroviral drugs. African Americans in general, African American women, or African Americans with 12 years of schooling were more likely never to have heard of didanosine (ddI)/zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), protease inhibitors, and non-nucleoside reverse transcriptase inhibitors (NNRTIs). In addition, women were more likely never to have heard of protease inhibitors, and respondents with < or = 12 years of schooling were more likely never to have heard of NNRTIs. African Americans were more likely never to have taken azidothymidine (AZT), and African American women were more likely never to have taken 3TC and protease inhibitors. Sociodemographic variables were not significantly associated with current use of specific antiretroviral drugs among those with CD4 levels <500 cells/mm3, nor with recognition, prior use, or current use of Pneumocystis carinii pneumonia prophylaxis among those with CD4 counts <200 cells/mm3. Findings indicate that, even among patients receiving HIV care, African Americans, women, and those with < or = 12 years of schooling were more likely never to have heard of and never to have used various specific antiretroviral medications. More focused efforts are needed to help patients become aware of available antiretroviral drugs and to encourage greater use of these drugs among all patients for whom the drugs are indicated. MeSH Terms:
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AIDS Care 1998 Jun;10(3):267-81 Changing HIV infection rates and risk in an African-American community cohort.Brunswick AF, Flory MJColumbia University, New York, NY 10032, USA. This longitudinal study of a homogeneously urban African-American community cohort drawn from the metropolitan New York area (USA) analyzed three-year change in HIV-1 antibody prevalence and self-reported risk practices separately for men and women. Specifically, risk practices reported on personal interviews and results from blood sero-assay in 1989-1990 were compared to similar interview reports of risk practices and HIV assay from saliva samples in 1993. Results showed: (1) women's infection rates increased more than men's, resulting in a male to female infection ratio of 1.5:1; (2) heterosexual transmission accounted for most of women's new infection; (3) in multivariate analysis, multiple partners was a significant heterosexual risk indicator for both men and women, increasing infection odds five-fold; and (4) buying sex also increased heterosexual men's infection odds approximately five-fold. Results document increasing rates of African-American HIV infection linked largely to heterosexual exposure risk, that the African-American male-female infection ratio resembles the global rather than North American one, and also the utility of an expanded classification of heterosexual exposure risk. MeSH Terms:
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AIDS Care 1998 Oct;10(5):549-62 Factors associated with HIV-infected women's delay in seeking medical care.Raveis VH, Siegel K, Gorey EColumbia University, School of Public Health, Division of Sociomedical Sciences, New York, NY 10032, USA. vhr1@columbia.edu Data from an investigation of HIV-infected African-American, Puerto Rican and non-Hispanic white women's treatment behaviour and decision-making are presented. Findings are based on a thematic analysis of the narrative accounts of 31 women who exhibited significant delay in seeing a physician about their HIV infection after testing positive for HIV antibodies. Analysis of the women's qualitative interview data indicated that a variety of barriers impeded them from actively pursuing treatment. The women's psychological responses to learning their serostatus were the most pervasive factors associated with delaying seeking care. Implications of the analysis for informing the design of secondary prevention efforts to move women into treatment earlier are discussed, such as the need to develop interventions or supportive services designed to assist women in coming to terms with their infected status. MeSH Terms:
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J Natl Med Assoc 1998 Nov;90(11):665-74 Neuropsychological functioning in HIV-positive African-American women with a history of drug use.Mason KI, Campbell A, Hawkins P, Madhere S, Johnson K, Takushi-Chinen RDepartment of Psychology, Howard University, Washington, DC 20059, USA. This preliminary investigation examined neuropsychological performance in a sample of human immunodeficiency virus (HIV)-positive and HIV-negative African-American women with a history of drug use. The study population was comprised of 10 HIV-negative, 9 asymptomatic HIV-positive, 13 symptomatic HIV-positive, and 10 acquired immunodeficiency virus (AIDS) patients. A neuropsychological battery designed to assess attention, psychomotor processing, verbal memory, and visual memory was administered to participants. No evidence of HIV-related cognitive impairment was found in patients in the early stages of HIV infection. Multivariate analyses of variance revealed significant deficits in psychomotor processing and verbal recall in persons with AIDS. These individuals showed greater difficulty in tasks requiring maintained attention and performed poorly on measures of immediate and delayed verbal recall. In contrast, HIV status was not related to visual memory, verbal recognition, or the number of errors made during a verbal recall task. The pattern of cognitive deficits observed in persons with AIDS resembles that commonly associated with subcortical pathology. The cognitive deficits observed were not related to depression or recentness of drug use. MeSH Terms:
J Natl Med Assoc 1998 Nov;90(11):643-4 Human immunodeficiency virus/acquired immunodeficiency syndrome crisis.Dennis GCMeSH Terms:
Int J STD AIDS 1998 Oct;9(10):608-12 Frequency of alcohol use and its association with STD/HIV-related risk practices, attitudes and knowledge among an African-American community-recruited sample.Morrison TC, DiClemente RJ, Wingood GM, Collins CSchool of Public Health, Department of Health Behavior, University of Alabama, Birmingham 35294-0022, USA. The aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n=201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age=37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol < =15 days and = > 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices. MeSH Terms:
J Infect Dis 1998 Dec;178(6):1799-802 Major histocompatibility complex genotype is associated with disease progression and virus load levels in a cohort of human immunodeficiency virus type 1-infected Caucasians and African Americans.Mann DL, Garner RP, Dayhoff DE, Cao K, Fernandez-Vina MA, Davis C, Aronson N, Ruiz N, Birx DL, Michael NLImmunogenetics Division, Department of Pathology, University of Maryland Medical System, Baltimore, MD 21201, USA. dmann001@umaryland.edu To assess the influence of HLA on AIDS-free survival, human immunodeficiency virus load, and CD4 cell counts, 91 Caucasian and 48 African-American seroprevalent men were typed for HLA classes I and II and TAP alleles. HLA associations with these markers were assessed by assigning sum integer scores based on 7 class I allele-TAP variants (+1) and 13 class I-class II-TAP combinations (-1) with different AIDS-free survival times found in a prior study. Subjects in both racial groups and combined with positive sum scores were less likely to have CD4 cell decline (P=.0004), to have increased virus burden (P=.014), and to develop AIDS (P=.034) in the follow-up period than were Caucasians and African Americans with scores of 0 or -1. These results confirm the reported associations of specific major histocompatibility complex genes with AIDS-free survival time in Caucasians and specifically extend them to African Americans and to two established markers of disease progression. MeSH Terms:
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Dis Mon 1998 Oct;44(10):545-606 Human immunodeficiency virus infection, Part I.Horowitz HW, Telzak EE, Sepkowitz KA, Wormser GPDepartment of Medicine, New York Medical College, Valhalla, USA. Initially recognized in 1982, acquired immunodeficiency syndrome (AIDS) has been the leading cause of death among young adults in the United States for much of this decade, and it has had a devastating impact on people in the developing world. It is estimated that 42 million people worldwide have been infected with human immunodeficiency virus (HIV), the virus that causes AIDS, and that almost 12 million people have died from AIDS-related diseases through 1997. Among these 12 million are 3 million children. Two thirds of the more than 30 million people with HIV or AIDS reside in sub-Saharan Africa. In the United States, 641,086 patients have been diagnosed with AIDS through 1997, and at least 385,000 have died. However, for the first time, new highly active antiretroviral therapies that include multiple drugs that attack the virus at several sites have slowed the progression from HIV to AIDS and from AIDS to death for those infected with HIV. The cumulative effect of these changes has been a reduction in both AIDS incident cases and AIDS deaths. Recent epidemiologic trends indicate that the proportion of AIDS incident cases and new HIV infections are increasing among women, African-Americans, and Hispanics, and the infections are more likely to be acquired through heterosexual transmission. The clinical management of HIV infection and AIDS has become increasingly complex in recent years. In addition to complete medical and social histories and physical examinations, hematologic, biochemical, serologic, and immunologic laboratory tests are required to predict the likelihood that patients will develop opportunistic infections and other complications related to HIV infection. Among the most important laboratory tests are measurements of HIV in plasma (viral load) in conjunction with peripheral blood CD4+ helper T lymphocyte counts. These tests are potent predictors of disease progression and their results have become markers for clinical response to therapy. The development of highly active antiretroviral therapy has had a profound impact on the epidemiology of AIDS and on the lives of individual patients. Through combinations of antiretroviral drugs, especially protease inhibitors, viral suppression can be achieved. However, adherence to these complex medical regimens and drug interactions have been problems for many patients. In addition, numerous questions remain unanswered, most importantly those regarding the timing of the initiation of treatment, the durability of viral suppression and clinical response, and the optimal "salvage" regimens for patients failing therapy either clinically or virologically. Publication Types:
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Am J Addict 1998 Fall;7(4):262-71 Comparing i.v. and non-i.v. cocaine users. Characteristics of a sample of cocaine users seeking to participate in research.Lexau BJ, Nelson D, Hatsukami DKUniversity of Minnesota, Department of Psychiatry, Minneapolis 55455, USA. The authors examined differences between current intravenous (i.v.), past i.v., and no i.v. cocaine use among a sample of cocaine users on measures of drug use, medical history, psychiatric history, and criminal history. Past i.v. cocaine users were older than non-i.v. cocaine users. The current i.v. cocaine-using group included more white participants, and the non-i.v. group included more African Americans. Those with past or current i.v. use had more extensive drug use histories than non-i.v. users. Also, more current and past i.v. cocaine-using groups reported having been tested for HIV and reported testing positive for hepatitis. Former i.v. cocaine users reported more emergency room visits for complications stemming from cocaine use. They also reported more treatment for substance abuse and were convicted of more crimes. These results suggest that the route of administration is important in studying the characteristics of drug users. MeSH Terms:
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J Acquir Immune Defic Syndr Hum Retrovirol 1998 Nov 1;19(3):245-53 Provider attitudes regarding participation of women and persons of color in AIDS clinical trials.Stone VE, Mauch MY, Steger KADepartment of Medicine, Memorial Hospital of Rhode Island, Brown University School of Medicine, Providence 02860, USA. Valerie_Stone@mhri.org Provider attitudes and perceptions that may influence recruitment and enrollment of diverse patients into AIDS clinical trials were examined by conducting a cross-sectional survey of all HIV/AIDS providers at a municipal teaching hospital. Providers were less likely to feel confident explaining trials to non-English-speaking patients (p < .05). Providers also reported being more confident of their ability to give an overview of clinical trials in culturally appropriate terms to white patients than to patients of other races/ethnicities (p < .05). Many providers perceived the interest in clinical trials by African American (25%), Latino (14%), and Haitian patients (30%) to be lower; and primarily cited suspicions about clinical research as the reason. Some providers (13%) perceived that women with HIV/AIDS are less interested in clinical trials. Despite these perceptions, all providers reported that they are just as likely to inform women and African Americans about available clinical trials; a small proportion reported that they were less likely to inform Latinos (6%) and Haitians (11%). None of these findings differed significantly by provider race, gender, HIV experience, languages spoken, or specialty. Underrepresentation of minorities and women in AIDS Clinical Trials may partially result from attitudes and perceptions of providers. MeSH Terms:
AIDS Educ Prev 1998 Oct;10(5):465-80 Acceptability of the female condom among STD clinic patients.el-Bassel N, Krishnan SP, Schilling RF, Witte S, Gilbert LSocial Intervention Group, Columbia University School of Social Work, New York, NY 10025, USA. ne5@Columbia.edu This study examines the acceptability of the female condom among African American and Latino patients from two inner-city sexually transmitted disease (STD) clinics through focus group discussions. Prior to the initial focus group sessions, 90% (n = 90) had heard about the female condom, 8% (n = 8) had seen it, and 2% (n = 2) had used it. Among the 41 participants (22 males and 19 females) attending a second focus group session, 85.4% (n = 35) had used the female condom at least once. Female study participants who had previous experience inserting a barrier contraceptive device, such as a diaphragm, indicated that they felt more comfortable inserting the female condom than those who had never used such a device. Male participants indicated that they were more comfortable using the female condom with their steady partners than with casual partners, whereas female participants indicated no such distinctions. These and other study findings suggest that need to promote and expand the use of the female condom as a device that protects women from STD transmissions including HIV and AIDS. MeSH Terms:
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AIDS Educ Prev 1998 Oct;10(5):447-64 Perceived AIDS risk among adult arrestee injection drug users in Los Angeles county.Henson KD, Longshore D, Kowalewski MR, Anglin MD, Annon KDepartment of Sociology and Anthropology, Loyola University, Chicago, IL 60626, USA. khenson@luc.edu In this paper we examine the determinants of perceived risk for getting HIV and AIDS among adult Los Angeles arrestees reporting any lifetime injection drug use (N = 958). Our sample, drawn from the Drug Use Forecasting program, is 60% male and 40% female. Higher rates of reported risky drug and sexual behaviors than in the general population make this a particularly relevant sample within which to explore correlates of perceived risk for getting HIV and AIDS. We used multiple logistic regression to assess the relationship between perceived risk and a variety of demographic, behavioral, and psychosocial variables. Arrestees reporting celibacy in the past year, having an injection-drug-using sexual partner, having more than 20 sexual partners, engaging in sex while high, knowing someone with AIDS, and having been tested for HIV antibodies were more likely to perceive themselves at greater risk of getting HIV and AIDS. African American arrestees and arrestees reporting having attempted to reduce their sexual risks were less likely to perceive themselves at greater risk for getting AIDS. Implications for AIDS education and prevention are discussed. MeSH Terms:
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J Psychoactive Drugs 1998 Jul-Sep;30(3):247-53 Drug use and HIV risks among African-American, Mexican-American, and Puerto Rican drug injectors.Estrada ALMexican-American Studies and Research Center, University of Arizona, Tucson 85721-0023, USA. This article documents the prevalence of injection-related HIV risk behaviors among a sample of 758 Mexican-American, Puerto Rican, and African-American drug injectors derived from the National Institute on Drug Abuse Cooperative Agreement database. The results show that the two Hispanic subgroups had higher injection-related risks than the African-American group. Further, among Hispanics, Puerto Ricans had higher rates of drug injection than Mexican-Americans, but Mexican-Americans had higher rates of sharing injection paraphernalia than Puerto Ricans. The research suggests that more aggressive HIV/AIDS intervention efforts be targeted to minority injection drug users, especially those that are contextualized by the racial/ethnic group targeted. MeSH Terms:
Am J Hematol 1998 Nov;59(3):199-207 Viral burden and disease progression in HIV-1-infected patients with sickle cell anemia.Bagasra O, Steiner RM, Ballas SK, Castro O, Dornadula G, Embury S, Jungkind D, Bobroski L, Kutlar A, Burchott SCenter for Human Virology and The Cardeza Foundation of the Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. The spleen and lymph nodes are major sites of human immunodeficiency virus type 1 (HIV-1) replication, mutation, and genetic variation in vivo. If a major portion of the lymphatic tissue, such as the spleen, is removed or otherwise is unavailable for invasion by the HIV-1 virus, will the course of the infection be altered, resulting in a prolonged symptom-free interval or even increased survival? The spleen of most adults with sickle cell anemia (SS) is nonfunctional due to recurrent episodes of microinfarction. If autosplenectomized SS patients are exposed to HIV-1, they may be ideal candidates to examine the question of whether absence of splenic function at the time of infection will positively alter the course of HIV-1-related disease. All SS patients with a diagnosis of HIV-1 infection at five university sickle cell centers were included in the patient cohort. Patients in active treatment or in follow-up (group A, n = 11) underwent a series of quantitative viral studies to determine their HIV-1 viral burden. The studies included the branched-DNA signal amplification assay, quantitative DNA-polymerase chain reaction (PCR), quantitative reverse transcription (RT)-initiated-PCR, and in situ PCR. All patients who died of the complications of the acquired immunodeficiency syndrome (AIDS) or of SS, lost to follow-up, or were otherwise unavailable for study (Group B: n = 7) were included in the total patient group. None of the patients in group B underwent quantitative viral studies. In addition, a control population (group C, n = 36) of HIV-1-infected African Americans without SS, of similar age and gender to the SS patients, were compared with the study population for outcomes. In eight of 11 active patients (group A), the CD4+ T-lymphocyte counts were normal and viral burdens were low for an average of 10.25 years following diagnosis. These eight patients all from group A were the only long-term nonprogressors (44%) among a total of 18 SS patients (groups A and B). In group C (control), only five patients of 36 were long-term nonprogressors (13.9%). Five patients (28%) of the total SS group (groups A and B) succumbed to AIDS. One of the five was from Group A. The evaluation of a limited number of adult individuals suggests that a significant proportion of HIV-1-seropositive SS patients (44%) may be asymptomatic long-term nonprogressors. In these patients, the CD4+ T-lymphocyte counts remained high and their viral burdens were remarkably lower than in non-SS HIV-1-seropositive individuals. Whereas this study does not prove an "autosplenectomy" hypothesis, it suggests that in patients with both SS and HIV-1 infection, the retroviral disease may be ameliorated by host factors of which absence of splenic function prior to HIV-1 infection may be one. Publication Types:
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Women Health 1998;27(4):19-32 Women's self-reported condom use: intra and interpersonal factors.Soet JE, DiIorio C, Dudley WNRollins School of Public Health, Emory University, Atlanta, GA, USA. In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use. MeSH Terms:
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Mil Med 1998 Oct;163(10):672-6 Human immunodeficiency virus (HIV) education and HIV risk behavior: a survey of rapid deployment troops.Nannis ED, Schneider S, Jenkins PR, Sharp-Breslau E, Daniell FD, McKee KT JrHenry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD 20852, USA. A paper-and-pencil questionnaire was administered to 1,377 U.S. Army troops from rapid deployment units at Fort Bragg, North Carolina. This yielded 1,368 surveys available for analysis. The primary goal of the survey was to evaluate this group's experience with the Army human immunodeficiency virus (HIV) education program and to determine their level of HIV risk behaviors as related to participation in the Army's HIV education program. Seventy-seven percent of the respondents (1,052 of 1,368) reported receiving some HIV education from the Army. Of those, 55% (578 of 1,052) reported receiving 1 hour of education within the past year. Soldiers of Asian, Native American, and "other" race/ethnicity, and to a lesser extent, Hispanic background, were more likely to report receiving no HIV education compared with whites and African Americans. Self-reported receipt of HIV education did not strongly differentiate individuals in their partner selection or in key sexual risk behaviors in which they engaged. MeSH Terms:
Sex Transm Dis 1998 Sep;25(8):443-7 Sexually transmitted infections in women infected with the human immunodeficiency virus. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).Capps L, Peng G, Doyle M, El-Sadr W, Neaton JDDepartment of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, USA. BACKGROUND AND OBJECTIVES: Limited prospective data are available on sexually transmitted infections (STIs) among HIV-infected patients. The incidence and predictors of STIs were assessed among HIV-infected women enrolled in a clinical trial. STUDY DESIGN: Prospective cohort of 323 women. RESULTS: Sixty-five percent had at least one STI based on history and/or examination at baseline. Most conditions identified at baseline were based on patient history; only 10 of 123 women with no history of an STI (8.1%) had one identified upon examination. During a median follow-up of 2.1 years, 25% developed a new/recurrent STI. Being African-American (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 1.45-12.26), reporting sex with an intravenous drug user as an HIV risk behavior (OR = 2.29, 95% CI: 1.34-3.92), and a history/presence of STIs at baseline (OR = 1.79, 95% CI: 1.01-3.19) were factors associated with significantly increased risk of STI's. CONCLUSIONS: A substantial proportion of women developed new STIs during the course of the clinical trial. Prevention efforts should be emphasized among high risk HIV-infected patients. MeSH Terms:
J Acquir Immune Defic Syndr Hum Retrovirol 1998 Oct 1;19(2):158-64 Trends in HIV prevalence among childbearing women in the United States, 1989-1994.Davis SF, Rosen DH, Steinberg S, Wortley PM, Karon JM, Gwinn MDivision of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. We used data from a national serosurvey to describe national and regional trends in the prevalence of HIV among women giving birth in the United States from 1989 through 1994, and to estimate the number of women between 15 and 44 years old with HIV infection who had not yet developed opportunistic infections defining AIDS. We compared these estimates with AIDS prevalence and mortality estimates from the national AIDS case surveillance system. HIV seroprevalence among childbearing women remained stable nationwide from 1989 through 1994, ranging from 1.5 to 1.7/1000 women. In the Northeast, seroprevalence declined significantly after 1989. Seroprevalence increased significantly in the South through 1991 and then stabilized, although seroprevalence among black women continued to increase through 1994 in some southern states. Although AIDS prevalence and mortality increased nationwide each year from 1989 through 1994, the number of women infected with HIV who had not yet developed AIDS changed little and was approximately 86,000 in 1994. Our data suggest that new HIV infections among women of reproductive age are occurring at a rate that offsets losses from this population due to aging, disease progression, and death. MeSH Terms:
J Adolesc Health 1998 Oct;23(4):205-11 Condom use by Hispanic and African-American adolescent girls who use hormonal contraception.Roye CFHunter-Bellevue School of Nursing, New York, New York 10010, USA. PURPOSE: The purpose of the present study was to examine condom use by teens who use hormonal contraceptives [i.e., Depo-Provera, Norplant, or oral contraceptives (OCs)]. METHODS: This is a cross-sectional study of 578 Hispanic and African-American female adolescents between the ages of 12 and 21 years who came to a reproductive health care clinic. A paper-and-pencil questionnaire which addressed sexual behaviors, sexual history, and communication about sexuality was distributed to adolescent girls attending the clinic. Several important analyses included only those who had been sexually active in the last 4 weeks (n = 452). RESULTS: Adolescents who used OCs [odds ratio (OR) 1.7], long-acting agents (i.e., Depo-Provera or Norplant) (OR 1.6), were less likely to have used a condom in the last 4 weeks than teens whose only method of birth control was condoms. Only those teens who had previously been diagnosed with a sexually transmitted disease (STD) were more likely to have used a condom (OR .67 for not using a condom). Overall, condom use by teens in this sample was low, with only 19% reporting that they "always" use a condom, and 47% of the teens who had been sexually active in the last 4 weeks reporting that they had not used a condom at least once during that time. CONCLUSIONS: This study provides data which suggest that adolescent girls who use hormonal contraceptives are less likely to use condoms than other sexually active teens. Therefore, when prescribing hormonal contraception to prevent pregnancy, clinicians must provide appropriate counseling to mitigate against the potential to increase the risk of STDs. MeSH Terms:
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Br J Gen Pract 1998 Jun;48(431):1329-30 Do women with HIV infection consult with their GPs?Madge S, Mocroft A, Olaitan A, Johnson MDepartment of Thoracic Medicine, Royal Free Hospital, London. In a cohort of 106 HIV-positive women, 86 (81%) were registered with a general practitioner (GP) and 71 (83%) had a GP who was aware of their HIV status. GPs were primarily consulted for perceived non-HIV-related problems and prescriptions. This is encouraging. However, primary and secondary care services should aim to increase the proportions of HIV-positive individuals with access to primary care. Comments:
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J Assoc Nurses AIDS Care 1998 Sep-Oct;9(5):61-72 Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators.Villarruel AM, Jemmolt LS, Howard M, Taylor L, Bush EUniversity of Pennsylvania, School of Nursing, USA. The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population. MeSH Terms:
J Ark Med Soc 1998 Aug;95(3):104-5 HIV infections increasing among women and minorities.Publication Types:
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Bol Asoc Med P R 1998 Jan-Mar;90(1-3):12-5 CCR5 chemokine receptor genotype frequencies among Puerto Rican HIV-1-seropositive individuals.Gonzalez S, Tirado G, Revuelta G, Yamamura Y, Lu Y, Nerurkar VR, Yanagihara RPonce School of Medicine AIDS Research Program, PR 00732. Some individuals remain uninfected by human immunodeficiency virus type 1 (HIV-1), despite multiple sexual contacts with subjects with confirmed HIV-1 infection. Several studies have confirmed that individuals who are homozygous for a 32 base pair (bp) deletion mutation in the chemokine receptor gene CCR5, designated as delta 32/ delta 32, are protected against HIV-1 infection. Heterozygotes of the same chemokine receptor deletion mutation are, however, not protected from acquiring HIV-1 infection but seemingly have slower progression to acquired immunodeficiency syndromes (AIDS). Genotype frequencies of the delta 32 CCR5 mutation vary markedly among different ethnic groups; heterozygosity is found in approximately 15% of Caucasians, about 5-7% of Hispanics and African Americans and 1% or less of Asians. The ethnic background of Puerto Ricans is highly complex and usually includes admixture of Caucasian, Caribbean Indian and African traits to a varying extent. This study was conducted to examine the frequencies of the delta 32 CCR5 mutation among Puerto Ricans who are infected with HIV-1. Samples were received from different geographical regions of the island. Of 377 samples tested, 94.2% were wild type (non-deletion mutant) homozygotes, 5.8% were delta 32 CCR5 heterozygotes, and none were delta 32 CCR5 homozygotes. The incidence of CCR5 delta 32/w heterozygous mutation among Puerto Ricans seems to be somewhat lower than what was reported with US Hispanics. Some age and gender associated bias of the mutation frequency were observed with the study population, the reason for which is unclear at present. MeSH Terms:
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J Acquir Immune Defic Syndr Hum Retrovirol 1998 Sep 1;19(1):67-73 HIV infection in disadvantaged out-of-school youth: prevalence for U.S. Job Corps entrants, 1990 through 1996.Valleroy LA, MacKellar DA, Karon JM, Janssen RS, Hayman CRDivision of HIV/AIDS Prevention--Epidemiology and Surveillance, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lav0@cdc.gov To describe HIV infection prevalence and prevalence trends for disadvantaged out-of-school youth in the United States, we analyzed the HIV prevalence for and demographic characteristics of youth, aged 16 through 21 years, who entered the U.S. Job Corps from January 1990 through December 1996. Job Corps is a federally funded jobs training program for socially and economically disadvantaged out-of-school youth. All 357,443 entrants residing at Job Corps centers during their training were tested for HIV infection; 822 (2.3 per 1000) were HIV-positive. HIV prevalence was higher for women than for men (2.8 per 1000 versus 2.0 per 1000; relative risk [RR]=1.4; 95% confidence interval [CI]=1.2-1.6). Among racial/ethnic groups, prevalence was highest for African Americans (3.8 per 1000). Prevalence was higher for African American women (4.9 per 1000) than for any other gender and racial/ethnic group. From 1990 through 1996, standardized HIV prevalence-stratified by age, race/ethnicity, home region, population of home metropolitan statistical area, and year of entry--declined for women and for men: for women, from 4.1 per 1000 in 1990 to 2.1 per 1000 in 1996 (p=.001); and for men, from 2.8 per 1000 in 1990 to 1.4 per 1000 in 1996 (p=.001). These data suggest that HIV prevalence for disadvantaged out-of-school youth declined from 1990 through 1996. However, considering their youth, prevalence was still high, particularly for women and African Americans, most notably African American women. These data support the need for ongoing HIV prevention programs targeting such youth. MeSH Terms:
J Acquir Immune Defic Syndr Hum Retrovirol 1998 Aug 15;18(5):479-87 Sexual behavior and pregnancy outcome in HIV-infected women. Canadian Women's HIV Study Group.Hankins C, Tran T, Lapointe NMontreal Regional Public Health Department, and McGill AIDS Centre, McGill University, Quebec, Canada. md77@musica.mcgill.ca Sexual behavior and pregnancy outcome data for 392 HIV-infected women were analyzed. During the 6 months before study entry, 71.2% (279 of 392 women) were sexually active. In multivariate regression, women with baseline CD4+ > or = 200/microl were more likely than women with CD4+ < 200/microl to be sexually active (adjusted odds ratio [OR] = 1.75; 95% confidence interval [CI], 1.06-2.88; p = .03). Consistent condom use was reported with 58.4% (149 of 255) of steady male partners and 65.7% (23 of 35) of casual partners. Overall, 90.3% of 279 sexually active women were using contraception. Among women aged between 15 and 44 years (n = 320), the incidence of pregnancy in the year before HIV diagnosis was 27.5 per 100 person-years (PY) (95% CI, 22.1-33.9) compared with 8.3/100 PY (95% CI, 6.8-10.2) in the time since HIV diagnosis (p < .001). The incidence of therapeutic termination of pregnancies conceived in the 20 weeks before HIV diagnosis (10.6/100 PY) was more than triple that after diagnosis (3.1/100 PY; p = .001). After publication of results of zidovudine prophylaxis of mother-to-child transmission, pregnancy rates did not increase, but the incidence of therapeutic abortion dropped from 4.3/100 PY to 1.4/100 PY (p = .009). Knowledge of sexual behavior, including pregnancy frequency and outcome, can assist in tailoring counseling for HIV-infected women concerning sexual and reproductive health. MeSH Terms:
Sex Transm Dis 1998 Aug;25(7):342-5 Failure to learn human immunodeficiency virus test results in Los Angeles public sexually transmitted disease clinics.Wiley DJ, Frerichs RR, Ford WL, Simon PAHIV Epidemiology Program, Los Angeles County Department of Health Services, California, USA. BACKGROUND: Early human immunodeficiency virus (HIV) defection is essential for initiating treatment and partner-notification activities. Sexually transmitted disease (STD) clinic attendees are at high risk for infection and should be made aware of their HIV status. GOAL: To determine the characteristics associated with not receiving an HIV test result in an STD clinic setting. STUDY DESIGN: Confidential HIV testing was offered to 6,705 persons attending four public STD clinics in Los Angeles who submitted blood for syphilis serology and were tested for HIV antibody in an unlinked HIV serosurvey. Human immunodeficiency virus test results and return status were anonymously linked to other risk information. RESULTS: Only one-third of attendees were tested and given their results. Those testing HIV positive in the anonymous survey and those requesting HIV testing were most likely to receive a test result (i.e., 41% and 49%, respectively). Those solely requesting an STD examination, repeat testers, and African-Americans were least likely to receive a result (i.e., 32%, 30%, and 26%, respectively). CONCLUSIONS: Most STD clinic patients fail to receive an HIV test result. Other strategies, such as rapid HIV testing, are needed to increase participation and receipt of HIV test results in this high-risk population. MeSH Terms:
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Fam Plann Perspect 1998 Jul-Aug;30(4):170-2, 200 Sexual behavior among U.S. high school students, 1990-1995.Warren CW, Santelli JS, Everett SA, Kann L, Collins JL, Cassell C, Morris L, Kolbe LJSurveillance Research Section, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. CONTEXT: High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS: Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS: The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS: Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection. MeSH Terms:
Science 1998 Jul 17;281(5375):353-4 Elimination of syphilis in the United States.St Louis ME, Wasserheit JNNational Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop E-02, Atlanta, GA 30333, USA. Comments:
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J Acquir Immune Defic Syndr Hum Retrovirol 1998 Aug 1;18(4):341-8 Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility.Mostashari F, Riley E, Selwyn PA, Altice FLYale University AIDS Program, New Haven, Connecticut 06510-2483, USA. We examined attitudinal and demographic correlates of antiretroviral acceptance and adherence among incarcerated HIV-infected women. Structured interviews were conducted with 102 HIV-infected female prisoners eligible for antiretroviral therapy. Three quarters of the women were currently taking antiretroviral agents, of whom 62% were adherent to therapy. Satisfaction was very high with the HIV care offered at the prison; 67% had been first offered antiretroviral agents while in prison. Univariate and multivariate analyses showed acceptance of the first offer of antiretroviral therapy to be associated with trust in medication safety, lower educational level, and non-black race. Current acceptance of therapy was associated with trust in the medication's efficacy and safety. Medication adherence was correlated with the patient-physician relationship and presence of emotional supports. Nearly one half of these HIV-seropositive women were willing to take experimental HIV medications in prison. This was correlated with satisfaction with existing health care, the presence of HIV-related social supports, and perceived susceptibility to a worsening condition. Acceptance and adherence with antiretroviral agents appear to be significantly associated with trust in medications, trust in the health care system, and interpersonal relationships with physicians and peers. Development of models of care that encourage and support such relationships is essential for improving adherence to antiretroviral therapy, especially for populations that have historically been marginalized from mainstream medical care systems. MeSH Terms:
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ABNF J 1998 May-Jun;9(3):61-4 Recruitment of African Americans in AIDS clinical trials: some recommended strategies.Mabunda-Temple GSouthern Illinois University School of Nursing, Edwardsville 62026-1066, USA. gmabund@siue.edu AIDS traditionally has been more prevalent among homosexual white males, but it has been spreading rapidly among the heterosexual populations. The great impact of AIDS has been among the under-privileged population, especially African Americans. AIDS is now a leading cause of death among African Americans age 25 to 44. In spite of this fact, African Americans are disproportionately under-represented in AIDS clinical trials. The lack of participation in clinical trials means that this population is not benefiting from the state-of-the-art drugs that are emerging. It also means that the results of the clinical trials cannot be generalized to the larger African American population. This paper describes ways to recruit and retain African Americans in AIDS clinical trials. Increased participation in clinical trials by African Americans will help researchers better evaluate the effects of the new drugs on African Americans, which is often different than the effects on whites. Above all, there is a great potential to reduce the high morbidity and mortality from AIDS-related illnesses among African Americans who participate in clinical trials. MeSH Terms:
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ABNF J 1998 May-Jun;9(3):56-60 Caregiver burden and coping strategies used by informal caregivers of minority women living with HIV/AIDS.Baker S, Sudit M, Litwak EDivision of Nursing, School of Education, New York University 10012, USA. Bakerson@nyu.edu The incidence of HIV/AIDS among minority women has been reported in record numbers in inner cities. In considering the shift toward community-based care, these minority women living with HIV/AIDS (MWLWHA) are receiving care from informal caregivers in their communities. As caregivers strive to meet the needs of these women, understanding the impact on these caregivers of providing support is critical. In this qualitative study, caregiver burden and coping strategies used by informal caregivers of minority women living with HIV/AIDS were studied. Thirty-one caregivers were interviewed. Data analyses included the constant comparative method consistent with the grounded theory approach. Two caregiver groups emerged, male companion and relative/girlfriend caregivers. All caregivers reported the emotional burden of not revealing the HIV/AIDS diagnoses. Relative/girlfriend caregivers had similar burdens related to the children of the women; their social networks, health and finances. Maintaining a physical exercise regimen and a spiritual focus were coping strategies use by all caregivers. Implications and recommendations are discussed. MeSH Terms:
Nat Med 1998 Jul;4(7):786-93 Genealogy of the CCR5 locus and chemokine system gene variants associated with altered rates of HIV-1 disease progression.Mummidi S, Ahuja SS, Gonzalez E, Anderson SA, Santiago EN, Stephan KT, Craig FE, O'Connell P, Tryon V, Clark RA, Dolan MJ, Ahuja SKDepartment of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, Audie L. Murphy Division, 78284-7870, USA. Allelic variants for the HIV-1 co-receptors chemokine receptor 5 (CCR5) and CCR2, as well as the ligand for the co-receptor CXCR4, stromal-derived factor (SDF-1), have been associated with a delay in disease progression. We began this study to test whether polymorphisms in the CCR5 regulatory regions influence the course of HIV-1 disease, as well as to examine the role of the previously identified allelic variants in 1,090 HIV-1 infected individuals. Here we describe the evolutionary relationships between the phenotypically important CCR5 alleles, define precisely the CCR5 regulatory sequences that are linked to the CCR5-delta32 and CCR2-641 polymorphisms, and identify genotypes associated with altered rates of HIV-1 disease progression. The disease-retarding effects of the CCR2-641 allele were found in African Americans but not in Caucasians, and the SDF1-3'A/3'A genotype was associated with an accelerated progression to death. In contrast, the CCR5-delta32 allele and a CCR5 promoter mutation with which it is tightly linked were associated with limited disease-retarding effects. Collectively, these findings draw attention to a complex array of genetic determinants in the HIV-host interplay. MeSH Terms:
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Womens Health 1998 Summer;4(2):135-53 Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women.St Lawrence JS, Eldridge GD, Brasfield TLCommunity Health Program, Jackson State University, USA. This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women. MeSH Terms:
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J Assoc Nurses AIDS Care 1998 Jul-Aug;9(4):23-34 Hazardous terrain and over the edge: the survival of HIV-positive heterosexual, minority men.Sherman DW, Kirton CANew York University, USA. The purpose of this study was to describe and explore the experience and perceptions of heterosexual minority men living with and surviving HIV infection. This descriptive, exploratory qualitative study used in-depth interviews that were guided by Rosenstock's health belief model and Ajzen's theory of planned behavior. A purposive sample of 18 HIV-positive heterosexual, minority men were accrued from an outpatient HIV/AIDS clinic in upstate New York and a community-based AIDS service organization in New York City. The findings revealed that the experience of surviving HIV infection encompassed several stages. The men of this study described the choices they made in adolescence that led them down a trail of life that may be metaphorically described as "hazardous terrain," as the majority became involved in substance use or other illicit activities. With the diagnosis of HIV infection came a "Falling Off" stage, in which the participants went "over the edge" and initially were afraid to die but realized at this point that they were okay but vulnerable. The next stage was "Hanging On," in which they attempted to gain control, reevaluated priorities, and developed a new perspective on life and health. In the "Pulling Up" stage, participants realized that the rescue team included self, God, family, and friends, with self-rescue occurring on emotional, physical, and spiritual levels. As the participants reached the "Turning Around" stage, they began to accept responsibility for their health, focused on their abilities rather than their limitations, and reframed their perspectives to living with rather than dying from HIV infection. This study has implications for health-education programs, AIDS prevention, health assessment, and interventions for HIV-positive, heterosexual, minority men. MeSH Terms:
MMWR Morb Mortal Wkly Rep 1998 Jun 26;47(24):493-7 Primary and secondary syphilis--United States, 1997.Syphilis is an acute and chronic sexually transmitted disease (STD) caused by infection with Treponema pallidum. The disease is characterized by skin and mucous membrane lesions in the acute phase (primary and secondary [P&S] syphilis) and lesions of the bone, viscera, and cardiovascular and neurologic systems in the chronic phase. Because syphilis enhances transmission of human immunodeficiency virus (HIV), prevention of syphilis is important for controlling HIV. During 1986-1990, an epidemic of syphilis occurred throughout the United States. Syphilis rates began to decline in 1991 and have declined each year since that time. To determine whether this decline is reflected in changes in the epidemiology of syphilis, CDC analyzed notifiable disease surveillance data for 1997. This report summarizes the findings of the analysis, which indicate that 8551 cases of primary and secondary (P&S) syphilis were reported in 1997, an 83% decline in cases from the peak of the epidemic in 1990, and that syphilis remains substantially more common in non-Hispanic blacks than in other racial/ethnic groups and continues to be concentrated in the Southern region of the United States [corrected]. MeSH Terms:
Am J Prev Med 1998 Jul;15(1):54-9 The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior.Wingood GM, DiClemente RJDepartment of Behavior Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta GA 30322, USA. OBJECTIVE: The present study examines psychosocial and behavioral influences, particularly drug and alcohol use, as correlates of inconsistent condom use and having multiple sexual partners during the past months among African-American women. METHODS: The cross-sectional study, conducted between May and June 1996, recruited a convenience sample of 180 African-American women in Birmingham, Alabama. Women completed a face-to-face interview that assessed alcohol and drug use, sexual behaviors, depression, condom use, and negotiation skills. RESULTS: The majority of women, 51.6% (n = 93), had used either alcohol or drugs during the previous month. Many women, 31.1%, consumed alcohol, 18.3% used marijuana, and 8.3% had smoked crack within the past month. Nearly 42.7% of women used condoms inconsistently in the past month and 13.3% of women had multiple sexual partners within the past month. A logistic regression model predicting inconsistent condom use indicated that women were less likely to use condoms if they consumed alcohol between 20 and 30 days of the month (OR = 2.8, 90% CI = 1.3-5.9) and if they had not negotiated condom use (OR = 32.4, 90% CI = 7.9-131.6). The logistic regression model predicting multiple sexual partners indicated that women were more likely to have multiple sexual partners if they had smoked crack in the past month (OR = 5.3, 90% CI = 1.6-18.2). CONCLUSION: HIV sexual risk-reduction interventions for African-American women need to address the overlapping epidemics of drugs, alcohol, and STDs. Additionally, HIV sexual risk reduction efforts should be incorporated into existing drug and alcohol treatment programs and STD clinics. MeSH Terms:
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J Consult Clin Psychol 1998 Jun;66(3):513-20 The Family Health Project: psychosocial adjustment of children whose mothers are HIV infected.Forehand R, Steele R, Armistead L, Morse E, Simon P, Clark LInstitute for Behavioral Research, University of Georgia, Athens 30602, USA. The psychosocial adjustment of 87 inner-city African American children 6-11 years old whose mothers were HIV infected was compared with that of 149 children from a similar sociodemographic background whose mothers did not report being HIV infected. Children were not identified as being HIV infected. Mother reports, child reports, and standardized reading achievement scores were used to assess 4 domains of adjustment: externalizing problems, internalizing problems, cognitive competence, and prosocial competence. The results indicated that, on average, children from both groups had elevated levels of behavior problem scores and low reading achievement scores when compared with national averages. Relative to children whose mothers were not infected, those whose mothers were HIV infected were reported to have more difficulties in all domains of psychosocial adjustment. Potential family processes that may explain the findings are discussed. MeSH Terms:
AIDS Educ Prev 1998 Jun;10(3):278-92 Homophobia, self-esteem, and risk for HIV among African American men who have sex with men.Stokes JP, Peterson JLDepartment of Psychology, University of Illinois at Chicago 60607, USA. jstokes@ulc.edu Qualitative data from individual interviews with 18-29 year old African American men, who have sex with men (n = 76) were used to examine the relationship of negative attitudes toward homosexuality, self-esteem, and risk for HIV. Respondents perceived members of their communities as holding negative attitudes toward homosexuality, and many thought the African American community was less accepting of homosexuality than the white community. There was evidence that these negative attitudes are internalized by some of the young African American men themselves. Respondents mentioned several ways that negative attitudes toward homosexuality could lead to lower self-esteem and psychological distress in young gay and bisexual men. In addition, respondents articulated several mechanisms by which low self-esteem and psychological distress might be associated with sexual behaviors that put one at risk for HIV. We concluded that addressing and changing society's negative views of homosexuality are important components of a comprehensive approach to reducing the transmission of HIV, especially among young people in communities of color. MeSH Terms:
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Women Health 1998;27(1-2):87-103 Sex partners of Alaskan drug users: HIV transmission between white men and Alaska Native women.Fenaughty AM, Fisher DG, Cagle HHDepartment of Psychology, University of Alaska, Anchorage 99577, USA. ANAMF1@UAA.ALASKA.EDU This study describes patterns of sexual behavior and condom use in a sample of 1125 Black, White, and Alaska Native drug users. Data are self-reports of recent sexual behavior, including descriptions of (up to) the five most recent sex partners. This provided information on 1116 sex partner pairs, of which at least one partner was a drug user. Sex partner pairs involving a White man and an Alaska Native woman were frequently reported. Level of condom use within these pairs was significantly lower than within all other pairs. The implications of a potential vector of HIV transmission from White, drug using men to Alaska Native women are discussed. MeSH Terms:
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Women Health 1998;27(1-2):49-66 Effectiveness of HIV interventions among women drug users.McCoy HV, McCoy CB, Lai SFlorida International University, USA. A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms--standard and a standard-plus-innovative intervention--was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups. Publication Types:
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Sex Transm Infect 1998 Feb;74(1):45-9 Racial origin, sexual lifestyle, and genital infection among women attending a genitourinary medicine clinic in London (1992).Evans BA, Kell PD, Bond RA, MacRae KDDepartment of Genitourinary Medicine, Charing Cross Hospital, London. OBJECTIVES: To compare variables of sexual behaviour and incidence of genital infections among women of different racial origins and lifestyles. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 1084 consecutive women newly attending in 1992. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual lifestyle, condom use, sexually transmitted diseases, and other genital infections stratified by racial origin. RESULTS: There were 948 evaluable women, of whom 932 (98.3%) were heterosexual and 16 (1.7%) were lesbian. Previous heterosexual intercourse was reported by 69% of lesbian women and their most frequent diagnosis was bacterial vaginosis (38%). The majority of heterosexual women were white (78%) and 16% were black. The black women were more likely to be teenagers (18% cf 8%; p = 0.0004) or students (28% cf 15%; p = 0.0008), and to have had an earlier coitarche (48% cf 38% before aged 17; p < 0.004). They also had a higher proportion of pregnancies (58% cf 38%; p < 0.00001) and births (38% cf 20%; p < 0.00001). The white women showed significantly more sexual partners during the preceding year (p = 0.004) and in total (p < 0.00001) and more reported non-regular partners (48% cf 35%; p = 0.004) with whom they were more likely to use condoms (p = 0.009). However, the black women were more likely to have gonorrhoea (7% cf 2% p < 0.0003), chlamydial infection (12% cf 5% p < 0.002), trichomoniasis (10% cf 2% p < 0.00001), or to sexual contacts of men with non-gonococcal urethritis (19% cf 12% p < 0.02). They were less likely to have genital warts (3% cf 12% p = 0.002). Logistic regression showed that all these variables were independently associated with the black women. The Asian women (2%), none of whom had a sexually transmitted disease, had commenced intercourse later (mean 19.7 years) than both black women (mean 16.8 years) and white women (mean 17.6 years). CONCLUSIONS: Sexual intercourse commenced approximately 1 year earlier in the black women, who were more likely to have become pregnant, had children, and to have acquired a bacterial sexually transmitted infection than were the white women. MeSH Terms:
Sex Transm Infect 1998 Feb;74(1):40-4 Racial origin, sexual behaviour, and genital infection among heterosexual men attending a genitourinary medicine clinic in London (1993-4).Evans BA, Bond RA, MacRae KDDepartment of Genitourinary Medicine, Charing Cross Hospital, London. OBJECTIVES: To compare variables of sexual behaviour and incidence of genital infections among heterosexual men of different racial origins. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 1212 consecutive heterosexual men newly attending in 1993-4. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted diseases, and other genital infections stratified by racial origin. RESULTS: There were 941 evaluable heterosexual men of whom the majority were white (79%) and 17% were black. The black men comprised more teenagers (11% cf 2%; p < 0.00001), were more likely to be unemployed (26% cf 12%; p < 0.00001), to have commenced intercourse much earlier (45% cf 22% before aged 16: p < 0.0001), and to have had intercourse with an African woman (14% cf 6%; p < 0.001). Both fellatio (64% cf 96%; p < 0.00001) and cunnilingus (40% cf 92%; p < 0.00001) were practised less frequently by the black men and so too was anal intercourse (11% cf 27%; p < 0.00001). Similar proportions from both groups were non-smokers (53% cf 57%), but a significantly higher proportion of the black men did not drink alcohol (13% cf 5%; p < 0.001). Gonorrhoea (15% cf 1%; p < 0.00001), chlamydial infection (17% cf 8%; p < 0.001), and non-gonococcal urethritis (37% cf 24%; p = 0.001) were diagnosed more frequently in the black men. These findings remained significant after logistic regression and are therefore independently associated with black race. However, there was no significant difference in numbers of sexual partners in the preceding year (median 2), nor in condom use with regular and non-regular partners. The Asian men had commenced intercourse later (mean 19.1 years) than both the black men (mean 15.9 years) and the white men (mean 17.3 years). CONCLUSIONS: Compared with white men, black men attending a genitourinary medicine clinic were much more likely to be unemployed, to have commenced intercourse earlier and to have urethral infection. They were much less likely to practice fellatio, cunnilingus, or anal intercourse. However, there was no difference between the two racial groups in respect of numbers of sexual partners and condom use. MeSH Terms:
JAMA 1998 Jun 17;279(23):1894-9 Trends in HIV incidence among young adults in the United States.Rosenberg PS, Biggar RJBiostatistics Branch, National Cancer Institute, Bethesda, MD 20892, USA. philip_rosenberg@nih.gov CONTEXT: Behaviors that result in potential exposure to human immunodeficiency virus (HIV) usually begin in adolescence or young adulthood, but trends in HIV incidence in young people remain unclear. OBJECTIVE: To estimate trends in HIV incidence in teenagers and young adults. DESIGN AND SETTING: Back-calculation of past HIV incidence in persons born between 1960 and 1974 using US national acquired immunodeficiency syndrome (AIDS) incidence data and estimates of the distribution of times between HIV infection and AIDS. MAIN OUTCOME MEASURES: Incidence and prevalence of HIV in 1988 and 1993 in persons aged 20 and 25 years, respectively, in each of those years. RESULTS: As of January 1993, about 22000 men and 11000 women aged 18 to 22 years were living with HIV infection in the United States. Homosexual contact was the leading route of infection among young men. Heterosexual contact was the leading route of infection among young women. The HIV incidence attributed to homosexual contact or injection drug use decreased among persons aged 20 and 25 years between 1988 and 1993, but HIV incidence attributed to heterosexual contact was stable or increasing. Notably, in men aged 20 and 25 years, HIV prevalence declined by about 50% in white men but was relatively stable in black and Hispanic men. In contrast, HIV prevalence in women aged 20 and 25 years rose by 36% and 45%, respectively, because of increasing heterosexual transmission. Overall, HIV prevalence in persons aged 20 and 25 years declined by only 14% between 1988 and 1993. CONCLUSIONS: In young persons, HIV incidence in homosexual men and injection drug users was slowing by 1993; this favorable trend was offset by increasing heterosexual transmission, especially in minorities. MeSH Terms:
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J Int Neuropsychol Soc 1998 May;4(3):291-302 The effect of African-American acculturation on neuropsychological test performance in normal and HIV-positive individuals. The HIV Neurobehavioral Research Center (HNRC) Group.Manly JJ, Miller SW, Heaton RK, Byrd D, Reilly J, Velasquez RJ, Saccuzzo DP, Grant IDepartment of Psychiatry, University of California, San Diego, CA, USA. manlyje@sergievsky.cpmc.columbia.edu Two studies were conducted to examine the relationship of acculturation to neuropsychological test performance among (1) medically healthy, neurologically normal African Americans (N = 170); and (2) HIV positive (HIV+) subgroups of African Americans and Whites (Ns = 20) matched on age, education, sex, and HIV disease stage. Acculturation was measured through self report for all participants, and linguistic behavior (Black English use) was assessed in a subset of medically healthy individuals (N = 25). After controlling for the effects of age, education, and sex, medically healthy African Americans who reported less acculturation obtained lower scores on the WAIS-R Information subtest and the Boston Naming Test than did more acculturated individuals. Black English use was associated with poor performance on Trails B and the WAIS-R Information subtest. HIV+ African Americans scored significantly lower than their HIV+ White counterparts on the Category Test, Trails B, WAIS-R Block Design and Vocabulary subtests, and the learning components of the Story and Figure Memory Tests. However, after accounting for acculturation, ethnic group differences on all measures but Story Learning became nonsignificant. These results suggest that there are cultural differences within ethnic groups that relate to neuropsychological test performance, and that accounting for acculturation may improve the diagnostic accuracy of certain neuropsychological tests. Publication Types:
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Res Nurs Health 1998 Jun;21(3):239-50 An intervention for changing high-risk HIV behaviors of African American drug-dependent women.Harris RM, Bausell RB, Scott DE, Hetherington SE, Kavanagh KHUniversity of Maryland School of Nursing, Baltimore 21201, USA. The purpose of this study was to test the effectiveness of an AIDS education intervention for methadone-dependent, African American women. The women were randomly assigned to experimental (n=107) or control (n=97) group. The experimental group participated in a peer counseling and leadership training program conducted by two experienced nurse counselors over an 8-week period, followed by 8 weeks of reinforcement. The program was designed to reduce AIDS high-risk sexual behavior, increase self-esteem, decrease depressive affect, and increase the women's community-based AIDS prevention communication activities. A total of 130 women completed all phases of the study, including longitudinal Posttests at 2, 4, and 7 months after enrollment. Compared to the control group, there were statistically significant differences in three of the outcomes for the experimental group: The experimental group reported an increased number of safer sexual behaviors (p=.029), showed decreases in depression (p=.001), and reported engaging in more AIDS-related, community-based communication activities regarding prevention (p=.005). Publication Types:
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JAMA 1998 May 20;279(19):1529-36 Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial.Jemmott JB 3rd, Jemmott LS, Fong GTDepartment of Psychology, Princeton University, NJ 08544-1010, USA. jemmott@princeton.edu CONTEXT: African American adolescents are at high risk of contracting sexually transmitted infection with human immunodeficiency virus (HIV), but which behavioral interventions to reduce risk are most effective and who should conduct them is not known. OBJECTIVE: To evaluate the effects of abstinence and safer-sex HIV risk-reduction interventions on young inner-city African American adolescents' HIV sexual risk behaviors when implemented by adult facilitators as compared with peer cofacilitators. DESIGN: Randomized controlled trial with 3-, 6-, and 12-month follow-up. SETTING: Three middle schools serving low-income African American communities in Philadelphia, Pa. PARTICIPANTS: A total of 659 African American adolescents recruited for a Saturday program. INTERVENTIONS: Based on cognitive-behavioral theories and elicitation research, interventions involved 8 1-hour modules implemented by adult facilitators or peer cofacilitators. Abstinence intervention stressed delaying sexual intercourse or reducing its frequency; safer-sex intervention stressed condom use; control intervention concerned health issues unrelated to sexual behavior. MAIN OUTCOME MEASURES: Self-reported sexual intercourse, condom use, and unprotected sexual intercourse. RESULTS: Mean age of the enrollees was 11.8 years; 53% were female and 92.6% were still enrolled at 12 months. Abstinence intervention participants were less likely to report having sexual intercourse in the 3 months after intervention than were control group participants (12.5% vs 21.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=.14; 20.0% vs 23.1%, P=.42, respectively). Safer-sex intervention participants reported significantly more consistent condom use than did control group participants at 3 months (odds ratio [OR]=3.38; 95% confidence interval [CI], 1.25-9.16) and higher frequency of condom use at all follow-ups. Among adolescents who reported sexual experience at baseline, the safer-sex intervention group reported less sexual intercourse in the previous 3 months at 6- and 12-month follow-up than did control and abstinence intervention (adjusted mean days over prior 3 months, 1.34 vs 3.77 and 3.03, respectively; P< or =.01 at 12- month follow-up) and less unprotected intercourse at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85, respectively, P<.001, at 12-month follow-up). There were no differences in intervention effects with adult facilitators as compared with peer cofacilitators. CONCLUSION: Both abstinence and safer-sex interventions can reduce HIV sexual risk behaviors, but safer-sex interventions may be especially effective with sexually experienced adolescents and may have longer-lasting effects. Publication Types:
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Ann Behav Med 1997 Winter;19(1):36-41 Correlates of HIV risk appraisal in women.Morrison-Beedy DNiagara University College of Nursing, Niagara University, NY 14109-2203, USA. This study examined the relationship of safer sex behavior practices, knowledge of acquired immunodeficiency syndrome (AIDS), social norms, and familiarity with persons infected with the human immunodeficiency virus (HIV) with HIV risk appraisal in women. Risk appraisal was measured by perceived susceptibility and seriousness of AIDS. The AIDS Risk Reduction Model was used to construct a salient framework for this descriptive, correlational survey in which 208 urban women of mixed ethnicity residing in areas with high rates of sexually transmitted diseases/AIDS participated. Behavior, knowledge, and social norms, contributed significant amounts of variance to perceived susceptibility but none of the independent variables contributed significant amounts of variance in perceived seriousness. Overall findings indicate that risk behaviors are commonly reported. AIDS knowledge is incomplete, and denial of risk is pronounced. MeSH Terms:
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J Assoc Nurses AIDS Care 1998 May-Jun;9(3):77-90 Behavioral factors affecting HIV prevention for adolescent and young adult IDUs.Morse EV, Morse PM, Burchfiel KE, Zeanah PDTulane University, New Orleans, LA, USA. Epidemiological and sociobehavioral data regarding HIV-related risk and injection drug use among adolescents and young adults are examined to provide insight and assistance to nurses delivering preventive intervention and community and clinical care. The increase in HIV/AIDS cases among injection drug users (IDUs), adolescents, and African Americans strongly suggests that clinical care providers acquire a better understanding of the sociocultural and behavioral context within which health care is provided. Transition into injection drug use, high-risk injecting and sexual behaviors, sociodemographic differences, and the importance of social networks are discussed. Nurses are encouraged to provide health promotion, disease prevention messages, and health care to IDUs in small nontraditional clinical settings and to seek out the assistance of the IDUs' social network to increase adherence and compliance to complex prevention and therapeutic efforts. Publication Types:
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J Assoc Nurses AIDS Care 1998 May-Jun;9(3):48-58 Understanding barriers to condom usage among HIV-infected African American women.Bedimo AL, Bennett M, Kissinger P, Clark RADelta AIDS Education and Training Center, New Orleans, LA 70112, USA. bedimo@mailhost.tcs.tulane.edu Drawing on focus group discussions with adolescent and adult HIV-infected women between the ages of 16 and 45, this study explores the barriers to condom use among women infected with HIV. Although most of the participants were comfortable discussing condoms and sexuality, there was little, if any, negotiation of condom use with their male partners. Most of the participants used condoms inconsistently or not at all. Reasons for nonuse included a lack of trust in the reliability of condoms to protect them, a lack of desire for pregnancy prevention, and the male partner's refusal to use condoms. Women in discordant relationships explained their uninfected partner's refusal to use condoms as denial of the risk of contracting HIV or as a way of expressing their love for the infected partner. Women also had great difficulty in disclosing their HIV status to both family and partners. Prevention efforts to increase condom use among HIV-infected women should target both men and women and focus on negotiation and communication skills. MeSH Terms:
Arthritis Rheum 1998 May;41(5):863-8 Prevalence of the diffuse infiltrative lymphocytosis syndrome among human immunodeficiency virus type 1-positive outpatients.Williams FM, Cohen PR, Jumshyd J, Reveille JDUniversity of Texas Health Science Center at Houston, 77225, USA. OBJECTIVE: To ascertain the prevalence of the diffuse infiltrative lymphocytosis syndrome (DILS) in human immunodeficiency virus type 1 (HIV-1)-positive outpatients. METHODS: The presence of sicca symptoms and visible salivary gland enlargement was determined by interview and physical examination, and the clinical stage was determined by chart review, in 523 HIV-positive patients. The diagnosis of DILS was established in those with parotid gland enlargement by minor salivary gland biopsy or radionuclide scintigraphy. RESULTS: Definite DILS was found in 15 (3%) of the 523 patients, and possible DILS in 18 (3.4%). The prevalence of definite DILS was significantly higher in African Americans (4.5%). Self-reported facial swelling and xerophthalmia that was not explained by the effects of medication were found more frequently in those with DILS than in the non-DILS patients. Patients with DILS had higher CD8 counts (mean +/- SD 1,456 +/- 813/mm3) compared with those without DILS (934 +/- 624/mm3; P < 1 x 10(-6)), and were less advanced in their HIV clinical stage (Centers for Disease Control and Prevention stages A or B in 76% compared with 60% of the non-DILS group; P = 0.01). CONCLUSION: DILS is an important problem in HIV-infected outpatients and tends to occur in patients whose clinical disease is at a less advanced stage. Patients with parotid gland enlargement accompanied by sicca symptoms should be screened for HIV infection. MeSH Terms:
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Am J Epidemiol 1998 May 1;147(9):840-5 Effect of HIV/AIDS versus other causes of death on premature mortality in New York City, 1983-1994.Obiri GU, Fordyce EJ, Singh TP, Forlenza SNew York City Department of Health, Office of AIDS Surveillance, NY 10013, USA. This study examined years of potential life lost (YPLL) before age 65 years to assess the relative impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) versus other leading causes of death on premature mortality in New York City, New York, between 1983 and 1994. Most causes of death showed substantial year-to-year variation in YPLL, with the exception of HIV/AIDS. The YPLL attributed to HIV/AIDS increased monotonically from 11,866 in 1983 to 167,317 in 1994, a nearly 15-fold increase. The rank order of the relative contribution of HIV/AIDS to total YPLL changed from the eighth leading cause of death to the leading cause. YPLL from heart disease, which ranked second in 1983, declined to fourth in 1994, homicide was unchanged, and chronic liver disease declined from fifth to ninth rank. The annual YPLL attributed to malignant neoplasms was similar to that for heart disease, but peaked in 1984, and the reduction over the subsequent decade was about 13%. Total YPLL was 78% greater among males than among females in 1983 and was nearly twice as high in 1994. Premature mortality decreased steadily for non-Hispanic whites, from 150,967 to 135,027 years for the years 1983-1994, while increasing 20% among blacks (from 179,176 to 215,826 years) and 48% among Hispanics (from 89,869 to 132,869 years). Among blacks and Hispanics, homicide contributed more years of YPLL than did either heart disease or malignant neoplasms in every year of observation. The HIV/AIDS epidemic and mortality associated with violence have become important public health challenges to the health and well-being of New Yorkers. MeSH Terms:
J Womens Health 1998 Apr;7(3):371-8 Sexual coercion, domestic violence, and negotiating condom use among low-income African American women.Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson DCenter for AIDS Intervention Research (CAIR) and Psychology Department, Georgia State University, Atlanta, USA. Coercion to engage in unwanted sex places women at risk for human immunodeficiency virus (HIV) infection. A survey of 125 women living in low-income housing developments in Fulton County, Georgia, showed that 53 (42%) women had engaged in unwanted sex because a male partner threatened to use force or used force to obtain sexual access. Women who had been sexually coerced were more likely to have used marijuana and crack cocaine and to have abused alcohol. Coerced women were more likely to have been physically abused by a domestic partner. These women were also more likely to perceive that requesting male partners to use condoms would create a potentially violent situation. These results suggest that women experience an interactive constellation of social problems that create risks for HIV infection and, therefore, that efforts to prevent HIV infection among women will require multifaceted intervention strategies to reach both men and women at risk. MeSH Terms:
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Am J Trop Med Hyg 1998 Apr;58(4):495-500 Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention.Sorvillo F, Kovacs A, Kerndt P, Stek A, Muderspach L, Sanchez-Keeland LHIV Epidemiology Program, Los Angeles County Department of Health Services, California 90005, USA. Persons with human immunodeficiency virus (HIV) infection who subsequently develop an acute sexually transmitted disease have an increased probability of transmitting HIV. Therefore, characterizing such persons can help direct prevention efforts to a group who are likely to be continuing sources of HIV transmission. We assessed the incidence and factors associated with trichomoniasis in a cohort of HIV-infected women receiving care at a public clinic in Los Angeles County, California from 1992 through 1995. Demographic, clinical, and behavioral data were available from medical records and from patient interviews. Trichomonas infection was the most frequently identified sexually transmitted disease and was found in 37 (17.4%) of 212 women representing a crude incidence rate of 14.1 per 100 person-years experience. The crude rate of trichomoniasis was highest in black women (69.0 per 100 person-years), women with a history of trading sex for drugs or money (51.0 per 100 person-years), those using crack or cocaine (35.5 per 100 person-years), women with four or more sex partners (43.0 per 100 person years), and those born in the United States (23.3 per 100 person-years). Among women with severe immunosuppression (CD4+ count < 200), 18.4% (18 of 98) were diagnosed with trichomoniasis. After multivariate analysis using a Cox proportional hazards approach, black race (adjusted rate ratio [RR] = 5.6, 95% confidence interval [CI] = 2.3, 13.3) continued to be strongly associated with Trichomonas infection. Trading sex for money or drugs (adjusted RR = 25.2, 95% CI = 4.3, 148.6) and single marital status (adjusted RR = 3.7, 95% CI = 1.1, 13.0) were independent risk factors for trichomoniasis in nonblack women but not among black women. Data from this study indicate that Trichomonas may be a frequently acquired infection in HIV-positive women. Our findings suggest that HIV-infected women who are black, and nonblack women who trade sex for money or drugs or are unmarried, are at increased risk of trichomoniasis and therefore may be more likely to transmit HIV infection. Local HIV prevention strategies should target such women for intervention efforts. MeSH Terms:
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Am J Community Psychol 1998 Feb;26(1):29-51 Partner influences and gender-related factors associated with noncondom use among young adult African American women.Wingood GM, DiClemente RJDepartment of Health Behavior, School of Public Health, University of Alabama, Birmingham 35294-0022, USA. We examined the partner influences and gender-related correlates of noncondom use among African American women. The prevalence of noncondom use was 45.3%. Women whose sexual partners were noncondom users were four times more likely to believe that asking their partner to use a condom implied he was unfaithful, three times as likely to have a partner who resisted using condoms, three times more likely to receive AFDC, twice as likely to be sexually nonassertive, three times more likely to believe that it was not difficult to find an "eligible" African American man, and three times as likely to have had one sexual partner. HIV prevention tailored towards African American women should address these partner influences and gender-related factors. MeSH Terms:
Am J Community Psychol 1998 Feb;26(1):7-28 Factors influencing condom use among African American women: implications for risk reduction interventions.St Lawrence JS, Eldridge GD, Reitman D, Little CE, Shelby MC, Brasfield TLCenters for Disease Control and Prevention, Atlanta, USA. Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed. MeSH Terms:
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Cancer Detect Prev 1998;22(2):109-19 Cigarette smoking and cervical dysplasia among non-Hispanic black women.Kanetsky PA, Gammon MD, Mandelblatt J, Zhang ZF, Ramsey E, Wright TC Jr, Thomas L, Matseoane S, Lazaro N, Felton HT, Sachdev RK, Richart RM, Curtin JPCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia 19104, USA. This is the first case-control study to determine whether smoking is associated with cervical dysplasia, after adjustment for human papillomavirus (HPV) infection, among a group of non-Hispanic black women. Subjects were interviewed and asked questions about smoking and other risk factors for cervical cancer. HPV infection was determined by hybrid capture. Thirty-two women with histologically confirmed incident dysplasia and 113 control women with normal cytologic smears were enrolled; all women were HIV negative. Smoking was more strongly associated with dysplasia among women with high-grade lesions than among all case women combined. After adjustment, women with high-grade lesions were roughly four times more likely to be ever (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 0.76-18.4) or current (OR: 4.3; 95% CI: 0.83-21.9) smokers, compared with control women. Larger studies among black women that control for HPV infection are needed to confirm these findings and to explore associations among black women with low-grade lesions. MeSH Terms:
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Nurs Res 1998 Mar-Apr;47(2):107-13 The experience of being a grandmother who is the primary caregiver for her HIV-positive grandchild.Caliandro G, Hughes CSeton Hall University College of Nursing, South Orange, NJ, USA. BACKGROUND: The number of grandparents assuming care for their grandchildren is increasing, and this affects grandparents both positively and negatively. The current study builds on an earlier study of the effects of social support, stress, and level of illness on caregiving of children with acquired immune deficiency syndrome (AIDS) that identified both positive and negative effects of caregiving. OBJECTIVES: To identify the lived experience of African American and Latino grandmothers as the primary caregivers for their grandchildren who are human immunodeficiency virus (HIV)-infected or have AIDS and to identify the similarities and differences between the two groups. METHODS: Using Van Manen's method for hermeneutical phenomenological research, the lived experiences of 10 African American and Latino grandmothers who were the primary caregivers for their HIV-positive grandchildren were investigated. Additionally, the similarities and differences between the two groups were studied. RESULTS: Four themes identified were (a) upholding the primacy of the family, (b) living in the child-centered present, (c) being strong as mature women, and (d) living within a constricting environment. Twelve subthemes expanded and clarified the meaning of these themes. CONCLUSIONS: Although there were differences related to family structure and cultural backgrounds, the grandmothers were more alike than different. Comments:
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Int J STD AIDS 1998 Mar;9(3):139-45 Gender-related correlates and predictors of consistent condom use among young adult African-American women: a prospective analysis.Wingood GM, DiClemente RJDepartment of Health Behavior, School of Public Health, University of Alabama at Birmingham 35294-0022, USA. The present study examined the correlates of consistent condom use among African-American women and prospectively evaluated the stability of these significant variables to predict consistent condom use at 3-month follow-up. A sample of 128 African-American women, 18-29 years of age completed a baseline interview and 3 months later completed a similar follow-up interview (n = 100). Compared to women who were inconsistent condom users, women who were consistent condom users were more likely to: have high assertive communication skills (OR=13), desire not becoming pregnant (OR=8.6), have high sexual self-control over condom use (OR=7.6), perceive having control over their partners' use of condoms (OR=6.6), be younger (OR=5.8), and report having a partner that was not committed to the relationship (OR=3.3). Prospective analyses identified baseline level of condom use as the best predictor of condom use at 3-month follow-up. Women who were consistent condom users at baseline were 6.3 times as likely to be consistent condom users at 3-month follow-up. In conclusion, HIV prevention programmes for women need to be gender specific and need to be implemented before high-risk behaviours are established and may be more difficult to modify. MeSH Terms:
J Womens Health 1998 Feb;7(1):77-84 Rape among African American women: sexual, psychological, and social correlates predisposing survivors to risk of STD/HIV.Wingood GM, DiClemente RJDepartment of Health Behavior, School of Public Health, University of Alabama at Birmingham, USA. The aim of this study was to examine the association of rape of adult African American women and sexual, psychologic, and social factors that predispose them to risks of sexually transmitted diseases, including human immunodeficiency virus (HIV). This cross-sectional study, conducted between February and December 1993, recruited 165 African American women, 18-29 years of age, from an African American community of low socioeconomic status in San Francisco, California. Women completed a face-to-face interview. The prevalence of adult rape (rape experienced after age 15) in this sample was 14%. Compared with women who did not report a history of adult rape, women who reported such a history were significantly more likely to report HIV-related sexual, psychologic, and social experiences. Specifically, adult rape survivors were nearly 6 times more likely to have had sex 10 or more times in the past 3 months, 3 times as likely to report never using condoms during the past 3 months, 3.3 times less likely to use condoms consistently during the past 3 months, to have used a condom at last intercourse, and to use condoms when intoxicated, nearly 3 times less likely to negotiate condom use, 11 times as likely to have a partner who was physically abusive, nearly 10 times more likely to believe that there were no eligible African American males with whom to establish a relationship, and more than 3 times as likely to believe that sex was unenjoyable. HIV-related social and behavioral interventions for women may be more effective if they address all sexual violence against women, including rape, and provide resources for women who are rape survivors. MeSH Terms:
J Natl Med Assoc 1998 Feb;90(2):73-6 Tuberculosis in African Americans: clinical characteristics and outcome.Funnye AS, Ganesan K, Yoshikawa TTDivision of General Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA. This study examined the clinical characteristics and outcome of pulmonary tuberculosis in African Americans hospitalized in a teaching hospital in south-central Los Angeles from May 1992 through April 1994. The charts of 41 African Americans with culture-positive Mycobacterium tuberculosis were reviewed. Predisposing factors for pulmonary tuberculosis were identified in nearly half of cases. Cough and fever were the most common symptoms. Seventy-six percent had positive acid-fast bacilli (AFB) smears. Nine patients were human immunodeficiency virus (HIV)-positive, and 6 of 9 HIV-positive patients had positive AFB smears whereas 17 of 19 HIV-negative patients had positive AFB smears. Radiographic changes were not significantly different between HIV-positive and HIV-negative patients. Drug resistance was identified in nine of 31 patients (29%). Eight of 41 patients (19.5%) died, with 2 being drug resistant. Human immunodeficiency virus infection was a major predisposing factor for tuberculosis, and no statistical differences were found in radiographic features or AFB smear positivity between HIV-positive and HIV-negative patients. Drug resistance and mortality were disproportionately high. These results indicate that HIV infection and drug resistance are major problems that predispose for tuberculosis infection and make its treatment difficult. MeSH Terms:
Fam Plann Perspect 1998 Jan-Feb;30(1):4-10, 46 Trends in contraceptive use in the United States: 1982-1995.Piccinino LJ, Mosher WDReproductive Statistics Branch, National Center for Health Statistics (NCHS), Hyattsville, MD, USA. CONTEXT: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS: Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS: The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS: The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women. MeSH Terms:
Am J Epidemiol 1998 Feb 1;147(3):269-72 Seroprevalence of human immunodeficiency virus type 1 and sexual behaviors in bisexual African-American and Hispanic men visiting a sexually transmitted disease clinic in New York City.Lehner T, Chiasson MABureau of Disease Intervention Research, New York City Department of Health, NY, USA. A cross-sectional human immunodeficiency virus type 1 (HIV-1) serosurvey was conducted between January 1988 and January 1993 at a New York City sexually transmitted disease clinic serving predominantly African-American and Hispanic patients. Overall, 14% (415/3,069) of participating men reported having sex with men; among these, only 52 (13%) were classified as "homosexual" (having had sex with men exclusively since 1978). Most men (87%) who reported having sex with other men also reported having sex with women. These included 147 (35%) "bisexuals" (sex with more than one man and at least one woman since 1978) and 216 (52%) "heterosexuals" (sex with women since 1978 and sexual contact with men before 1978 or only once thereafter). Although HIV-1 seroprevalence was highest among "homosexual" men (70%, 95% confidence interval (CI) 55-81), it was also high among "bisexual" men (35%, 95% CI 27-43) and "heterosexual" men (17%, 95% CI 13-23), and was lowest in men who reported having no male sex partners in their lifetime (9%, 95% CI 7-10). It is possible that transmission of HIV-1 from bisexual men to female sexual partners plays a greater role in heterosexual transmission than was previously recognized. MeSH Terms:
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Mt Sinai J Med 1998 Jan;65(1):27-32 HIV-associated nephropathy.Winston J, Klotman PEMount Sinai School of Medicine, New York, NY 10029, USA. BACKGROUND: Patients with HIV-1 infection are at risk for developing renal diseases with diverse etiologies. Acute renal failure occurs in up to 20% of hospitalized patients with HIV infection, and chronic renal disease of diverse etiology has been reported. The single most common cause of chronic renal insufficiency in HIV-1+ patients is HIV-associated nephropathy (HIVAN). Typical morphologic features include enlarged kidneys, microcystic tubule dilatation, tubulointerstitial inflammation, and focal and segmental glomerulosclerosis. METHODS: The pathogenesis, epidemiology, and treatment options for HIVAN are discussed. In studying the epidemiology of the disease, we reviewed several renal disease databases, including the United States Renal Data Systems and New York State End Stage Renal Disease Network. We have previously reported our experience with HIVAN at Mount Sinai Medical Center. RESULTS: The exact cause of the renal disease remains unknown. The importance of a direct effect of HIV-1 viral protein(s) or renal HIV-1 gene expression in disease pathogenesis is supported in the murine model of HIVAN, but definitive proof of renal cell infection in humans is lacking. Further study is required to clarify this issue. We estimate that HIVAN is the fourth leading cause of end-stage renal disease (ESRD) among Blacks between the ages of 20 and 64 years, only slightly behind hypertension, diabetes, and chronic glomerulonephritis. At Mount Sinai Hospital HIVAN accounts for 20% of newly diagnosed ESRD in young black adults. It has become the third leading cause of ESRD in this group, after hypertension and diabetes. CONCLUSIONS: In seropositive patients with renal disease, renal biopsies should be performed to confirm the diagnosis and determine the true incidence. Special attention should be directed toward understanding the underlying cause(s) of HIVAN. A multicenter trial to explore the potential for antiviral therapy in this disease should be initiated. Publication Types:
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Cell Mol Biol (Noisy-le-grand) 1997 Nov;43(7):1123-30 Stress, appraisal and coping in HIV-infected African-American men and women.Linn JGSchool of Nursing, Tennessee State University, Nashville 37209, USA. With the development and utilization of the new multidrug therapies, many persons with HIV have experienced dramatic improvements in their physical condition, health self-appraisal, and psychological well-being. This treatment process has demonstrated the interrelationship of physical stress, perceived health status, and successful coping with HIV illness. The objective of this analysis is to assess the importance of perceived health for the level of mental distress in African-American men and women who have HIV disease. Interviews were completed with 255 HIV-infected black adults (age > or = 18) who were clients of AIDS care and referral centers in Tennessee. The results suggest that persons with a positive health appraisal are more effectively coping with the stresses of HIV illness. These observations have clinical implications for the care of African-Americans and others with HIV/AIDS. MeSH Terms:
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Int J Tuberc Lung Dis 1997 Apr;1(2):128-34 Two-step tuberculin skin testing of injection drug users recruited from community-based settings.Lifson AR, Grant SM, Lorvick J, Pinto FD, He H, Thompson S, Keudell EG, Stark MJ, Booth RE, Watters JKDivision of Epidemiology, University of Minnesota, Minneapolis 55424, USA. lifson@epivax.epi.umn.edu SETTING: Cross-sectional study of drug users recruited from street-based settings in four US cities: Denver, Portland, Oakland and San Francisco. OBJECTIVE: To evaluate responses to two-step tuberculin skin testing among HIV-positive and HIV-negative injection drug users. DESIGN: Subjects were recruited from existing studies of HIV and risk behaviors for tuberculin skin testing. Those with a negative initial tuberculin test were referred for a second skin test 1-3 weeks later. A positive tuberculin test was defined as > or = 10 mm, or > or = 5 mm if the subject was HIV-positive. RESULTS: Of 997 persons receiving an initial tuberculin test, 13% had a positive response. Of 644 persons receiving a second tuberculin test, 8% had a positive response, with rates as high as 14% among those from Oakland and 12% among African Americans. HIV-positive subjects were less likely to have skin test responses > or = 10 mm on the initial test (P = 0.03), or increases between the initial and second test of > or = 10 mm (P = 0.06). CONCLUSION: Boosting occurred in both HIV-positive and HIV-negative injection drug users. Two-step testing should be considered for this population, particularly those on whom repeat tuberculin testing will be performed. Publication Types:
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Am J Med Sci 1998 Jan;315(1):11-6 HIV vaccine acceptance among heterosexual clients of a sexually transmitted diseases clinic.Tello J, Soong SJ, Hunter B, Meriwether R, Hook EW 3rd, Mulligan MJUniversity of Alabama at Birmingham, 35294-2170, USA. We evaluated the willingness of clients at a large urban sexually transmitted diseases (STD) clinic in the southeastern United States to participate in future trials of preventive vaccines for HIV type 1 (HIV-1). A single trained interviewer administered an oral survey instrument to STD clinic clients over a 4-week enrollment period. The participants were 167 randomly selected clients (90 men and 77 women), most of whom were young, African-American heterosexuals. Risk behaviors for HIV-1 infection were highly prevalent. Overall, 67% of clients expressed willingness to consider participation in an HIV-1 vaccine trial. By univariate analysis, prior HIV-1 testing was significantly associated with willingness to participate (P = 0.04). Multivariate analysis revealed that female gender (P = 0.05) and prior HIV-1 testing (P = 0.03) were significant predictors of willingness to participate. MeSH Terms:
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Ethn Health 1997 Aug;2(3):183-96 The African-American Health Project (AAHP): study overview and select findings on high risk behaviors and psychiatric disorders in African American men.Myers HF, Satz P, Miller BE, Bing EG, Evans G, Richardson MA, Forney D, Morgenstern H, Saxton E, D'Elia L, Longshore D, Mena IDepartment of Psychology, University of California 90095-1563, USA. The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV-1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV-1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub-sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV-1 and substance use. An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV-negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High-risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV-seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk. MeSH Terms:
Womens Health 1997 Fall-Winter;3(3-4):349-66 HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group.Sikkema KJ, Heckman TG, Kelly JACenter for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee 53202, USA. This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women. MeSH Terms:
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JAMA 1998 Jan 7;279(1):35-40 Prognostic indicators for AIDS and infectious disease death in HIV-infected injection drug users: plasma viral load and CD4+ cell count.Vlahov D, Graham N, Hoover D, Flynn C, Bartlett JG, Margolick JB, Lyles CM, Nelson KE, Smith D, Holmberg S, Farzadegan HDepartment of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA. DVLAHOV@jhsph.edu CONTEXT: Plasma human immunodeficiency virus type 1 (HIV-1) viral load and CD4+ cell count are used to predict prognosis of persons infected with HIV. However, whether combining these markers improves prognostic accuracy and whether they predict prognosis for injection drug users (IDUs) and nonwhite persons infected with HIV has not been extensively investigated. OBJECTIVE: To evaluate plasma viral load and CD4+ cell count as prognostic indicators for the acquired immunodeficiency syndrome (AIDS) and infectious disease deaths. DESIGN: Cohort study initiated in 1988 and 1989 with follow-up for up to 7.9 years. PARTICIPANTS: Injection drug users infected with HIV recruited from the community in Baltimore, Md. MAIN OUTCOME MEASURES: Plasma HIV-1 RNA and CD4+ cell count measured at baseline compared with time to first clinical AIDS diagnosis and death due to an infectious disease. RESULTS: Of 522 subjects, 96% were African American, 80% were male, 96% injected drugs within the past 6 months, and the median age was 33 years. A total of 146 cases of AIDS and 119 infectious disease deaths were seen during a median follow-up period of 6.4 years. Time-fixed baseline levels of viral load and CD4+ cell count were independent predictors of progression to AIDS and infectious disease deaths, but in proportional hazards models, viral load had better predictive value than CD4+ cell count. Kaplan-Meier analysis of time to AIDS and to infectious disease deaths by viral load (<500, 500-9999, 10000-29 999, > or =30000 copies/mL) at 3 levels of CD4+ cell count (<0.20, 0.20-0.49, and > or =0.50x10(9)/L [<200,200-499, and > or =500/microL]) was reduced to a 5-stage classification scheme using a backward stepwise regression procedure. The 5-year cumulative probabilities for AIDS and infectious disease deaths ranged from 0% and 0%, respectively, for group I (viral load, <500 copies/mL; CD4+ cell count, 0.50x10(9)/L) to 81.2% and 76.1% respectively, for group V (viral load, > or =10000 copies/mL; CD4+ cell count, 0.20x10(9)/L). CONCLUSIONS: In this study, plasma HIV-1 viral load independently and in combination with CD4+ cell count measurements provided powerful prognostic information for progression to AIDS and death caused by infectious disease in a population of predominantly African American IDUs. Combining categories of both markers provided a simple method for prognostically staging HIV disease. MeSH Terms:
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Med Anthropol Q 1997 Dec;11(4):454-5 African American males and HIV: the challenge of the AIDS epidemic.Wright JDepartment of Social Work, Savannah State University, USA. MeSH Terms:
Med Anthropol Q 1997 Dec;11(4):448-53 Gender, sexuality, and health in a turn-of-the-century "black metropolis".Harrison FVDepartment of Anthropology and Women's Studies Program, University of South Carolina, Columbia, USA. MeSH Terms:
Med Anthropol Q 1997 Dec;11(4):411-47 Urban low-income African American men, HIV/AIDS, and gender identity.Whitehead TLDepartment of Anthropology, University of Maryland, USA. In a 1993 Human Organization article, Jerome Wright called for more research on African American male sexual behavior and the risk for HIV infection. The present article is a response to that call. Wright pointed out a well-known fact of HIV/AIDS prevention programs: such programs have not been very successful in reaching low-income African American males. The present article suggests that perhaps the key to better understanding sex-related health-risk behavior is to conduct more systematic research on gender identity, and the historical and sociocultural origins of such identities. I argue that if we are truly interested in developing effective HIV/AIDS programs targeting low-income African American males, then the sociocultural "meanings" that this population attaches to AIDS-related phenomena must be understood in the broader contexts of American constructs of masculinity, and in the real and perceived experiences of black men in America. Data from several ethnographic and qualitative research projects carried out among low-income African American male and female residents of Baltimore, other parts of Maryland, and Washington, D.C. are used in support of my primary arguments. MeSH Terms:
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South Med J 1997 Nov;90(11):1123-8 Depressive symptoms as correlates of polydrug use for blacks in a high-risk community.Wang MQ, Collins CB, DiClemente RJ, Wingood G, Kohler CLHealth Studies Program, University of Alabama, Tuscaloosa 35487, USA. BACKGROUND: This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community. METHODS: A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the past 30 days, as well as about their depressive symptoms during the past week. RESULTS: Odds ratios and logistic regressions, adjusted for age and sex, were used to assess the relationship between depressive symptoms and drug and polydrug use (drug use involving cocaine). Results showed that depressive symptoms are significantly associated with polydrug use. However, depressive symptoms were not associated with alcohol use or with the combination of alcohol and marijuana use. CONCLUSIONS: Depressive symptoms are related to polydrug use involving cocaine, though the causal relationship is uncertain. Previous reports on depressive symptoms and alcohol or marijuana may be inconclusive. MeSH Terms:
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Nurs Ethics 1997 Sep;4(5):394-402 Ethical issues experienced by HIV-infected African-American women.Smith KV, Russell JUniversity of Missouri-Kansas City, School of Nursing 64108-2676, USA. The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led to many ethical problems. Most studies have focused on the ethical issues faced by nurses who provide care to persons with AIDS (PWA), rather than the ethical issues faced by PWAs themselves. The purpose of this study, therefore, was to explore the ethical issues faced by five HIV/AIDS-infected African-American women. An analysis of interview data revealed that these women deal with four broad categories of ethical issues: diagnosis; disclosure; treatment by, and of, others; and future pregnancies. The results of this study provide an initial description of the ethical issues faced by HIV/AIDS-infected African-American women, and begin to lay the foundation necessary for nurses appropriately to facilitate and support their decisions. MeSH Terms:
J Acquir Immune Defic Syndr Hum Retrovirol 1997 Dec 1;16(4):239-42 CCR5del32 in perinatal HIV-1 infection.Rousseau CM, Just JJ, Abrams EJ, Casabona J, Stein Z, King MCDivision of Medical Genetics, University of Washington, Seattle 98195-7720, USA. cmr@u.washington.edu CCR5, a chemokine receptor, serves as a coreceptor for macrophage-tropic HIV-1 (1-3). A 32-bp deletion within the gene encoding CCR5, CCR5del32, has been shown to prevent HIV-1 infection of T cells in the absence of a wild-type allele. This alteration is present in low frequency in Caucasian populations (4-6). To investigate the effect of CCR5del32 in perinatal HIV-1 transmission and disease progression, two cohorts of perinatally exposed infected and uninfected children were analyzed for the presence of the allele. Polymerase chain reaction (PCR) was used to identify CCR5del32 in prevalent and prospective cases among 144 African American children from New York City and 73 Caucasian children from Barcelona, Spain. HIV-1 transmission; clinical manifestations of disease, including encephalopathy, opportunistic infections, and death before 2 years of age; survival; Centers for Disease Control and Prevention (CDC) classification; and degree of immunosuppression were compared in children with and without CCR5del32. The allele frequency in HIV-1-infected African Americans (0.016) was lower than in Catalan children (0.041). No evidence for a dominant protective effect of CCR5del32 for HIV-1 transmission or disease progression was found in these cohorts. Publication Types:
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Am J Hum Genet 1997 Dec;61(6):1261-7 Novel alleles of the chemokine-receptor gene CCR5.Carrington M, Kissner T, Gerrard B, Ivanov S, O'Brien SJ, Dean MIntramural Research Support Program, Scientific Applications International Corporation-Frederick, MD 21702, USA. carringt@ncifcrf.gov The CCR5 gene encodes a cell-surface chemokine-receptor molecule that serves as a coreceptor for macrophage-tropic strains of HIV-1. Mutations in this gene may alter expression or function of the protein product, thereby altering chemokine binding/signaling or HIV-1 infection of cells that normally express CCR5 protein. Indeed, homozygotes for a 32-bp deletion allele of CCR5 (CCR5-delta 32), which causes a frameshift at amino acid 185, are relatively resistant to HIV-1 infection. Here we report the identification of 16 additional mutations in the coding region of the CCR5 gene, all but 3 of which are codon altering or "nonsynonymous." Most mutations were rare (found only once or twice in the sample); five were detected exclusively among African Americans, whereas eight were observed only in Caucasians. The mutations included 11 codon-altering nonsynonymous variants, one trinucleotide deletion, one chain-termination mutant, and three synonymous mutations. The high predominance of codon-altering alleles among CCR5 mutants (14/17 [81%], including CCR5-delta 32) is consistent with an adaptive accumulation of function-altering alleles for this gene, perhaps as a consequence of historic selective pressures. MeSH Terms:
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Pathobiology 1997;65(4):210-5 HLA-DQB1 markers associated with human immunodeficiency virus type I disease progression.Achord AP, Lewis RE, Brackin MN, Cruse JMDepartment of Pathology, University of Mississippi Medical Center, Jackson 39216-4505, USA. In a previous investigation, we demonstrated that certain human leukocyte antigens (HLA) may be associated with human immunodeficiency virus type I (HIV-1) infection or protection from infection among regional African Americans and Caucasians. We demonstrated that HLA-DQB1*0605 was associated with a possible increased risk of susceptibility to infection in African Americans and that DQB1*0602 was associated with a possible increased risk of infection in Caucasians. The present study was designed to demonstrate possible HLA associations with HIV-1 disease progression and AIDS in regional African American and Caucasian populations. To differentiate rapid from slow progressors, immune parameters of the HIV-1-positive patient population were monitored over a mean follow-up period of 23 +/- 2 months for African Americans (n = 30) and 25 +/- 5 months for Caucasians (n = 22). To determine significance, HLA allele frequencies among rapid progressors were compared to those of slow progressors, separated by race. Results were analyzed by chi 2 analysis, with Fisher's exact test where applicable, linear logistic regression and Kaplan-Meier survival analysis. In the HIV-1-positive African American group, a better prognosis was associated with HLA-DQB1*0602. In the HIV-1-positive Caucasian group, HLA-DQB1*0302 was associated with rapid HIV disease progression, but no marker was associated with a more favorable prognosis. MeSH Terms:
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Ethn Health 1996 Mar;1(1):77-85 Gender and ethnic differences in survival in a cohort of HIV positive clients.Bright PE, Arnett DK, Blair C, Bayona MDepartment of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa 33612-3805, USA. OBJECTIVES: The purpose of this study was to examine gender and ethnic differences in survival of persons receiving treatment for HIV infection to determine if differences existed, and if they did, to assess the possibility of explaining these differences by examining other factors, such as age, disease severity when beginning treatment, alcohol, illicit drugs, tobacco, educational level, living arrangements, antiretroviral treatment, PCP prophylaxis, sexually transmitted diseases, mode of transmission and opportunistic infections. DESIGN: A retrospective cohort study of all clients receiving treatment at an HIV only clinic from its opening in early 1988 until the end of May 1993. Statistical methods used to examine the data included incidence density ratios, Kaplan-Meier survival curves, Breslow (generalized Wilcoxon) tests of equality of survival curves and Cox proportional hazards models both with and without time dependent covariates. RESULTS: In the cohort (37% African American, 7% Hispanic American and 25% female), 220 deaths occurred during 1223 person years of follow-up. Compared to European American males, the following incidence density ratios were observed: European American females: 0.50, Hispanic American females: 0.70, Hispanic American males: 0.96, African American females: 1.28 and African American males: 2.38. The differences were noted above for gender/ethnicity groups were significant at the p < 0.0001 level. After adjusting for disease stage (as measured by laboratory testing of CD4 positive T-lymphocytes), educational level, and age, no differences in survival by gender or ethnicity remained. Disease stage and educational level had the greatest prognostic significance. CONCLUSIONS: European Americans entered treatment at a much earlier disease stage (as measured by CD4 positive T-lymphocyte counts) and had higher educational levels (a surrogate for socioeconomic status) than African Americans. These factors may explain the longer survival in European Americans as compared to African Americans in this cohort. MeSH Terms:
Am J Epidemiol 1997 Oct 15;146(8):662-4 Estimation of human immunodeficiency virus (HIV) seroincidence among repeat anonymous testers in San Francisco.McFarland W, Kellogg TA, Dilley J, Katz MHAIDS Office, San Francisco Department of Public Health, CA 94102, USA. The authors approximated human immunodeficiency virus (HIV) seroincidence in a population of men who have sex with men and who sought repeated anonymous HIV testing in San Francisco in 1995. The number of seroconversions and person-years of observation were estimated using the date and result of the current test and the self-reported date and result of the previous test. Estimates for HIV seroincidence (2.8 per 100 person-years, 95% confidence interval 2.3-3.4) and predictors of seroconversion were similar to those estimated from a prospective study of men who have sex with men conducted in San Francisco at the same time. While the limitations of self-reported data in a self-selected population are recognized, data from repeat testers may provide a practical surveillance tool. MeSH Terms:
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Am J Nurs 1997 Oct;97(10):25 A racial divide in use of AIDS drugs?MeSH Terms:
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J Natl Med Assoc 1997 Oct;89(10):652-6 HIV and the black community: the role of the National Medical Association.Rawlings MK, Lewis RPublication Types:
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Fam Plann Perspect 1997 Sep-Oct;29(5):212-4 Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents.Miller KS, Clark LF, Moore JSDivision of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA. Data from a 1993-1994 survey of 150 black and Hispanic teenagers were used to examine differences in HIV risk-related behavior between young women who have a first sexual partner three or more years older than themselves and those whose first partner is their age. Compared with teenagers whose first partner had been roughly their age, the 35% of adolescents with an older partner had been younger at first intercourse (13.8 years vs. 14.6) and less likely to use a condom at first intercourse (63% vs. 82%). They also were less likely to report having used a condom at last intercourse (29% vs. 44%) or having used condoms consistently over their lifetime (37% vs. 56%) or in the previous six months (44% vs. 66%). Some 38% of teenagers with an older first partner had ever been pregnant, compared with 12% of those with a peer-age first partner. The mean number of partners and history of sexually transmitted diseases did not differ between the two groups. Publication Types:
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Addiction 1997 Aug;92(8):1017-22 HIV infection among victims of accidental fatal drug overdoses in New York City.Tardiff K, Marzuk PM, Leon AC, Hirsch CS, Portera L, Hartwell NDepartment of Psychiatry, Cornell University Medical College, New York 10021, USA. AIMS: To determine the factors associated with HIV seroprevalence rates for victims of drug overdoses. DESIGN: Descriptive epidemiologic survey of a complete 3-year sample of accidental fatal drug overdoses. SETTING: New York City (population 7,322,564). PARTICIPANTS: All people over 15 years of age (n = 2159) who died of accidental fatal drug overdoses during 1991-93. MEASUREMENTS: Using medical examiner data and logistic regression analyses were conducted to examine the association between HIV seroprevalence and gender, race, age and type of drug overdose. FINDINGS: There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV positive. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). Victims residing in communities with higher levels of poverty had higher rates of HIV infection but poverty did not account for the high rates of HIV infection among African-Americans. The highest rates of HIV infection were found among victims aged 35-44 years (38.8%) and 45-54 years (33.7%). Dying from an opiate overdose was associated with a 2.4 times increase in the likelihood of being HIV positive. CONCLUSION: If opiate abuse continues to rise in the United States, HIV infection will increase in the next few years. Women who abuse drugs participate in risky sexual practices and are more likely than men to develop HIV infection from receptive sex as well as sharing of needles. Harm reduction programs should address risky sex as well as needle programs. There should be further study of why African-Americans who died of drug overdoses have the highest rates of HIV infection. MeSH Terms:
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Am J Community Psychol 1997 Jun;25(3):371-94 Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders.Unger JB, Kipke MD, Simon TR, Montgomery SB, Johnson CJDivision of Adolescent Medicine, Childrens Hospital Los Angeles, California 90054-0700, USA. Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults. MeSH Terms:
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Am J Prev Med 1997 Sep-Oct;13(5):380-4 Child sexual abuse, HIV sexual risk, and gender relations of African-American women.Wingood GM, DiClemente RJDepartment of Health Behavior, School of Public Health, University of Alabama, Birmingham 35294-0022, USA. INTRODUCTION: A cross-sectional study was conducted to examine the association between childhood abuse, HIV-related sexual risks, and gender relations among African-American women. METHODS: The sample 165 African-American women, 18-29 years of age, were recruited by street outreach from a lower socioeconomic community in San Francisco, CA. A face-to-face interview was administered to assess HIV/STD-sexual risk practices, alcohol use, physical abuse, affective health, and relationship commitment. Childhood sexual abuse was defined as experiencing forced sex prior to age 16. RESULTS: The prevalence of childhood sexual abuse in this sample was 13.3%. Compared to women who were not abused during childhood, women who reported a history of childhood sexual abuse were 1.5 times more likely to have had an abortion, 1.4 times more likely to report having an STD, 2.4 times as likely to report having greater than two lifetime STDs, 3.8 times as likely to have a history of anal sex, 2.6 times as likely to worry about acquiring HIV, 3.9 times more likely to believe their partner did not care for them, twice as likely to doubt the longevity of their relationship, 5.1 times as likely to have a partner who had been physically abusive within the previous 3 months, 2.6 times as likely to have a partner who was physically abusive when asked to use condoms, and 1.5 times as likely to consume three or more glasses of alcohol at one time. CONCLUSIONS: Awareness of a women's history of child sexual abuse can assist in making appropriate medical and social referrals and can lead to the development of more tailored HIV prevention programs for African-American women. MeSH Terms:
AIDS Educ Prev 1997 Aug;9(4):359-72 Magic Johnson and children's conceptions of AIDS.Quadagno D, Eberstein IW, Foster K, Sittig JE, Sly DF, Kistner JAFlorida State University, Center for the Study of Population, Tallahassec 32306-4063, USA. Longitudinal data for a heterogeneous sample of 609 elementary school children are used to assess the long-term effects of Magic Johnson's announcement on children's HIV and AIDS conceptions. Four hypotheses are tested concerning these relationships, and background variables measured prior to Johnson's announcement are controlled. Findings suggest that Johnson's announcement increased children's HIV and AIDS knowledge and reduced their prejudice toward a hypothetical child with AIDS. No relationship is evident between the announcement and perceived vulnerability to HIV and AIDS. Males are more likely to be aware of Johnson's announcement, but its effects are more pronounced among blacks. Findings from the present research affirm the potential for celebrities like Johnson in HIV and AIDS education campaigns directed toward children. Publication Types:
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AIDS Educ Prev 1997 Aug;9(4):299-313 Lack of positive outcomes from a cognitive-behavioral HIV and AIDS prevention intervention for inner-city men: lessons from a controlled pilot study.Kalichman SC, Rompa D, Coley BCenter for AIDS Intervention Research (CAIR), Medical College of Wisconsin, USA. African American men are at increasingly high risk for HIV infection, but there have been few studies of HIV risk reduction interventions for heterosexual ethnic minority men. The present study randomly assigned 81 African American men to one of two HIV prevention interventions: a four-session cognitive-behavioral skills training HIV risk reduction intervention that has been successful with other populations or a four-session HIV risk education and sensitization control condition. Men were assessed at baseline, at immediate postintervention, and at a 3-month follow-up. Forty-five percent of participants dropped out of the intervention; dropouts were younger, more likely to have used condoms, and less likely to have been tested for HIV antibodies than men who completed the study. Outcome analyses showed that both interventions significantly increased AIDS-related knowledge, initial intentions to change HIV risk behaviors, and reduced unprotected vaginal intercourse. However, there were no significant differences between groups on any of the measures at postintervention or follow-up assessments. Recognizing the limitations of our small sample size, the results of this initial study caution against generalizing skills training HIV prevention interventions that have been successful with other populations to African American heterosexual men. Publication Types:
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J Infect Dis 1997 Sep;176(3):794-7 Human immunodeficiency virus RNA levels in US adults: a comparison based upon race and ethnicity.Brown AE, Malone JD, Zhou SY, Lane JR, Hawkes CACombined Military Diagnostic Retrovirology Service, Walter Reed Army Institute of Research, Henry M. Jackson Foundation, and SRA Technologies, Rockville, Maryland, USA. Volunteers in a natural history study of human immunodeficiency virus type 1 (HIV-1) at two military medical centers were studied to determine whether plasma HIV-1 RNA levels differ among racial and ethnic groups of US adults infected with HIV-1. Cross-sectional analyses of plasma HIV-1 RNA and CD4 cell counts were done using demographic and clinical data collected during study visits. Age, gender, CD4 cell count, seroconversion status, and use of antiretroviral therapy were studied in 545 military members (46% white, 49% black, and 6% Hispanic). No association was found between HIV-1 RNA levels and race or ethnicity among infected adults for whom access to care and socioeconomic status were not confounding factors. MeSH Terms:
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AIDS Care 1997 Jun;9(3):297-309 Testing and treatment behaviour of HIV-infected women: white, African-American, Puerto Rican comparisons.Siegel K, Karus D, Raveis VHMemorial Sloon-Kettering Cancer Center, New York, NY 10021, USA. Findings from a study of the testing and treatment behaviour and experiences of African-American (n = 31), Puerto Rican (n = 30) and non-Hispanic white (n = 23) HIV-infected women are reported. All women were 20-45 years of age and had not yet been diagnosed with AIDS. Data for the analyses presented were gathered through an interviewer-administered questionnaire completed before respondents participated in an unstructured interview. The analyses examine race/ethnic differences in women's delays in seeking testing and medical care, and in sources and types of HIV-treatment. Most significant for primary and secondary prevention efforts, the findings suggest that a significant proportion of women who suspect they are infected may delay being tested, and further, a substantial proportion who learn they are seropositive may delay seeking medical care. Thus important opportunities among HIV-infected women for secondary prevention through timely antiviral and prophylactic treatment, and for primary prevention through risk-reduction counselling may be being missed in many cases. MeSH Terms:
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