Talking with patients about their use of alternative therapies.

Discussion of alternative therapy use provides the primary care clinician with important information regarding patients' health-related practices and beliefs. The dialogue itself may also serve as an important foundation for effective and mutually rewarding doctor-patient relationships. This article reviews demographic and ethnographic data that document patterns and rationales of complementary and alternative therapy use in the United States. Specific principles to facilitate discussion in counseling patients who use, or who consider use of, alternative therapies are discussed.

Promoting cultural competence in HIV/AIDS care.

The importance of cultural competence in providing health care to a diverse patient population is well-recognized throughout the health professions, though there is as yet no widely accepted set of criteria for establishing and maintaining cultural competence. In HIV/AIDS, where behavioral factors figure so prominently in transmission, prevention, and treatment, cultural appropriateness is crucial to providing patient education and nursing care. This article suggests some specific cultural competence training strategies and offers a broad conceptual framework for teaching and learning about the issues involved in cultural competence, with specific illustrations relating to HIV/AIDS.

Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS.

OBJECTIVE: To investigate the extent of recourse to alternative therapies among 184 HIV-positive patients who continued to attend conventional medical clinics. The study describes the specific alternative therapeutic modalities that were more commonly sought by our respondents, and provides data on the subjective assessment of the efficacy of both conventional and alternative therapies. METHODS: Demographic and behavioral information were obtained from standard, self-administered, anonymous questionnaires distributed at three HIV clinics in the Philadelphia area. RESULTS: Forty per cent of patients reported having used alternative or complementary therapies. Forty-two per cent of respondents who had been enrolled in clinical trials had used alternative therapies at some stage. Recourse to such therapies was significantly associated with risk-group affiliation, duration of seropositivity, and sex. The decision to use alternative therapies was not significantly related to age, race, education, religion or severity of symptoms. Of respondents using alternatives, 10% expected the unconventional treatments to cure their HIV infection, and 36% expected them to delay the onset of symptoms. CONCLUSION: The results of this study will contribute to conventional practitioners' understanding of those unconventional explanations and therapies for HIV infection that many patients find relevant and meaningful. Health-care workers should be aware of their patients' interest in participating in decisions about their treatment--whether alternative or conventional--and be prepared to work with them to achieve satisfactory outcomes.

The home birth movement in the United States.

The home birth movement in the United States is an alternative health belief system that promotes a model of pregnancy and childbirth contradictory to the conventional biomedical model. The alternative model stresses normalcy and non-intervention and is informed by an ideology that promotes individual authority and responsibility for health and health care. It is founded in an epistemological system that assigns primacy and goodness to the Natural, fuses moral and practical injunctions in the arena of health behavior, and valorizes subjective as well as objective sources of knowledge. (Natural = as found in nature without technical intervention). Differences of opinion with the conventional medical model of childbirth do not spring from misunderstanding of this model, but from disagreement with it. Members of this movement are typically educated, middle class, and white.