Knowledge about HIV in a Community Sample of Urban African Americans in the South.

PURPOSE: Race and HIV are intertwined in complex ways. African Americans, particularly those residing in the southern United States, are at great risk for contracting and subsequently transmitting HIV. Research on the extent to which members of this population understand the risks associated with engaging in specific behaviors is limited. This paper examines HIV knowledge among at-risk adult African American men and women and the factors associated with levels of HIV knowledge. METHODS: Based on a conceptual model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011. Questionnaire-based interviews were conducted with 1,864 respondents from 80 strategically-chosen census block groups in Atlanta, Georgia. An innovative approach to assessing amount of HIV knowledge was implemented, to derive better estimates of the extent of knowledge. RESULTS: Overall, HIV knowledge was low (average=43.5% correct answers). Seven factors were identified as contributing uniquely to having higher levels of knowledge about HIV transmission: (1) younger age, (2) being educated beyond the high school level, (3) being gay, lesbian or bisexual, (4) experiencing sexual abuse during childhood and/or adolescence, (5) drinking alcohol less frequently, (6) knowing a larger number of HIV-infected persons and (7) knowing anyone currently living with "full blown" AIDS. CONCLUSION: HIV educational and intervention programs targeting at-risk African American adults need to develop effective ways of bolstering a solid understanding of how HIV is/not transmitted. In particular, efforts need to be targeted toward older adults, those with lower levels of educational attainment and persons who are not acquainted with anyone who is HIV-infected.

How the Interaction of Childhood Sexual Abuse and Gender Relates to HIV Risk Practices among Urban-Dwelling African Americans.

PURPOSE: Previous research has demonstrated that HIV risk practices often differ based on gender and on whether or not people experienced sexual abuse during their formative (i.e., childhood and adolescence) years. The interaction of these two factors, which is the focus of this paper, has received limited attention. METHODS: Based on a model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2012 with 1,864 African American adults residing in Atlanta, Georgia in 80 strategically-chosen consensus block groups. RESULTS: Based on multiple regression and structural equation analyses, the interaction of sexual abuse and gender was found to be a significant predictor of involvement in (un)protected sex. The interaction of sexual abuse and gender also was related to condom use self-efficacy, which was one of the strongest factors underlying (un)protected sex. CONCLUSION: The relationship of sexual abuse history and gender is relevant in the understanding of HIV risk practices. The interaction of these factors with one another and with other relevant influences that shape people's HIV risk profiles is complex. The Syndemics Theory approach used to conceptualize the relationships among relevant variables in this study is an effective way of trying to understand and address HIV risk practices.

Drug users' willingness to encourage social, sexual, and drug network members to receive an HIV vaccine: a social network analysis.

This study examined feasibility of peer-based promotion of HIV vaccination and dyadic correlates to vaccine encouragement in risk- and non-risk networks of drug users (n = 433) in the US. Data were collected on HIV vaccine attitudes, risk compensation intentions, likelihood of encouraging vaccination, and recent (past 6 months) risk (i.e. involving sex and/or injecting drugs) and non-risk (i.e. involving co-usage of noninjected drugs and/or social support) relationships. Willingness to encourage HIV vaccination was reported in 521 and 555 risk- and non-risk relationships, respectively. However, 37 % expressed hesitancy, typically due to fear of side effects or social concerns. Encouragement was often motivated by perceived HIV risk, though 9 % were motivated by risk compensation intentions. In non-risk partnerships, encouragement was associated with drug co-usage, and in risk relationships, with perceived vaccine acceptability and encouragement by the partner. Network-based HIV vaccine promotion may be a successful strategy, but risk compensation intentions should be explored.

The challenges of managing vestibular disorders: a qualitative study of clinicians' experiences associated with low referral rates for vestibular rehabilitation.

AIMS: To explore clinicians' perspectives influencing the under-diagnosis and management of patients with vestibular impairment (VI). METHODS: Data were collected using open-ended, semi-structured interviews with 18 clinical providers from primary care, neurology, otolaryngology and audiology affiliated with the Veterans Administration Medical Center in Atlanta, Georgia, from January to September 2007. Topics discussed included healthcare experiences for dizzy patients with possible VI, and perceived barriers and facilitators for clinical practice according to published guidelines. The constant comparison method was used for qualitative content analysis. RESULTS: Clinicians rarely, if ever, diagnosed VI themselves or were aware of vestibular rehabilitation as the appropriate treatment for vestibular disorders. They infrequently performed bedside tests for positional nystagmus or vestibular hypofunction to identify VI and almost never performed canalith repositioning. Not uncommonly, they ordered a wide variety of diagnostic tests, such as neuroimaging, cardiac studies and audiograms, prior to make referral to a specialist, if they made referral at all. Perceived barriers to identifying VI in patients and giving treatment consistent with published recommendations commonly included lack of knowledge and training, perceived time constraints in clinic and difficulties with dizzy patients giving vague descriptions of their symptoms. CONCLUSIONS: Perceptions of lacking knowledge in caring for patients with possible VI were experienced by clinicians both in primary and specialty care. Clinicians were frequently unaware of the concept of vestibular rehabilitation. Many wanted to learn more to improve healthcare delivery for their patients. Education appears necessary not only for enhancing patient therapeutic benefit, but also for minimising costs for unnecessary physician hours and diagnostic tests.

The Atlanta Urban Networks Study: a blueprint for endemic transmission.

OBJECTIVE: To study prospectively social networks and behavior in a group of persons at risk for HIV because of their drug-using and sexual practices, with particular emphasis on the interaction of risks and concomitant network structure. METHODS: A longitudinal study was conducted of 228 respondents in Atlanta, Georgia in six inner-city community chains of connected persons, interviewing primary respondents and a sample of their contacts every 6 months for 2 years. Ascertained were: HIV and immunologic status; demographic, medical, and behavioral factors; and the composition of the social, sexual, and drug-using networks. RESULTS: The prevalence of HIV in this group was 13.3% and the incidence density was 1.8% per year. Substantial simultaneity of risk-taking was observed, with a high level of both non-injecting (crack, 82%) and injecting (heroin, cocaine or both, 16 30%) drug use, the exchange of sex or money for drugs by men (approximately 35%) and women (57-71%), and high frequency of same-sex sexual activity by men (9.4%) and women (33%). The intensity of interaction, as measured by network features such as microstructures and concurrency, was significantly greater than that observed in a low prevalence area with little endemic transmission. CONCLUSION: The traditional hierarchical classification of risk for HIV may impede our understanding of transmission dynamics, which, in the setting of an inner-city population, is characterized by simultaneity of risk-taking, and moderately intense network interactions. The study provides further evidence for the relationship of network structure to transmission dynamics, but highlights the difficulties of using network information for prediction of individual seroconversion.

Syringe disposal options for injection drug users: a community-based perspective.

This study was a qualitative exploration of syringe disposal interventions for injection drug users (IDUs). Data were collected through in-depth interviews with 26 community members who injected drugs and 32 noninjecting community members in Atlanta, Georgia. Both groups supported syringe exchange programs as syringe disposal interventions, while noninjecting community members favored a one-way drop box. IDUs identified fear of arrest for possession of syringes as the most salient barrier to safe syringe disposal, revealing the negative consequences of drug paraphernalia laws.

Epidemiological indicators and ethnographic realities of female cocaine use.

This study is an ethnographic examination of differences in the male-to-female ratio among cocaine users in epidemiological indicators from emergency room departments, local drug-user treatment programs, and the pretrial detention center. In-depth interviews were conducted with female cocaine users. The lower female ratio in drug treatment and emergency department sources seems related to barriers to drug-user treatment for women and the image of emergency departments as an extension of the criminal justice system. The women's involvement in visible illegal activities and their perception as easy arrestees may explain the arrestee data ratio. The findings indicate that epidemiological indicators may misrepresent the gender distribution among drug users.

HIV seroprevalence and risk factors among clients of female and male prostitutes.

OBJECTIVES: To document the HIV and STD infection rates among clients of female (CFP) and clients of male prostitutes (CMP) and to identify the risk factors for HIV among CFP and CMP. METHODS: Structured interviews were conducted with 82 CMP and 69 CFP in 1990 and 1991 in Atlanta, Georgia, U.S.A. Blood samples were tested for HIV, syphilis, and hepatitis B. RESULTS: The HIV-positive rate was 36.6% among CMP and 2.9% among CFP. Syphilis seromarkers were found in 15.9% of CMP and 10.1% of CFP; hepatitis B seromarkers were identified in 58.0% of CMP and 24.6% of CFP. Key risk factors for HIV among CMP included serologic history of syphilis, serologic history of hepatitis B, receptive anal sex with a male prostitute, ever injecting drugs, ever using crack cocaine, and little education. CFP had no significant risk factors for HIV in the logistic analysis. CONCLUSIONS: Several studies have focused on risk factors for HIV among female and male prostitutes; however, research on their clients has been limited. Although HIV infection rates among CFP are relatively low, their infection rate for syphilis and hepatitis warrants serious health education efforts. Even more critical are harm-reduction programs targeting CMP. Generic health and HIV risk reduction messages on heterosexual transmission might be insufficient.

New needle and syringe use, and use of needle exchange programmes by street recruited injection drug users in 1993.

BACKGROUND: Needle exchange programmes (NEP) provide injection drug users (IDU) with sterile injection equipment and receive used needles in exchange. In this paper we describe the use of new syringes and NEP by IDU and characteristics associated with using NEP in 1993. METHODS: Street-recruited IDU were interviewed in five US locations: Atlanta, Philadelphia, Chicago, New York City, and Los Angeles (LA) county. RESULTS: Most (75-95%) reported it was easy to get a new syringe and for their last injection, 45-77% used a new syringe and 2-18% used a syringe previously used by another IDU. Use of NEP ranged from 8% to 16% in Chicago, Philadelphia, and LA County. In LA County not having injected 'speedball' in the last 30 days, last injection with a new syringe, and reporting it was very easy to get a new syringe were associated with NEP use. In Philadelphia, NEP use was associated with 'speedball' injection in the last 30 days, and in Chicago, not injecting with 'speedball' and injecting with cocaine were associated with NEP use. CONCLUSIONS: In 1993, most street-recruited IDU in Chicago, Philadelphia, and LA County had not used NEP. Factors associated with NEP use were not consistent across sites. Dispersion of NEP and removal of legal barriers restricting access to sterile syringes may be more important in increasing the use of sterile syringes and NEP than client characteristics.

Women and AIDS: a brief update.

PIP: An increasing proportion of those infected with HIV are women. During 1995, the proportion of new HIV infections among women worldwide was 39%. Initially, gender differences in HIV/AIDS were assumed to relate to biologic differences. However, it is now believed, for example, that the fact that HIV-infected men appear to have a longer survival time than infected women reflects the tendency for women to delay diagnosis and treatment. To reduce heterosexual transmission of HIV, it will be necessary to provide women with female-controlled prevention methods and to develop programs that consider the sociocultural context in which heterosexual transmission occurs.^ieng

Crack, sex, and STD.

Increasing rates of syphilis, gonorrhea, chancroid, and sexually transmitted human immunodeficiency virus infection appear to be related to crack cocaine use. This article critically reviews 16 epidemiologic studies that examine drug use, sexual behavior, and sexually transmitted disease (STD). Eight studies found an association between crack and STD, one study found no association between crack and STD, and seven studies found STD to be related to other drugs or methods of cocaine use. The exchange of sex for money or drugs was associated with STD in seven studies. Publications that were reviewed have numerous methodologic weaknesses: broader sampling, uninfected comparison groups, and greater specification of drug use and sexual risk behaviors are needed. Further research should compare different drugs and associated sexual behavior and STD to assess the unique risk conferred by crack. Designing effective interventions will require investigation of risk behavior determinants and barriers to health care.

AIDS and the social relations of intravenous drug users.

Gauging the impact of AIDS on intravenous drug users requires analysis of the cultural, political, and racial contexts of American society in which drug use is embedded. Considerable variation in behavior among drug injectors and noninjectors in different cities over time further complicates an understanding of the dynamics of drug use. AIDS has prompted many IV drug users to change their behavior, though not all users have reduced the risks of transmitting HIV infection. While expanded harm-reduction strategies and drug abuse treatment systems may help limit the epidemic's spread, weak federal support, constrained hospital resources, and racial stigma inhibit more direct action needed to stem the negative social and personal consequences of drug use.