Sex, drugs, and the spread of HIV/AIDS in Belle Glade, Florida.

Belle Glade, Florida, an agricultural community in the heart of the state's vegetable and sugar cane production areas, has the highest cumulative per capita incidence of AIDS in the United States. A risk reduction intervention program was introduced to lessen unsafe AIDS-related behaviors and to generate data on the epidemiology of HIV infection. Initial attention focused on individuals who were believed to be at the core of the transmission pattern, injection drug users and their sexual partners. We found, however, that injection drug use was much less widespread than anticipated. Results suggested that the primary mode of HIV transmission is heterosexual intercourse-mediated by drug taking (particularly crack smoking) and a flourishing sex industry-a finding that is corroborated by the increased and disproportionate rate of heterosexual AIDS in Belle Glade. The prevalence and types of risk behaviors engaged in would not have been completely explained without the use of ethnographic methods including observation of, and lengthy interviews with, the populations at risk.

HIV-related risk behaviors and seropositivity among homeless drug-abusing women in Miami, Florida.

This article examines the multifaceted interactions among homelessness, HIV, substance abuse, and gender. Data were collected on 1,366 chronic drug users using a nationally standardized validated instrument within the Miami CARES project of a multisite federally funded program. HIV testing accompanied by pretest and posttest counseling was conducted on-site by certified phlebotomists and counselors. In addition to descriptive analyses and corresponding tests of significance, logistic regression analyses were used to clarify the complex associations between the outcome variables of homelessness and HIV, recognizing difficulties of determining temporal sequence. HIV infection was found to be 2.35 times more prevalent among homeless women than homeless men and significantly higher for homeless women. The findings indicate that among women, homelessness and HIV have a highly interactive effect increasing the vulnerability of this population and thus rendering them an extremely important priority population on which to focus public health efforts and programs.

Prostate cancer in Florida: knowledge, attitudes, practices, and beliefs.

In Florida, prostate cancer continues to be an increasing public health problem, especially among the elderly and medically underserved. Bilingual, random-digit-dialed telephone interviews were conducted with 897 men who were 65 years and older in Dade and Hillsborough counties, with the sample stratified along racial and ethnic lines. The purpose of the survey was to obtain information regarding knowledge, attitudes, practices, and beliefs about prostate cancer, its prevention, and early detection. More than 60% of the 897 respondents believed that a person with prostate cancer had an 80% or greater chance for cure, yet only 67% reported ever having a digital rectal examination. Black (35.7%) and Hispanic respondents (42.5%) were twice as likely to have never had a digital rectal examination than were their white counterparts (19.8%). When asked why they had never had this examination or had not had one in the past 2 years, 38.5% replied that it was "not needed/not necessary" and 27.6% replied they "had not had any problems." When asked their sources for answers to health-related questions, physicians ranked first whereas family and friends ranked near the bottom on a list of some 11 sources. Clearly, efforts need to be increased to identify, reduce, and/or eliminate potential barriers to use of early-detection programs.

Breast cancer screening of the medically underserved: results and implications.

Socioeconomic status is the most significant factor influencing the decreased survival associated with breast cancer in minority groups in the United States. Barriers to the use of early detection programs by low-income women often result in the detection of breast cancer at stages too advanced to assure optimum outcomes. In an effort to increase accessibility of breast cancer screening among such individuals, the Early Detection Program (EDP) was initiated in 1987. The program provided breast cancer screening to women 40 years of age and older who attended eight primary healthcare centers located in low-income neighborhoods throughout Dade County, Florida. From its inception in October 1987 through December 1993, 23,866 medically underserved women had mammography examinations, with more than 17,000 of these women undergoing baseline mammograms. Since the program's inception, 126 cancers were diagnosed in 123 women. A dramatic shift from later to earlier stage breast cancers was observed. These results warrant a greater inclusion of medically underserved and lower socioeconomic status women in screening programs for the early detection of breast cancer.