Intention to get naloxone among patients prescribed opioids for chronic pain

BACKGROUND

Prescription opioids have been increasingly prescribed for chronic pain while the opioid-related death rates grow. Naloxone, an opioid antagonist, is increasingly recommended in these patients, yet there is limited research that investigates the intention to get naloxone. This study aimed to investigate intention toward getting naloxone in patients prescribed opioids for chronic pain and to assess the predictive utility of the theory of reasoned action (TRA) constructs in explaining intention to get naloxone.

METHODS

This was a cross-sectional study of a panel of U.S. adult patients prescribed opioids for chronic pain using a Qualtrics_®^XM survey. These patients participated in the study during February to March 2020. The online internet survey assessed the main outcome of intention to get naloxone and constructs of TRA (attitudes and subjective norms); additional measures assessed the characteristics of patients' opioid overdose risk factors, knowledge of naloxone, and their demographics. The relationship between TRA constructs, namely, attitudes and subjective norms, and the intention variable was examined using logistic regression analyses with the intention outcome contrasted as follows: high intention (scores ≥ 5) and non-high intention (scores < 5).

RESULTS

A total of 549 participants completed the survey. Most of them were female (53.01%), White or Caucasian (83.61%), non-Hispanic (87.57%) and had a mean age of 44.16 years (SD = 13.37). Of these, 167 (30.42%) had high intention to get naloxone. The TRA construct of subjective norm was significantly associated with increased likelihood of higher intentions to get naloxone (OR 3.04, 95% CI 2.50-3.70, P < 0.0001).

CONCLUSIONS

Our study provides empirical support of the TRA in predicting intention to get naloxone among chronic pain patients currently taking opioids. Subjective norms significantly predicted intention to get naloxone in these patients. The interventions targeting important reference groups of these patients would have greater impact on increasing intention to get naloxone in this population. Future studies should test whether theory-based interventions focusing on strengthening subjective norms increase intention to get naloxone in this population.

Barriers and Facilitators to DATA Waivered Providers Prescribing Buprenorphine: A Qualitative Analysis Applying the Theory of Planned Behavior

Background: Provider beliefs about the treatment of people with addiction may influence their prescribing behavior. Objective: This study applied the Theory of Planned Behavior (TPB), to identify the salient beliefs of Drug Addiction Treatment Act of 2000 (DATA 2000) waivered providers, concerning prescribing buprenorphine to patients with Opioid Use Disorder (OUD). Methods: Texas buprenorphine providers participated in one of four online focus group discussions conducted in fall 2019. The focus group discussion were audio recorded and the total length was between 60-90 minutes. Thematic analysis was conducted to identify emerging themes and to categorize the behavioral, normative, and control beliefs related to buprenorphine prescribing. Results: Of the 14 total participants, 57% of the participants were male and annually treated between zero to sixty patients with buprenorphine. The codes generated were represented in thematic maps, specifying the positive or negative aspects of buprenorphine prescribing. Results indicate that providers' primary motivation to prescribe buprenorphine was, implementation of a whole-patient approach through collaboration with behavioral health providers, in the provision of medications for opioid use disorder (MOUD). Providers primary normative belief was the recognition of key members of the medical community and patients' families and friends as influential groups. Providers' control beliefs focused on their ability to use buprenorphine in different practice settings. Conclusion: These results indicate that buprenorphine access may be expanded by increasing support for DATA waivered providers from other parts of the healthcare system such as behavioral health providers and pharmacists. Implications for clinical practice and future research will be discussed.

Risk of Cardiovascular Outcomes and Antihypertensive Triple Combination Therapy Among Elderly Patients with Hypertension Enrolled in a Medicare Advantage Plan (MAP)

OBJECTIVES

The aim was to evaluate the risk of cardiovascular-specific hospitalizations with different types of antihypertensive triple combination therapy among patients enrolled in a Medicare Advantage Plan (MAP).

METHODS

A retrospective cohort study was conducted among patients with hypertension enrolled in a Texas MAP between January 2014 and December 2016. Antihypertensive combination therapy users were classified into three treatment groups: single-pill triple combination, fixed-dose dual combination plus a third agent, and free triple combination. Group differences were assessed using Chi-square tests for binary variables and Student's t tests for continuous variables. Cox proportional hazards model was performed to assess the association between type of combination therapy and risk of cardiovascular-specific hospitalization adjusting for potential confounders.

RESULTS

A total of 10,836 triple combination users were identified. The risk of cardiovascular disease (CVD) hospitalization for the fixed-dose dual combination plus a third agent group [hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.80-8.12] and for the free triple combination therapy group (HR 3.65, 95% CI 1.43-9.31) was significantly higher than for the single-pill triple combination group.

CONCLUSION

Single-pill triple combination therapy was significantly associated with a lower risk of CVD hospitalizations in comparison to other types of triple combination therapy.

Enhancing Statin Adherence Using a Motivational Interviewing Intervention and Past Adherence Trajectories in Patients with Suboptimal Adherence

BACKGROUND

Statins have been shown to be effective in reducing the occurrence of cardiovascular (CV) events and are widely prescribed for the risk reduction of CV diseases and recurrent CV events. However, poor adherence prevents some patients from receiving the maximum benefit of the therapy. Motivational interviewing (MoI) is a patient-centered collaborative approach that can be used to improve medication adherence. Group-based trajectory modeling depicts patterns of adherence over time and may help tailor the MoI intervention to further enhance adherence.

OBJECTIVE

To assess the effect of a phone-based MoI intervention tailored by patients' past adherence trajectory in improving adherence to statins among patients in a Medicare Advantage prescription drug plan (MAPD).

METHODS

Patients continuously enrolled in an MAPD from 2013 to 2017 with a statin prescription between January and June 2015 to allow 2 years of pre-index period and 1 year of follow-up were included in the study. Adherence to statins was measured monthly during the 1-year follow-up as proportion of days covered (PDC) and incorporated into a group-based trajectory model to provide 4 distinct patterns of adherence: adherent, rapid decline, gradual decline, and gaps in adherence. Patients in the 3 nonadherent groups were randomized to either control or intervention. The intervention was an initial counseling call and up to 2 monthly follow-up calls by pharmacy students trained in MoI, providing education consistent with a previously identified pattern of use. Refill data at 6 months post-intervention were evaluated to examine the intervention's effect on PDC, as continuous and dichotomized as PDC ≥ 0.8, as well as discontinuation. Multivariable regression adjusted for baseline demographics, clinical characteristics, and past adherence trajectory.

RESULTS

There were 152 patients included in the analysis who received MoI phone calls and 304 randomly selected controls. Mean PDC for the intervention group (0.67 ± 0.3) was significantly higher than the control (0.55 ± 0.4; P < 0.001). The intervention group was also less likely to discontinue (OR = 0.38; 95% CI = 0.19-0.76) and more likely to be adherent in the linear regression model (β = 12.4; P < 0.001) as well as in the logistic regression model (OR = 1.87; 95% CI = 1.18-2.95). Previous adherence trajectories were significantly associated with adherence in the follow-up.

CONCLUSIONS

Patients who received the MoI intervention were more likely to be adherent and less likely to discontinue the statin in the 6 months follow-up compared with controls. Future research can identify other approaches to tailor interventions and expand the intervention to other languages. This intervention may also prove valuable to improve adherence to other medications for chronic and asymptomatic diseases.

DISCLOSURES

This study was funded by Regeneron Pharmaceuticals, which provided critical input during study design, implementation, and manuscript preparation. Abughosh reports grants from Sanofi, BMS/Pfizer, and Valeant Pharmaceuticals, unrelated to this study. Vadhariya reports a past internship at Regeneron Pharmaceuticals, unrelated to this study. Esse, Serna, and Gallardo are employees of CareAllies, a Cigna subsidiary. Boklage is an employee of Regeneron Pharmaceuticals. Choi was an employee of Sanofi during this study. Johnson, Essien, Fleming, and Holstad have nothing to disclose. A poster based on this study was presented at AMCP Nexus 2018; October 22-25, 2018; Orlando, FL.

Group-Based Trajectory Models to Identify Sociodemographic and Clinical Predictors of Adherence Patterns to Statin Therapy Among Older Adults

BACKGROUND

The benefits of statins in the prevention of primary and secondary atherosclerotic cardiovascular (CV) disease events have been well documented. Suboptimal adherence is a persistent problem associated with increased CV events and increased healthcare utilization. Proportion of days covered (PDC) is widely used to measure medication adherence, and provides a single value that does not adequately depict different adherence behavior patterns. Group-based trajectory modeling has been used to identify adherence patterns (or trajectories) over time. The identification of characteristics unique to each pattern can help in the early identification of patients who are likely to be poor adherents and can inform the development of interventions.

OBJECTIVES

To identify distinct trajectories of statin adherence in patients enrolled in a Medicare Advantage plan and the sociodemographic and clinical predictors associated with each trajectory.

METHODS

Patients were included in the study if they were continuously enrolled in a Medicare Advantage plan between 2013 and 2016 and had a statin prescription between January 2015 and June 2015. We observed each patient for 360 days and computed the monthly PDC. The monthly PDC was incorporated into a group-based trajectory model to provide distinct patterns of adherence. Using group-based trajectory modeling, the patients were categorized into groups based on their adherence patterns. Multinomial logistic regression was performed to identify the sociodemographic and clinical factors associated with each group.

RESULTS

A total of 7850 patients were included in the analysis and were categorized into 4 distinct groups based on statin adherence-rapid discontinuation (7.8%), gradual decline (16.8%), gaps in adherence (17.2%), and high or nearly perfect adherence (58.2%). Significant predictors of being placed into one or more of the low-adherence trajectories compared with the high-adherence trajectory included sex, age, low-income subsidy, language, Charlson Comorbidity Index score, statin intensity, and 90-day refills.

CONCLUSIONS

The predictors identified in this study provide valuable insight into patient characteristics that increase the risk for statin nonadherence, which has the potential to inform targeted interventions. Identifying patient trajectories can inform the future development of protocols to individualize appropriate interventions for these patients.

Spiritual care may impact mental health and medication adherence in HIV+ populations

OBJECTIVE

To explore a potential role for spirituality in medication-related needs assessment for integrated care in chronically ill populations.

METHOD

A systematic literature review was conducted to explore the impact of faith beliefs on health and/or medication adherence in individuals with depression and/or HIV+/AIDS. Retrospective electronic medical record review of adult HIV+ patients of an urban primary care clinic with integrated mental health services was conducted, with Substance Abuse and Mental Illness Symptoms Screener (SAMISS), major depressive disorder (MDD) incidence over the preceding year, and history of contact with a spiritual advisor. A convenience sample was interviewed to qualitatively assess potential medication therapy management needs and medication-related problems. Another sample was examined utilizing the Daily Spiritual Experience Scale.

RESULTS

The literature reports positive influence on health behaviors, coping and outcomes; and poor medication adherence and treatment decisions due to patient passivity or resistance. Spiritual advisor contact (not limited to a specific religion) was significantly associated with MDD absence (1.7% vs. 15.3%, P<0.005) and inversely related to SAMISS, depression, and poor health behaviors. Patient interviews reflected significance of faith in terms of insight and acceptance of illness, the role or need for medications, coping, and medication adherence. An illustrative model was designed based on the literature and data collection.

CONCLUSION

Spiritual assessment may help identify positive or negative influence on health. Spiritual interventions could be beneficial in promoting adherence and positive health outcomes. Further research is recommended.

Risk of Nondherence to Diabetes Medications Among Medicare Advantage Enrollees: Development of a Validated Risk Prediction Tool

BACKGROUND

Low adherence to oral antidiabetic drugs (OADs) in the Medicare population can greatly reduce Centers for Medicare & Medicaid Services (CMS) star ratings for managed care organizations (MCOs).

OBJECTIVE

To develop and validate a risk assessment tool (Prescription Medication Adherence Prediction Tool for Diabetes Medications [RxAPT-D]) to predict nonadherence to OADs using Medicare claims data.

METHODS

In this retrospective observational study, claims data for members enrolled in a Medicare Advantage Prescription Drug (MA-PD) program in Houston, Texas, were used. Data from 2012 (baseline period) were used to identify key variables to predict adherence in 2013 (follow-up period). Members aged 65 years and older with a diabetes diagnosis, at least 1 prescription for OADs (biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, or meglitinides), and continuously enrolled for both years were included in the study. Patients with insulin prescriptions were excluded from the cohort. The study outcome, nonadherence in 2013, was defined as proportion of days covered (PDC) < 80%. Multivariable logistic models using 200 bootstrap replications (with replacement) identified factors associated with nonadherence. The final model was tested for discrimination and calibration statistics and internally validated using 10-fold cross-validation. Using weighted beta coefficients of the predictors, the RxAPT-D was created to stratify nonadherence risk and was tested for sensitivity, specificity, positive prediction value, and negative prediction value. The predictive ability of the tool was compared with that of past PDC values using net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.

RESULTS

Data from 7,028 MA-PD members were used for tool development. Seven predictors (age, total OAD refills, total OAD classes filled, days supply of last filled OAD, pill burden, coverage of last filled OAD, and past adherence) statistically significant in ≥ 50% of the bootstrapped samples were identified from the logistic models. The final model demonstrated good discrimination (c-statistics = 0.75) and calibration (Hosmer-Lemeshow goodness-of-fit P < 0.05) statistics, with good internal validity (area under the curve = 0.73). The RxAPT-D demonstrated adequate sensitivity statistics: sensitivity = 0.73, specificity = 0.63, positive prediction value = 0.74, and negative prediction value = 0.62. Compared with use of past adherence measures, the RxAPT-D had higher prediction ability, relative IDI = 2.09, and user defined NRI = 0.16 with 24% events correctly reclassified.

CONCLUSIONS

The RxAPT is an effective tool to identify patients who are likely to become nonadherent to OADs in the follow-up year. Pharmacists in MCOs can use this tool to identify patients expected to be nonadherent to OADs and develop targeted intervention programs to assist in improving MCO CMS star ratings.

DISCLOSURES

This study received unrestricted partial funding from the Pharmaceutical Research and Manufacturers of America (PhRMA) Foundation Adherence Research Starter Award. Serna is employed by Cigna-HealthSpring. Mhatre is now employed with Genentech. The authors report no other potential conflicts of interest. The material in this study is based on work supported (or supported in part) by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. The abstract for this article was presented at the Academy of Managed Care Pharmacy's 28th Annual Meeting & Expo, April 2016, San Francisco, California, with the title "Development and Validation of a Tool to Predict Nonadherence to Oral Antidiabetic Drugs in Medicare Beneficiaries." Study concept and design were primarily contributed by Sujit Sansgiry and Mhatre, with assistance from the other authors. Mhatre, Serna, and Sujit Sansgiry took the lead in data collection, assisted by the other authors, and data interpretation was performed by Mhatre, Shubhada Sansgiry, and Essien, assisted by the other authors. The manuscript was written by Mhatre and Fleming, assisted by the other authors, and revised primarily by Mhatre, along with Sujit Sansgiry and assisted by the other authors.

Intention to quit water pipe smoking among Arab Americans: Application of the theory of planned behavior

In this study, we examined the effect of theory of planned behavior (TPB) constructs on the intention to quit water pipe smoking by using an observational, survey-based, cross-sectional study design with a convenient sample of Arab American adults in Houston, Texas. Multivariate logistic regression models were used to determine predictors of intention to quit water pipe smoking in the next year. A total of 340 participants completed the survey. Behavioral evaluation, normative beliefs, and motivation to comply were significant predictors of an intention to quit water pipe smoking adjusting for age, gender, income, marital status, and education. Interventions and strategies that include these constructs will assist water pipe smokers in quitting.

Predictors of intention to quit waterpipe smoking: a survey of arab americans in houston, Texas

Waterpipe smoking has been described as "the second global tobacco epidemic since the cigarette." Both Middle Eastern ethnicity and having a friend of Middle Eastern ethnicity have been reported as significant predictors of waterpipe smoking. Addressing waterpipe smoking in this ethnic minority is essential to controlling this growing epidemic in the US. We investigated the predictors of an intention to quit waterpipe smoking by surveying 340 Arab American adults in the Houston area. Primary analyses were conducted using stepwise logistic regression. Only 27% of participants reported having an intention to quit waterpipe smoking. Intention to quit waterpipe smoking was significantly higher with history of cigar use, a prior attempt to quit, and not smoking when seriously ill and significantly lower with increasing age, medium cultural acceptability of using waterpipe among family, high cultural acceptability of using waterpipe among friends, longer duration of smoking sessions, and perceiving waterpipe smoking as less harmful than cigarettes. Educational programs that target Arab Americans in general, and specifically older adults, those who smoke waterpipe for more than 60 minutes, those whose family and friends approve waterpipe smoking, and those with no former attempts to quit, may be necessary to increase the intention to quit waterpipe smoking.

The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria

BACKGROUND

Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in Nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. The use of the partograph would engender a remarkable reduction in the number of these deaths since abnormal markers in the progress of labor would be identified early on.

OBJECTIVE

This study aimed to evaluate the non-physician obstetric caregivers' (OCGs) knowledge of partograph use, assess the extent of its use, determine the factors that impede its usage, and unravel the relationship between years of experience and partograph use among the respondents (OCGs) in General Hospital, Calabar, Nigeria.

METHODOLOGY

Using a self-administered semi-structured questionnaire, a cross-sectional descriptive study was conducted among 130 purposely selected and consenting OCGs working in the General Hospital, Calabar, Nigeria.

RESULTS

The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in-depth knowledge of the component parts of the partograph. Knowledge of partograph (χ(2) =12.05, P=0.0001) and partograph availability (χ(2) =56.5, P=0.0001) had a significant relationship with its utilization. Previous training (χ(2) =9.43, P=0.002) was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70%), shortage of staff (61.5%), and the fact that it is time-consuming to use (30%).

CONCLUSION

Lack of detailed knowledge of the partograph, nonavailability of the partograph, poor staff numbers, and inadequate training are factors that work against the effective utilization of the partograph in the study facility. Usage of this tool for labor monitoring can be enhanced by periodic training, making partographs available in labor wards, provision of reasonable staff numbers, and mandatory institutional policy.

Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk

A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.

Ethnicity and waterpipe smoking among US students

OBJECTIVES

To examine the effect of ethnicity on waterpipe smoking among college students.

DESIGN

A cross-sectional study utilized data from University of Houston students through an online survey (n = 2334) from March to April 2011. The survey included questions on demographic characteristics (sex, age, race/ethnicity), tobacco use experience, risk perception, social acceptability and popularity. Multivariate logistic regression was used to determine predictors of waterpipe use with three outcomes: ever-use vs. no use, past-year use vs. no use and past-month use vs. no use.

RESULTS

Half of the sample had previously smoked tobacco using a waterpipe, approximately a third in the past year and 12.5% in the past month. Significant predictors included Middle Eastern ethnicity, Middle Eastern friend, past cigarette or cigar use. Perception of harm was associated with less use in the ever-use model, while perceived addictiveness, social acceptability and popularity of waterpipes were predictors in all models.

CONCLUSION

Our findings underscore the importance of developing culturally appropriate interventions to control waterpipe smoking among Middle Eastern Americans and those of Indian/Pakistani descent to curb further spread in US society, and highlight the importance of developing interventions that target the perceived addictiveness, social acceptability and popularity of waterpipe smoking.

Waterpipe smoking among students in one US university: predictors of an intention to quit

OBJECTIVE

To examine the intention to quit waterpipe smoking among college students.

PARTICIPANTS

A total of 276 University of Houston students identified through an online survey administered in February 2011. Participants indicated they had smoked a waterpipe in the month prior to the survey.

METHODS

Cross-sectional study. Questions included demographics, tobacco use, perceived risk of waterpipe smoking, and social acceptability. Multivariate logistic regression was used to determine predictors of an intention to quit.

RESULTS

Most of the sample participants (n = 227; 83%) reported that they had no intention to quit. Students believing that waterpipe smoking was harmful were more likely to have an intention to quit (odd ratio [OR] = 2.38, 95% confidence interval [CI; 1.05, 5.36]). Those who smoked for more than 60 minutes were less likely to have a desire to quit (OR = 0.29, 95% CI [0.12, 0.73]).

CONCLUSIONS

The low level of a desire to quit demonstrated underscores the urgent need to develop interventions that educate users about expected harms of continued use.

Routine HIV testing in health care settings: the deterrent factors to maximal implementation in sub-Saharan Africa

The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population's awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population's serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region.

A training need for rural primary care in Nigeria

The major causes of maternal death in Nigeria are avoidable and preventable. Many of these deaths occur in the rural health facilities and hospitals which are severely lacking in skilled birth attendants. Of the many strategies that have been developed to reduce avoidable maternal death significantly, increasing the availability of skilled human resources is crucial. The shortage of obstetric specialists, especially in the rural and peripheral health facilities in rural Nigeria where more than 60% of the population resides, has been a major contributing factor to the low number of skilled birth attendants. The increased availability of skilled human resources ensures that all aspects of obstetrics, such as antenatal care, postnatal care and other life-saving interventions, including emergency surgery, is available for women during labour and in the immediate postpartum period. In this paper, we propose a short obstetric-training programme for generalist medical officers to increase the number of skilled birth attendants in both rural and peripheral health facilities in Nigeria. These general practice/family practitioners (GP/FPs) and hospital medical officers (MO), will have designated career structures within the primary and secondary healthcare systems, while the consultant obstetrician and sub-specialists, trained with long postgraduate programmes will function at the urban 'specialists' and in teaching hospitals.

Correlates of HIV knowledge and sexual risk behaviors among female military personnel

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.

Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel

Anecdotal evidence suggests that the HIV/AIDS prevalence rates in several African armed forces are high, with gender inequality rendering female military personnel more vulnerable to the disease. The objective of this study was to replicate a successful videotape-based HIV prevention intervention among Nigerian female military personnel in an effort to establish the cross-cultural stability, feasibility and cost-effectiveness of this approach in resource-limited countries. Enlisted women (N346) were recruited from two cantonments in Southwestern Nigeria and randomly assigned to either (a) a 5-session video-based, small group, cognitive-behavioral, HIV prevention intervention, or (b) a 5-session, video-based, contact-matched, HIV education control condition. Participants provided self-report of their HIV/AIDS-related knowledge and sexual behaviors at baseline, 3 and 6 months after completing the intervention. The results indicate that the motivational skills-building intervention did not improve participants' knowledge of HIV/AIDS any better than did the HIV education control condition at each assessment period, but it significantly increased condom use among women in this group by 53.6% at 3-month follow-up. HIV preventive behaviors among women in the motivational skills-building intervention group improved significantly, being 2 and 3 times more, compared to women in the HIV education control group at 3-month and 6-month follow-up assessments. The intervention also significantly improved behavioral intentions of participants as well as reduced alcohol use before sex by 25%, after 3 months; and number of sexual partners by 12% after 6 months. Women in the intervention group were five times more likely than women in HIV education control group to suggest that their new male partners use condom. These findings indicate that a videotape-based, HIV prevention intervention is a feasible and effective approach to HIV prevention among female military personnel from sub-Saharan Africa.

Predictors of frequency of condom use and attitudes among sexually active female military personnel in Nigeria

Background

Despite awareness of condom efficacy, in protecting against both human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) and unintended pregnancy; some females find it difficult to use or permit condom use consistently because of the power imbalances or other dynamics operating in their relationships with males. The purpose of this study was to determine the factors that predict the frequency of condom use and attitudes among sexually active female military personnel in Nigeria.

Methods

This study used a cross-sectional design in which a total of 346 responses were obtained from consenting female military personnel in two cantonments in Southwestern Nigeria between 2006 and 2008. The study instrument was designed to assess HIV/acquired immunodeficiency syndrome (AIDS) knowledge (HAK), HIV risk behaviors (HRB), alcohol and drug use, condom attitudes and barriers (CAS) condom use self-efficacy (CUS) and social support to condom use (SSC). The sociodemographic characteristics of participants were also captured. Univariate analysis and multivariable logistic regression were used for modeling the predictors of condom use.

Results

The results showed that 63% of the respondents reported using condoms always, 26% sometimes used condoms and 11% never used condoms during a sexual encounter in the past three months. Univariate analysis revealed that significant associations existed between CAB (P < 0.05), HRB (P < 0.01) and SSC (P < 0.01) with the frequency of condom use. The following sociodemographic variables: age, marital status, number of children, employment status and type of sexual relationship were also significantly (P ≤ 0.05) associated with consistent condom use in the study group. Multivariate analysis indicated that marital status, type of relationship and CAB were the only significant predictors (r² = 0.37; P ≤ 0.05) of condom use behaviors after adjusting for all other factors in the model.

Conclusions

Findings indicate that consistent condom use could be enhanced through gender-specific intervention programs that incorporate the predictor variables identified. These are likely to be successful in decreasing sexual risk behaviors in the subpopulation.

Adherence to antiretroviral therapy in Nigeria: an overview of research studies and implications for policy and practice

Both Human Immunodeficiency Virus (HIV) infection and AIDS remain major public health crises in Nigeria, a country which harbors more people living with HIV/AIDS than any country in the world, with the exception of South Africa and India. In response to the HIV pandemic, global and international health initiatives have targeted several countries, including Nigeria, for the expansion of antiretroviral therapy (ART) programs for the increasing number of affected patients. The success of these expanded ART initiatives depends on the treated individual's continual adherence to antiretroviral (ARV) drugs. Thirteen peer-reviewed studies concerning adherence to ART in Nigeria were reviewed with very few pediatric and adolescent studies being found. Methodologies of adherence measurement were analyzed and reasons for nonadherence were identified in the geopolitical zones in the federal republic of Nigeria. The results of the literature review indicate that adherence to ART is mixed (both high and low adherence) with patient self-recall identified as the common method of assessment. The most common reasons identified for patient nonadherence include the cost of therapy (even when the drugs are heavily subsidized), medication side effects, nonavailability of ARV drugs, and the stigma of taking the drugs. This manuscript highlights the policy and practice implications from these studies and provides recommendations for future ART program management.

Sociocultural dimensions of HIV/AIDS among Middle Eastern immigrants in the US: bridging culture with HIV/AIDS programmes

The population of Middle Eastern immigrants in the US has been increasing dramatically over the past 30 years, growing from 200,000 in 1970 to 1.5 million in 2000. These immigrants and their descendants constitute an important new population of interest for public health and other social programmes. With this addition to the cultural diversity of American society, it is important for healthcare programmes to be responsive to the unique cultural needs of those of Middle Eastern origin and to include them in healthcare curricula. This need is particularly imperative for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) intervention programmes, where the reduction of risky behaviours is essential to controlling the epidemic. When Middle Easterners emigrate to the US they must adjust to the American culture, which leads to preservation of some aspects of their culture and adjustment of behaviors to match American customs. This article aims to present sociocultural factors of HIV risk behaviours that are specific to Middle Eastern culture. The article also provides recommendations for HIV/AIDS-culturally appropriate intervention programmes.

HIV/AIDS-related stigma and discrimination in Nigeria: review of research studies and future directions for prevention strategies

Human Immunodeficiency Virus (HIV) infection and AIDS remain a major public health crisis in Nigeria which harbors more people living with HIV than any other country in the world, except South Africa and India. A significant challenge to the success of achieving universal access to HIV prevention, treatment, care and support by 2010 is HIV-AIDS stigma and discrimination. Eight studies looking at some degree of measurement of stigma and discrimination in Nigeria were reviewed in an attempt to investigate the cultural context of stigma, health seeking behavior and the role both perceived and community stigma play in HIV prevention. Results suggest that reducing stigma does increase the individual as well as community acceptance of people living with HIV-AIDS (PLWHAs), but long term studies are needed. Some suggestions are recommended for future research on culture specific stigma studies in Nigeria.

Impact of androgen deprivation therapy on racial/ethnic disparities in the survival of older men treated for locoregional prostate cancer

BACKGROUND

Racial disparities persist in prostate cancer (CaP) treatment and survival, but disparities in androgen deprivation therapy (ADT) and the degree to which it affects racial differences in survival remains to be fully assessed.

METHODS

Using the Surveillance, Epidemiology and End Results-Medicare linked data, we examined a large cohort of men (N = 64,475) diagnosed with locoregional CaP during 1992 to 1999 and followed through 2003. The effects of ADT and race on survival were analyzed using a Cox proportional hazards model.

RESULTS

The receipt of ADT was significantly lower in African Americans (24%) relative to Caucasians (27%), Asians (34%), and Hispanics (28.7%) (P < .05). Compared with Caucasian race, African American race was associated with a statistically significant increased mortality (HR = 1.26, 95% CI = 1.21-1.32), which remained significant after adjusting for ADT but was substantially decreased after controlling for primary therapies such as radical prostatectomy, radiation, and watchful waiting (HR = 1.06, 95% CI = 1.01-1.10) and was no longer statistically significant after controlling for comorbidities (HR = 0.98, 95% CI = 0.94-1.03).

CONCLUSIONS

There were marked racial variations in the receipt of ADT, primary therapies (namely surgery and surgery combined with radiation), and comorbidities. However, racial disparities in survival were not affected by racial variations in ADT but were explained by racial variations in primary therapies and by racial differences in comorbidities.

Smoking cessation recruitment among African American youth: what youth think will help them attend

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio 95% confidence interval CI=1.96; 12.40), health educators (4.70 AOR; 95% CI=1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI=1.04; 9.80), teachers (2.73 AOR; 95% CI=1.3; 5.60), and celebrities (2.44 AOR; 95% CI=1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI=1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI=1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth.

Potential markers of female condom use among inner city African-American women

Despite the availability of the female condoms and theoretically based interventions to promote its use, studies have indicated a low level of acceptability of their use among women in most populations. We aimed to determine female condom use prevalence and the potential markers among African-American women. In an intervention trial to test the efficacy of the Information-Motivation-Behavioral Skills model in increasing condom use, we utilized the baseline data of 280 subjects and examined the potential predictors of female condom use. Chi square statistic and unconditional logistic regression were used to test for group independence among users and non-users of the female condom and to assess the potential markers of female condom use respectively. After adjustment for relevant covariates associated independently with female condom use, the significant potential markers for female condom use were age, multiple sexual relationships, knowledge of female condom, and educational status. Women having multiple sexual relationships compared with a monogamous relationship were five times more likely to use the female condom, while women with high school education were three times more likely to use the female condom; prevalence odds ratio, POR=5.32, 95% CI=1.79-15.83 and POR=3.01, 95% CI=1.01-8.93. Women who were not knowledgeable of the female condom, compared to those who were, were 81% less likely to use the female condom, POR=0.19, 95% CI=0.08-0.45. Among African-American women in this sample, knowledge of female condom use, age, educational status, and multiple sexual relationships were significant markers of female condom use. This study is therefore suggestive of the need to educate African-American women on female condom use, given the obstacles in male condom negotiation, especially among the socio-economically challenged.

Knowledge, beliefs and attitudes about HIV/AIDS-related issues, and the sources of knowledge among health care professionals in southern Nigeria

The HIV/AIDS pandemic has become one of the most important public health problems in recent times and it is having a profound impact on the lives of infected people and their families. There is an acknowledged burden of HIV/AIDS in Nigeria. As the prevalence of HIV/AIDS infection rises, health care professionals worldwide can expect greater clinical exposure to infected patients. The care of people living with AIDS presents a significant challenge to the health care sector. This study seeks to explore the relationship between sources of HIV/AIDS information and knowledge, and the relationship between knowledge of HIV/AIDS and care for people with AIDS among health care providers in three different levels of health care institutions in the southern region of Nigeria. Health care workers from two states in southern Nigeria completed a questionnaire that was designed to assess knowledge, attitudes and practices about HIV/AIDS. The sample was composed of 277 (65%) females and 135 (31.7%) males. The results showed a fair level of knowledge among all health care professionals, with the highest level of knowledge among the doctors and the lowest among laboratory workers. There was a significant gender difference in the level of knowledge but the data suggested that knowledge did not differ by hospital settings. There were generally negative feelings and views about the care of HIV/AIDS patients among the professionals, these views being worst at the community health centers and best at the government hospital. The greatest source of information for the majority of professionals was health talks/seminars, and those respondents who got their information from school scored the highest on the items on general knowledge of HIV/AIDS incidence, cause, transmission, and clinical treatment. This has important implications for future interventions designed for health care professionals including doctors, nurses and laboratory workers.

Racial variance in rationale for HIV testing in community-based setting in the United States: evidence from the National Health Interview Survey

BACKGROUND

HIV testing varies across racial/ethnic groups in the United States, but it is unclear whether the rationale for testing differs as well racially. The authors aimed to assess the rationale for HIV testing and the racial/ethnic variation therein.

METHODS

Using the National Health Interview Survey 2003 (n = 29 753), the authors examined the association between rationale for HIV testing and race. Chi-square statistic and multinomial logistic regression analyses were used to test for racial differences and the effect of race/ethnicity on the rationale for HIV testing.

RESULTS

There was a statistically significant racial difference with respect to HIV testing rationale, chi(2) = (24, N = 10,481) = 808.9, P < .001. After adjustment for relevant covariates, compared with Caucasians, African Americans were 37% less likely to be tested due to exposure to sex/drugs, whereas Hispanics were not (prevalence risk ratio [PRR], 0.63, 95% confidence interval [CI] = 0.47-0.84, respectively). Likewise African Americans and Hispanics were less likely to be tested if they were sick or had a medical problem (PRR = 0.66, 95% CI = 0.44-0.99 and PRR = 0.65, 95% CI = 0.43-0.98).

CONCLUSIONS

Substantial racial variation occurred in the reasons for being tested for HIV in the United States, indicative of the need to understand such rationale for effective HIV screening and testing.

Influence of educational status and other variables on human immunodeficiency virus risk perception among military personnel: a large cohort finding

Human immunodeficiency virus (HIV) risk perception remains an effective determinant of HIV transmission. Although higher educational attainment has been associated with increased HIV risk perception, this predictor remains to be assessed among Nigerian military personnel (NMP). In a prospective cohort of 2,213 NMP, the effects of education and other factors on HIV risk perception were assessed at baseline by using the X2 statistic and unconditional logistic regression. There was an inverse correlation between higher educational attainment and HIV risk perception in the univariate model (prevalence odds ratio, 0.64; 95% confidence interval, 0.52-0.79). This association persisted after adjustment for relevant covariates in the multivariate model (prevalence odds ratio, 0.70; 95% confidence interval, 0.56-0.88). Similarly, there was a direct correlation between use of alcohol and marijuana and HIV risk perception (p < 0.05). In contrast, casual sex and gender were not statistically significantly associated with HIV risk perception (p > 0.05). This study indicates an inverse correlation between educational attainment and HIV risk perception, as well as a direct correlation between alcohol and marijuana use and HIV risk perception, among NMP. Therefore, HIV prevention interventions targeted at NMP need to include multiple factors that may affect risk perception regardless of the educational status of the participants.

Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention

Female Genital Mutilation (FGM) which involves alteration of the female genitalia for non-medical grounds is prevalent in Sub-Saharan Africa, associated with long-term genitourinary complications, and possible HIV transmission. This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure. We performed an electronic search using Medline for articles published between 1966 to 2006 for evidence of FGM practice, its complications, and the nexus between this procedure and HIV sero-positivity. The results indicate ongoing FGM practice, albeit prevalence reduction, due probably to the increasing knowledge of the consequences of FGM as a result of non-sterile techniques. Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies in order to assess the association between FGM and HIV transmission.

The impact of a situationally focused individual human immunodeficiency virus/sexually transmitted disease risk-reduction intervention on risk behavior in a 1-year cohort of Nigerian military personnel

Human immunodeficiency virus (HIV) and sexually transmitted disease (STD)-related risks in peacekeeping troops is a concern when they are stationed in areas of high HIV prevalence. We carried out an assessment of a situationally focused individual HIV/STD reduction intervention (where avoidance of risk situations, as well as risk behaviors, are emphasized) in one Nigerian military unit (N = 1,222), with a comparable unit from the same service as a waiting list control (N = 987). The intervention consisted of a possible five modules that were presented to groups of up to 50 personnel. Data were collected on reported sexual behaviors, condom beliefs, sexual risk behaviors with casual partners, and number of interventions attended. Data indicated significant increases in reported condom use with casual partners and positive condom beliefs at 6- and 12-month follow-up. Risk behavior was reduced 30% from baseline at 6 months and 23% from baseline at 12 months. There was also a significant dose-response effect for number of interventions attended. These data suggest that relatively brief situationally focused individual interventions are effective in military and West African contexts in reducing HIV/STD risk behaviors.

Beliefs regarding cigarette use, motivations to quit, and perceptions on cessation programs among minority adolescent cigarette smokers

To gain a better understanding of minority smoking cessation interventions, our study used a qualitative approach to investigate smoking uptake beliefs regarding cigarette use, motivations to quit, and perceptions on cessation programs among 65 minority high school students who were current smokers.

HIV/AIDS in the Middle East: a guide to a proactive response

After 24 years of being declared an epidemic, the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has found its way to the remote parts of the Middle East. There are no fastidious HIV/AIDS epidemiological data available specific for the Middle East and insufficient surveys have been conducted in a larger area including the Middle East and North Africa. Currently the total number of people living with HIV in the Middle East and North Africa is 540,000. About 92,000 individuals were newly infected in 2004 and 28,000 people have died of AIDS during the same time period.2 With increasing spread of sexually transmitted infections (STIs), injection drug users (IDUs), numbers of unemployed youth, a conservative culture and low awareness of HIV the region is especially vulnerable to a large-scale epidemic. In this age of globalization the rapid spread of HIV along with highly virulent and multi-drug-resistant HIV strains that progress rapidly to AIDS, the more difficult and expensive prevention efforts and treatment regimes become. Complicating the issue there are many unresolved socio-economic conflicts in the Middle East. Valid and reliable HIV/AIDS epidemiological data, to facilitate policy formulation and to effect urgent prevention intervention is inadequate. This article identifies numerous gaps and shortfalls in the existing programs, elucidates the reasons behind the lack of information, and provides suggestions for taking actions.

Conspiracy beliefs about the origin of HIV/AIDS in four racial/ethnic groups

We examined beliefs about the origin of HIV as a genocidal conspiracy in men and women of four racial/ethnic groups in a street intercept sample in Houston, Texas. Groups sampled were African American, Latino, non-Hispanic white, and Asian. Highest levels of conspiracy theories were found in women, and in African American and Latino populations (over a quarter of African Americans and over a fifth of Latinos) with slightly lower rates in whites (a fifth) and Asians (less than one in ten). Reductions in condom use associated with such beliefs were however only apparent in African American men. Conspiracy beliefs were an independent predictor of reported condom use along with race/ethnicity, gender, education, and age group. Data suggest that genocidal conspiracy beliefs are relatively widespread in several racial/ethnic groups and that an understanding of the sources of these beliefs is important to determine their possible impact on HIV prevention and treatment behaviors.

Reported condom use and condom use difficulties in street outreach samples of men of four racial and ethnic backgrounds

The epidemiology of the HIV/AIDS epidemic in the United States has focused research attention on lesbian, gay, bisexual and transgendered communities as well as on racial and ethnic minorities. Much of that attention has, however, been focused on specific racial and ethnic groups, and specific sexual minorities. We report on the results of a study that examined the association between condom use and partnership types among men from four major racial/ethnic groups. Self-reported data on sexual identity (homosexual, bisexual, and heterosexual) and condom use in the past three months were collected from 806 African Americans, Hispanic, Asian, and white men intercepted in public places in Houston, TX. Data indicated that condom use was lowest in African Americans and Hispanic men, bisexual men reported the highest levels of use, with heterosexual men reporting the lowest use. African Americans and Hispanic men reported generally that it was very difficult to use a condom during sexual contact, although the patterns for self-identified homosexual, heterosexual, and bisexual men varied across race/ethnicity. Homosexual African American men reported the least difficulty, and white homosexual men the most difficulty compared with heterosexual and bisexual peers. For homosexually identified men, there were considerable differences across race/ethnicity in the proportion of partners who never or rarely disagreed to use condoms, with Asians disagreeing least, and African Americans most. Within racial/ethnic groups, the levels of condom use and difficulty were similar for male and female partners, suggesting that it is sexual identity, rather than partner gender, that has impacted condom-use messages. These data suggest that racial/ethnic targeting of condom use is likely to be most efficacious in increasing condom use in men.

The Relationship Between Sexual Abuse and Drug Use

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were 4 times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.

Strategies to prevent HIV transmission among heterosexual African-American women

BACKGROUND: African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. METHODS: Twenty five low income African American women, ages 18-29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and personal experience with someone who had contracted HIV. CONCLUSION: This study offers a foundation for further research that may be used to create culturally relevant HIV prevention programs for African-American women.

Primary source of income is associated with differences in HIV risk behaviors in street-recruited samples

BACKGROUND: The relationship between primary source of income and HIV risk behaviors and the racial/ethnic differences in risk behavior profiles among disadvantaged populations have not been fully explored. This is unusual given that the phenomenon of higher risk in more disadvantaged populations is well-known but the mechanisms remain unclear. We examined the relationship between primary source of income and differences in HIV risk behaviors among four racial/ethnic groups in the southern United States. METHODS: Self-reported data on primary source of income and HIV risk behaviors were collected from 1494 African American, Hispanic, Asian, and White men and women in places of public congregation in Houston, Texas. Data were analyzed using calculation of percentages and by chi-square tests with Yates correction for discontinuity where appropriate. RESULTS: Data revealed that a higher proportion of whites were involved in sex for money exchanges compared to the other racial groups in this sample. The data suggest that similar street sampling approaches are likely to recruit different proportions of people by primary income source and by ethnicity. It may be that the study locations sampled are likely to preferentially attract those involved in illegal activities, specifically the white population involved in sex for drug or money exchanges. Research evidence has shown that people construct highly evolved sexual marketplaces that are localized and most unlikely to cross racial, ethnic, and socioeconomic or geographical boundaries. Thus, the areas that we sampled may have straddled a white sexual marketplace more than that of the other groups, leading to an over-representation of sex exchange in this group. Drug use was highest among those with illegal primary sources of income (sex exchange and drug dealing and theft), and they were also those most likely to have injected drugs rather than administered them by any other route (p < 0.001). In addition, bisexual or homosexual identification was reported by more respondents in the sex exchange as primary source of income category. The number of sexual partners in the last three months followed a similar pattern, with those whose primary source of income was drug dealing or theft reporting relatively high partner numbers. CONCLUSIONS: These data suggest that social disadvantage is associated with HIV risk in part by its association with drug and sex work for survival, and offers one variable that may be associated with the concentration of disease among those at greatest disadvantage by having an illegal and unstable primary income source.

Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups

BACKGROUND

There is a discrepancy between self-reported sexual identity and sexual behavior. The magnitude of this discrepancy is unclear, as is its variation across race/ethnicity and gender.

GOAL

The goal of the study was to assess the range of discrepancy in self-reported sexual identity and sexual behavior in men and women of four racial/ethnic groups.

STUDY DESIGN

Self-reported data on sexual identity (homosexual, bisexual, heterosexual) and sexual behavior in the past 3 months were collected from 1494 African American, Hispanic, Asian, and white men and women in public congregation places in Houston, Texas.

RESULTS

Data indicated that concordance rates between self-reported sexual identity and sexual behavior varied widely across racial/ethnic groups, with the highest rates of concordance in Asian males and females and the lowest in African American females and white males. The largest discordant category was in those self-described heterosexuals who reported partners of both genders. Breakdown of data to exclude those who reported sex trade work or illegal sources of income improved the concordance rates for African American and Hispanic subsamples.

CONCLUSION

Data indicate the importance of designing and targeting HIV risk interventions and clinical screening, based on behavior and not reported sexual identity.

Misperceptions about HIV transmission among heterosexual African-American and Latino men and women

This research was conducted to identify myths and misperceptions about HIV/AIDS and barriers to risk reduction among heterosexual African-American and Latino-American men and women in Houston, Texas. Sixty four Latino-American and 69 African-American men and women, aged 13 to 59 years, participated in 10 and 11 focus groups, respectively. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. The data confirmed the existence of myths and misperceptions among both groups about HIV/AIDS, specifically that HIV is an agent of genocide, suspicion of government information, belief that one can identify risky partners by odor and appearance, that partners' reported histories are accurate, significant misperceptions as to the meaning of "safe sex" (particularly in women), and belief that specific classes of people (not including oneself) are at risk for HIV. These data strongly suggest that concentration on narrow targeting of misinformation common in particular minority populations is important in the development of HIV/AIDS prevention programs.

The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial

The aim of the study was to improve health workers' skills and confidence in dealing with patients with HIV disease and increase attention to patients' human rights. A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management, health education, and attitudinal change toward patients with HIV disease. The intervention group n=1072, control group n=480. Following initial questionnaire-defining focus groups, nurses, laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training. Data were collected in all sites pre-training and 1 y later. Hierarchical multiple regression analysis controlling for baseline data, and orthogonal factor analysis to define scales were used. Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment, attitudes and beliefs about people with HIV disease, less fear and more sympathy for and responsibility toward HIV patients, and an increase in self-perceived clinical skills. There was increased willingness to treat and teach colleagues about people with HIV. Clinician fear and discrimination were significantly reduced, and the climate of fear that was associated with HIV was replaced with a professional concern. There was increased understanding of appropriate psychosocial, clinical and human rights issues associated with HIV treatment and prevention. This intervention, targeting health workers in an entire state and using HIV/AIDS information, role modeling, diffusion of training and discussions of discrimination and human rights, significantly affected the perception of risk groups and behaviors, perceived skills in treatment and counseling, reduced fears and increased concern for people with HIV disease, and improved the climate of treatment and prevention of HIV disease compared with a control state.

HIV/AIDS behind bars: an avenue for culturally sensitive interventions

The prevalence of HIV infection and the incidence of AIDS are higher among prison inmates compared to the general population. Although African Americans and Hispanics constitute approximately 13% and 12.5% of the population, respectively, they are over-represented among the prison population. The current trend in the adult/adolescent AIDS cases among African Americans and Hispanics outpaces that of the white population. The sociodemographic data of HIV/AIDS looks similar to the sociodemographics of U.S. prisons. This suggests that there may be a link between HIV transmission in prison and the current AIDS epidemic in the community. In addition, this high incidence is also a reflection of the high-risk lifestyle of the incarcerated population. High-risk behavior common among the incarcerated and inner city minority communities includes injection drug use, sharing of drugs and drug paraphernalia, and multiple sex partners. HIV transmission risk-reduction efforts such as mandatory screening of inmates, preventive HIV/AIDS education, and appropriate and adequate therapeutic management are essential to curtail the epidemic. However, any HIV/AIDS reduction program for minority communities must include culturally sensitive interventions.

Perception of reliability of human immunodeficiency virus/AIDS information sources

The sources of human immunodeficiency virus (HIV)/AIDS information as well as the perception of reliability of information from these sources may have a significant impact on the effectiveness of HIV risk reduction messages in reaching high risk populations. We examined the sources of HIV information and the perception of reliability of information from these sources among African Americans (n = 441), Hispanic Americans (n = 456), and whites (n = 297), in Houston, Texas. The data revealed that African Americans and Hispanics were most likely to receive their HIV/AIDS information from the "media" compared with whites who received most of their information from "government agencies and professionals." Information from "family, friends and schools" were regarded as the least reliable by respondents from all three ethnic groups. The data also showed that perceptions of reliability of information sources were influenced by level of educational attainment. Implications for designing target audience-specific intervention strategies for the prevention of the spread of HIV disease are discussed.

Cross-national HIV infection control practices and fear of AIDS: a comparison between Nigeria and the USA

Fears about occupational transmission of HIV may have a significant impact on the behaviour of health care workers and on infection control practices. We investigated the relationships between fear of AIDS and infection control practices in health care workers in major university teaching hospitals in Nigeria and the USA. Data from the fear of AIDS scale and on a measure of infection control practices and beliefs showed that knowledge of whether the patient was HIV-infected determined infection control practices in Calabar but not Texas. Where the patient was known to be infected, there were no differences between the 2 countries. Fears of AIDS were related to infection control practices significantly more in the USA than in Nigeria where there was almost no relationship. These data may be influenced by the greater availability of disposable equipment in the USA compared with Nigeria.

HIV/AIDS infection control enforcement: a comparison between Nigeria and the United States

We examined differences in approaches to HIV-related infection control practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infection control practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher in USA), and a greater probability of peer ridicule as a way of enforcing group norms on infection control in Nigeria. Peer enforcement of norms was significantly lower in the USA. In both countries, more precautions would be taken if it was known that the patient was HIV infected. Infection control practices were more likely to be followed in the USA compared with Nigeria if they were praised for this activity, if appropriate facilities (sharps containers, gloves, etc.) were nearby, and if they felt that infection control procedures were effective. These data point to the importance of normative social pressures in Nigeria and of knowing the patient is HIV infected in the USA and feeling that infection control procedures are effective ways of avoiding occupational HIV infection. The role of normative pressures and assumptions about HIV infection status as well as cues and availability of facilities for infection control appear to differ between these health care workers in Nigeria and the USA.