Longitudinal Stigma Reduction in People Living with HIV Experiencing Homelessness or Unstable Housing Diagnosed With Mental Health or Substance Use Disorders: An Intervention Study

Objectives. To assess changes in perceived external stigma among people living with HIV (PLWH) experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders following an intervention including care coordination and navigation assistance, building trusting relationships, addressing unmet needs, and reducing barriers to seeking and engaging in care.Methods. This study was part of a national multisite intervention project delivered at 6 geographically diverse sites throughout the United States from September 2013 through February 2017. Participant surveys were conducted at baseline, 6 months, and 12 months. We assessed perceived external stigma, defined as people's beliefs about others' attitudes toward them, related to HIV, homelessness, mental health disorders, and substance use disorders with modified stigma scales.Results. A total of 548 individuals participated. At baseline, more participants reported experiencing any perceived external HIV stigma (81%) than any stigma related to homelessness and mental health or substance use disorders (38.9%). Over time, those reporting any HIV stigma decreased significantly from baseline (81%) to 61.4% and 57.8% at 6 and 12 months, respectively.Conclusions. PLWH experiencing homelessness or unstable housing with mental health or substance use disorders are impacted by multilayered stigma. Interventions to engage them in care may help reduce stigma.

You're never too old: a cancer education and risk reduction program for the elderly

BACKGROUND

Although age is the most significant risk factor for cancer, older adults are less likely to be informed about and to follow through with screening procedures.

METHODS

The University of Chicago Cancer Research Center, working in collaboration with health educators and city elderly organizations, developed a carefully scripted, hour-long presentation on cancer awareness and screening, designed specifically for older adults. The program was designed to be delivered in the community by trained graduate students. Pre-post-program surveys were used to evaluate the program's effectiveness in increasing cancer awareness.

RESULTS

The presentation was delivered 40 times at Chicago nutrition sites, regional senior centers, retirement homes, and community clinics, reaching close to 1,000 individuals. Responses to revised surveys showed improvements of an average of 22 (ranging from one to 41) percentage points per question.

CONCLUSIONS

This program gives older adults the basic knowledge and tools they need to take more active roles in their health care, follow healthier lifestyles, and reduce cancer risk.

Building Internet accessible medical education software using the World Wide Web

We describe work to enhance existing software protocols and develop a suite of new software utilities based upon a set of standards known as the World Wide Web (WWW). Specifically, we have developed an effective X-windows based WYSIWYG WWW browser/editor and a prototype for integrated wide-area authentication and authorization support for delivery and maintenance of WWW service. These software development activities, along with parallel work in content development, are empowering individuals to better use the Internet as a resource to easily author, publish, and access materials. As an illustrative application, we describe one Web-based self-instructional unit designed to increase users' knowledge of hazardous substances in the environment. This on-line monograph was adapted from a series of paper-based case studies developed by the Agency for Toxic Substances and Disease Registry of the U.S. Department of Health & Human Services. The on-line version illustrates many of the innovative features provided by the Web, and demonstrates how such materials can significantly impact medical education at all levels.