Mental Health and HIV Risk Among African American Adolescents

Summary

The family system is integral to adolescent mental health and HIV risk. However, few studies have addressed family variables and adolescent outcomes among African American families. This study tested a longitudinal model of parenting, adolescent mental health, and adolescent HIV risk, among a community sample of low-income, urban African American families from the Collaborative HIV prevention and AdolescentMental Health Project (CHAMP). Consistent with general adolescent population data, we expected less parental monitoring, greater psychological control and less positive parenting to increase risk for adolescent depression and conduct problems. We hypothesized that these variables would in turn increase rates of HIV risk. We followed one hundred and thirty-four African American youth and theirmaternal caregivers as part of the CHAMP project. Study variables included: positive parenting, parental monitoring, psychological control, adolescent distress, conduct problems, and recent HIV risk. We examined the relationship among these variables via longitudinal path analysis. Age was strongly associated with increased adolescent HIV risk. Contrary to hypotheses, more parental psychological control was marginally associated with less HIV risk, while positive parenting was marginally associated with greater HIV risk. Adolescent depression was associated with more conduct problems, but unrelated to HIV risk. Thus, parenting practices generally considered negative might actually be protective among some lower SES African American families. This underscores the importance of extending studies of family context and adolescent risk behaviors to diverse social and ethnic groups. Designing prevention programs for diverse groups will require articulating culturally specific effects for different parenting practice.     

Theory-Based Community Practice for HIV Prevention in Midlife and Older Women

ABSTRACT

In the last decade there has been a significant increase in HIV transmission among midlife and older women, particularly those from racial/ethnic minority communities. Although the number of women aged 50 and older diagnosed with HIV infection in the United States is increasing, they are rarely included in community HIV prevention strategies. This article presents integrating social capital with social justice themes into a socioecological framework for community practice that can significantly impact the efficacy of HIV prevention programs for midlife and older women. It also reviews the research and program implications for including midlife and older women in community interventions to halt the spread of HIV infection in this at-risk group. Suggestions for HIV prevention community practice with this underserved population are presented.     

Interventions to Developing Community Partnerships for HIV Prevention Planning

Abstract

Since 1985 the Centers for Disease Control and Prevention (CDC) have entered into a series of cooperative agreements with the states and territories of the United States to fund human immunodeficiency virus (HIV) prevention activities. In 1994, the CDC mandate shifted from using a central entity to plan HIV prevention programs throughout its jurisdictions to fostering partnerships among a central state or territorial agency, health departments in local counties, and community-based organizations. This article discusses and applies a model developed by social workers to facilitate HIV prevention community planning at the local level. The model used to facilitate community planning emphasizes the use of the social principles of empowerment, self-determination, ownership, and inclusion to foster the development of community-relevant HIV prevention plans. This approach resulted in the completion of a successful HIV prevention plan, and application for continuing and supplemental funds ($6.6 million and $1.2 million respectively) from the CDC for HIV prevention efforts, the continued use of the model in HIV prevention planning, and the ability to use the principles of the model as a basis for providing future technical assistance in community planning.     

Gay Men and HIV

SUMMARY

This paper reports on the results of qualitative studies examining the personal experiences of sex and sexual negotiation for British gay men who are diagnosed HIV positive and those who know or presume themselves to be uninfected. These are contrasted with the results of a study of representations of HIV and AIDS within an international review of community health promotion literature aimed at gay men. The paper highlights the disparity between specific community responses to the epidemic as engendered in the cultural production of health promotion materials and the individual experience of HIV, suggesting a! paradigm for a community response to the epidemic which reflects the personal experience of gay men both infected and uninfected.     

Sexuality,Morality and Lifestyle: The ABC of HIV Prevention Strategies in Rural Papua New Guinea

This article explores the national program for the prevention of the spread of HIV/AIDS in Papua New Guinea and its intersection with the experiences of a rural community in Western Province. The social marketing of HIV/AIDS awareness and prevention has seen an influx of categories and definitions of people, sexual behaviour and HIV/AIDS that have the potential to create confusion, but also spaces in which rural populations can understand and conceptualise AIDS. In the present paper, the preventative program is examined from the perspective of the Gogodala, whose understandings of sickness and prevention are based on an intimate and interactive relationship with the local environment. In this context, ‘lifestyle’ (ela gi) and the maintenance of certain ‘laws’ is the primary method of sickness prevention. I argue that an exploration of the local dynamic between sexuality, morality and lifestyle is vital to the evaluation of the impact of these awareness and prevention programs and the possibilities for future prevention strategies.     

The Adolescent Sexual Development of African American Gay Men with AIDS: Implications for Community-Based Practice

ABSTRACT

This qualitative study describes the adolescent sexual development of ten African American gay men living with AIDS. The informants retrospectively describe the challenges of being a gay adolescent in a mostly heterosexist and homophobic environment. They report unsupportive homophobic and heterosexist family members, community members and school officials. They also describe their burgeoning sexual orientation, sexual initiation as well as consensual and non-consensual sexual experiences with their peers. Additionally, several informants describe seeking sexual experiences with adult men. Later they suggest the adult men became their primary sources of emotional and psychological support. Implications for community practice, intervention and research with both African American gay adolescents and adult men living with AIDS are discussed.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

Indigenous Sistergirls’ Experiences of Family and Community

ABSTRACT

While increasing attention has been paid to the experiences of Indigenous sistergirls over the past decade there still remains a dearth of empirical research on the experiences of this diverse population of Indigenous people. This paper seeks to add to the small body of existing literature by reporting on a thematic analysis of existing media in which 18 sistergirls shared their experiences of family and community. The thematic analysis identified two themes within each of these topics. Specifically, when talking about family, both familial acceptance and rejection were salient themes. When talking about community, both the traditional role of sistergirls in their communities and negative responses from communities were salient themes. The paper concludes by suggesting that increased knowledge about the lives of sistergirls may assist social workers in supporting sistergirls both in their own outreach endeavours, and in providing more culturally competent services.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Preventing HIV/AIDS Among Trinidad and Tobago Teens Using a Family-Based Program

Summary

This paper describes a family-based HIV/AIDS prevention project currently underway in Trinidad and Tobago—an English speaking twin-island nation in the Caribbean. The project involves a partnership between U.S.-based researchers and a social service agency on the Islands. It describes the development and adaptation of the intervention and reports preliminary outcomes from a pilot intervention (n= 32). Findings indicate high participant retention; statistically significant pre to posttest changes in HIV/AIDS knowledge and awareness; parent/youth discussions at home; condom self-efficacy; and parental monitoring. Findings are discussed within the context of collaborative HIV/AIDS prevention research.     

The GIG

SUMMARY

The GIG¹ is an innovative community based intervention which offers education regarding pregnancy and sexually transmitted infection (STI) risks and prevention in the context of a social event that is open to the adolescent community. This intensive, six hour intervention features live and recorded music, celebrities from local radio stations, raffles and prizes, and a number of educational activities providing instruction regarding pregnancy and STI risks and prevention. A total of 609 Latino adolescents completed matched pre and posttest measures. The increase in the total mean score from pretest to posttest was found to be statistically significant, as were the separate analyses for items related to pregnancy and those related to STIs. Information regarding specific attitudes and areas of knowledge are provided. Important intervention components related to the research literature are discussed along with areas of success, especially with regard to risk factors, and those in need of further attention in future intervention events. Recommendations for reinforcing and enhancing the GIG messages are presented along with implications of the findings for social work and health care professionals responsible for designing interventions for at-risk youth.     

Rethinking Girls “At-Risk”

Abstract

This conceptual article critically analyzes influential theoretical frameworks concerning adolescent female development, including psychosocial identity stage theory, person-in-environment theory, and feminist psychology. Based on the strengths and limitations of these approaches, the author introduces social workers to an emerging framework that addresses the gender, race, and class intersections that contextualize adolescent girls' developmental experiences. This perspective also discusses young women's capacity to resist norms and stereotypes in their search for an authentic identity. This innovative theory complements a strengths-based approach to social work and can be used to guide research andpractice with this population.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.     

Social work guanxi: a reflexive account of the social work relationship in the Chinese context

ABSTRACT

In a guanxi-driven acquaintanceship, the worker, the client, and the community are tied together more closely than they are in mutually agreed-upon service contracts. This paper re-examines the contemporary boundaries in the social work relationship, especially in Asian nations such as China, where ‘relationships’ are generally translated and perceived as ‘guanxi’. The indigenisation of social work must be managed with care when translating from West to East. Drawing from the experiences of community development projects in rural Hong Kong, this paper discusses how guanxi among social workers, clients and other stakeholders in Chinese communities might challenge the professionalism of social work and breach the boundaries of social work relationships.     

Experiences of adolescent mothers in Costa Rica and the role of parental support

ABSTRACT

Adolescent pregnancy is often thought of as a social problem, one that can cause the adolescent mother hardship, including poverty, low-educational attainment, and housing instability. Although much research has been conducted about adolescent pregnancy in the developed world, less has considered adolescent pregnancy in the developing world. This qualitative study focuses on women who were impoverished in Costa Rica who had been pregnant in adolescence. The goal of the study was to gain a better understanding of the lived experiences of the mothers, as well as the kinds of support they received during and after the pregnancy. The research sample consisted of 22 female participants who were impoverished and had experienced an unintended pregnancy in adolescence. The key finding from this study was that parental support was the most important factor in mitigating adolescent experiences of stress and negative feelings about their choices related to the pregnancy. The study has implications for the understanding of the experiences of women who are vulnerable with respect to adolescent pregnancies in Latin America and for Latina migrants to the United States.     

Potential Roles of Black Churches in HIV/AIDS Prevention

Abstract

This study examines the role of Black churches in AIDS/HIV prevention. This is a pilot survey study design administered to 11 churches represented by 11 ministers and one church member. The analysis is both qualitative and quantitative. The results showed that most of the ministers had spoken with their congregation on HIV/AIDS. A few ministers had previously sponsored or taken part in HIV/AIDS workshops and disseminated HIV/AIDS educational material in the African American community. None of the churches had an established HIV/AIDS prevention program. Most of the ministers were receptive to implementing an HIV/AIDS prevention program, provided that it did not violate the church doctrines. The findings in this study suggest that Black churches represent an important potential resource for HIV/AIDS prevention. For success, the initial strategy should involve the minister in the early planning stage. Future research should focus on expanding the scope of this study and improving communication between the church, community-based organizations, and health professionals.     

The applicability of social control theory in understanding adolescent alcohol use

Utilizing panel data on 345 high school students, this study investigates the efficacy of social control theory in accounting for adolescent orientations toward alcohol use. The findings suggest that the differing informal control mechanisms under consideration place varying constraining influences upon adolescent alcohol use, and upon problems which arise in the lives of adolescents as a consequence of their drinking, throughout the three high, school years. Similarly, alcohol use and its attendant problems are generally found to be associated with a decrease in the strength of adolescents’ bonds to conventionality, though these influences differ in degree from year to year as well.     

A Model of Heterosexual Adaptive Relationship Functioning in South Africa: Implications for HIV Prevention Interventions

Abstract

Objectives: Couple-based HIV prevention efforts are an important HIV prevention strategy in South Africa but there is a lack of understanding as to what constitutes healthy relationships in South African sociodisadvantaged communities. Methods: To address this, 8 focus group discussions were conducted with 27 men and 23 Black African women living in a large disadvantaged community in Cape Town, South Africa. Results: A model of adaptive relationship functioning is put forth, which involves four primary relationship components that emerged as central to healthy relationships: active relationship building, emotional support/display, communication, and problem-solving. Conclusions: The results of this study can inform couple-based HIV prevention efforts.     

Social Security in Africa

Abstract

Africa is the poorest region of the world and has the youngest and least developed social security programs. Most Africans are not covered by social security programs. The high prevalence of HIV/AIDS in some sub-Saharan countries and internal armed conflicts in others have created difficult problems in some countries for social security programs. As a result, some countries do not have functioning social security programs. The social security programs that do exist in Africa are influenced by their colonial heritage, with the programs in English-speaking Africa differing from those in French-speaking Africa. Six different patterns of social security provision can be identified.