HIV seroprevalence and clinical characteristics of severe inpatient mentally Ill homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.     

Internet Use Among People with HIV/AIDS

ABSTRACT

The Internet offers people with HIV/AIDS timely information about treatment advances and supportive social contacts for this stigmatized disease, yet little is known about Internet use patterns among people with HIV/AIDS. This study of 120 persons with HIV/AIDS in the U.S. found approximately 19% used the Internet for HIV/AIDS-related purposes, much lower than the rate for general Internet use among the U.S. population. Lower incomes were associated with lower rates of use, echoing the “digital divide” found in the general population. Access from home was most common and information sought was primarily on medical treatments and medications. Possible reasons for low access rates, strategies for increasing access, and implications for other client groups are discussed.     

Service providers to the homeless mentally Ill: Their thoughts,perceptions, and recommendations for the homeless

A qualitative research study was conducted to obtain an understanding of the people who provide services to persons who are homeless and mentally ill. Service providers were asked about the kinds of services they provide, what they consider beneficial to this population, the kinds of services they would like to provide, and what is needed to alleviate the homeless problem. Services found in the study included, those that meet basic needs, psychiatric/medical services, social services, and activities. Service providers indicated the major service priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social services, (c) day programs, and (d) health care. It is recommended that service providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

Pachedu‐Zenzele in the Diaspora: Promoting Sexual Health Amongst Zimbabweans in England

Migrants have been found to be at enhanced risk for the Human Immune Deficiency Virus (HIV) in comparison with settled populations. As they migrate, they often bring with them their traditions and cultural values, which may influence the ways they access or make sense of health promotion interventions in the host country. In the diaspora, should they experience compromised citizenship, marked by an unresolved immigration status, some may need to remain invisible and this may include not accessing or presenting late for vital health care interventions. Addressing the needs of such invisible populations is key to health promotion work and paramount to public health interests. This paper describes how ever‐changing “traditions”, in particular the notions of Pachedu and Zenzele, were harnessed to develop ethically grounded sexual health care interventions amongst Zimbabweans in Luton, Bedfordshire, England. These interventions were delivered in mundane settings that formed some of the key everyday networks of this population. The reinvention of “tradition” for the purposes of delivering health and social care interventions has been one of the cornerstones of health promotion interventions in Africa, where the rates of HIV are some of the highest in the world. The concept of Pachedu harnessed confidentiality in the delivery of sexual health interventions with Zenzele calling for communal involvement in such initiatives. A key point that resulted in the success of this intervention was partnership work between statutory providers and the local Zimbabwean population throughout the project’s life span. Rather than being construed as passive recipients of health and social care interventions, local Zimbabweans and their statutory partners were engaged in mutual capacity building initiatives. Local Zimbabweans were also engaged and consulted throughout, from the conceptualization of the project, delivery, monitoring, and dissemination of the findings.     

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African-American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N = 197) and heterosexual (N = 365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts.     

Reducing HIV risk among people with serious mental illness

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.     

Gauging the Acceptability of HIV Vaccines: An Exploratory Study Examining Knowledge,Attitudes, and Beliefs Among Injecting Drug Users in Viet Nam

ABSTRACT

In contrast to other countries in Southeast Asia, the HIV/ AIDS epidemic is in the initial stages in Viet Nam, although the rates have increased notably since 1997. This study examined attitudes towards the use of an HIV vaccine (when one becomes available) as a means for preventing the disease. Since injecting drug users are the great majority of those affected by the HIV/AIDS epidemic in Viet Nam, two focus groups (n = 18) were conducted among this population to identify potential barriers and incentives for HIV vaccination. Most were willing to be vaccinated if an HIV vaccine were available. Although there were some concerns about side effects, financial costs, and stigmatization, the benefits were seen to outweigh the risks. The findings may help governments better understand the potential demand for this type of vaccine and design social marketing campaigns for post-trial HIV vaccine dissemination in order to maximize potential uptake of an HIV vaccine.     

Rural/Urban Residence,Migration, HIV/AIDS,and Safe Sex Practices among Men in Zimbabwe*

Abstract The AIDS epidemic was initially thought to be primarily an urban phenomenon. However, migration between rural and urban areas has resulted in the spread of the virus to all segments of the population. Prevention efforts continue to focus on the ABCs of AIDS, namely, abstinence among young adults, being faithful within a monogamous relationship, and/or using condoms at each sexual encounter. We examine the effects of residence, migration status, and selected social and demographic variables on the use of these three practices among men in Zimbabwe, a nation experiencing one of the highest HIV/AIDS prevalence rates in the world. Both residence and migration status were found to be significantly related to safe sex practices. Knowledge of a source with easy access to condoms was the strongest predictor of this behavior. Knowledge of prevention methods and experience with persons with AIDS also exerted significant effects, although not always in the manner hypothesized. Possible reasons for the findings and implications for policy are discussed.     

A comparison of HIV risk practices among unprotected sex-seeking older and younger men who have sex with other men

Purpose: In recent years, much attention has been devoted to understanding the HIV risk behaviors of younger men who have sex with men (MSM). Recent data suggest that HIV is becoming an increasing problem for older adults, but little attention has been devoted to understanding their HIV risk behaviors or the factors that underlie their risk taking. This study provides a comparison of these issues among younger and older MSM. Methods: The data come from a subset of younger (ages 18–39, n?=?113) and older (ages 50+, n?=?109) men participating in a national study of 332 men who use the Internet to find other men for unprotected sex. Men were sampled randomly from 16 websites. Data were collected via telephone interviews conducted in 2008 and 2009. Results: Younger and older men reported comparable involvement in HIV risk, including involvement in unprotected sex, proportion of sex acts involving internal ejaculation, number of times having anonymous sex, and number of times having multiple-partner sex. Generally speaking, the factors underlying the risk practices of younger and older men were quite different (e.g. self-esteem and condom use self-efficacy for younger men, versus HIV serostatus and depression for older men). Conclusions: Older MSM using the Internet to find partners for unprotected sex engage in high rates of behaviors that place them at risk for contracting or transmitting HIV. They were just as likely as their younger counterparts to practice these behaviors. The factors “fueling” involvement in risk generally differ for older and younger men, thereby warranting the development of age-specific HIV interventions that can take into account the unique life circumstances and needs of older MSM.     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore,Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HW prevention study, intelViewed at baseline, 324 (57%) were reintelViewed 5.2 months late!: At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both intelViews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports ofpresence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.     

A Survey of AIDS Knowledge and Attitudes Among Prostitutes in an International Border Community

Prostitutes are a high risk population engaged in high risk behavior for the transmission of HIV Disease (AIDS). This paper presents the results of a survey to evaluate the knowledge, attitudes and behaviors of prostitutes about HIV Disease (AIDS). This survey was conducted in an International Border Community. A total of sixty women participated in this survey. The sources of information on AIDS and its accuracy were explored. The impact of this knowledge on behavior was identified. The most important finding is that the prostitutes are not utilizing risk reduction behaviors while having sexual relationships with their clients. The survey found that fifty-four percent of the participants did not use condoms on a regular basis. And an alarming ten percent did not use condoms at all. The results of this survey have implications for social workers and public health workers who must develop strategies to work effectively with this high risk population.     

Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials

Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.     

Development,Implementation, and Outcomes of Post-stroke Mood Assessment Pathways: Implications for Social Workers

Depression and anxiety are prevalent in the stroke population and can have a significant impact on the patient and their family’s long-term outcomes, however the screening for these conditions does not meet best practice recommendations. To address this deficit, this study developed “Post-Stroke Mood Assessment Pathways” and embedded them into practice by utilising the PARiHS framework (for the implementation of evidence-based practice), in conjunction with staff training. The study examined the rates of mood screening, clinical interviews, and completion of interventions for stroke patients through a retrospective chart audit (n?=?213) one year prior to, and one year post-implementation (n?=?238) of the pathways. The data show statistically significant increased documentation around mood screening and clinical interview 95% CI [4.86, 19.88], p?<?.0012 and specifically, an increase in the number of patients who had a clinical interview following the introduction of the pathways 95% CI [8.05, 19.69], p?<?.0001.     

Mechanisms of Adherence in a Harm Reduction Housing Program

Advances in clinical therapies for people living with HIV have greatly increased life expectancies, but the high levels of adherence that are necessary for clinical success are infrequently achieved, especially for chronically homeless substance users. The Open Door is a harm reduction housing program that seeks to improve clinical outcomes for this population. We present findings from qualitative interviews with residents of the program, conducted to explore facilitators of residents’ success in the program, which is ultimately defined as HIV clinical adherence. Two major themes developed. Positive changes captures processes or characteristics that residents reported as having changed as a result of living in the program. Mechanisms of success reflects aspects of the program to which residents attributed their improved adherence. Given that improving adherence in vulnerable populations has both clinical and public health implications, our study suggests future avenues for research and foundations on which to build future interventions.     

Keynote Address: Making Campuses Safer Communities for Students

As a chief spokesperson for a national movement to prevent violence and a frequent speaker in national media and public forums, Dr. Deborah Prothrow-Stith is a nationally recognized public health leader. In 1987, she was appointed the first woman Commissioner of Public Health for the Commonwealth of Massachusetts. In that role, she established the first Office of Violence Prevention in a state department of public health, expanded prevention programs for HIV/AIDS, and increased drug treatment and rehabilitation programs. Dr. Prothrow-Stith currently serves as Associate Dean for Faculty Development and Professor of Public Health Practice at the Harvard School of Public Health (HSPH) and founding director of the Division of Public Health Practice.

Dr. Prothrow-Stith supports the application of rigorous scientific methods to strengthen violence prevention programs. She developed and wrote The Violence Prevention Curriculum for Adolescents, a forerunner of violence prevention curriculum for schools and communities. She is the author of Deadly Consequences, the first book to present the public health perspective on violence to a mass audience. She has authored and co-authored more than 80 publications on medical and public health issues.

Dr. Prothrow-Stith was the keynote speaker for the annual meeting of American College Health Association in May 2006. The Editors of The Journal of American College Health have revised her speech to share her comments in this issue and thought her words would be a proper introduction to the ACHA White Paper on Domestic Violence.     

Sociodemographic and Health-Related Risk Factors Among African-American,Caucasian and Hispanic Homeless Men: A Comparative Study

Data from a 1989-1990 cross-sectional survey of homeless adults in California were stratified by ethnicity to examine whether adverse childhood events and adult medical disorders preceding homelessness differed between 269 African-American, 599 Caucasian, 201 foreign-born Hispanic, and 136 native-born Hispanic men. Although African-Americans were overrepresented (21%) compared with their presence in local (3%) and state (7%) populations, within the homeless they were better educated and more likely to have held white collar jobs than Caucasians or Hispanics. In addition, despite being more likely to grow up in poverty, African-Americans reporled lower prevalences of alcohol and drug abuse, overnight psychiatric hospitalizations, placement in foster care, and physical or sexual abuse than Caucasians. Foreign-born Hispanics were the most likely to have low levels of education and job skills, but were least impaired by adult medical disorders. Native-born Hispanics reported lower rates of adverse childhood events, illegal drug use, and psychiatric hospitalizations than Caucasians, but were most likely among the three ethnic groups to suffer from alcohol abuse. The lower prevalences of adverse childhood events, addictive disorders, and psychiatric hospitalizations among homeless African-Americans, despite their higher representation in absolute numbers, suggests that factors such as childhood poverty may play a disproportionate role in homelessness among this ethnic minority group.     

Differences in Facilities' Acceptance of Patients Under Long-Term Care Insurance in Japan

Abstract

Objectives. In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI.

Methods. We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions.

Results. We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor.

Discussion. In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.     

They tell us “we don’t belong in the world and we shouldn’t take up a place”: HIV discourse within two-spirit communities

Objectives: We investigated how HIV discourse is negotiated and given meaning in the lives of young, male two-spirit leaders, when considering their communities’ and their own health and wellness. These men are also unique in that they have always lived under the specter and dominant discourse of HIV; that is, they are part of a second generation since the time of HIV/AIDS. Methods: We conducted a discourse analysis of six qualitative interviews from the HONOR Project, a multi-site, mixed-methods study of the two-spirit community across the United States, foregrounding the relationships among trauma, coping, and health. Results: HIV functions discursively in four ways: as a shadow presence, professionalized identity, health sub-/priority, and vehicle for belonging and (re)claiming. Conclusions: This study is important to social work as well as HIV prevention and care as it affords voice to two-spirit men, a highly marginalized community and one often silenced in scientific discourse. And, it centralizes language and context, complicating social epidemiological characterizations of HIV/AIDS, risk, and historically traumatized populations.     

The Interaction of HIV Knowledge,Perceived Risk,and Sex Differences on Risky Sex

Objectives: Risky sexual behavior increases during college. HIV knowledge and risk perception have been inconsistent predictors of risky sex independently. Methods: This study tested the interaction between HIV knowledge, risk perception, and sex to predict risky sex in college students (N = 171; 52.0% female). Results: Women's HIV knowledge resulted in greater reports of risky sex when risk perception was low. Conversely, men's HIV knowledge translated into greater reports of risky sex when risk perception was high. Conclusions: Although preliminary, this study calls for nuanced models of risky sex and the inclusion of risk perception modules in HIV reduction programs.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.