NC Institute for Public Health, UNC School of Public Health

28th Annual Minority Health Conference


 1.  Lower Reported Rate of Suspected Hypersensitivity Reaction (HSR) to Abacavir (ABC) Among Black Patients (abstract)

 2.  The Association of Lifetime Sexual Assault Experiences and Risky Sexual Behaviors among Inner-City Women in a Drug-Using Community (abstract)

 3.  African American Men Who Have Sex with Men and HIV/AIDS: A Review of the Literature (abstract)

 4.  Sexual Health for Latino Men in Correctional Settings (abstract)

 5.  Cost Description of HIV/AIDS patient care at a Tertiary Care Hospital in India. (abstract)

 6.  Utilizing Student Organizations at Historically Black Colleges and Universities in the Rural South to Facilitate HIV/AIDS Education (abstract)

 7.  Project Commit to Prevent (abstract)

 8.  HIV Prevention Needs in African American Women 50 years and Older (abstract)

 9.  The Phoenix Program: A Culturally Competent Intervention Program for Incarcerated African American Males (abstract)

10.  Marketing an HIV Testing Event at an Historically Black University. (abstract)

11.  The Construction of Masculinity: The Role of Gender and Incarceration As It Relates to HIV Transmission Among Recently Released South African Inmates and The Communities to Which They Return. (abstract)

12.  Identifying gaps in HIV prevention services in North Carolina (abstract)

13.  Project GRACE: A Participatory Approach to Address Health Disparities (abstract)

14.  EPICC (Eastern Piedmont Coalition for Comprehensive Care): Using PRECEDE-PROCEED as a Model for Reducing AIDS-Related Mortality among Rurally-Loacted African American Women in North Carolina (abstract)

15.  HIV Risk Perceptions Among African American College Women in the South (abstract)

16.  Is there a relationship between intimate partner violence and HIV status or HIV-risk among minority females in the U.S.?: A systematic literature review (abstract)

17.  Beliefs About Reinfection among HIV-Positive Patients in the South: Does Race Matter? (abstract)

18.  Use of the electronic Primary Care Research Network (ePCRN) to Create An Electronic Infrastructure for Patients at Risk for HIV/AIDS (abstract)

19.  Sexual Risk Behaviors of Black Men Who Have Sex with Men (BMSM) and Black Men Who Have Sex with Men and Women (BMSMW) (abstract)

20.  Sister Connect: A Peer Education Treatment Program (abstract)

Poster abstracts

 1.  Lower Reported Rate of Suspected Hypersensitivity Reaction (HSR) to Abacavir (ABC) Among Black Patients

D. Sutherland-Phillips, MD, C. Brothers, P. Wwannamaker, J Hermandez, MD

Introduction: ABC is an effective drug for HIV-1 infection. Approximately 5% of patients treated with ABC develop HSR that in rare cases has proved fatal. An association between ABC HSR and carriage of the genetic allele HLA-B*5701 has been reported by several groups and reaches high statistical significance in Caucasian subjects but is less significant in Black subjects. In multivariable analyses assessing clinical risk factors for HSR, black race consistently demonstrated a lower odds for reporting HSR.

Methods: Reported rates of HSR from recent randomized, controlled clinical trials using ABC-containing products were reviewed across the study populations and by self-report of black race.

Results: Incidence rates from 5 studies comprising 2798 subjects from the Americas and Europe are described below:
StudyID N Black HSR cases HSR cases Overall
    (%) Black Nonblack HSR Rate
      N(%) N(%) N(%)
KLEAN* 879 32 9(3.3%) 44(7.3%) 53(6%)
ALOHA 680 34 6(2.6%) 30(6.7%) 36(5.3%)
ACTION* 139 32 1(2.3%) 6(6.3%) 7(5.0%)
CNA30024* 330 20 2(3.0%) 25(9.5%) 27(8.2%)
CNA30021 770 27 12(5.7%) 52(9.3%) 64(8.3%)
TOTAL 2798 30 30(3.6%) 157(8.0%) 187(6.7%)
* 48 week data
** subjects randomized to ABC only

Conclusion: Across 5 randomized controlled trials, there was a consistently low rate of HSR reported among Black subjects. This finding supports previous risk factor findings and recently reported HSR rates in the DART trial (CROI 2006). The prevalence of HLA-B*5701 differs among racial groups and is low in people of black race, which may partially explain this finding. Additional research is underway to more fully address the association of the allele and HSR across racially diverse populations.

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 2.  The Association of Lifetime Sexual Assault Experiences and Risky Sexual Behaviors among Inner-City Women in a Drug-Using Community

Carol Strong, MPH, Amy Knowlton, ScD, and Carl Latkin PhD

Introduction: Sexual violence against women has tremendous impact on the victim's health and quality of life, including higher risks of HIV infection. The association between sexual violence and risky sexual behaviors has been documented. However, very few studies have focused on a drug-using community. The paper examines the association of lifetime sexual assault and risky sexual behaviors among inner-city women in a drug-using community.

Methods: The study sample of women were analyzed from Self-Help in Eliminating Life-Threatening Diseases (SHIELD) study, a social network-oriented HIV prevention intervention recruited through peer outreach in areas with high drug activity in Baltimore City, MD. The data in the paper were collected through face-to-face interview in the second follow-up period during April 2000 to June 2002. We analyzed 397 female data and 96.9% of them were African American.

Results: Women in this cohort have high prevalence of risky sexual behaviors (42-43%) and lifetime sexual assault experiences (43%). Multiple logistic regression was performed and we found that after adjusting for various factors, women who traded sex for drugs or money in the past 90 days are 2.45 times more likely to report lifetime sexual assault experiences (95% CI: [1.13-5.35]).

Conclusion: HIV Prevention programs should not only address consensual sexual relationship, but more importantly, consider women's past and current sexual traumatic experiences. Public health interventions for inner-city women should address their basic needs, and focus on economic empowerment to minimize their risk of trading sex for drugs or money.

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 3.  African American Men Who Have Sex with Men and HIV/AIDS: A Review of the Literature

Sara LeGrand, MS, Judith Bacchus Cornelius, DNSc, RN, Linda Moneyham, DNS, RN, FAAN

Introduction: Recently the 'Down Low,' a term used to describe African American men who identify themselves as heterosexual but have sex with other men, has received attention in the media. To increase understanding of the sexual behaviors of African American men who have sex with men (AAMSM), this review aimed to identify differences in men who have sex with men (MSM) by race/ethnicity; identify the sexual risk behaviors of AAMSM; and identify HIV prevention strategies for AAMSM.

Methods: The literature was searched in two steps. In the first step, MEDLINE and CINAHL databases were searched using the keywords men who have sex with men, bisexual, down low, non-gay identified men, HIV prevention, HIV risk, and African American. Reference lists of articles identified were searched for additional relevant articles. Twenty-nine articles were found that were based on empirical research, written in the English language, and peer-reviewed.

Results: The findings suggest that AAMSM are less likely to identify as homosexual, are less likely to disclose same sex behavior, and are more likely to be bisexually active than white or Hispanic MSM. However, it cannot be concluded that the decreased likelihood of a homosexual identity or same sex behavior disclosure among AAMSM translates into an increase in risky sexual behaviors.

Conclusion: Instead of focusing on the 'Down Low,' it will be more productive to focus HIV prevention efforts on reducing homophobia in African American communities so that the need for AAMSM to identify as heterosexual and hide same sex behaviors is minimized.

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 4.  Sexual Health for Latino Men in Correctional Settings

Donna Rzewnicki, BA (

Introduction: The Wake County HIV/STD Program is implementing a sexual health curriculum for Latino males at county jails. Participants explore gender roles and cultural expectations that can lead to HIV/STD risk for men and women.

Methods: Groups of 15 males participate in five three-hour sessions. After covering health education and HIV/STD risk reduction, the group discusses gender roles, substance abuse, and related topics, using activities based on the gender and power model. HIV and syphilis testing is offered. Three weeks after the course, the facilitator meets individually with participants to return test results, issue the post-test, and discuss referrals. Changes in participants' knowledge, attitudes and behaviors are evaluated using pre-tests and post-tests. The program is establishing a system to track participants as they move or are released, in order to conduct long-term evaluations of the curriculum.

Results: According to pre- and post-tests, 96% of class participants demonstrate increased knowledge of HIV/STD HE and RR. Seventy-nine percent of participants choose to be tested; of those tested, 64% have never been tested before. Most participants express that prior to the course, they had not received comprehensive information about HIV/STDs or related topics.

Conclusion: Wake County's program was developed to engage a low-literacy population in need of comprehensive information about HIV/STDs, substance abuse, and violence. The activities used in the curriculum may be adapted for non-correctional settings, with youth and women.

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 5.  Cost Description of HIV/AIDS patient care at a Tertiary Care Hospital in India.

Sunil K Agarwal,MBBS; Naveet Wig ,MD; D. Nath, MD;Chandrakant S. Pandav, MD, MPH;Hemraj Pal, MD; Madhu Vajpayee MD

Introduction: More than 5.1 million people are living with HIV in India. Against the backdrop of many illnesses competing for scarce resources, there is a high demand of subsidized health care.Present study estimates direct and indirect costs for inpatients as well as outpatients infected with HIV from a societal viewpoint. Such knowledge may provide vital clues towards cost reduction approaches and rational cost sharing. Methodology: Cross sectional tertiary hospital based study. All the HIV positive visiting during study period were enrolled. For regular hospital costs, using step down methodology, the fixed cost of capital goods, manpower cost, and overheads from supporting services like laundry, diet, blood bank, administrative services, AC, water, electricity etc. were calculated. Using step up approach, another structured questionnaire identified other costs from patients and their relatives such as hospital charges, drugs and investigations.

Results: Out of 82 enrolled patients, 38 (46%) were outpatients, 42 (53%) had active tuberculosis. 44 (53%) had CD4 count>200 cells/mm3. 42% spouses and 48% children tested HIV positive. The mean number of outpatient visits and hospital stay duration per month were 4 + 3.3 and 19.5 + 9.4 days respectively. Costs per patient per month for inpatient and outpatient respectively were as follows: US$20 and US$46 paid as hospital charges, US$662 and US$42 direct hospital cost; US$541.6 and US$557 as total patient cost; US$1204 and US$600 as societal cost.

Conclusion: Despite substantial subsidy in public hospitals, the cost borne by patients is high. Provisions to cut down indirect cost on patient are vital, especially so for outpatients.

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 6.  Utilizing Student Organizations at Historically Black Colleges and Universities in the Rural South to Facilitate HIV/AIDS Education

Martinique C. Free

Introduction: HIV/AIDS among students at Historically Black Colleges and Universities (HBCU) in the rural South is a growing public health concern. Lack of basic HIV/AIDS knowledge, underestimating risky behaviors, and lack of discussions about sexuality are some factors that contribute to the spread of HIV/AIDS within this population. Objectives of the study included: 1) To examine how HIV/AIDS is viewed by student leaders and organizations on campus; 2) To examine barriers to HIV/AIDS education and the role student organizations and administrators are playing in HIV/AIDS education.

Methods: This study utilized a qualitative research design in which student leaders and administrators were interviewed and asked a series of questions related to HIV/AIDS education on their campus. Interview data were analyzed using principles of grounded theory.

Results: Findings suggest that student organizations may be useful in HIV/AIDS peer-led interventions if their members are well trained and first address underlying issues such as cultural homophobia, sexuality, and stigma relating to HIV/AIDS.

Conclusion: University administrators should encourage students to be creative when addressing their peers about issues surrounding HIV/AIDS. Researchers and public health officials must create appropriate interventions to address issues surrounding HIV/AIDS before effective education of HIV/AIDS can take place. Improving HIV education among HBCU students presents a potentially effective strategy that addresses HIV/AIDS among African Americans by focusing their efforts and targeting a smaller sub-population first. This sub-population is particularly important because many of these individuals will become leaders of the African American community, and influence community behavior and attitudes towards HIV/AIDS.

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 7.  Project Commit to Prevent

Kimberly Hoke

Introduction: In keeping with the North Carolina Department of Health and Human Services' mission to eliminate health disparities for racial and ethnic minorities, the Division of Public Health, HIV/STD Prevention and Care Branch developed Project Commit to Prevent (PC2P). This project has as its overall goal to empower Historically Black College/University students, with special emphasis on African Americans and American Indians, to change behaviors that put them at risk for HIV and STD infections.

Methods: To achieve this end, the NC HIV/STD Prevention and Care Branch partners with eleven of North Carolina's twelve Historically Minority-Serving Colleges/Universities to assist each institution with: 1.Expanding HIV/STD prevention/risk reduction educational programs on campus 2.Enhancing the capacity of the health services on each campus to provide HIV/STD risk reduction services 3.Strengthening linkages between each institution and other HIV/STD service providers near the campus, particularly those providing HIV/STD counseling and testing

Results: Peer Health Educators have been trained on each campus to promote HIV prevention through health education/risk reduction messages amongst their peers. Campus Coordinators have been identified on each campus to oversee prevention activities such as health fairs, HIV/AIDS counseling and testing events, STD screenings, public service announcements, social marketing campaigns, and student leadership development workshops.

Conclusion: Students, faculty, and staff are learning how to stop the spread of the disease by practicing safer sexual behaviors. More North Carolinians are taking action to eliminate this health disparity by getting tested, treatment and changing risk behaviors once they learn of their status.

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 8.  HIV Prevention Needs in African American Women 50 years and Older

Ina Ananda Jones, MPH

Introduction: This study examined the HIV prevention needs of two groups of African American women 50 years and older, injection drug users and non injection drug users.

Methods: Data were collected through focus groups on general HIV knowledge, experience with HIV prevention, psychosocial factors, drug involvement, and risks and barriers to HIV infection and prevention. Data were also collected through a survey on sources of HIV information, HIV testing, HIV risks, and demographics.

Results: This study found: 1) lack of education and misconceptions regarding disease transmission act as barriers for prevention efforts; 2) a need for inclusive HIV prevention efforts such as multi-generational in-home programs, multi-family programs and the incorporation of prevention messages with existing health services; 3) a need for skills building, condom negotiation skills and self-empowerment. Effective prevention methods suggested by participants were techniques that align with African American culture and heritage such as storytelling, and the inclusion of family and community components.

Conclusion: Future research should include a more representative sample such as churchgoers, sorority women, health conscious women, ex offenders, past injection drug users, infected or affected women and newly single women. The findings of this study contribute to the small body of knowledge regarding the HIV prevention needs of African-American women 50 years and older. Moreover, the study findings provide insight into what a sample of this group views as effective prevention methods and can be used to design prevention messages for the population from which they were gathered.

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 9.  The Phoenix Program: A Culturally Competent Intervention Program for Incarcerated African American Males

Aminifu R. Harvey, DSW, LICSW

Introduction: The Phoenix Program was developed with funding from the HIV/AIDS Division of Mental Hygiene and Mental Health for the State of Maryland. The purpose of the program is to address the spread of HIV/AIDS by African American heterosexual males both in prison settings, and in the overall community upon their release from prison.

Methods: The Program is a culturally competent program based upon the values, principles and ethics of Afri-centric theory and practice. The Phoenix Model Program Curriculum consists of five (5) sessions:
  1. Ethnic /Gender Pride
  2. Use of Power in One's Personal and social life
  3. HIV Education/Condom Use
  4. Power: Responsibility to self, family and community
  5. Transition
Contract agency personnel were trained in the implementation of the Program. Surveys were distributed to the agencies' trainers after one year of implementation. There was also a qualitative feedback session by the trainees after their first program implementations. The Center for Disease Control's (CDC) standard HIV/AIDS evaluation form was used as an evaluation Instrument for all program participants.

Results: Agency personnel receiving the training rated the Program effective. Qualitative results show non African American males participated in the Program and found the Program to be effective. The results of the CDC instrument (not designed to evaluate this unique) indicted only moderate change by the participants.

Conclusion: The conclusion is that the Phoenix Program is potentially a culturally competent intervention program for incarcerated African American and probably for males in general. The author is designing an evaluation instrument, specially for this intervention.

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10.  Marketing an HIV Testing Event at an Historically Black University.

Tanya M. Bass, MS; David Jolly, DrPH; Jeffrey Love

Introduction: On October 26, 2006, an HIV testing event was held at North Carolina Central University. A multi-pronged, graduated marketing campaign was conducted to recruit students to this event. This poster will discuss how we: involved numerous campus partners in the campaign, developed our marketing strategy, and conducted the campaign. We will also display samples of media developed for the campaign.

Methods: Testing Day represented collaborative efforts among Student Health and Counseling Services, a grant-funded HIV program (Project Style), three academic departments (Health Education, Art, and Public Administration), and seven student organizations. These partners developed flyers, handbills, articles for the campus newspaper, a special student-developed newsletter, campus radio and television spots, announcements on Facebook, and an HIV art installation. Designed by students from the Art Department, the art installation consisted of 252 pairs of shoes arranged in a large spiral in the center of campus under the banner, 'Shoes Too Easy To Fill.' Each pair of shoes represented a young African American diagnosed with HIV infection in North Carolina in 2005. Signs explaining the exhibit and encouraging students to learn their HIV status were posted along the spiral.

Results: Some 230 students registered for testing in the first 2 hours of the event, and 200 were actually counseled and tested over an 8-hour period. Ultimately over 50 students were turned away because of time and staff constraints.

Conclusion: This marketing campaign successfully recruited students for HIV testing and can serve as a model for testing events on other college campuses.

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11.  The Construction of Masculinity: The Role of Gender and Incarceration As It Relates to HIV Transmission Among Recently Released South African Inmates and The Communities to Which They Return.

Aba D. Essuon PhD, MPH, MSW

Introduction: In South Africa, the risk of HIV transmission is confounded by two factors: 1) the historic and social-cultural constructions of masculinity that dictate male/ female relationship power roles and 2) the large influx of inmates (up to 300,000 per year) back into the community. The nature of the South African prison system creates an environment which is conducive to the spread of HIV through various mediums, thus increasing the likelihood of infection among recently released inmates. The association of power with gender, suggest that the health of the community and the health of the women within that community is directly linked to the health, attitudes, beliefs, and behaviors of men. This paradigm suggests the need for prison based interventions to educate and influence behaviors related to safer sex practices; yet, there has been little research which examines and suggests interventions to impact the HIV related health risk of inmates while incarcerated and/ or upon their release.

Methods: This is a cross sectional descriptive survey study. It is a part of a larger ongoing study designed to assess 357 South African pre-release male inmates participating in a pre-release health education intervention program.

Results: Inmates demonstrated male dominancy attitudes regarding women and sexuality. They exhibited HIV behavioral beliefs which included the perception of forced intercourse as a means of curing HIV, obtaining respect, and dominating women.

Conclusion: Cultural competent public health efforts should be made to address the heightened threat of HIV associated with gender roles and incarceration history in South Africa.

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12.  Identifying gaps in HIV prevention services in North Carolina

Elizabeth Torrone, James Thomas and Brooke Levandowski

Introduction: HIV prevention programs and agencies in North Carolina (NC) are fighting growing rates of infection with decreasing resources. Community planning boards at the local and state level should consider what gaps in prevention services exist and how those gaps may contribute to disease rates and persisting racial disparities in sexually transmitted diseases (STDs).

Methods: We conducted a cross-sectional analysis of HIV prevention networks in ten counties in NC. In face-to-face interviews with representatives of HIV prevention agencies, as well as persons considered by others in their community to be "influential informants" of the community's HIV prevention services, we identified current gaps in prevention services. We purposefully selected counties based on STDs rates, racial disparities in STDs and urban/rural locality, to compare unmet needs by county characteristics using the exact Wilcoxan rank sum test.

Results: We conducted 415 key informant interviews (mean=41.5, standard deviation (sd)=28.2) and 169 agency interviews (mean=16.9, sd= 7.3). The most commonly reported barrier to meeting the needs of persons at risk for HIV was funding, followed by stigma. Community resistance to HIV prevention was more common in counties with racial disparities in STDs. Lack of programs and problems with service program coordination/cooperation were more common in rural counties.

Conclusion: By using key informants' and HIV prevention agencies' perspectives, we identified perceived gaps in prevention service provision. Findings from this study can help inform local and regional planners on how to efficiently target prevention programs, including programs aimed at reducing racial and geographic disparities in STDs.

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13.  Project GRACE: A Participatory Approach to Address Health Disparities

Selena Youmans, BA, Arlinda Ellison, MSc (Presenting Author), Melvin Muhammad, AA (Presenting Author), Connie Blumenthal, MPH, Ada Adimora, MD, MPH, Barbara Council, Reuben Blackwell, BA, Joynicole Martinez, MBA, Giselle Corbie-Smith, MD, MSc

Introduction: Some of the highest HIV rates in the Southeast are in Edgecombe and Nash counties in North Carolina. The Project GRACE Consortium (Growing, Reaching, Advocating for Change and Empowerment) uses a community-based participatory (CBPR) approach to develop culturally sensitive, feasible and sustainable interventions to prevent the spread of HIV in African American communities in these counties through a community-academic partnership. We will describe the innovative approach used by Project GRACE to develop an intervention to address individual and environmental/contextual factors that influence the spread of HIV.

Methods: The Project GRACE Consortium has employed a staged approach to intervention development that includes: 1)conducting focus group interviews to describe community members' perceptions of contributors to the spread of HIV; 2)conducting semi-structured interviews with community stakeholders to identify perceptions of the community needs, strengths and resources, and; 3)establishing baseline level of individual risk behaviors by surveying community members. We will pilot test the delivery of developed interventions within a lay health advisor framework. Each stage is directed by a research design committee (RDC) comprised of eight community members and five UNC representatives. The RDC reports monthly to a steering committee of community members who represent a range of institutions and constituencies and UNC representatives.

Results: Project GRACE has completed eleven focus groups using teams that include community members, and the RDC is beginning the analysis. Trained community members are currently conducting in-depth interviews with stakeholders.

Conclusion: A participatory approach to designing multilevel interventions can effectively include community members in all aspects of research design and implementation.

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14.  EPICC (Eastern Piedmont Coalition for Comprehensive Care): Using PRECEDE-PROCEED as a Model for Reducing AIDS-Related Mortality among Rurally-Loacted African American Women in North Carolina

Dinushika Mohottige, Michael Schwartz, and Jennifer Wieland MPH

Introduction: Studies have shown that adherence to ART (Anti-Retroviral Therapy) can significantly prolong life and reduce mortality due to AIDS-related illnesses. However, HIV-positive African American (AA) women living in rural North Carolina are less likely to adhere to ART and are dying at an accelerated rate compared to other populations.

Methods: By using PRECEDE-PROCEED to address issues surrounding access to healthcare and daily needs, physical and financial access to ART, adherence to ART, the negative stigma associated with HIV-positive status and self-efficacy to adhere to the ART regimen, we hope to address a prioritized health outcome and quality of life factors within the target population.

Results: The focus of the intervention is the operation of a co-located comprehensive care clinic in Edgecombe County, North Carolina. The clinic includes: a policy/lobbying arm; provision of transportation and physical access to the clinic and other services; internal and outreach HIV/AIDS education programs aimed at health professionals and the general population; comprehensive case management; and (ART) adherence self-efficacy strategy development.

Conclusion: Although co-located care facilities have proven to be very successful in treating HIV/AIDS and reducing mortality in both rural and urban settings, each component of this intervention is dependent on 1) securing a large, sustained budget to meet high costs, and 2) extensive coordination. However, the later, more debilitating stages of AIDS require the use of more expensive ARVs; therefore, the benefits of implementing this intervention outweigh the costs because currently underserved individuals in the target population will receive lower cost, timely, and sustained HIV/AIDS care and treatment.

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15.  HIV Risk Perceptions Among African American College Women in the South

Sarahmona M. Przybyla MPH, LaToya M. White, MPH candidate, Carol E. Golin MD

Introduction: Recent data continue to demonstrate an alarmingly disproportionate trend in HIV prevalence among minority women. Nearly half of all HIV infections occur among people under 25, with the majority of cases among females. In addition, the first documented HIV outbreak among college students occurred among African Americans in North Carolina which has alerted HIV researchers to the importance of college campuses as intervention sites.

Methods: The study's qualitative methodology used focus group discussions to explore HIV risk behaviors and their antecedents among college women. Eligible participants were African American females enrolled at the University of North Carolina. We conducted ten focus groups with 66 women, ages 18-32. These discussions were audiotaped, transcribed, and analyzed using theme analysis.

Results: The most commonly cited factors placing college women at risk for HIV included a sense of invincibility, promiscuity, serial monogamy, low self-esteem, alcohol and drug use, and an unbalanced African American female-to-male ratio on college campuses. Women believed that disproportionate HIV rates among African American women stem from a lack of communication between partners, relationship violence, overlapping sexual networks, incarceration rates among African American men, "down low" phenomenon, and hyper-sexualization of African American women in the media.

Conclusion: This study's findings will assist health educators in developing HIV prevention programs for minority college women that are cognizant of the context of sexual relationships and the interpersonal dynamics influencing communication between partners.

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16.  Is there a relationship between intimate partner violence and HIV status or HIV-risk among minority females in the U.S.?: A systematic literature review

Dieula Delissaint, MPH; Heather H. Honore, MSW; Joy L. Anderson, MS

Introduction: Intimate partner violence (IPV) and HIV are two of the most prevalent concerns affecting women in the U.S. The National Violence Against Women survey estimated 201,394 women were raped by an intimate partner. Women are twice as likely to be a victim of IPV as their male counterparts. Many of these women are living with HIV. To date, more than 40 million people are living with HIV/AIDS worldwide. The purpose of this systematic literature review is to explore the relationship between IPV and HIV risk/serostatus among minority females in the U.S.

Methods: Several electronic databases were accessed using key search terms HIV, female, and IPV. Inclusion criteria included English peer-reviewed, empirical studies performed in the U.S., and assessed the relationship between IPV and HIV. Fourteen published studies met the inclusion criteria. A coding system was then used to rank the methodological quality of each article.

Results: Findings included two studies reported no relationship between IPV and HIV+. However, these studies describe relationship between IPV and HIV- women experience more abuse than their HIV+ counterparts. One study reported IPV as a causal factor in HIV infection. Most studies reported that these variables were not correlated; however, some studies reported that IPV and HIV were correlated.

Conclusion: The burden of two co-occurring social and health issues in women is very disconcerting and troublesome. Based on this literature review, the relationship between HIV and intimate partner violence is inconclusive. Further studies are warranted to explore the relationship between HIV and IPV.

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17.  Beliefs About Reinfection among HIV-Positive Patients in the South: Does Race Matter?

Sarahmona Marie Przybyla

Introduction: Few existing studies examine beliefs about HIV reinfection among persons living with HIV/AIDS (PLWHA) and how such beliefs vary by racial group.

Methods: Using data from two clinical HIV prevention studies, we assessed racial differences in study one about beliefs in: 1) the concern of personal reinfection and 2) the general possibility of reinfection occurring for PLWHA. In study two, we assessed differences about beliefs in: 3) the personal likelihood of reinfection and 4) the harmfulness of reinfection to one's health.

Results: Studies one (n=234) and two (n=140) had similar demographics with a mean age of 43, approximately 60% males, two-thirds African American, and one-quarter White. In study one, 1) more than half of patients reported concern about reinfection (54%) and 2) few believed it is not possible to reinfect PLWHA (14%). We found no racial differences in concern about reinfection or belief in the possibility of reinfection. In study two, 3) one in five believed they are likely to be reinfected in the next year (22%) and 4) virtually all believed reinfection was harmful to their health (95%). While beliefs about the harmfulness of reinfection did not vary by race, Whites were more likely than African Americans to report likelihood of reinfection (p=.005).

Conclusion: Beliefs about reinfection did not vary by race, except for belief in the personal likelihood of reinfection. More than half the HIV-infected patients reported concern about reinfection, and almost all believed reinfection was damaging to their health. The next step for future researchers is to investigate how reinfection beliefs influence sexual risk behaviors among seroconcordant partners.

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18.  Use of the electronic Primary Care Research Network (ePCRN) to Create An Electronic Infrastructure for Patients at Risk for HIV/AIDS

Laura Marie Myerchin, MA

Introduction: LA Net is a practice based research network (PBRN) based in the University of Southern California that is committed to researching and transforming health disparities in Southern California. LA Net, as part of the National Primary Care Registry Pilot Project, is taking part in the electronic Primary Care Research Network (ePCRN). The ePCRN is funded by the Roadmap Initiative of the National Institutes of Health and administered by the Federation of Practice Based Research Networks. By electronically linking primary care practices, locally and across the country, through billing data, lab information and ICD-9 codes, the ePCRN creates a low cost infrastructure for electronic health records. LA Net is beta-testing the ePCRN in three community clinics in underserved areas of Los Angeles.

Methods: HIPAA compliant software has been developed that will screen de-identified billing data and ICD-9 codes for indicators of patients who are at-risk for later contracting HIV.

Results: The ePCRN will electronically link 3 community clinics in Los Angeles. Of these clinic's patients, 15% are African-American and 62% are Hispanic. A low-cost infrastructure will be created for these clinics to maintain electronic health records and improve their quality of care, specifically enabling improvement in quality of care for patients at risk of contracting HIV.

Conclusion: Often community clinics do not have the resources to establish and maintain an IT/electronic health record keeping system. The ePCRN provides a low-cost method. The ePCRN establishes an infrastructure to improve quality of care, particularly for diseases such as HIV/AIDS.

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19.  Sexual Risk Behaviors of Black Men Who Have Sex with Men (BMSM) and Black Men Who Have Sex with Men and Women (BMSMW)

Patricia Ann Clubb, PhD

Introduction: Men who have sex with men (MSM) are disproportionately affected by HIV/AIDS, particularly Black MSM (Blair et al., 2002; CDC, 2000; CDC, 2004). Black MSM are more likely than white MSM to report having had sex with women (Bingham et al., 2003; Montgomery et al., 2003). Men who conceal their sexual activity with other men from their female partners have been termed 'on the down low' in the popular media and have heightened concern about the role of this population in spreading the transmission of HIV/AIDS. This study investigates how Black men who have sex with men (BMSM) and Black men who have sex with men and women (BMSMW) differ in terms of risky sexual behaviors.

Methods: Analyses are based the 2001 HBCU Substance Use Survey, in which freshmen enrolled at 34 HBCUs completed self-administered surveys. The analytic sample includes 130 Black freshmen who reported same-gender sex, 31 who indicated only same-gender sex (24%) and 99 who were classified as men who had sex with both men and women (76%).

Results: Descriptive analyses were conducted given that the small sample size precluded in-depth analyses. The percentages of respondents by same-gender group status are as follows: always used a condom (57% of BMSM and 56% of BMSMW), condom use at last intercourse (68% of BMSM and 65% of BMSMW), never had an STD (91% of BMSM and 80% of BMSMW), and ever tested for HIV (62% of BMSM and 58% of BMSMW).

Conclusion: Implications of this research will be discussed.

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20.  Sister Connect: A Peer Education Treatment Program

Fiodaliza Gomez, BA and Rose Jean Baptiste, MPH, CHES

Introduction: For the last 18 years, New Jersey Women and AIDS Network (NJWAN) has provided African American and Latino HIV infected women, living in areas with high prevalence of HIV, with educational and risk reduction skills. Needs assessments demonstrated that there is significant need for education and skills building among HIV infected women of color in understanding HIV basics, treatment, adherence issues and empowerment. The objectives were to increase the prevention skills and knowledge base of HIV infected women; improve compliance and adherence to treatment and to ultimately reduce the spread of HIV/AIDS among women.

Methods: The State (DHAS) funded prevention program was implemented over a two-year period, servicing 150 women. Groups of 8-12 women enrolled in eight, two-hour skills-building training sessions. Pre/post tests were utilized to measure increase in knowledge base. Journaling and client evaluation forms were used to document personal attitudes, thoughts and feelings during the Sister Connect experience regarding motivation to change HIV risk behavior.

Results: Outcome measures for the Sister Connect program were:
  • 80% of the women increased their knowledge of HIV/AIDS,
  • 65% of the participants self reported intentions to reduce participation in sexual behaviors that may lead to transmission of HIV/AIDS,
  • 80% of the participants know and understand the importance of compliance and adherence,
  • 80% of the women have the skills to educate their peers.

Conclusion: Women-specific, HIV/AIDS prevention/education programs are both urgently necessary and efficient in areas of high prevalence.

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