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BACKGROUND: HIV stigma is widely regarded as a major obstacle to effective HIV prevention, risk reduction, testing, and treatment. Research is urgently needed to anticipate, understand, and combat HIV stigma in the African American cultural context because African Americans have the highest HIV incidence, HIV/AIDS prevalence, and HIV mortality. PURPOSE: The purpose of this analysis was to explore African American women's narratives of living with HIV to understand how they experienced and responded to HIV stigma. METHOD: Twenty-nine HIV-infected African American women participated in this longitudinal qualitative study. Each narrated her life since HIV diagnosis in ten open-ended interviews conducted over the course of two years. A multi-staged narrative analysis was used. FINDINGS: HIV stigma, which these African American women experienced on multiple levels, manifested internally as existential despair, socially as shunning and callousness, and institutionally as disregard. While participants were constrained by this multi-layered hegemonic cultural negativity about HIV, they refused to be determined by it. Their stories demonstrate how they resisted stigma. Over time, by enlisting support, facing the illness, disclosing only at strategic times, redefining stigma as ignorance, and becoming advocates, they were able to challenge and oppose the shame and discredit that HIV infection had brought into their lives. CONCLUSION: The elements of stigma resistance described in this study may be starting points for designing participatory interventions for and with African American women living with HIV. [ABSTRACT FROM AUTHOR]

A major shortcoming to the understanding and development of HIV/AIDS programs to mitigate social stigma is the paucity of research pertaining to how young people in sub-Saharan African countries perceive those infected with HIV, and how these stigmatizing attitudes are formed, projected and reinforced. The purpose of this study was to examine stigmatizing attitudes toward people living with HIV/ AIDS among young people in Swaziland, southern Africa. A purposive convenience sampling provided urban and rural data for this crosssectional survey. Participants included 941 secondary school students attending four co-educational public schools in Swaziland. Data were collected and analyzed on individual and environmental related factors with students' stigmatizing attitudes toward people with HIV/AIDS as outcome variable. Findings from the study suggest that greater HIV/AIDS knowledge and increased peer influence were associated with lower stigmatizing attitudes. Perceived susceptibility was associated with increased stigma toward people living with HIV/AIDS. Both individual and environmental factors contributed to explaining the variance in social stigma; individual factors accounted for the largest amount. A better understanding of the factors associated with social stigma could assist healthcare and social workers to develop appropriate programs to reduce HIV/AIDS related stigma. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe: (a) development and implementation of an urban outreach health program for Latino immigrants; (b) nurse-community-health advocate (CHA) partnership roles in primary health care delivery, and (c) lessons learned from these activities over 7 years in urban community settings. METHODS: Descriptive study of a community-based health project in a large Midwestern American city. Information was gathered from participants and staff, from observing staff, and from a variety of sources to describe the program and its individual, family, and community effects. FINDINGS: Major findings pertain to the project team's ability to address the health promotion needs of Latino immigrant families and to successfully incorporate CHAs in planning and implementing the program. CHAs were a 'bridge' between health programs and the community, promoting cultural sensitivity. CHAs and nurses provided a range of services including health education and promotion, outreach through home visits, assessment of family needs for referrals to appropriate resources, and follow-up support. CONCLUSIONS: The nurse-CHA team was an effective strategy for promoting Latino immigrant families' access to needed health care. This framework allowed for flexibility in assisting clients of different cultural backgrounds to obtain appropriate health care. [ABSTRACT FROM AUTHOR]