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Introduction: Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high‐impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. Discussion: A group of IS experts affiliated with NIMH‐funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH‐related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence‐based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. Conclusions: HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high‐impact HIV/MH implementation research. [ABSTRACT FROM AUTHOR]

Black women in the United States continue to be disproportionately affected by the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) epidemic. HIV/AIDS activism among Black women for Black women may be one solution to reduce the disparate rates of HIV/AIDS among Black women. However, little is known about what processes and experiences prompt Black women to participate in HIV/AIDS activism. In this paper, I aim to identify mechanisms of empowerment for Black women to engage in HIV/AIDS activism. I draw upon empowerment theory as a theoretical framework to guide analysis of the literature and to offer a strengths‐based perspective on Black women's efforts to reduce the spread of HIV/AIDS. An extensive literature search was conducted to identify studies of Black women's participation in HIV/AIDS activism. The search yielded 11 studies that were included for review. Synthesis of the literature indicated the following analytic themes as mechanisms of empowerment for Black women to participate in HIV/AIDS activism: relationships and interactions with others, critical awareness, self‐reflection, and spirituality. Article limitations, suggestions for future research, and implications for social change are also discussed. Overall, findings from this study suggest that there are unique mechanisms that facilitate psychological empowerment and prompt Black women's entry into HIV/AIDS activism. Highlights: A comprehensive review of 11 articles on Black women's participation in Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) activism. Explores how Black women become psychologically empowered to become HIV/AIDS activists. Many mechanisms of empowerment for Black women engaged in HIV/AIDS activism are communal. Emphasizes psychological empowerment as not only an intrapsychic process. [ABSTRACT FROM AUTHOR]

This paper explores beliefs revealed in classroom discussions at a majority black university in the United States that HIV/AIDS is a form of genocide. The perspective of the sociology of knowledge, a critique of the realist interpretation of science, argues that these beliefs are rational given the students' social relationship to the scientific establishment. Paolo Friere's philosophy of popular education and the anthropological method teach us to take these beliefs seriously. The white instructor's own gaps in knowledge counsel humility in teaching about the origins of HIV to students of colour. Finally, the paper describes how the students and the instructor were able to find a common ground in the interpretation of AIDS as a man-made epidemic. [ABSTRACT FROM AUTHOR]

In 1998, the US Supreme Court first held that asymptomatic HIV infection constituted a disability when it ruled on the case of Bragdon v. Abbott. The use of yet another label (disabled) to identify women living with HIV has been rarely (if ever) questioned. While we do value the use of this label as an anti-discriminatory strategy, we believe that there is a need to examine how language and more specifically, the use of words such as disability, limitation, and impairment may create new forms of identities for women living with HIV. Using this legal case as a starting point, the goal of this paper is to critically examine the 'fabrication' of asymptomatic HIV infection as a disability. Grounded in a feminist poststructuralist perspective, this paper exposes the relationship between language, social institutions, subjectivity, and power in the construction of difference. By doing so, it addresses the identification of women living with HIV/AIDS as disabled and the self-differentiation process that they must go through in order to live as normally as possible. [ABSTRACT FROM AUTHOR]

Intravenous drug users may hold the key to the future epidemic of AIDS in the United States. Although gay men have changed their social norms to lower the risk of AIDS, such change will be more difficult to bring about in drug users. Several intervention efforts have been developed and are being evaluated. The psychoeducational workshops developed by the authors have shown promise in random-assignment trials with drug abusers in residential treatment, methadone maintenance, and outpatient detoxification. By orientation and training, community psychologists are uniquely qualified to develop, evaluate, and disseminate AIDS prevention programs to change community norms among drug users. [ABSTRACT FROM AUTHOR]

Objective: People living with HIV have high rates of obesity and obesity‐related comorbidities. Our study sought to evaluate weight trajectory in a retrospective cohort of people living with HIV and matched HIV‐negative veterans (controls) and to evaluate risk factors for weight gain. Methods: This was a retrospective database analysis of data extracted from the VA Corporate Data Warehouse that included people living with HIV (n = 22 421) and age‐matched HIV‐negative controls (n = 63 072). The main outcomes were baseline body weight and weight change from baseline at 1, 2, and 5 years after diagnosis (baseline visit for controls). Results: Body weight at baseline was lower in people living with HIV than in controls. People living with HIV on antiretroviral therapy (ART) gained more weight than did controls. In a sub‐analysis of ART‐exposed people living with HIV, age >50 years, African American race, body mass index (BMI) <25, CD4 ≤200, and HIV diagnosis year after 2000 were associated with more weight gain at year 1. Nucleoside reverse transcriptase inhibitors (NRTI) plus non‐NRTIs (NNRTIs) were associated with less weight gain than NRTIs plus protease inhibitors, NRTIs plus integrase inhibitors, or NRTIs plus other agents at year 1. Conclusions: Among US veterans, those living with HIV had lower rates of obesity than age‐matched HIV‐negative controls; however, primarily in the first 2 years after starting ART, people living with HIV gained more weight than did controls. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on the progress of health services research in the U.S. Significance of the success and popularity of the red AIDS ribbon symbol; Use of an evocative image of a commitment beyond identifying a need; Role in galvanizing public opinion; Need to work together to ensure that health services research addresses the issues and questions that will lead to change; Evidence linking measurement to improvement.

This paper shows how federal resources and mandates concerning the HIV epidemic combined with the political economy and political culture of Dallas, Texas to create a distinctive local HIV/AIDS service system. The infusion of federal funds allowed nonprofit organizations to expand their services, especially in the areas of economic assistance and social services. In additions, funding to minority agencies and services to minority clients were expanded. While the fund administration structure imposed on the nonprofit providers necessitated greater administrative efforts on their part and enhanced the power of local government, it also greatly improved coordination. [ABSTRACT FROM AUTHOR]

Focuses on the 18th Annual Symposium on Nonhuman Primate Models for AIDS held in Madison, Wisconsin during October 4-7, 2000. Session papers from the 18th Symposium; Schedule of the 19th Symposium.

This article tests whether programs that provide housing assistance to homeless people can reduce chronic homelessness. I analyze data from the Department of Housing and Urban Development for 130 communities across the United States over the period 2005 to 2007. Because the amount of federal money allocated to a community to combat homelessness may depend on unobserved characteristics of that community, I estimate a fixed-effects model that estimates the effect of new federal homeless funding on chronic homelessness. I find that the first-year cost of moving one chronically homeless person into permanent supportive housing is $55,600. An analysis of new funding to specific types of homeless programs indicates that programs that provide long-term housing and services to homeless people with disabilities drives this relationship. [ABSTRACT FROM AUTHOR]

By 2015, most of the people living with the human immunodeficiency virus ( HIV) in the United States will be aged 50 and older. Many will have known their HIV status for at least a decade, and most will have received antiretroviral therapy for some, if not all, of the time since testing positive. As these individuals advance in years, they frequently acquire diseases more commonly associated with aging than with HIV. This represents a unique challenge for today's medical providers. Although these individuals may appear considerably older than their chronological age, they are typically too young to see a geriatrician. An HIV specialist, although knowledgeable in the nuances of antiretroviral therapy, may be less comfortable managing multiple age-related illnesses. Similarly, a geriatrician experienced in managing multiple, age-related conditions may be less familiar with adjusting HIV-related therapies. In this era of caring for older adults with HIV, these two medical disciplines are finding they have much to learn from each other. [ABSTRACT FROM AUTHOR]

Aim Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH. [ABSTRACT FROM AUTHOR]

Objective: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. Design: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Sample and Measurements: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. Results: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. Conclusions: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs. [ABSTRACT FROM AUTHOR]

Background: The burden of HIV/AIDS has not been described for certain rural areas of the United States (Appalachia, the Southeast Region, the Mississippi Delta, and the US-Mexico Border), where barriers to receiving HIV services include rural residence, poverty, unemployment, and lack of education. Methods: We used data from Centers for Disease Control and Prevention (CDC) HIV/AIDS Reporting System to determine the rates of HIV (data from 29 states) and AIDS diagnoses (data from 50 states and the District of Columbia) in 2000 for the 4 regions by demographic and residential (rural and economic indicators of county of residence) characteristics. Results: The rate of HIV diagnoses in 2000 was lower in rural areas (7.3 per 100,000) than in suburban (8.6 per 100,000) or urban areas (22.7 per 100,000). The highest race-adjusted rate was observed for the US-Mexico Border (21.1 per 100,000), followed by the Mississippi Delta (17.3 per 100,000), Southeast Region (14.7 per 100,000), and Appalachia (10.4 per 100,000). Heterosexually acquired HIV was more common in the Southeast Region and the Mississippi Delta than elsewhere. The Mississippi Delta had the highest proportion of HIV diagnoses among young people aged 13-24 years (18.4%). More than three quarters of people diagnosed with HIV in the Mississippi Delta and the Southeast Region were black, and diagnosis rates were higher among blacks and Hispanics than whites in all regions. The distribution of demographic and residential characteristics among people with AIDS was similar to that of all people with a diagnosis of HIV. Conclusion: Strategies are needed to reach the populations of these areas to reduce transmission of HIV. [ABSTRACT FROM AUTHOR]

This study examines how drug injection and needle sharing propensities respond when a needle exchange program (NEP) is introduced into a city. I analyze 1989–1995 Drug Use Forecasting data on adult male arrestees from 24 large U.S. cities, in nine of which NEPs opened during the sample period. After controlling for cocaine and heroin prices, AIDS prevalence, fixed effects for cities and years and city-specific time trends, the model indicates that the presence of a NEP is associated with declines of 13 percent in drug injection and 20 percent in needle sharing among drug injectors. © 2005 by the Association for Public Policy Analysis and Management [ABSTRACT FROM AUTHOR]

Needle exchange programs exist in every major population area in the United States and in many other countries. Some operate legally under emergency health decrees issued by local departments of health, with the stated intention of risk reduction through the removal of used injection equipment from use by injection drug users. It is theorized that this results in a reduced transmission of human immunodeficiency virus, hepatitis, and, possibly, other blood-borne diseases. Needle exchange programs also offer access to drug treatment programs for the participants. It is a difficult but necessary task to evaluate these programs. This article examines examples of evaluations attempted in the past and discusses the challenges of such evaluations. Experimental evaluations, economic program analysis, legal aspects, and risk–benefit assessment along with ethical aspects are considered. An outline of program evaluation is proposed. Needle exchange programs offer an opportunity to encourage risk reduction and to offer counseling and access to health care for individuals at high risk. It is essential that such programs demonstrate their effectiveness. Assumptions of efficacy are insufficient for health care in the twenty-first century. [ABSTRACT FROM AUTHOR]

Abstract Mycobacterium tuberculosis (MTB) is an important problem for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. This study investigated whether all cases of MTB reported to the HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information Management System (TIMS) to determine the sensitivity of TIMS and the predictive value of HARS. We found 262 total MTB cases registered in HARS. Of these, 145 (55%) were included in the TIMS. Thirty-eight of the remaining 117 were caused by mycobacteria other than TB leaving 79 for investigation. Chart review of the 79 revealed 16 cases of MTB. Sensitivities and predictive values were calculated first including unknown/unreported group as being MTB-positive and the second including this group as being MTB-negative. Sensitivities for TIMS were 83 and 90%, respectively, and predictive values for HARS were 68 and 63%, respectively. The fact that there were at least 16 unreported cases of MTB has significant public health implications for TB control in Missouri. Public health nursing could work with HARS surveillance staff to help improve the accuracy of case finding and reporting. By whatever means necessary, communications between the TB and HIV programs within the Missouri Department of Health should be enhanced. [ABSTRACT FROM AUTHOR]

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Focuses on the types of support as a strategy for coping with AIDS-related stresses and haemophilia in the U.S. Integration of social support into a social network; Increase on the prevalence of HIV infection; Severity of haemophilia according to the statistics from the World Health Organization.

The article focuses on the question of AIDS from the perspective of the local government workplace. AIDS epidemic is becoming the most pressing issue facing the American workplace. Of the more than 210,000 people in the United States that have contracted AIDS, 98 percent are between 20 and 65 years of age and approximately 80 percent are in the prime working ages of 24 to 40. Government must take care of its own work setting, especially if it expects the private sector to do the same. Yet in the sixteenth year of this crisis, many governmental units are die prepared to deal with the consequences of AIDS. A recent study of local government preparedness, for example, found that only 10 percent of municipalities had a plan to deal with AIDS in their own work setting. These two factors, unprepared and underestimation of the impact of the epidemic, spell potential disaster for the public-sector workplace. There are many reasons why employers should institute a plan for managing the workplace ramifications of AIDS.

Addresses the issue of the proposed mandatory AIDS testing of applicants for marriage licenses in the United States. Desirability of premarital testing; Relative costs and benefits of mandatory versus voluntary testing regimes; Arguments presented by the opponents of premarital mandatory AIDS testing.

Psychotherapy use and depression among AIDS caregivers were examined with two waves of data from a panel survey of caregivers in Los Angeles and San Francisco (N = 472). Both were studied as outcomes driven by an array of determining factors (e.g., caregivers and care recipient health; care-related stress). AIDS caregivers exhibited relatively high rates of psychotherapy use (31% reported using at the time of initial interview). Care-related stress did not significantly predict the use of psychotherapy in either the baseline or longitudinal analyses. Instead, the health status, relationship, and living arrangements of the caregiver and the care recipient were the important correlates of psychotherapy use. Factors affecting depression over the course of caregiving were caregiver health status and care-related stress, particularly secondary stressors which arise as a consequence of, but not directly due to, caregiving. Thus, although the stressors of caregiving do not prompt the use of psychotherapy, they clearly led to an elevation in symptoms of depression, which is associated with psychotherapy use. Findings regarding the relation of psychotherapy to changes in depression over the course of caregiving also are discussed. [ABSTRACT FROM AUTHOR]

Highlights the 16th Symposium on Nonhuman Primate Models for AIDS in Atlanta, Georgia on October 7-10, 1998. Attendance of virologists, pathologists, veterinarians and scientists; Discussions on the occurrence of immunodeficiency syndrome in macaques; Use of non-human primates as the appropriate animal model for the study of host-virus relationships and diseases.