Search

This analysis of 84 interviews with female Black Church leaders and members from Atlanta, GA, examined how women in Black churches construct definitions of, and identities in relation to, HIV narratives about men on the down low. We analyse these narratives as collective memories, through the theoretical lens of memory and trauma studies, by identifying how women understand themselves as the victims of men on the down low transmitting HIV; describe this as a painful experience; make public claims about this experience; and draw on theological understandings to make these claims. The narratives articulate how Black communal modes of meaning making have been disrupted by the HIV epidemic and assign responsibility for HIV transmission to men on the down low, who are perceived to be engaged in risky sexual behaviour. We discuss these results in relation to HIV education and prevention and suggest health educators can engage Black church leaders by understanding these narratives as forms of countermemory. [ABSTRACT FROM AUTHOR]

This study examined the reliability of an inventory measuring AIDS-related knowledge among 553 black drug users. Data were collected from a socially high-risk community in Birmingham, Alabama. The KR-20 reliability scores were computed from the inventory for each drug-use group. The KR-20 reliabilities ranged from .39 to .57. These findings may suggest that the inconsistent reports of the predictive power of AIDS knowledge among drug users reported in previous studies might be related to the low internal consistencies of the inventory.

Consistent condom use may be fostered through community HIV risk-reduction programs and interventions. A total of 100 low-income, heterosexual African-American women living in the Bayview-Hunter's Point neighborhood of San Francisco completed an initial in-depth interview and a three-month follow-up. A social skills intervention program was administered that advised women on how to manage risky situations that could expose them to HIV infection, such as a partner not using a condom. The type of intervention was based on the assumption that African-American women may lack power in relationships which could contribute to a lack of caution in sexual situations. Ethnic and gender pride, as well as HIV risk-reduction, sexual self control, sexual assertiveness and communication were emphasized. Overall, 47% of the women reported consistent use of condoms after the intervention, compared to 35% reporting condom use before the program., Objective.--To evaluate the efficacy of a community-based social skills human immunodeficiency virus (HIV) prevention intervention to enhance consistent condom use. Design.--A randomized, single-blind controlled trial. Setting.--Bayview-Hunter's Point neighborhood of San Francisco, Calif, a predominantly African-American community that is economically disadvantaged. Participants.--A sample of 128 sexually active, heterosexual, African-American women 18 through 29 years of age was recruited using street outreach techniques. Participants completed a structured baseline interview; 100 women (78.1%) completed 3-month follow-up interviews. Intervention.--Women randomized to the social skills intervention completed five sessions that emphasized ethnic and gender pride, HIV risk-reduction information, sexual self-control, sexual assertiveness and communication skills, proper condom use skills, and developing partner norms supportive of consistent condom use. Women randomized to the HIV education condition participated in a single session that provided HIV risk-reduction information. Women randomized to the delayed HIV education control condition received no HIV risk-reduction information until all follow-up interviews were completed. Main Outcome Measures.--Consistent condom use, HIV risk-reduction knowledge, sexual self-control, sexual assertiveness, sexual communication, and partner norms supportive of consistent condom use. Results.--Compared with the delayed HIV education control condition, women in the social skills intervention demonstrated increased consistent condom use (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.03 to 4.15; P=.04), greater sexual self-control (adjusted OR, 1.9; 95% CI, 1.00 to 3.60; P=.05), greater sexual communication (adjusted OR, 4. 1; 95% CI, 1.67 to 1 0.01; P=.002), greater sexual assertiveness (adjusted OR, 1.8; 95% CI, 1.01 to 3.27; P=.05), and increased partners' adoption of norms supporting consistent condom use (adjusted OR, 2. 1; 95% CI, 1.08 to 3.87; P=.03). No statistically significant differences in outcome variables were observed between the HIV education condition relative to the delayed HIV education control condition. Conclusion.--Community-based HIV risk-reduction programs that are gender relevant and culturally sensitive and provide social skills training can effectively enhance consistent condom use. (JAMA. 1995;274:1271-1276)

Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient–provider race concordance, we conducted this study to assess if patient–provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient–provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient–provider race combinations [White–White: B = −0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (−1.161 to −0.624); Black patient–White provider: B = −0.19, SE = 0.06, p = 0.003, 95% CI (−0.309 to −0.062); and Black–Black: B = −0.30, SE = 0.14, p = 0.037, 95% CI (−0.575 to −0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White–White: B = −0.42, SE = 0.07, p = 0.000, 95% CI (−0.552 to −0.289); Black patient–White provider: B = −0.17, SE = 0.03, p = 0.000, 95% CI (−0.232 to −0.106); and Black–Black: B = −0.18, SE = 0.06, p = 0.002, 95% CI (−0.293 to −0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White–White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient–provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes. [ABSTRACT FROM AUTHOR]

This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables—protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH. [ABSTRACT FROM AUTHOR]