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Kirstin Kielhold,1,2 Erik D Storholm,2,3 Hannah E Reynolds,2 Wilson Vincent,4 Daniel E Siconolfi,3 Susan M Kegeles,5 Lance Pollack,5 Chadwick K Campbell1 1Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA; 2School of Public Health, San Diego State University, San Diego, CA, USA; 3RAND Corporation, Pittsburgh, PA, USA; 4Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; 5Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USACorrespondence: Kirstin Kielhold, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA, Tel +12093292720, Email kkielhold7624@sdsu.eduBackground: Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South.Methods: Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis.Findings: Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients’ needs, and making patients feel “seen”. Less supportive providers were described as making their patients “feel like a number” and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care.Discussion: We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.Plain Language Summary: Black sexual minority men in the Southern region of the United States experience a disproportionate burden of HIV. While the role of patient-provider relationships for HIV care engagement has been shown in some contexts, less is known about the specific role of supportive healthcare providers in the care engagement among Black sexual minority men living with HIV in the United States South.Semi-structured qualitative interviews were conducted among Black sexual minority men living with HIV in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement.We found that supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Our findings suggest the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers.Keywords: HIV, black sexual minority men, care engagement, patient-provider relationship

Background: Comprehensive HIV prevention and care strategies focused on MSM and transwomen (TW) in Peru remain elusive. We conducted a trial of a combination prevention strategy including establishing a community [...]

Objectives. We compared the influence of awareness of the Tuskegee Syphilis Study and the presidential apology for that study on the willingness of Blacks, non-Hispanic Whites, and Hispanics to participate in biomedical research. Methods. The Tuskegee Legacy Project Questionnaire was administered to 1133 adults in 4 US cities. This 60-item questionnaire addressed issues related to the recruitment of minorities into biomedical studies. Results. Adjusted multivariate analysis showed that, compared with Whites, Blacks were nearly 4 times as likely to have heard of the Tuskegee Syphilis Study, more than twice as likely to have correctly named Clinton as the president who made the apology, and 2 to 3 times more likely to have been willing to participate in biomedical studies despite having heard about the Tuskegee Syphilis Study (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.4, 6.2) or the presidential apology (OR = 2.3; 95% CI = 1.4, 3.9). Conclusions. These marked differences likely reflect the cultural reality in the Black community, which has been accustomed to increased risks in many activities. For Whites, this type of information may have been more shocking and at odds with their expectations and, thus, led to a stronger negative impact.

Objectives. We compared the influence of awareness of the Tuskegee Syphilis Study and the presidential apology for that study on the willingness of Blacks, non-Hispanic Whites, and Hispanics to participate in biomedical research. Methods. The Tuskegee Legacy Project Questionnaire was administered to 1133 adults in 4 US cities. This 60-item questionnaire addressed issues related to the recruitment of minorities into biomedical studies. Results. Adjusted multivariate analysis showed that, compared with Whites, Blacks were nearly 4 times as likely to have heard of the Tuskegee Syphilis Study, more than twice as likely to have correctly named Clinton as the president who made the apology, and 2 to 3 times more likely to have been willing to participate in biomedical studies despite having heard about the Tuskegee Syphilis Study (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.4, 6.2) or the presidential apology (OR = 2.3; 95% CI = 1.4, 3.9). Conclusions. These marked differences likely reflect the cultural reality in the Black community, which has been accustomed to increased risks in many activities. For Whites, this type of information may have been more shocking and at odds with their expectations and, thus, led to a stronger negative impact. (Am J Public Health. 2008;98:1137-1142. doi:10.2105/AJPH.2006.100131) [ABSTRACT FROM AUTHOR]

Young people constitute a priority for sexual health research, policy and planning. Many studies, however, regard youth as a homogeneous group defined by developmental stages and their problems as inherent rather than factors resulting from structural vulnerability. Ethnographic data from this study provided strong evidence of the inappropriateness, in prevention interventions, of the concept of 'young people' as a group defined only by age and gender. When incorporating social resources and support into the analysis, specific segments of youth with diverse sexual practices and health seeking behaviours emerge. Thus, although most young people in urban areas show a similar level of HIV/STI knowledge, their exposure to risk varies according to their living conditions. Two population segments - "street guys" and "fast girls" - identified as vulnerable for sexual risk, are characterized. Both groups hang out on the streets, and most are involved in using alcohol and drugs, and/or practicing transactional sex. This study provided evidence for the need of various approaches according to level of poverty and social vulnerability in order to develop more effective HIV/AIDS and STI prevention programs to meet the needs of young men and women in low-income areas. [ABSTRACT FROM AUTHOR]

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness. [ABSTRACT FROM AUTHOR]

We examined correlates of condom use among heterosexual whites, blacks, and Hispanics (ages 20-45 years) with an human immunodeficiency virus (HIV) risk factor in a community-based longitudinal sample (San Francisco; n = 716. Lag models were used to examine hypothesized antecedents of condom use at wave 2. High levels of condom use were associated with labeling one's sexual behavior as risky for HIV infection, high levels of condom enjoyment and commitment to use condoms, good sexual communication practices, gender (trend), and marital status. The results support the need for wide-ranging intervention programs that stimulate people to make personal risk assessments, teach basic sexual skills, and direct those in need of intensive help to appropriate agencies. [ABSTRACT FROM AUTHOR]

This paper deals with some practical implications of the present research, some gaps in the current research, and some future directions for social research in fluoridation. The articles reported are a beginning of research on why fluoridation referenda have succeeded and why they have failed. They document certain occurrences, and suggest hypotheses for further study. Unfortunately for the practitioner, these reports do not yet present any clear answer on how to win a referendum. While future research will undoubtedly continue to emphasize understanding rather than action, there seems reason to be optimistic that help for the practitioner will be one of the eventual by-products.

Research indicates that boys' cigarette use has declined nationwide, but the total tobacco use of boys may actually have remained high because of substantial use of smokeless tobacco (snuff). A random sample of boys and girls in grades 7 to 12 from 59 Connecticut towns was surveyed about. Although girls smoked more cigarettes per day, boys' total daily tobacco use was higher than that of girls in grades 7 through 9, and only slightly lower in grades 10 through 12.