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Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Roger's diffusion theory and Rutten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention. (Contains 3 tables and 1 figure.)

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

Community-based organizations (CBOs), particularly minority-based CBOs, are instrumental in the delivery of HIV/AIDS prevention programs and services. Despite a tremendous need, many CBOs lack the capacity to plan, implement, and evaluate targeted prevention interventions to serve culturally diverse populations. This article describes a comprehensive, innovative curriculum for building capacity within CBOs providing HIV prevention programming. An overview of the process through which the Centers for Disease Control and Prevention/Association of Schools of Public Health Institute for HIV Prevention Leadership evolved is discussed. The development of the curriculum occurred in four phases: needs assessment, curricular design, implementation, and evaluation. A description of the Institute's evaluation strategies and procedures are described. Selected preliminary evaluation results from two cohorts of participants indicate significant knowledge gains and high levels of satisfaction with the Institute sessions, assignments, and faculty. The Institute's model shows promise for the provision of capacity building education at the individual and organizational level for community-based professionals implementing HIV prevention programs.

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be "stupid" for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans. (Contains 1 table.)

Reports a random-digit-dialed telephone survey in a conservative southern state that examined the level of support for sexuality education in public schools. Surveys of 534 registered voters indicated that most supported sexuality education, instruction on many sexuality education topics, and instruction at all grade levels. The paper presents characteristics of opponents to and supporters of sexuality education. (SM)

Collaboration between schools of public health and communities is essential to creating healthier communities. Community-Campus Partnerships for Health has established a policy agenda that recognizes the importance of supporting the […]

Six focus groups were conducted in South Carolina with African American women (n = 42) aged 19-51 years to identify factors that influence physical activity. Transcripts were analyzed using NUD*IST. Cultural influences were seen as more important in determining the type of physical activity than its level. Barriers to and enablers of physical activity were identified in the social and physical environments, as were policy issues affecting physical activity in the community and at the work site. Potential community and work site interventions were suggested. Child care and monetary costs were frequently cited as barriers to physical activity. KEYWORDS. Physical activity, women's health, social ecology, intervention, culture, recreation, African American

Purpose: This exploratory study used focus groups to examine attitudes and beliefs of HIV-infected African American women of child-bearing age about pregnancy and antiretroviral therapy. Methods: A convenience sample of thirty-three African American women of child-bearing age participated in five focus groups. Attitudes and beliefs about pregnancy decisions and the use of antiretroviral therapy during pregnancy were examined. Results: Many of the women in this study living with HIV remained committed to having children and expressed confusion about their chances of transmitting the virus to their children. Conclusions: Health care providers must be aware of these concerns and convey clear and accurate information through the most readily accepted channels. Participants suggested that messages about these issues be conveyed by other women living with HIV who have faced these same decisions. KEYWORDS. Antiretroviral Therapy, HIV/AIDS, pregnancy

Women's perceptions of alternative therapies available for managing symptoms related to menopause and to the need for hysterectomy were explored. Data are reported from 17 focus groups of periand menopausal aged women (n = 82) living in two southern U.S. coastal counties. Analysis showed that emergent themes did not vary by race or surgery experience. Herbal preparations, vitamin supplements, 'healthy living' (diet & exercise), and mind/body practices (prayer & 'mental healing') were mentioned as possible alternatives for managing symptoms. Participants more frequently identified 'other' conventional medical approaches-prescription medication, laser surgery, dilation and currettage, and 'watchful waiting'--as alternatives to hysterectomy. Alternative therapies are linked to women's desire to gain control over their own health care decisions and practices. KEYWORDS. Menopause, hysterectomy, alternative therapies, women and aging, health and aging, reproductive health

Medicaid waivers play an important role in the health policy process. Various health care policy initiatives have encouraged states to experiment with their Medicaid programs by expanding coverage to populations not traditionally covered by Medicaid, or by delivering Medicaid services in non traditional ways. Lessons learned by individual states' Medicaid waivers could be an important part of the health care reform debate. This paper presents an evaluation of a Medicaid waiver operating in South Carolina. The South Carolina Community Long-term Care Waiver for the Elderly and Disabled is evaluated for cost effectiveness, quality of care, and client satisfaction. This evaluation shows that the waiver is highly effective in offering individuals who are medically and financially eligible for Medicaid supported nursing home care a viable, cost effective, high quality alternate to institutionalization.

This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (< age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts., For the past two decades, sexual intercourse among U.S. adolescents has resulted in increases both in sexually transmitted diseases (STDs) and unintended pregnancies.[1] A greater proportion of adolescent females are [...]

This study examines the association between knowledge of acquired immune deficiency syndrome (AIDS) and skill among social workers in South Carolina and attitudes toward people with human immunodeficiency virus (HIV) and AIDS. A stratified random sampling method was used to obtain a representative sample of social workers in South Carolina. Findings show that AIDS-related knowledge and skill were significantly associated with improving the general attitudes of social workers toward HIV/AIDS clients. In addition to knowledge and skill-related measures, other significant covariates of attitudes include levels of contact with HIV/AIDS clients and sensitivity to minorities. As with previous studies, demographic variables such as age and gender were not found to be significantly related to variations in attitudes toward HIV/AIDS clients. Furthermore, locality of practice and supervisory position did not significantly correlate with attitudes. The implications of these findings for social services agencies are discussed., The acquired immune deficiency syndrome (AIDS) epidemic will pose a significant challenge to social workers in the 1990s and beyond. Between 1980 and 1990 more than 100,000 Americans died of [...]

This research explored the diffusion process of distance education in schools of public health to determine best practices in the planning and implementation of future programs. The researcher traced the diffusion process by utilizing a multiple-case study methodology using a semi-structured interview to collect the perceptions of Distance Learning Coordinators within five schools of public health and a monitor survey of each program's website to corroborate interview data. The research focused on the implementation of programs and explored why schools of public health developed distance education programs; how schools of public health restructured to facilitate development and implementation of distance education programs; and how distance education was refined to meet the needs of the schools of public health.

Examined barriers to learning in adult students (N=111) using the Adult Student Survey. Results indicated that in many cases students were able to predict barriers before enrolling. Lack of time was the most difficult barrier to anticipate correctly. (JAC)

In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%,n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study. [ABSTRACT FROM PUBLISHER]