Aaron G. Buseh

Relationship of Symptoms, Perceived Health, and Stigma With Quality of Life Among Urban HIV-Infected African American Men

OBJECTIVESnTo explore the relationship of symptom prevalence and intensity, perceptions of health, and stigma on quality of life (QOL) among HIV-infected African American men.nnnDESIGNnCross-sectional correlational descriptive study.nnnSAMPLESnThe sample consisted of HIV-infected African American men (N=55), all urban, age range 23-66 years (M=48.84, SD=7.67), average length of time since HIV diagnosis 10.79 years (SD=6.4).nnnMEASUREMENTSnA questionnaire consisting of 5 instruments was used: (a) sociodemographic characteristics, (b) Holzemer Signs and Symptom Checklist for HIV, (c) perceptions of health, (d) Berger HIV Stigma Scale, and (e) Holmes HIV/AIDS-Targeted Quality of Life Scale.nnnRESULTSnPrevalent symptoms were fatigue (98%), fear (92.7%), shortness of breath (92.7%), gastrointestinal upset (85.5%), numbness (80.0%), and headache (76.4%). Symptoms with the highest intensity were gastrointestinal upset, body changes, fear, and fatigue. Symptom intensity was significantly associated with the measures of stigma and QOL.nnnCONCLUSIONSnThe results underscore the importance of incorporating a holistic view of the relationship of symptoms with QOL for HIV-infected African American men. Without efforts to ameliorate stigmatizing effects, however, nurses may be falling short in helping individual African American men with HIV infection achieve a better QOL.

CULTURAL AND GENDER ISSUES RELATED TO HIV/AIDS PREVENTION IN RURAL SWAZILAND: A FOCUS GROUP ANALYSIS

HIV/AIDS is a serious public health problem in Swaziland, a small land-locked Southern African country. The epidemic affects all subpopulations, but women are increasingly at risk for contracting the disease. Focus groups were conducted in a rural area to obtain qualitative information on the rural dimensions of HIV/AIDS, vulnerability to HIV/AIDS, and sociocultural factors influencing the spread of AIDS. Five themes were identified from analyses of the focus groups that are relevant in developing an AIDS prevention program for this population in Swaziland. Implications for future research and health care practice focus on gender-sensitive cultural research (e.g., women and mens roles and responsibilities in rural Swaziland society) and how social, economic, and cultural factors impact the spread of AIDS. Recommendations include reorienting and allocating resources for health, education, and social services to address the relative neglect of rural areas and strengthening policies and programs to achieve the equal participation of all women in all aspects of societys decisions. Specifically, policies related to economic and food security should result in programs to improve local access by women to all resources.

Primary and preferred sources for HIV/AIDS and sexual risk behavior information among adolescents in Swaziland, Southern Africa

The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescents preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.

Patterns of sexual behaviour among secondary school students in Swaziland, southern Africa.

Among the many sub‐Saharan African countries hardest hit by HIV/AIDS is the Kingdom of Swaziland. In an effort to reduce the spread of HIV, young people are an important group to reach with prevention messages. However, before developing such programmes, it is essential to understand young peoples sexual risk behaviours. Students (n=941) from four coeducational secondary schools in Swaziland participated in a cross‐sectional survey of sexual behaviours. Results indicate that considerable proportions of young people in this study were sexually experienced, irrespective of gender. Findings also suggest unacceptable high levels of sexual coercion, irrespective of age or gender. While boys may be less likely than girls to experience sexual coercion, being a male in this setting was not a protective factor. No significant differences were found on these variables in relation to location of the schools (rural vs. urban). Implications for developing and implementing HIV prevention programmes are suggested.

The Ebola epidemic in West Africa: Challenges, opportunities, and policy priority areas

n Abstractn n The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.n n

Black African immigrant community leaders' views on participation in genomics research and DNA biobanking

BACKGROUNDnThe emergence of DNA biobanks and the power they lend to genomics research promise substantial advances in disease prevention and treatment. Greater participation of racial/ethnic minority populations is necessary to assure a future of personalized medicine for all.nnnPURPOSEnThe purpose of this study was to explore perspectives on genomics research and DNA biobanking among black African immigrants, an often overlooked US subpopulation.nnnMETHODSnAs part of a larger staged study using community-based participatory research (CBPR) methods, we conducted four focus groups with 27 leaders in the black African immigrant community, exploring perceptions about genomics, barriers, and facilitators to participation in DNA biobanks and ethical ways to engage communities.nnnFINDINGS/DISCUSSIONnProminent in their views on genomics research was the legacy of colonial mistreatment and exploitation by Western researchers in their home countries in sub-Saharan Africa. The central dilemma for participants was balancing responsibilities to protect their people from harm and to find solutions for African generations to come. They insisted that nothing short of a transformation of research practice would elicit the full and sustained participation of African immigrants in the genomics enterprise.nnnCONCLUSIONnTo better align practice and policy in the field of genomics research and DNA biobanking with values expressed by African immigrant leaders, it is recommended that the field adopt a CBPR model for research and a benefit-sharing model for policy.

Community leaders' perspectives on engaging African Americans in biobanks and other human genetics initiatives.

There is limited information about what African Americans think about biobanks and the ethical questions surrounding them. Likewise, there is a gap in capacity to successfully enroll African Americans as biobank donors. The purposes of this community-based participatory study were to: (a) explore African Americans’ perspectives on genetics/genomic research, (b) understand facilitators and barriers to participation in such studies, and (c) enlist their ideas about how to attract and sustain engagement of African Americans in genetics initiatives. As the first phase in a mixed methods study, we conducted four focus groups with 21 African American community leaders in one US Midwest city. The sample consisted of executive directors of community organizations and prominent community activists. Data were analyzed thematically. Skepticism about biomedical research and lack of trust characterized discussions about biomedical research and biobanks. The Tuskegee Untreated Syphilis Study and the Henrietta Lacks case influenced their desire to protect their community from harm and exploitation. Connections between genetics and family history made genetics/genomics research personal, pitting intrusion into private affairs against solutions. Participants also expressed concerns about ethical issues involved in genomics research, calling attention to how research had previously been conducted in their community. Participants hoped personalized medicine might bring health benefits to their people and proposed African American communities have a “seat at the table.” They called for basic respect, authentic collaboration, bidirectional education, transparency and prerogative, and meaningful benefits and remuneration. Key to building trust and overcoming African Americans’ trepidation and resistance to participation in biobanks are early and persistent engagement with the community, partnerships with community stakeholders to map research priorities, ethical conduct of research, and a guarantee of equitable distribution of benefits from genomics discoveries.

Enhancing the Participation of African Americans in Health-Related Genetic Research: Findings of a Collaborative Academic and Community-Based Research Study

The involvement of African Americans in research has long been expressed as a concern by the scientific community. While efforts have been undertaken to identify factors inhibiting the participation of African Americans in health-related research, few efforts have been undertaken to have highlight factors associated with their engagement of health-related research. An exploratory study of factors presumed to be associated with participation in health-related research was conducted among a nonprobability sample of African Americans (n = 212) from a large urban community in the Midwest. The study was guided by a framework that hypothesized the influence of knowledge, beliefs, and perceptions about genetics and the involvement of providers in decision-making on willingness to participate in health-related genetic research. The results revealed that knowledge, beliefs, and perceptions about genetics and the involvement of providers were associated with willingness to engage in health-related genetic research (P < .05). The most interesting, however, was that 88.7% of the participants who had not previously been involved in a health-related study who expressed a willingness to participate reported that they “had never been asked.” Study findings suggest the need for research that further examines factors associated with the involvement of African Americans in health-related genetic research.

Life With HIV: Insights from HIV-infected Women in Cameroon, Central Africa

&NA; Women in Cameroon are disproportionately burdened by HIV illness. Understanding the impact HIV has on women is essential for developing interventions to enhance their quality of life. Our aim was to explore and provide an in‐depth understanding of the daily experiences of a sample of women living with HIV in Cameroon. Qualitative semi‐structured in‐depth interviews were conducted with women (N = 30) from the northwest region of Cameroon who self‐reported being infected with HIV. Participants shared that they had multiple challenges in their daily experiences living with HIV. The themes that emerged included: (a) receiving an HIV diagnosis is traumatic, (b) living with HIV is a constant struggle, (c) limited resources and support cause problems, and (d) stigma and powerlessness exacerbate the impact of HIV. We provide insight into the daily experiences of HIV‐infected women in Cameroon. Implications for improving health care and social services to women living with HIV in Cameroon are suggested.

Reflections on attitudes, experiences, and vulnerability of intimate partner violence among Southeast Asian college women living in United States.

To provide culturally sensitive intimate partner violence (IPV) prevention programs for ethnic groups, a basic foundational understanding of Southeast Asian (SEA) women living in the United States is vital. The purpose of this study was to describe SEA college womens perceptions of IPV and how the women recognize their vulnerability to such violent situations. Qualitative methods using focus group discussions were employed to elicit participants perceptions. Participants included 18 SEA college women, ages 18-34 (Mean=22; SD=7.22). Transcriptions were analyzed using a content analysis approach. Five themes emerged: recognition of IPV; perception of individual vulnerability to IPV; experience and responses to IPV; help seeking and support system; and strategies used for prevention of IPV. Findings yielded an understanding of intertwined issues of cultural norms associated with IPV, social and economic disparities, and challenges for IPV prevention in SEA communities. Culturally sensitive prevention programs will be more effective by reforming cultural values, while at the same time promoting non-violent relationships and increasing access to services.