Lori Leonard

Transition of Adolescents With HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions

&NA; The transition process from pediatric to adult health care for adolescents with chronic diseases is always challenging and can be even more so for adolescents with HIV disease. The purpose of this study was to describe characteristics and current practices surrounding the transition of adolescents from the clinics of the Adolescent Trials Network for HIV/AIDS Interventions to adult medical care. This report focuses on the processes of transition, perceived barriers and facilitators, and anecdotal reports of successes and failures. Practice models used to assist adolescents during transition to adult medical care are described. Interviews were conducted with 19 key informants from 14 Adolescent Trials Network clinics. Findings revealed no consistent definition of “successful” transition, little consensus among the sites regarding specific elements of a transition program, and a lack of mechanisms to assess outcomes. Sites that viewed transition as a process rather than an event consistently described more structured program elements.

Sexual Behaviour, STDs and Drug use in a Crack House Population:

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack users on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex virus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 41% of cases. On DSM–III–R criteria, 12% were crack abusers and 84% crack dependent: over half reported previous treatment. Forty per cent reported also injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, although women also reported more than twice the level of oral sex of men. Significant multivariate predictors for HIV and hepatitis B and C were previous reported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2, and additionally condom use for HSV-2, were significant risks. These data confirm high rates of STDs in a crack house population as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found should lead to considering STDs and substance abuse to be dual diagnoses in crack users and the integration of STD diagnosis and treatment into crack outreach and treatment programmes.

Female circumcision in southern Chad: Origins, meaning, and current practice

Female circumcision is widely practiced on the African continent; however, published reports describing genital operations on women in non-Islamic, sub-Saharan societies are scarce. This paper examines female circumcision as it is practiced by the Sara, one of Chads largest ethnic groups. For the Sara, circumcision is an integral part of the female initiation ceremony, the rite of passage marking the transition from childhood to adulthood. Through in-depth interviews and archival research, we trace the origins of female circumcision among this group and examine its role and function in the context of contemporary Sara culture. Urban womens attitudes and practices regarding circumcision are also examined via household surveys. The data indicate that female circumcision has been recently incorporated into the Saras cultural repertoire, and suggest strategies to reduce its incidence in this setting.

Older partner selection in young African-American men who have sex with men.

PURPOSE Young African-American (AA) men who have sex with men (YAAMSM) have experienced the greatest proportional increase in new HIV cases compared with other groups. Bridging sexual partnerships between YAAMSM and older aged cohorts with higher rates of primary HIV infection has emerged as an important independent risk factor for the development of HIV. We explored reasons young AAMSM cite for being attracted to and seeking an older partner and the interpersonal needs met within older sexual partnerships. METHODS Seventeen in-depth semistructured qualitative interviews were conducted in YAAMSM residing in a midsized urban city with high HIV prevalence. Two coders independently evaluated transcribed data to identify/collapse codes that emerged. We analyzed data using categorical and contextualizing analytic methods. RESULTS Two themes emerged from the text for seeking an older sexual partner: the emotional maturity the older partner represented and the ability of the older partner to expose the younger partner to more life experiences. In addition, two themes emerged around attraction: support and physical attractiveness of the older partner. Few men described seeking age-discordant relationships for the sole purpose of exchange sex. Older partners during first same-sex experience helped younger partners sort through sexual position and how to perform in relationships. CONCLUSIONS These interviews suggest that YAAMSM may be seeking older partners to fulfill desires to be in a stable, emotionally mature relationship and for exposure in the larger community. Prevention strategies aimed at targeting adolescent MSM age-discordant relationships will need to address the interpersonal needs met within older sexual partnerships.

Adherence to Travel Health Guidelines: The Experience of Nigerian Immigrants in Houston, Texas

The objective of this study was to learn about the travel health practices of Nigerians in Houston, Texas, and to describe factors affecting adherence to recommendations for the prevention of malaria, typhoid, and hepatitis A set forth by the Centers for Disease Control and Prevention (CDC). Data were collected through focus group discussions and one-on-one interviews with travelers and health care providers. Data collection and analysis relied on a process-based framework that included questions about health and health-maintenance strategies before, during, and after travel. The cost of travel health services and the availability of vaccines and medications were important structural barriers to adherence. Perceptions of individual susceptibility and disease severity varied across the infections of interest. Travelers perceive themselves to be at risk for malaria, but are generally not concerned about its consequences. A notable exception is the fear of becoming symptomatic post-travel in the United States. Typhoid was less salient than malaria, and few had heard of or worried about acquiring hepatitis A. Stigma associated with the acquisition of travel-related conditions and the perceived incompetence of physicians to treat illnesses related to overseas travel, and malaria in particular, also affect preventive decisions and strategies. The results of the study have broad relevance for the traveling public and for programs and services that seek to improve travel health and travel health care.

Adherence to scheduled appointments among HIV-infected female youth in five U.S. cities.

OBJECTIVE Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults. METHODS HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping. RESULTS Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior. CONCLUSIONS Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.

A community level syphilis prevention programme: outcome data from a controlled trial.

Objectives: This study investigated the impact of a small media campaign to reduce syphilis through testing, treatment, and condom use in two urban predominantly African-American communities with high syphilis rates. Methods: Data were collected from intervention and comparison zip codes using cross sectional street intercept interviews at baseline and 2 years later (n = 1630) following a small media syphilis prevention campaign with role model story posters, billboards, and other merchandise. Community businesses and a community based organisation served as partners, distributing condoms and small media. Results: Comparing intervention with comparison zip codes, there were significant increases in condom use in last sexual act, and some aspects of knowledge of syphilis. However, there was significant cross contamination of media impact, with respondents in the comparison zip code seeing an average of two media items compared with three in the intervention zip code. Media exposure was associated with significant increases in knowledge of syphilis, testing, and condom use. Conclusions: Targeted community based small media interventions using community partners for distribution are effective in increasing syphilis knowledge, testing, and condom use.

We did it for pleasure only : Hearing alternative tales of female circumcision

This article is based on fieldwork conducted in southern Chad on the recent adoption of female circumcision. In Myabé, a village with a population of about 1,000, girls were first circumcised around 1980. Residents describe female circumcision and their experiences of it in ways that contrast sharply with popular notions of what female circumcision means and how it is practiced, and with the descriptions and interpretations available in the medical, public health, and anthropological literatures. In making sense of these findings, the author questions the reasons for the hegemony of the “standard tale” and argues for the need to allow a plurality of stories and experiences of female circumcision to emerge.

On the Modalities of the Domestic

ABSTRACT This article focuses on experiences of the domestic—of houses, of intimacy and privacy—and what relation these bear to the kinds of sentiments about life which are given expression as fragile, endangered or fleeting. We think of singularity as lying in the potential for multiple domesticities that emerge at different times and are neither coterminous with family nor indeed with household. Based on fieldwork with African-American and Caribbean families in Miami, Florida and Baltimore, MD, the article tracks how intimacy and alienation marks the constant moves from, to, and through households. This oscillation engenders an itinerant domesticity and life lived in the interstices of the house, the clinic, the prison, and the street. These spaces and places come to bear on what comes to be marked as so-called “African-American kinship.” Given the disproportionate incarceration of African-American men in US prisons, the article contemplates the permeable relation between carceral institutions and the home, as well as the constitution of kinship as “criminal.” All names used in this text are pseudonyms to protect the confidentiality of respondents.

Poverty and sexual concurrency: a case study of STI risk.

This paper is about sexual concurrency, or maintaining multiple sexual partnerships that overlap in time. Sexual concurrency is a concept that is used in the field of public health to explain the spread of sexually transmitted diseases. Sexual concurrency has also been proposed as a site of intervention to reduce sexually transmitted infection (STI) rates, particularly among those populations who carry the heaviest STI burden: adolescents and African Americans. In this paper, we use ethnographic data collected from a group of African American adolescents living in Baltimore to examine the socially produced configurations of risks and relationships that are obscured by the term sexual concurrency. The data we present show the limits of this concept, and suggest that structural reforms, including improvements to education, drug treatment, and work opportunities, are necessary to reduce racial disparities in STI rates.