Robert E. Fullilove

Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010

Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. Results. Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940–1999. Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

Heterosexually Transmitted Hiv Infection Among African Americans in North Carolina

Context: Rates of heterosexually transmitted HIV infection among African Americans in the southeastern United States greatly exceed those for whites. Objective: Determine risk factors for heterosexually transmitted HIV infection among African Americans. Methods: Population-based case-control study of black men and women, aged 18-61 years, reported to the North Carolina state health department with a recent diagnosis of heterosexually transmitted HIV infection and age- and gender-matched controls randomly selected from the state driver s license file. A lower-risk stratum of respondents was created to identify transmission risks among people who denied high-risk behaviors. Results: Most case subjects reported annual household income <

Stigma as an Obstacle to AIDS Action: The Case of the African American Community

16,000, history of sexually transmitted diseases, and high-risk behaviors, including crack cocaine use and sex partners who injected drugs or used crack cocaine. However, 27% of case subjects (and 69% of control subjects) denied high-risk sexual partners or behavior. Risk factors for HIV infection in this subset of participants were less than high school education (adjusted odds ratio [OR] 5.0; 95% CI: 2.2, 11.1), recent concern about having enough food for themselves or their family (OR 3.7; 1.5, 8.9), and having a sexual partner who was not monogamous during the relationship with the respondent (OR 2.9; 1.3, 6.4). Conclusion: Although most heterosexually transmitted HIV infection among African Americans in the South is associated with established high-risk characteristics, poverty may be an underlying determinant of these behaviors and a contributor to infection risk even in people who do not have high-risk behaviors.

CRACK 'HOS AND SKEEZERS: TRAUMATIC EXPERIENCES OF WOMEN CRACK USERS

The control of the spread of AIDS depends on the willingness of the U.S. society to undertake a series of prevention actions. A corollary of this is that the prevention action must be managed in a manner that is sympathetic to affected populations. The presence of homophobia is widely recognized in African American churches, and has hampered their ability to engage in AIDS prevention. This article explores the problem of homophobia in the African American community. A secondary analysis of focus group transcripts was undertaken. The data indicate that homophobia is common in various segments of the community. Stigma creates a heavy burden for gay men and impedes their ability to fight AIDS. The data suggest that more effective AIDS prevention will require eradicating stigmatizing attitudes toward gay men.

Social context of sexual relationships among rural African Americans.

The involvement of women in crack cocaine abuse has had a severe impact on their health, the health of their children and the stability of their communities. Of particular concern has been the development of a system of barter in which crack‐for‐sex exchanges are the means through which women obtain the drug. Earlier studies have suggested that drug abuse may be related to and exacerbated by trauma. In the project described herein, we interviewed women crack users in Harlem to study the relationship between trauma, crack use, and crack‐related sexual behavior. Results suggested the existence of three types of trauma: (1) traumas that predate the respondents onset of crack use; (2) traumas that were the direct sequelae of crack use; and (3) stigma trauma, that is, trauma that results from membership in a despised or oppressed group. We observed a complex inter‐relationship involving crack use, crack‐for‐sex transactions, and these three types of trauma. Treatment of the eventual co‐morbidity of trauma and...

Concurrent Partnerships among Rural African Americans with Recently Reported Heterosexually Transmitted HIV Infection

Background Reasons for the strikingly increased rates of HIV and other sexually transmitted infections (STIs) among African Americans in the rural Southeastern United States remain unclear. Investigators have devoted little attention to the potential influence of the social and economic context on sexual behaviors. Goal To examine the potential influence of these contextual factors on behaviors that promote the transmission of STIs. Study Design Focus group interviews in which African Americans from rural North Carolina discussed life in their communities and contextual factors affecting sexual behavior. Results Respondents reported pervasive economic and racial oppression, lack of community recreation, boredom, and resultant substance abuse. Many perceived a shortage of black men because of their higher mortality and incarceration rates compared with whites, and believed this male shortage to be partly responsible for the concurrent sexual partnerships that they perceived as widespread among unmarried persons. Conclusion Contextual features including racism, discrimination, limited employment opportunity, and resultant economic and social inequity may promote sexual patterns that transmit STIs.

Criminal (In)Justice in the City and Its Associated Health Consequences

Objectives To investigate concurrent sexual partnerships among African Americans in North Carolina with recently reported heterosexually transmitted HIV infection. Design Population-based case series of persons with newly reported HIV infection. Methods Household interviews concerning sexual and other risk behaviors for HIV transmission were conducted among African Americans, 18–59 years old, who had been reported to the state health department within the preceding 6 months as having heterosexually acquired HIV infection. Dates of sexual partnerships were analyzed to identify concurrency among the 3 most recent partnerships. Results Concurrency prevalence in the past 1 and 5 years, respectively, was 45 and 63% for men and 37 and 58% for women. Most respondents (87%) believed that a recent partner had had a concurrent partnership. Multivariate analysis revealed associations between concurrency and male gender, youth, crack cocaine smoking, and incarceration of a sex partner. Conclusions Concurrent partnerships likely accelerate heterosexual HIV transmission among blacks in the rural southeastern United States. Future research should examine the socioeconomic context that supports this network pattern.

Concurrent sexual partnerships among African Americans in the rural south.

The American system of prisons and prisoners-described by its critics as the prison-industrial complex-has grown rapidly since 1970. Increasingly punitive sentencing guidelines and the privatization of prison-related industries and services account for much of this growth. Those who enter and leave this system are increasingly Black or Latino, poorly educated, lacking vocational skills, struggling with drugs and alcohol, and disabled. Few correctional facilities mitigate the educational and/ or skills deficiencies of their inmates, and most inmates will return home to communities that are ill equipped to house or rehabilitate them. A more humanistic and community-centered approach to incarceration and rehabilitation may yield more beneficial results for individuals, communities, and, ultimately, society.

Stories of spiritual awakening : The nature of spirituality in recovery

PURPOSE To investigate concurrent sexual partnerships among heterosexual African Americans, 18 to 59 years old, in rural North Carolina. METHODS Household interviews with persons randomly selected from the NC drivers license file were conducted to identify overlap among the 3 most recent sexual partnerships. RESULTS Concurrency prevalence in the past 5 years was 53% (men) and 31% (women). Most (61%) respondents believed that a recent partner had had a concurrent partnership. Multivariate analysis revealed strong associations between concurrency and male gender, being unmarried, age of sexual debut, and incarceration of a sex partner. CONCLUSIONS Concurrent partnerships may increase rates of heterosexual HIV among blacks in the rural Southeastern United States. Future research should examine the context that supports this network pattern.

Risk factors for excess mortality in harlem: Findings from the harlem household survey

Substance abuse has had a devastating impact on the lives of millions. As substance use and abuse continues to ravage communities, researchers remain in the dark about what works to ensure successful recovery from addiction. In searching for the answers, researchers have often overlooked the role of religious and spiritual practices and beliefs in preventing use and relapse. The study reported here describes the process of spiritual awakenings experienced by some persons in recovery during their quest for sobriety. The data suggests that persons in recovery often undergo life altering transformations as a result of embracing a power higher than ones self, that is, a Higher Power. The result is often an intense spiritual journey that leads to sustained abstinence. Given how widespread substance abuse is, research on the nature, implications, and limitations of a spiritual approach to addiction might offer new options for treatment.