Susan Gaskins

Older African Americans’ management of HIV/AIDS stigma

Abstract The purpose of this study was to describe HIV/AIDS-related stigma in older African Americans living in the South, a population disproportionately affected by HIV/AIDS. Four focus groups were conducted with 24 men and women over 50 years old and a confirmed diagnosis of HIV. The focus group discussions were audiotaped and transcribed for analysis. Additionally, two stigma instruments, Self-Perceptions of HIV Stigma, and Stigma Impact of HIV, were used to enhance the qualitative data from the focus groups. Constant comparative data analysis of the focus group discussions resulted in four themes related to HIV/AIDS stigma: (1) disclosure; (2) stigma experiences; (3) need for HIV/AIDS education; and (4) acceptance of the disease. Strategies to prevent or decrease anticipated stigma were described, such as selective or non-disclosure and not receiving care where they lived. The stigma instruments indicated that the participants had experienced the most stigma related to their internalized shame about having HIV disease, and had experienced little or no direct stigma. The study findings have implications for designing prevention programs, and strategies to improve social support for this age group.

Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain.

Summary Cognitive behavioral therapy was compared with pain education within an underserved, low‐socioeconomic status, rural chronic pain population. Both interventions were found to be viable treatment options. ABSTRACT Chronic pain is a common and costly experience. Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low‐socioeconomic status (SES) minority and nonminority groups. To address this question, we conducted a randomized controlled trial within a low‐SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). We hypothesized that although both interventions would elicit short‐ and long‐term improvement across pain‐related outcomes, the cognitively‐focused CBT protocol would uniquely influence pain catastrophizing. Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N = 26), the intention‐to‐treat sample (ITT; N = 83), and the completer sample (N = 61). Factors associated with treatment completion were examined. Results indicated significantly more drop‐outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain‐related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6‐month follow‐up (N = 54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate that CBT and EDU are viable treatment options in low‐SES minority and nonminority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.

Special population: HIV/AIDS among the deaf and hard of hearing

In America, 1 out of 10 people are deaf or hard of hearing (D&HH). The size of the D&HH population is estimated to be approximately 20 million persons according to the National Center for Health Statistics (Holt & Hotto, 1994). Deafness can be defined as a communication disability and as a minority culture. The community shares a common language (American Sign Language [ASL]) and life experiences and is maintained by specific social norms (Kennedy & Buchholz, 1995). Thus, there are linguistic and cultural distinctions that separate the deaf community from the hearing majority. Subgroups exist within the deaf community based on one’s linguistic ability. AIDS Education/Services for the Deaf (AESD) defines subgroups within the deaf community based on the frequently most used mode of communication: (a) verbal, (b) ASL, (c) manual English, or (d) gestures and body-expressive language. Those in the subgroup that predominantly uses verbal language refer to themselves as hearing impaired rather than deaf and frequently do not identify themselves as part of the deaf community. Kennedy and Buchholz (1995) identify several special aspects of the deaf community. It is a close-knit, homogenous group. There is a networking system or deaf grapevine used to share information among the members. They are more likely to learn information from each other via this communication route rather than from formal information sources. A danger of this mode of communication is that myths, fallacies, and misinformation may be construed and shared as truth and facts. HIV/AIDS Among the Deaf

Psychosocial responses among individuals with human immunodeficiency virus infection

The purpose of this research was to identify and describe psychosocial responses to being infected with human immunodeficiency virus (HIV). Ten adults infected with HIV were interviewed and audiotaped as they described their feelings and experiences as HIV-infected people. The interviews were analyzed using a grounded theory methodology. The core category that emerged from the data was Fighting to Survive with HIV Infection. Supporting concepts were Taking Care and Restructuring Ones Life. The concept of Taking Care included processes of everyday work and illness work. The processes involved in Restructuring Ones Life were living with uncertainty, accepting homosexuality, experiencing changing feelings, protecting confidentiality, dealing with the medical profession, handling multiple losses, and living with a terminal illness.

Reasons for HIV Disclosure and Non-Disclosure: An Exploratory Study of Rural African American Men

Disclosure of ones HIV status to others is an important decision. There are benefits and risks to be considered. Also decisions must be made about the recipients of the disclosure. This study explored reasons for disclosure and non-disclosure among rural African American men in the south. Audiotaped interviews were conducted with 40 men. The most common reasons for disclosure were to relieve stress, satisfy the need to tell, help others, and to receive support. The most common reasons for non-disclosure were the fear of negative reaction or stigma, the fear of the disclosure recipient telling others, a belief that there was no need to tell, not being ready to tell, and not wanting to burden others with the disclosure.

La desesperacion: migrant and seasonal farm workers living with HIV/AIDS.

Migrant seasonal farm workers (MSFWs) in south Texas are predominantly Mexican American and represent one of the most impoverished and medically underserved populations in the United States. La Frontera is a collaborative partnership between the University of Texas Health Science Center at San Antonio, migrant organizations, and HIV service delivery organizations to study and address special needs of MSFWs in Hidalgo and Maverick counties of south Texas. The purpose of this qualitative study is to explore the health-seeking experiences of HIV-positive MSFWs living in the La Frontera service area. Denzins interpretive interactionism methodology guided the study. Thirteen participants were interviewed and audiotaped as they described their experiences. Findings from content analysis of the interviews revealed a description of the life of an HIV-positive MSFW as la desesperacion (a separate way of life). After their diagnosis of HIV/AIDS, the major themes in their lives were living in secrecy (a silent cry), finding and receiving health care, and accepting the disease (may it be the will of God).

Literacy and cultural adaptations for cognitive behavioral therapy in a rural pain population.

Low literacy and chronic pain have been identified as significant problems in the rural USA. Cognitive behavioral therapy (CBT) is a widely used efficacious psychosocial treatment for chronic pain; adaptations for low-literacy rural populations are lacking. This paper reports on preparatory steps implemented to address this deficit. Adapting an existing group, CBT patient workbook for rural adults with low literacy is described, and adaptations to reduce cognitive demand inherent in CBT are explained via cognitive load theory. Adhering to health literacy guidelines, the patient workbook readability was lowered to the fifth grade. Two key informant interviews and four focus groups provided the impetus for structural and procedural adaptations. Using health literacy guidelines and participant feedback, the patient workbook and treatment approach were adapted for implementation in low-literacy rural adult chronic pain populations, setting the stage for proceeding with a larger trial using the adapted materials.

Making decisions: the process of HIV disclosure for rural African American men.

The purpose of this study was to identify and describe the process of HIV disclosure for rural African American men—a population disproportionately affected by HIV/AIDS. Forty men were interviewed about their experience of making an HIV disclosure. Grounded theory methodology guided data collection and analysis. The core category or variable that emerged from the data was a process—Making Decisions: The Process of HIV Disclosure. Five categories accounted for variations in disclosures: (a) beliefs and knowledge about HIV/AIDS, (b) influencing factors, (c) disclosure decisions, (d) disclosure efficacy, and (e) outcomes of disclosure. Most of the men had disclosed to others; however, the disclosures were selective, and the decisions were iterative. The majority of the men did not disclose their diagnosis for several months to several years. The findings provide a framework of the many factors related to HIV disclosure that can guide health care providers in counseling persons living with HIV/AIDS in making disclosure decisions.

Helping others: A response to HIV disease

Previous research supports that helping behaviors can be as beneficial to the person providing the help as to the recipient. Ten individuals infected with HIV describe how helping others became an important strategy in helping them live with their diagnosis of HIV/AIDS. A grounded theory study was done to identify and describe psychosocial responses to being infected with HIV. Audiotaped interviews were analyzed using grounded theory methodologies. The core category that emerged from the data was fighting to survive. Taking care and restructuring ones life were the supporting concepts. Processes involved in taking care were everyday work and illness work. Helping others was one strategy of everyday work the participants found to be helpful in the fight to survive. The benefits of helping are described and the various ways of helping are presented in this article.

Clinical skill and knowledge requirements of health care providers caring for children in disaster, humanitarian and civic assistance operations: an integrative review of the literature.

INTRODUCTION Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care. PURPOSE The purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations. DATA SOURCES A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches. CONCLUSIONS Infectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations. IMPLICATIONS FOR PRACTICE The information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.