Zamudio A

HIV Prevention Research: Are We Meeting the Needs of African American Men Who Have Sex with Men?

Two decades of HIV prevention efforts with men who have sex with men (MSM) have not eliminated the risk of new HIV infections in this vulnerable population. Indeed, current incidence rates in African American MSM are similar to those usually only seen in developing countries. A review of the existing literature suggests that the prevention research agenda for Black MSM could benefit from reframing conceptualization of risk as a function of individual properties to a broad consideration of social and interpersonal determinants. Studies that investigate dyadic and social-level influences on African American MSM’s relationships are needed. This includes research explicating the diversity existing within the categorizations of Black MSM with respect to perceived identity (gay, bisexual, “men on the down low,” “homo thugz”), constructions of masculinity, sexual scripts, sources of social support, and perceived norms and expectations. Recommendations are proposed for a research agenda focusing on linkages between interpersonal and social-structural determinants of HIV risk.

Embracing a Family Perspective: Essential Roles for Psychology in Primary Care

Primary care settings that provide integrative mental health-medical collaboration offer rich opportunities to enhance the quality of care, improve patient outcome, and highlight the value of psychosocial history taking. The authors illustrate these benefits in a detailed case study of an elderly African American female who presented with depression, hypertension, and “wandering” to a family medicine resident and a behavioral science faculty member in a family medicine residency program. A family genogram served as a psychological assessment technique and helped in the differential diagnosis, treatment planning, and deepening of the physician-patient relationship. Hidden family catastrophic experiences in the past, once identified, helped the patient and providers place the presenting symptoms of non-adherence and tragic losses in the greater context of medical and psychological traumas. The article highlights the benefits of a family system approach with genograms for residency training and enhanced quality of medical care.