The Four Cs of HIV Prevention with African Americans: Crisis, Condoms, Culture, and Community

Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California-Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA.
Current HIV/AIDS Reports (Impact Factor: 3.8). 11/2010; 7(4):185-93. DOI: 10.1007/s11904-010-0058-0
Source: PubMed


HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.

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Available from: Gail E Wyatt, Jul 20, 2015
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    • "In order to address the HIV epidemic, innovative research efforts must explore rarely examined factors that may influence sexual risk behaviors [7]. One important variable, experiences of childhood sexual abuse (CSA), has commonly been neglected within HIV prevention despite several studies having linked a history of CSA to a number of sexual health outcomes. "
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    ABSTRACT: HIV prevention has rarely explored the impact of childhood sexual abuse (CSA) across health domains among African American men who have sex with men and women (MSMW). Early sexual experiences may influence perceptions of gender roles, sexual identity, and risks for HIV/AIDS. The attribute of masculinity is commonly associated with strength and success. However, a legacy of racism and oppression may pose challenges for African American men in achieving gender-based milestones. Instead, proxies for success may include masculinity constructs with hypersexual posturing and prowess that contradict sexual health messages. Two groups, each meeting twice for 90-minutes, of HIV-positive African American MSMW participated in discussions focusing on masculinity and sexual experiences. Participants were bisexual HIV-positive African American men who engaged in unprotected sex and had histories of CSA. Discussions were recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Participant mean age was 40.5 years (n=16). Majority had a high school education (69%), half were unemployed, and almost two-thirds earned less than $20,000 annually. Three themes, each with two subthemes, emerged that described the sociocultural context for engaging in high-risk sexual behaviors, and included: 1) the importance of inhabiting a "traditional" masculine gender role with: a) general and b) sexual masculine traits; 2) the influence of conceptions of masculinity on sexual identity with the associations: a) between being gay and being effeminate and b) between being gay and being HIV-positive, and; 3) CSA experiences with: a) appraisal of CSA and b) early sexual experiences as rites of passage. Attempts to be masculine may contribute to high-risk sexual behaviors. Research needs to explore how early sexual experiences shape perceptions of masculinity and masculinity's influence on receiving health messages for African American MSMW who may prioritize a specific image over sexual risk reduction.
    Journal of AIDS & Clinical Research 06/2012; Suppl 1(8). DOI:10.4172/2155-6113.S1-008 · 6.83 Impact Factor
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    • "Other research finds that culturally tailored HIV prevention interventions should engage community leaders and members, build upon community strengths, and capitalize on cultural pride [32], [36], [69]. Using community leaders for HIV prevention can also help mitigate the heavy stigma often associated with HIV/AIDS [70]–[72]. Understanding faith leaders’ perceived barriers and proactive recommendations for effectively engaging faith institutions in HIV prevention are critical first steps for developing structural and community-based HIV prevention interventions intended to address racial disparities in HIV infection. The positive, proactive, and concrete recommendations presented in this study provide a roadmap that can inform public policy about how to effectively collaborate with African American faith institutions to reduce the United States’ racial disparities in HIV infection. "
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    ABSTRACT: In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.
    PLoS ONE 05/2012; 7(5):e36172. DOI:10.1371/journal.pone.0036172 · 3.23 Impact Factor
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    ABSTRACT: The purposes of the study were (1) to assess the acceptability of mental health screening in the pediatric emergency department (ED) for children and their parents; (2) to measure providers' perceptions on whether screening has an impact on patient care; and (3) to determine the impact of screening status on acceptability. A validated pediatric mental health screening instrument was administered to 384 parent-child dyads. A 6-item satisfaction questionnaire was administered by a trained research coordinator to assess parent-child reactions to the screen. Emergency department providers rated how difficult the screening made it for them to care for the patient. Research staff reported the difficulty of conducting screening during the ED visit and the amount of time parents/children spent completing the screen. Most parents (82%) and children (75%) felt the screening was acceptable. Parent reports of pediatric mental health problems were not associated with lower acceptability scores. The number of mental health problems reported by a child was associated with an increased likelihood that the screening made the child upset (P = 0.02). Parents who reported pediatric mental health problems were more likely to find the screening helpful (odds ratio,1.84 [95% confidence interval, 1.15-2.93]), with black parents more likely to report that the screen was helpful (odds ratio, 2.5 [95% confidence interval, 1.43-4.33]). Nearly all doctors (99%) and nurses (97%) reported that the screening did not make it difficult for them to care for the patient. Overall, mental health screening appears to be acceptable in the pediatric ED.
    Pediatric emergency care 06/2011; 27(7):611-5. DOI:10.1097/PEC.0b013e318222554e · 1.05 Impact Factor
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