Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
The Lancet (Impact Factor: 45.22). 07/2008; 372(9635):337-40. DOI: 10.1016/S0140-6736(08)61118-6
Source: PubMed
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Available from: Sevgi Okten Aral,
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    • "Research with collegiate Black women of diverse socioeconomic backgrounds found that condom negotiation and the prevalence of cross-risk Downloaded by [] at 17:21 01 September 2015 A c c e p t e d M a n u s c r i p t relationships placed these young women at risk for exposure to HIV as well (Alleyne 2008; Ferguson et al. 2006; Foreman 2003). Black men were more likely than White men to have concurrent sexual partnerships, which increased their risk for HIV and their partner's risk (Aral, Adimora, and Fenton 2008). In a qualitative study conducted by Ferguson et al. (2006) focusing on the relation of the gender composition of the environment to condom negotiation practices at two Historically Black Colleges (HBCUs), men often reported having multiple partners and a low frequency of condom use. "
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    ABSTRACT: Condoms are considered a highly effective form of STI prevention for heterosexual sex. Black American women (BAW) have been and are at elevated risk for heterosexual exposure to HIV because they have been and continue to be less likely to negotiate condom use with a partner that supports them financially. However, BAW who have made tremendous educational gains may still encounter challenges regarding the distribution of power that can affect condom use and negotiation. The purpose of this exploratory study was to examine the reasons that highly educated, emerging, adult BAW reported for using condoms. One hundred twenty-seven emerging adult BAW (ages 18-29 years) completed a mixed-methods online survey during the spring of 2013 (January-May). Approximately 80% of the women were in college or college graduates. They had a high rate of previous HIV testing (68.5%). Through the use of an interpretive paradigm and grounded theory, three themes emerged regarding the reasons that the participants in this sample used condoms as their primary form of protection: (a) The Reliable "Standard" (b) Pregnancy Prevention, and (c) Cost Effective and "Easily Accessible." Findings are discussed in terms of their public health significance for this seemingly lower-risk population.
    Women & Health 09/2015; DOI:10.1080/03630242.2015.1086469 · 1.05 Impact Factor
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    • "A low ratio of men to women, high incarceration rates that further exacerbate the low sex ratio and depress marriage rates, and pervasive poverty that discourages long-term monogamy may be contributing factors (Adimora et al., 2001, 2002, 2013; Adimora & Schoenbach, 2005). In addition, because concurrency is so prevalent, it may be viewed as normative in some Black communities that experience these social forces (Aral et al., 2008; Gorbach, Stoner, Aral, Whittington, & Holmes, 2002). Mathematical modeling suggests that small decreases in concurrency could yield substantial decreases in HIV transmission (Morris, Kurth, Hamilton, Moody, & Wakefield, 2009), and targeting concurrency may be a cost-effective HIV prevention strategy (Enns, Brandeau, Igeme, & Bendavid, 2011). "
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    ABSTRACT: In the United States, heterosexual transmission of HIV infection is dramatically higher among Blacks than among Whites. Overlapping (concurrent) sexual partnerships promote HIV transmission. The authors describe their process for developing a radio campaign (Escape the Web) to raise awareness among 18-34-year-old Black adults of the effect of concurrency on HIV transmission in the rural South. Radio is a powerful channel for the delivery of narrative-style health messages. Through six focus groups (n = 51) and 42 intercept interviews, the authors explored attitudes toward concurrency and solicited feedback on sample messages. Men were advised to (a) end concurrent partnerships and not to begin new ones; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. The narrative portrayed risky behaviors that trigger initiation of casual partnerships. Women were advised to (a) end partnerships in which they are not their partner's only partner; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. Messages for all advised better modeling for children.
    Journal of Health Communication 07/2015; 20(11):1-11. DOI:10.1080/10810730.2015.1018643 · 1.61 Impact Factor
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    • "Many black patients may preferentially seek medical treatment from black physicians, and black physicians are more likely to practice medicine in predominantly black communities, but black physicians account for only about 3% of physicians in the US [14,15]. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that afflict the black community [16]. To better understand some of the barriers to and facilitators of HIV testing in the black community, the characteristics of physicians who represent the gatekeeper to HIV testing recommendations should be studied and characterized. "
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    ABSTRACT: Background The Centers for Disease Control and Prevention recommends routine HIV testing in all healthcare settings, but it is unclear how consistently physicians adopt the recommendation. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that disproportionately afflict the black community. The goal of this survey-based study was to evaluate the perceptions and practices of black, primary care physicians regarding HIV testing. Methods A physician survey was administered at the 2010 National Medical Association Annual Convention, via online physician panels, and by email. Physician eligibility criteria: black race; practicing at least 1 year in the US; practice comprised of at least 60% adults and 20% black patients. Contingency tables and ordinary least squares regression were used for comparisons and statistical analyses. A Chi-square test compared percentages of physicians who gave a particular response and a t-test compared the means of values provided by physicians. Results Physicians over-estimated HIV prevalence and believed that HIV is a crisis in the black community, yet reported that only 34% of patients were HIV tested in the past year. Physicians reported that 67% of those patients tested did so due to a physician recommendation. Physicians who were younger, female, obstetricians/gynecologists, and had a higher proportion of black, low-socioeconomic status, and Medicaid patients reported higher testing rates. Most testing was risk-based rather than routine, and three of the five most commonly reported barriers to testing were related to disease stigma and perceived value judgments. Physicians reported that in-office patient informational materials, increased media attention, additional education and training on HIV testing, government mandates requiring routine testing, and accurate pre-packed tests would most help them test more frequently for HIV. Conclusions In this sample of black, primary care physicians, HIV testing practices differed according to physician characteristics and practice demographics, and overall reported testing rates were low. More physician education and training around testing guidelines is needed to enable more routine testing, treatment, and long-term management of patients with HIV.
    BMC Public Health 02/2013; 13(1):96. DOI:10.1186/1471-2458-13-96 · 2.26 Impact Factor
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