Knowledge, Awareness and Behavior: HIV/AIDS and Disasters

African Americans are the most affected by HIV/AIDS. Both males and females continue to be disproportionately affected by HIV/AIDS. They are often drug users or participate in street/drug subculture. Recent weather disasters have required identification of knowledge, beliefs, conduct norms and behavior patterns that are HIV/AIDS risk factors for disaster survivors. This paper examines patterns of behavior and common practices related to HIV among disaster survivors.

Study background

Data for this paper come from a three year renewal project which focused upon the processes by which illicit drug markets were reformulated after disasters and practices of risk behaviors for HIV/AIDS. Hurricanes Katrina, Gustav and Ike presented the opportunity to examine the impact of disasters upon risky behavior among illicit drug users and sellers.

Methods

From 2010-2013 ethnographic study was conducted in New Orleans, Louisiana, Houston and Galveston, Texas. Staff completed in-depth interviews with 132 focal respondents of drug users and sellers. There were 57 focus groups with 243 focus group participants; 350 drug using/selling respondents completed a survey protocol (CAPI), organized around their experiences during the hurricanes.

Results

In both cities respondents displayed knowledge about HIV, modes of transmission and knew that HIV infection can lead to AIDS. Knowledge about time between exposure and infection was mostly imprecise. Most respondents reported they had been tested for HIV multiple times. A large number of participants reported learning about HIV in school, older respondents (mid-40s to 60) reported their knowledge came from television or the streets. Participants expressed fatalistic attitudes toward HIV, believing the virus was fatal even with medication.

Conclusion

With the increase of disasters, more attention needs to be placed upon programs focused on drug consumers. Schools, clinics, public information sources, i.e., TV and radio can make understanding HIV/AIDS a priority through taking into consideration specific populations and making sure literature and other forms of information is adjusted to their understanding.

Full article at:   http://goo.gl/02sruz

By:  Eloise Dunlap

Eloise Dunlap, Director, National Development and Research Institutes, New York, USA;

^*Corresponding author: Eloise Dunlap, Director, National Development and Research Institutes, Institute for Special Population Research, 71 West 23rd Street, 4th floor, New York, United States, Tel: 6466427358; Fax: 9174380894

J Alcohol Drug Depend. 2016 Feb; 4(1): 230.

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Angola for Life: Rehabilitation and Reform Inside the Louisiana State Penitentiary - Video

Via:  http://goo.gl/vmNCvj

US States with the Highest Rates of Gun Ownership

Via:  https://atlas.qz.com/charts/NJt0vesF

Racial Discrimination and HIV-Related Risk Behaviors in Southeast Louisiana

OBJECTIVES:

We examined the relationship between cumulative experiences of racial discrimination and HIV-related risk taking, and whether these relationships are mediated through alcohol use among African Americans in semi-rural southeast Louisiana.

METHODS:

Participants (N = 214) reported on experiences of discrimination, HIV sexual risk-taking, history of sexually transmitted infection (STI), and health behaviors including alcohol use in the previous 90 days. Experiences of discrimination (scaled both by frequency of occurrence and situational counts) as a predictor of a sexual risk composite score as well as a history of STI was assessed using multivariate linear and logistic regression, respectively, including tests for mediation by alcohol use.

RESULTS:

Discrimination was common in this cohort, with respondents confirming their experience on average 7 of the 9 potential situations and on more than 34 separate occasions. After adjustment, discrimination was significantly associated with increasing sexual risk-taking and lifetime history of STI when measured either by frequency of occurrence or number of situations, although there was no evidence that these relationships were mediated through alcohol use.

CONCLUSIONS:

Cumulative experiences of discrimination may play a significant role in sexual risk behavior and consequently increase vulnerability to HIV and other STIs.

Purchase full article at:   http://goo.gl/HlBjnN

By:   Kaplan KC1, Hormes JM2, Wallace M3, Rountree M4, Theall KP5.

• 1Allan Rosenfield Global Health at the Centers for Disease Control and Prevention, Atlanta, GA, USA.
• 2University of Albany, State University of New York, Albany, NY, USA.
• 3Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
• 4University of Texas at Austin, Austin, TX, USA.
• 5Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Comprehensive Alcohol Research Center, Louisiana State University, Health Sciences Center, USA. ktheall@tulane.edu. 

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Advancing Behavioral HIV Prevention: Adapting an Evidence-Based Intervention for People Living with HIV and Alcohol Use Disorders

Alcohol use disorders (AUDs) are highly prevalent among people living with HIV/AIDS (PLWHA) and are associated with increased HIV risk behaviors, suboptimal treatment adherence, and greater risk for disease progression. 

We used the ADAPT-ITT strategy to adapt an evidence-based intervention (EBI), the Holistic Health Recovery Program (HHRP+), that focuses on secondary HIV prevention and antiretroviral therapy (ART) adherence and apply it to PLWHA with problematic drinking. Focus groups (FGs) were conducted with PLWHA who consume alcohol and with treatment providers at the largest HIV primary care clinic in New Orleans, LA. 

Overall themes that emerged from the FGs included the following: 

1. negative mood states contribute to heavy alcohol consumption in PLWHA; 
2. high levels of psychosocial stress, paired with few adaptive coping strategies, perpetuate the use of harmful alcohol consumption in PLWHA; 
3. local cultural norms are related to the permissiveness and pervasiveness of drinking and contribute to heavy alcohol use; 
4. healthcare providers unanimously stated that outpatient options for AUD intervention are scarce, 
5. misperceptions about the relationships between alcohol and HIV are common; 
6. PLWHA are interested in learning about alcohol's impact on ART and HIV disease progression. 

These data were used to design the adapted EBI.

...3.3.1. Reasons for Patient Engagement in Risky Behavior

The majority of providers who offered insight into this topic believed that their HIV+ patients engaged in risky substance use and unsafe sexual behavior due to habit and that these were the same behaviors that led to HIV infection. Responses included the following:

“They've already kind of created a pattern of behavior that probably is what caused them to get the virus in the first place.”

“Yeah I agree with the habit part too, because you know like they were practicing risky behaviors for so long beforehand and then as far as they're concerned, the worst thing that could have happened, happened to them already.”

Others believed that risky behaviors were more common in younger patients,

“I think my younger group, the younger population of our HIV… It's basically, I'm not going to be stigmatized or labeled that I am HIV positive so I'm just gonna act like everybody else is acting.”

3.3.2. Provider Insight regarding PLWHA Alcohol Use

Additionally, providers discussed possible determinants specifically for heavy alcohol use in their patients. They noted that common stressors such as poverty, chronic unemployment, and boredom may contribute to the use of alcohol as an inexpensive coping mechanism.

“I would say it's the same reason anybody becomes alcoholic. I mean, HIV, HIV positive and negative can become alcoholic for the same reason this genetic tendency to become addicted earlier or easier and then the reasons I..I think it's mostly to escape.”

They also noted that their patients often rely on alcohol as a coping mechanism and that this may exacerbate feelings of hopelessness and resistance to change drinking habits. As a result, all providers agreed that the adapted intervention should involve development of stress management skills.

3.3.3. Permissiveness and Pervasiveness of Drinking

All providers agreed that the local (New Orleans, LA) drinking culture is a contributor to heavy alcohol use in their patients living with HIV/AIDS. For example, many providers mentioned that beer and wine are often not considered alcoholic beverages and that this belief is not exclusive to their patients. Typical responses included the following:

“You gotta realize that, they say that wine is not an alcohol. I mean, in their minds they don't consider it. But in the minds of the professionals that work here too, it's not an alcohol!”

Others commented on cultural norms related to drinking,

“We have a lot of festivities where…^∗laughter from group^∗ like Mardi Gras where the norm is to drink. The culture of the area sets it up to do a lot of parties.”

Some providers gave specific examples of these alcohol-related practices,

“Growing up in a culture like this, even the kids' parties that they have (alcohol). You go to a kid's or a toddler's party and you know they have the stuff for kids and they got the stuff for adults too! Which it always includes alcohol, so it's like, from birth, that's the way it is...”

Full article at:   http://goo.gl/o7K7I4

By:   M. L. Armstrong, ¹ A. M. LaPlante, ¹ F. L. Altice, ^{2 , 3} M. Copenhaver, ⁴ and P. E. Molina ^{1 , *}

¹Comprehensive Alcohol Research Center and Alcohol and Drug Abuse Center, Department of Physiology, LSUHSC, New Orleans, LA 70112, USA

²Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT 06510, USA

³Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT 06510, USA

⁴Center for Health, Intervention, & Prevention (CHIP), University of Connecticut, Storrs, CT 06269, USA

*P. E. Molina: Email: ude.cshusl@nilomp

  

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What Factors Are Related to Success on Conditional Release/Discharge? Findings from the New Orleans Forensic Aftercare Clinic: 2002–2013

The present study investigated the empirically based factors that predicted success on conditional release among a sample of individuals conditionally discharged in Louisiana. Not guilty by reason of insanity acquittees and individuals on conditional release/discharge for incompetency to stand trial were included in the study. Success on conditional release was defined as maintenance of conditional release during the study period. Recidivism (arrest on new charges) and incidents were empirically evaluated. Success on conditional release was maintained in over 70% of individuals. Recidivism was low, with only five arrests on new charges. Success on conditional release was predicted by financial resources, not having a personality disorder, and having fewer total incidents in the program. 

After controlling for the influence of other variables, having an incident on conditional release was predicted by a substance use diagnosis and being released from jail. Individuals conditionally released from jail showed fewer number of days to first incident (67 vs. 575 days) compared with individuals discharged from the hospital. These data provide support for the successful management of forensic patients in the community via conditional release, although they highlight specific factors that should be considered when developing community-based release programming. 

Conditional release programs should consider empirical factors in the development of risk assessment and risk management approaches to improve successful maintenance of community-based forensic treatment alternatives.

Full article at:  http://goo.gl/rXTvXu

By:  Gina M. Manguno-Mire, Ph.D.,* Kelly L. Coffman, M.D., M.P.H.,† Sarah M. DeLand, M.D.,† John W. Thompson, Jr., M.D.,† and Leann Myers, Ph.D.‡

^†Department of Psychiatry and Behavioral Sciences, Tulane University, School of Medicine, New Orleans, LA

^‡Department of Biostatistics & Bioinformatics, Tulane University, New Orleans, LA

^*Correspondence to: Gina M. Manguno-Mire, Ph. D., Tulane University School of Medicine, Psychiatry and Behavioral Sciences, 1440 Canal Street TB-53, New Orleans, LA 70112-2715, U.S.A. Email: ude.enalut@erimg

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Relationship of Intimate Partner Violence, HIV Risk Behaviors, and Powerlessness in African-American Women of Childbearing Age

The purpose of this study was two-fold: 

1. to examine the relationships among IPV, HIV risk behaviors, and the phenomenon of powerlessness in African-American women of childbearing age, and
2. to investigate the differences between type and severity of IPV, HIV risk behaviors, and powerlessness in African-American women of childbearing age who have and have not reported IPV 

This study used the theory of gender and power as a conceptual framework. A purposive sample of 130 African-American women ranging from 18 to 49 years of age from southeastern Louisiana was recruited from community clinics. A correlation/comparative analysis design was used in this study. Three self-report, self-administered surveys were used: The Abuse Assessment Screen-Revised, the HIV-Risk Screening Instrument-Revised, items from the subscale of powerlessness in the Trauma-Related Belief Questionnaire, and a demographics questionnaire. 

Statistically significant relationships between IPV, HIV risk behaviors, and powerlessness were identified. Participants who had experienced emotional or physical abuse by their partners were identified to be at risk for HIV infection and a statistically significant relationship between IPV and powerlessness was identified. Participants who feared their partner or ex-partner reported higher degrees of powerlessness. 

Findings emphasized that for women who are identified as survivors of IPV, nurses need to screen for HIV infection, provide access to care and community resources, and teach skills for effective coping and risk-reduction decision-making.

Via: http://ht.ly/Smz3p 

By: Manfrin-Ledet L, Porche DJ, Westbrook S.