Predictors of Disclosure of Maternal HIV Status by Caregivers to their Children in an Inner-City Community in the United States

Disclosure of HIV status to children is a challenge parents living with HIV face. To evaluate predictors of maternal HIV disclosure in a low-income clinic in the U.S. that serves an African American, Hispanic and immigrant population with high HIV prevalence, 172 caregivers with 608 children completed a standardized survey. 

Caregivers were 93% female, 84% biological mothers, and 34% foreign born. Sixty-two (36 %) caregivers had at least one disclosed child, 42 of whom also had other nondisclosed children. Of all children, 581 (96%) were uninfected and 181 (30 %) were disclosed. Caregiver's U.S. birth, child's age, and increased HIV-stigma perception by caregiver predicted disclosure. Children were more often disclosed if their caregiver was born in the U.S. or reported higher HIV-related stigma. 

These findings suggest that complex family context may complicate disclosure, particularly among immigrants.

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By:  Abdulrahman R1, Stuard E2, Vachon ME2, Nicholas C2, Neugebauer R3, Hagmann SH2, Purswani MU2.

• 1Columbia University, Mailman School of Public Health, Environmental Health Department, New York, NY, USA. rozanabdul@gmail.com.
• 2Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA.
• 3Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA. 
• AIDS Behav. 2016 Mar 24. 

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Antiretroviral Therapy and Viral Suppression among Foreign-Born HIV-Infected Persons Receiving Medical Care in the United States

Immigrants to the United States are more likely to be diagnosed with human immunodeficiency virus (HIV) infection compared with native-born persons. Navigating access to healthcare in the United States can be challenging for foreign-born persons, and HIV treatment outcomes may be suboptimal for these persons. We compared characteristics of and assessed disparities in clinical outcomes of foreign-born persons in care for HIV in the United States.

The Medical Monitoring Project is a complex sample, cross-sectional survey designed to be nationally representative of HIV-infected adults receiving medical care in the United States. Using data from 2009, 2010, and 2011, we conducted descriptive analyses and multivariable logistic regression to assess associations between foreign-born status and antiretroviral therapy (ART) prescription, and between foreign-born status and viral suppression. 

In all, 13.4% of HIV-infected persons were self-identified as foreign-born; the most common regions of birth were Central America and Mexico (45.4%) and the Caribbean (16.0%). Nearly 90% of foreign-born persons were diagnosed with HIV after entry into the United States. Compared with US-born persons, foreign-born persons were more likely to be younger, Hispanic, less educated, and uninsured. The prevalence of ART prescription (prevalence ratio 1.00; 95% confidence interval 0.98-1.02) was not significantly different between foreign-born and US-born persons. A higher percentage of foreign-born persons achieved viral suppression compared with US-born persons (prevalence ratio 1.05; 95% confidence interval 1.00-1.09).

No major disparities in ART prescription and viral suppression were found between foreign-born and US-born HIV-infected persons receiving medical care, despite higher percentages being uninsured.

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

By:  Myers TR1, Lin X, Skarbinski J.

• 1From the Division of Healthcare Quality and Promotion (TRM); and Division of HIV/AIDS Prevention (XL, JS); and Epidemic Intelligence Service (XL), Centers for Disease Control and Prevention, Atlanta, GA. 
• Medicine (Baltimore). 2016 Mar;95(11):e3051. doi: 10.1097/MD.0000000000003051.

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Social Movements Against Racist Police Brutality and Department of Justice Intervention in Prince George's County, Maryland

Racist police brutality has been systemic in Prince George's County, Maryland. The victims include African Americans, the mentally challenged, and immigrant populations, creating a complex and uneven public health impact. Three threads characterize the social movements and intervention since 1970. 

First, a significant demographic shift occurred as African Americans became the majority population in the late 1980s when the first Black county executive was elected in 1994. Despite the change in political leadership, police brutality remained rampant. Lower-income households located close to the District of Columbia and "inside the beltway" experienced the most police brutality. 

In 2001, The Washington Post revealed that between 1990 and 2000, Prince George's police shot and killed more citizens per officer than any of the 50 largest city and county law enforcement agencies in the country, 84 % of whom were black. Of the 147 persons shot during the 1990s, 12 were mentally and/or emotionally disturbed; 6 of these shootings were fatal. 

Second, resistance to police brutality emerged in a variety of political formations throughout the period, especially in the late 1990s. Sustained community pressure prompted the Department of Justice (DOJ) to open a civil rights investigation of the police department in November 2000. To avoid a potential federal lawsuit, the county leadership negotiated a memorandum of agreement (MOA) with the DOJ to enact policy reforms, part of which called for supplementing the departmental mobile crisis team, comprised of mental health care professionals, to respond to all cases involving mentally challenged citizens. 

Third, the incomplete process of change subsequent to the ending of DOJ oversight suggests a continued challenge to social movements opposing police brutality. This study focuses on the effectiveness of the MOA along with the activism of the People's Coalition for Police Accountability (PCPA) in reforming a culture of police brutality. The intensive oversight by the DOJ, combined with engaged resident activism, reduced the incidences of police brutality during the period 2004-2013. 

Since the termination of DOJ oversight, disturbing developments suggest the need for continued and sustained activism. Since 2010, county police officers have fatally shot 21 people, several in questionable circumstances. 

At the same time, the Prince George's Police Department has received more tactical military weaponry than any other jurisdiction in the state of Maryland under the 1033 program of the National Defense Authorization Act.

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By:    Hutto JW Sr1, Green RD2.

• 1Howard University, Washington, DC, USA.
• 2Howard University, Washington, DC, USA. rgreen@howard.edu. 
• J Urban Health. 2016 Feb 16.

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Mycobacterium Tuberculosis Infection, Immigration Status, and Diagnostic Discordance: A Comparison of Tuberculin Skin Test and QuantiFERON(®)-TB Gold In-Tube Test among Immigrants to the U.S.

OBJECTIVE:

We used a recent source of nationally representative population data on tuberculosis (TB) infection to characterize concordance between the tuberculin skin test (TST) and the QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) blood test for immigrants in the United States.

METHODS:

We used TB screening data from the 2011-2012 National Health and Nutrition Examination Survey to examine concordance between the TST and QFT-GIT-an interferon-gamma release assay (IGRA) blood test-for 7,097 U.S. natives, naturalized citizens, and noncitizens.

RESULTS:

Consistent with prior findings, one in five immigrants in the survey was identified with latent TB infection (LTBI), a rate 14 times higher than for U.S. natives. We also found higher rates of discordant TST/IGRA results among immigrants than among U.S. natives. Unadjusted discordance between TST and IGRA was 3% among U.S. natives (weighted N=5,684,274 of 191,179,213) but ranged up to 19% for noncitizens (weighted N=3,722,960 of 19,377,147). Adjusting for age, sex, and race/ethnicity, noncitizens had more than nine times the odds of having a positive TST result but negative QFT-GIT result compared with U.S. natives.

CONCLUSIONS:

Our findings suggest that whether and how either of these tests should be deployed is highly context sensitive. Significant discordance in test results when used among immigrants raises the possibility of missed opportunities for harm reduction in this already at-risk population. However, we found little distinction between the tests in terms of diagnostic outcome when used in a U.S. native population, suggesting little benefit to the adoption and use of the QFT-GIT test in place of TST on the basis of test performance alone for this population.

Full PDF article at:   http://goo.gl/mykYBc

By:  Wilson FA1, Miller TL2, Stimpson JP3.

• 1University of Nebraska Medical Center, Department of Health Services Research and Administration, Omaha, NE.
• 2University of North Texas Health Science Center, Department of Health Management and Policy, Fort Worth, TX.
• 3City University of New York, New York, NY. 
• Public Health Rep. 2016 Mar-Apr;131(2):303-10.

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Tu Amigo Pepe: Evaluation of a Multi-Media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages

Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis in the United States. 

This paper describes the evaluation of a pilot of the Tu Amigo Pepe, a multimedia HIV testing campaign aimed at Latino MSM in Seattle, WA particularly targeting immigrants who may not identify as gay, ages 18-30 years old. The 16-week campaign included Spanish-language radio public service announcements (PSAs), a Web site, social media outreach, a reminder system using mobile technology, print materials and a toll-free hotline. 

In developing the PSAs, the Integrated Behavioral Model was used as a framework to reframe negative attitudes, beliefs and norms towards HIV testing with positive ones as well as to promote self-efficacy towards HIV testing. 

The campaign had a significant and immediate impact on attitudes, beliefs, norms and self-efficacy towards HIV testing as well as on actual behavior, with HIV testing rates increasing over time.

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By:  Solorio R1,2,3, Norton-Shelpuk P4, Forehand M5, Montaño D6, Stern J7, Aguirre J8,9, Martinez M9.

• 1Department of Health Services, School of Public Health, University of Washington, 4333 Brooklyn Ave NE., Box 359455, Seattle, WA, 98195, USA. solorio@u.washington.edu.
• 2Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA. solorio@u.washington.edu.
• 3Social and Behavioral Prevention Core, University of Washington Center for AIDS Research, Seattle, WA, USA. solorio@u.washington.edu.
• 4Activate Brands, Denver, CO, USA.
• 5University of Washington Foster School of Business, Seattle, WA, USA.
• 6Battelle Research Center, Seattle, WA, USA.
• 7Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
• 8Department of Health Services, School of Public Health, University of Washington, 4333 Brooklyn Ave NE., Box 359455, Seattle, WA, 98195, USA.
• 9Entre Hermanos, Seattle, WA, USA. 
• AIDS Behav. 2016 Feb 5. 

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HIV Stigma, Testing Attitudes and Health Care Access among African-Born Men Living in the United States

The purpose of this study was to describe HIV-testing attitudes, HIV related stigma and health care access in African-born men taking part in the African Health Cup (AHC), a soccer tournament held annually to improve HIV awareness and testing. 

Venue sampling was used to collect survey and qualitative interview data related to HIV-testing attitudes, stigma and experiences associated with the AHC. The sample included 135 survey respondents and 27 interview participants. 

AHC participants were successfully accessing health care services. Although the AHC was viewed positively, HIV testing rates remain low due to stigma and privacy concerns. This population continues to have misconceptions about HIV transmission and to use condoms inconsistently. 

The AHC is a successful intervention to engage African-born men in HIV awareness and education. More work is needed to enhance these AHC aspects and address stigma and privacy concerns related to using onsite health screenings. 

Continuing to develop novel strategies to educate African-born immigrants about HIV is urgently needed.

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By:  Bova C1, Nnaji C2, Woyah A2, Duah A3.

• 1Graduate School of Nursing (http://www.umassmed.edu/gsn/), University of Massachusetts Worcester, 55 Lake Avenue North, Worcester, MA, 01655, USA. carol.bova@umassmed.edu.
• 2Africans for Improved Access Program, Multicultural AIDS Coalition, Jamaica Plain, MA, USA.
• 3Graduate School of Nursing, University of Massachusetts Worcester, 55 Lake Avenue North, Worcester, MA, 01655, USA. 
• J Immigr Minor Health. 2016 Feb;18(1):187-93. doi: 10.1007/s10903-014-0136-2

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Community Connectedness, Challenges, and Resilience among Gay Latino Immigrants

To date, relatively little psychological research has focused on the experiences of lesbian, gay, bisexual, and transgender (LGBT) Latino/a immigrants to the United States. 

This qualitative study used face-to-face semi-structured interviews to explore the unique sources of stress, challenges, as well as opportunities and factors related to resilience among 13 gay Latino first- and second-generation immigrants. Iterative coding of interview transcripts revealed four key themes, each of which is illustrated with verbatim quotes: 1) feelings of connectedness to the LGBT community, 2) feelings of connectedness to the Latino/a community, 3) intersectional challenges and strategies, and 4) well-being, strength, and resilience. 

As suggested by these themes, gay Latino immigrants have distinct sources of stress and conflict, many of them associated with community memberships, but also draw on unique sources of support and adaptive thoughts and behaviors in facing stressors. 

Implications for studying risk and resilience factors among stigmatized populations, including LGBT individuals and immigrants, are discussed.

...As Hector, a 42-year-old second-generation gay man who adopted a more masculine gender presentation noted:

I guess because I'm not flamboyant a lot of people don't realize [I’m gay] in just general public settings. So I guess if I was more effeminate it would be more obvious and then it might've been an issue for me… because of that I also stay away from gay culture more.

Hector recalled that the only gay role models he had growing up were extremely feminine and that he never identified or saw commonality with them. Presently, he stated that he chooses to affiliate with more masculine men, and wishes to be seen by others and by mainstream society as “just a regular guy.”

Another source of disconnection involved the perceived tension between ethnic groups within the LGBT community or between an ethnic community and the “mainstream” gay community. Some participants felt that being an ethnic minority member of the LGBT community was difficult at times; they perceived the LGBT community as largely White and privileged. Perhaps reflecting this, many also felt that ethnic minorities were poorly represented within the community, including in community spaces, in discussions of activism, and in the media. Ernesto, a 49-year-old Peruvian who moved to the U.S. as an adult, described his perception of the LGBT community as narrowly focused, and as having an agenda that was mainly driven by White, gay men. Having lived in several multicultural communities throughout his lifetime, he was particularly attuned to what he felt was a one-dimensional approach to defining the priorities of the LGBT community:

I think their interests are very, like I said, self-serving. It’s about what interests them. It’s like this whole Prop 8 thing…everyone's fighting for that. That's fine, but you know minorities are fighting for other things. But, but still the White elite, they think that gay minorities should be fighting for the same thing they are fighting. But it’s like what about when they are fighting about immigration, or, you know, the Dream Act, or other stuff? We don't see them. You know, they’re, they’re just not there, you know? They're totally out of touch...

Sample demographics (n = 13).

Pseudonym	Age	Sexual Orientation	Generation (Birth Country)	Primary Language	Employment Status	Education	Income
Humberto	51	Gay	1st (Venezuela)	Spanish	Full time	Graduate	$75k-$100k
Jorge	21	Queer	1st (Mexico)	English	Student	Some College	<$20k
Ernesto	49	Gay	1st (Peru)	English	Unemployed	Bachelor's	<$20k
Jose Luis	37	Gay	1st (Mexico)	English & Spanish	Full time	Graduate	$75k-$100k
Manuel	32	Gay	1st (Mexico)	English	Full time	Bachelor's	$100k+
David	19	Gay	2nd (Mexico/Mexico)	English	Part time	High School	<$20k
Carlos	26	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Oscar	53	Gay	2nd (U.S./Mexico)	English	Unemployed	Some College	<$20k
Hector	42	Gay	2nd (U.S./Mexico)	English	Self-employed	Some College	<$20k
Gabriel	29	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Edgar	23	Gay	2nd (El Salvador/Guatemala)	English	Part time	Some College	<$20k
Raul	33	Gay	2nd (Mexico/Mexico)	English	Unemployed	Associate's	<$20k
Hugo	48	Gay	2nd (Venezuela/Italy)	English	Part time	Graduate	N/A

Note: Birth country for 2nd-generation is represented as (Mother’s Birth Country/Father’s Birth Country.)

Full article at:   http://goo.gl/KL9XCL

By:  Nicole N. Gray, David M. Mendelsohn, and Allen M. Omoto

Nicole N. Gray, Department of Psychology, Claremont Graduate University;

Contributor Information.

Correspondence concerning this article should be addressed to Nicole N. Gray, Department of Psychology, Claremont Graduate University (http://www.cgu.edu/pages/1.asp), 123 E. 8^th Street, Claremont, CA 91711. Email: ude.ugc@yarg.elocin

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ASPIRE: A Multi-Site Community-Based Participatory Research Project to Increase Understanding of the Dynamics of Violence Against Immigrant & Refugee Women in Australia

Background

One in three women around the world are or have been subjected to violence. This includes in Australia, where violence against women is an urgent public health and human rights issue. Immigrant and refugee women who have resettled in Australia are known to face barriers accessing services aimed at preventing and responding to family violence. However there is little evidence about the contexts, nature and dynamics of violence against immigrant and refugee women to inform appropriate responses to enhance their safety and well-being. The ASPIRE project will address this gap by identifying opportunities for the development of responsive local and community-based interventions for family violence against immigrant and refugee women, contributing to the currently limited Australian research in this area.

Methods/Design

This participatory research project will work with communities in eight geographic locations (two inner-city, three outer-suburban, and three regional) across two states (Victoria and Tasmania), to generate evidence about immigrant and refugee women’s experiences in a range of settings. The project will engage stakeholders and communities through extensive consultation prior to data collection and by facilitating community members’ participation in generating and analysing data. A mix of qualitative methods will be used to generate rich data about the family, cultural and place-based contexts that shape the prevalence and dynamics of violence against immigrant and refugee women; women’s prevention and help-seeking efforts; and community attitudes about and responses to violence across a range of cultural groups. Methods include in-depth interviews with women who have experienced family violence, key informant interviews with local community service providers, focus group discussions with men and women from predominant cultural groups that have migrated to areas covered by the research sites, and Photovoice with community leaders. Bilingual health educators will contribute to development of the research approach, the collection and analysis of data, and the dissemination of findings.

Discussion

Findings from this two-year study will be disseminated to communities, service providers and policy-makers, providing evidence to inform culturally-appropriate prevention and support interventions, and building local communities’ awareness and capacity to respond to violence against immigrant and refugee women.

Full article at:   http://goo.gl/lzky4f

By:   Cathy Vaughan, Adele Murdolo, Linda Murray, Erin Davis, Jasmin Chen, Karen Block, Regina Quiazon, and Deb Warr

Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010 Australia

Multicultural Centre for Women’s Health, Suite 207, Level 2, 134 Cambridge St, Collingwood, VIC 3066 Australia

School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, 7005 Australia

Cathy Vaughan, Email: ua.ude.bleminu@nahguav.c.

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Improving HIV Prevention, Screening and Clinical Care for African Immigrants

Via:  http://goo.gl/khv6Dh

Epidemiology of HIV/AIDS and Hep B among African Immigrants: Current Status, Barriers & Challenges

Via:  http://goo.gl/khv6Dh

Aggression Behavior & Substance Use among Immigrant Children: Mediating Effect of Antisocial Attitudes

In 2010, approximately one out of four youths in the United States were immigrant children. Hispanics and Asians comprised the largest groups (58% and 16%), respectively. Today, the Hispanic population is the largest ethnic minority in the United States (15%) and is a majority of the U.S. foreign-born population (47%). 

While immigration is a positive process for most immigrants, resettlement into a new country has challenges, including acculturation adjustments. Youth engage in risky behaviors such as substance use and antisocial behaviors. For immigrant youth with limited supportive opportunities, however, the acculturation process can be difficult. Stress, alienation, and stigma often manifest and cause behavioral problems, including aggression. 

This pilot study examines the mediating effect of antisocial attitudes using sociocultural, developmental, and environmental factors to understand Hispanic youth problem behaviors. We sampled 136 youths, ages 6-12, from predominantly Hispanic elementary schools in the southwestern United States to ascertain the role of aggression and antisocial behavior in substance use attitudes. 

The results show significant differences in aggression, antisocial attitudes, and substance use according to (1) age, (2) years in the United States, (3) English level, and (4) relationship with mother. Aggression significantly predicted antisocial attitudes and substance use, with antisocial attitudes having a mediating effect on the relationship between aggression and substance use. 

In developing social service programs to prevent substance use among children from immigrant families, social work educators and practitioners may consider addressing the role of aggression in Hispanic adolescents' future behavior.

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By:   Small E1, Kim YK1, Mengo C1.

• 1 School of Social Work , University of Texas , Arlington , Texas , USA. 

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Intimate Partner Violence and Animal Abuse in an Immigrant-Rich Sample of Mother–Child Dyads Recruited from Domestic Violence Programs

We examined rates of animal abuse in pet-owning families experiencing intimate partner violence (IPV). We also examined whether higher levels of IPV (as measured by subscales from the Conflict Tactics Scales) predicted increased risk for partner-perpetrated animal abuse. 

Our sample included 291 mother–child dyads, where the mothers sought services from domestic violence agencies. Nearly half the sample is comprised of Mexican immigrants. Mothers reported that 11.7% of partners threatened to harm a pet and 26.1% actually harmed a pet, the latter of which represents a lower rate than in similar studies. When examining animal abuse by “Hispanic status,” follow-up analyses revealed significant omnibus differences between groups, in that non-Hispanic U.S.-born partners (mostly White) displayed higher rates of harming pets (41%) than either U.S.-born or Mexican-born Hispanic groups (27% and 12.5%, respectively). 

Differences in rates for only threatening (but not harming) pets were not significant, possibly due to a small number of partners (n = 32) in this group. When examining whether partners’ IPV predicted only threatening to harm pets, no IPV subscale variables (Physical Assault, Psychological Aggression, Injury, or Sexual Coercion) were significant after controlling for income, education, and Hispanic status. 

When examining actual harm to pets, more Psychological Aggression and less Physical Assault significantly predicted slightly higher risk of harm. However, Mexican-born partners had nearly 4 times lower risk of harming a pet. Overall, these results suggest that Hispanic men who are perpetrators of IPV are less likely to harm pets than non-Hispanic perpetrators of IPV, particularly if Mexican-born. 

Considering that the United States has a significant proportion of Mexican immigrants, it may be worthwhile to explore the topics of IPV and animal abuse within this group.

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By:   Christie A. Hartman, PhD1⇑, Tina Hageman, MSW1, James Herbert Williams, PhD1, Frank R. Ascione, PhD1

1. ¹University of Denver, CO, USA

1. Christie A. Hartman, University of Denver, 2148 S. High St., Denver, CO 80208, USA. Email: christie.hartman@du.edu

 

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