Gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town, South Africa.

Because men account for nearly half of the HIV cases in South Africa, it is critical to understand the contexts in which they live and the behaviors in which they engage. The purpose of this study was to describe and examine gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town. We found that recent exposure to intimate partner violence among men was associated with all forms of drug use, whereas women who were recently abused were more likely to suffer from depression and problem drinking. We also found high levels of problem drinking among both men (58%) and women (42%). Men were more likely to use drugs. Exposure to community violence increased sexual risk behaviors among men. Overall, these gender differences have important implications for alcohol and drug prevention strategies as they relate to HIV transmission risk.

Differences in patterns of symptom attribution in diagnosing schizophrenia between African American and non-African American clinicians.

The authors examined clinician race differences in symptom attribution patterns in diagnosing psychiatric inpatients from a low-income, African American community. Different decision models were applied to patients based on clinician race. African American clinicians diagnosed schizophrenia with higher odds than non-African American clinicians when they believed hallucinations were present and avoided that diagnosis with lower odds when they considered substance abuse issues. Non-African American clinicians usually related the attribution of negative symptoms to the diagnosis of schizophrenia while African American clinicians did not make this linkage. The study highlights the need for more detailed examination of cultural influences on diagnostic judgments.

Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients.

OBJECTIVE: This retrospective study explored the interrelationship among aftercare, length of hospital stay, and rehospitalization within six months of discharge in a sample of psychiatric inpatients. METHODS: Data were analyzed for 1,481 patients who had received inpatient care at a state psychiatric hospital from November 1991 to July 1994. Logistic regression models were estimated to predict the likelihood of referral to aftercare and of readmission to a hospital within six months of the index discharge. Variables controlled for were patients' characteristics; psychiatric status at the time of discharge, including length of stay; and the availability of informal support. RESULTS: Sixteen percent of the patients received a referral to aftercare, and about 13 percent of the patients were readmitted within six months of discharge. White patients were twice as likely as African Americans to receive a referral to aftercare. Length of hospitalization and having a diagnosis of schizophrenia were also predictors of referral to aftercare. Referral to aftercare was not shown to mediate the relationship between length of stay and rehospitalization. However, having a schizoaffective disorder, a poor discharge prognosis, and a high number of previous admissions were associated with an increased risk of readmission. No other demographic characteristics were related to readmission within six months of discharge, but referral to aftercare significantly increased the risk of readmission. CONCLUSIONS: The study suggested the possibility of racial disparities in referral to aftercare and a complex relationship between referral and rehospitalization. Both these findings warrant further investigation that gives particular attention to individual-level indicators of need and system-level barriers to and facilitators of psychiatric care.

Provider perceptions of key barriers to providing state-of-the-art clinical care for HIV-infected African-American patients.

U.S. AIDS rates have declined among same population groups; however, African-Americans and other ethnic minorities have experienced the least amount of decline. As a result medical and public health authorities are tasked with developing strategies to help eliminate the disparity in HIV/AIDS incidence rate and clinical outcomes. Thus, in 1999, the National Minority AIDS Education and Training Center (NMAETC) was developed to facilitate training, clinical consultation and technical assistance to clinicians that provide care to HIV-infected minority patients. Its initial activities were designed solely to increase providers' clinical capacity to use state-of-art anti-retroviral therapies to treat and manage the disease. However, through focused discussions with target providers and a survey of medical care service sites, the NMAETC confirms that provider' training and assistance needs extend into non-medical domains.

Substance use among a sample of foreign- and U.S.-born southeast Asians in an urban setting.

Asian Americans (AA) are thought to have the lowest rates of substance use. This study examined substance use prevalence among 494 urban-dwelling Southeast Asians using snowball techniques. Prevalence estimates were age-adjusted proportionate to the U.S. Asian population. Findings show beer and alcohol consumption approximated the national percentage among 25-44 year olds. U.S.-born were about three times likelier to have past month substance use. Foreign-born Vietnamese were likelier than U.S.-born to use all substances except for beer. U.S.- and foreign-born beer consumption rates were similar. Future research is needed to delineate substance use determinants and patterns in foreign and U.S.-born AA sub-groups.