HIV/AIDS and disability: differences in HIV/AIDS knowledge between deaf and hearing people in Nigeria.

PURPOSE: Studies both in North America and Europe have found that deaf individuals lack access to AIDS information, due to problems in communication, low literacy and tightly woven social networks within the deaf community. However few comparable studies are available from countries in the Developing World. The present study was undertaken in Nigeria where there is an estimated adult HIV prevalence rate of 5.4%. We sought to compare HIV knowledge among deaf and hearing individuals in order to identify how effectively deaf members of the community are being reached by HIV/AIDS messages. METHODS: A survey comparing knowledge about HIV/AIDS among deaf and hard of hearing adolescents (n = 50) and young adults (n = 50) was undertaken. RESULTS: Significant differences (p < 0.05) in levels of understanding about certain aspects of how AIDS is spread were identified as well as differences in available resources for access to accurate information among deaf members of the population. CONCLUSION: These findings from Nigeria speak strongly to the need for the development of interventions that include people with disabilities in public health and HIV/AIDS strategies and that address their specific vulnerabilities. Evaluating the adaptation of education material and the inclusion of the deaf population in HIV awareness programmes is an urgent 'next step.'

Sociocultural influences on disability status in Puerto Rican children.

BACKGROUND AND PURPOSE: This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). SUBJECTS AND METHODS: More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. RESULTS: Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. DISCUSSION AND CONCLUSION: Puerto Rican values of interdependence, añoñar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.

From quarantine to condoms: shifting policies and problems of HIV control in Cuba.

This study reviews HIV prevention in Cuba in light of (1) the liberalization of HIV quarantine, (2) the growth in tourism, and (3) the aggressive system of public health promotion. Sixty-two key informants, including Cubans who are HIV-positive, at risk, or working as health professionals, were interviewed during June and July of 1996. Findings include: (1) there is a common public perception that the government's national HIV screening and contact tracing system obviates the need for individual precaution; and (2) both commercial sex workers and men who have sex with men believe that legal and social forces hinder their indigenous HIV prevention efforts. A well developed system of preventive health care offers the potential for effective HIV prevention. The fact that Cuban officials use the success of their HIV/AIDS control program to promote national pride may retard appropriate changes in their response to currently rising levels of infection.

Counseling and educational interventions for women with genital human papillomavirus infection.

Human papillomavirus (HPV) genital infection is a sexually transmitted disease that affects a large proportion of college-aged women. In addition to the distressing medical aspects of HPV infection, sometimes including lengthy and painful treatments, symptom recurrence, a lack of a definitive cure, and its potential for malignant transformation, HPV also results in significant emotional and psychosexual sequalae for the patient. Concurrent with the range of negative emotions experienced by the patient is also a knowledge deficit regarding the disease, its prevention, and its management. This combination of factors within the young women afflicted with this disease often precludes them from effective adherence to their treatment and follow-up plan of care, which are both essential elements in managing this chronic condition. Clinicians who are treating patients with HPV infection must address not only the medical aspects of the disease, but the psychosocial needs as well. This case report describes a newly diagnosed young women with HPV infection and discusses the necessary psychosocial and educational interventions that should be provided to all female patients who are diagnosed with HPV infection. Inclusion of these interventions can reduce the emotional stress that occurs with the diagnosis and can augment a patient's coping skills, thereby serving to improve adherence to the treatment plan and promote a greater sense of empowerment and wellness for the patient.

Psychosocial and educational services for female college students with genital human papillomavirus infection.

CONTEXT: College-age women have a high risk of acquiring human papillomavirus (HPV) infection, which may have substantial psychosocial and physical effects. Young women who become infected need information and support from health care professionals, but little is known about providers' attitudes toward or provision of interventions for helping women cope with HPV. METHODS: A survey of 73 nurse practitioners and 70 physicians in college-based health clinics explored their perceptions of the need for psychosocial and educational interventions and their practices regarding such services for HPV patients. Analysis of variance and chi-square testing were used to examine differences by providers' type and gender. RESULTS: At least 86% of providers agree that HPV infection has a variety of psychosocial effects on young women, but only 54% spend at least 10 minutes providing education and counseling to all of their HPV patients. Roughly 80-90% routinely take a sexual history, explain the potential of HPV recurrence and discuss the risk of cancer with HPV patients; however, fewer than half always offer a variety of other interventions that could help patients cope with the diagnosis and promote preventive behaviors. Female providers are more aware of the psychosocial impact of HPV and the need for support than are male providers. However, nurse practitioners provide counseling and educational interventions more frequently than do physicians, even when gender is controlled for. CONCLUSIONS: College-based health providers need to improve the content of the counseling and education they offer to women with HPV, as well as the consistency with which they deliver those interventions. When they are unable to provide services, they should be able to refer patients elsewhere.

Epidemiology of firearm mortality and injury estimates: state of Connecticut, 1988-1993.

STUDY OBJECTIVES: To retrospectively determine the 6-year cumulative incidence rate of firearm mortality and estimate nonfatal firearm injuries in Connecticut. METHODS: Retrospective analysis of data originating from the Connecticut State Medical Examiner's Office and records from the Trauma Registry of one urban hospital. RESULTS: From January 1988 through December 1993, 1,625 Connecticut residents died from firearm-related injuries. The cumulative incidence rate was 49.4 deaths per 100,000 population during the 6-year study period. Rates peaked among 20- to 24-year-olds at 18.1 deaths per 100,000. Males outnumbered females more than eightfold. The ratio of nonfatal firearm injuries to firearm deaths was 7:1 for those shot by another, self-inflicted injuries were fatal in half of all cases. CONCLUSION: Analysis of firearm mortality data indicated that males in younger age categories were disproportionately affected. These rates combined with nonfatal injury projections demonstrate that firearms represent a significant public health threat to the population of Connecticut, reaching epidemic proportions among specific subpopulations. These results are consistent with those obtained from national studies.

College health providers' knowledge, attitudes, and management practices of genital HPV infection.

This comparative survey of college health providers explored nurse practitioners' (N = 73) and physicians' (N = 70) knowledge, attitudes, and management practices related to genital human papillomavirus (HPV) infection in females. Both groups had adequate knowledge of basic issues of HPV epidemiology, diagnosis, and treatment. Divergent attitudes and management practices were reported among the providers, with generally low agreement with national STD treatment guidelines published by the Centers for Disease Control and Prevention (CDC). Generally, providers tended to practice a more aggressive management approach on several aspects of HPV infection than recommended by the CDC guidelines. The one major exception reported by the majority of providers was the conservative use of colposcopy for identifying subclinical HPV infection in patients with external genital warts, a finding consistent with CDC guidelines. The availability of colposcopy within a provider's health center was found to be associated with the reported use of colposcopy. Recommendation for future research and implications for college health and advanced nursing practice are addressed.

Multiculturalism, chronic illness, and disability.

To gain at least an initial understanding of the underlying beliefs and attitudes in a cross-cultural situation, we believe that the three key points discussed in this paper should prove a significant point of departure: 1. Traditional beliefs about the cause of chronic illness or disability will play a significant role in determining family and community attitudes toward individuals with a disability and will influence when, how, and why medical input is sought. 2. The expectation of survival on the part of parents and community will have an effect on the amount of time, energy, and cooperation shown by family and community for the individual who has an impairment. 3. The expectations by family and community for the social role(s) and individual with a chronic illness or disability will hold will affect a broad range of issues, including education, social integration, and independence. Furthermore, although chronic illness and disability are often considered as issues distinct from the full range of problems encountered in society for immigrant and minority groups, in fact, these issues could not be more closely tied. The frequently discussed concerns within the ethnic and minority community about the role of the family, integration and acculturation, social articulation with the greater American society, stress, cross-cultural misunderstanding, and outright prejudice can all compound the problems encountered for the chronically ill or disabled individual in a multicultural society.