HIV vaccine trial preparedness among Spanish-speaking Latinos in the US.

Latinos are under-represented in HIV/AIDS medical research in the US. Although they are disproportionately impacted by HIV/AIDS, Latinos may be reluctant to participate in HIV vaccine trials. Three focus groups were conducted with 32 Spanish-speaking Latinos recruited from two community-based healthcare organizations in Los Angeles, California. A qualitative focus group interview guide was developed to explore concerns, motivators and intentions in regard to participation in HIV vaccine trials. Mistrust and fear of government emerged as important themes related to reluctance to participate in an HIV vaccine trial. Specific concerns regarding trial participation included: (1) fear of vaccine-induced HIV infection, (2) physical side effects, (3) stigma and (4) false-induced HIV-positive test results and their social repercussions. Motivators for enrolling in an HIV vaccine trial included: (1) incentives, (2) convenience of participating in a study, (3) sufficient and appropriate study information, (4) personal benefits and (5) altruism. Interventions to facilitate participation by Latinos in HIV vaccine trials should address mistrust and fear of government-sponsored HIV/AIDS medical research, increase access to and convenience of clinical trials, address fear of vaccine-induced infection, combat HIV/AIDS stigma and raise awareness of the relevance of HIV/AIDS to Latino communities.

Perceived barriers to employment among persons living with HIV/AIDS.

This study examined factors associated with contemplating returning to work among unemployed persons living with HIV/AIDS (PLHA) in a large urban city in the United States. A mailed, self-administered survey gathered information from 757 unemployed PLHA. Chi-square and logistic regression analyses were used to determine associations between contemplating returning to work and sociodemographic characteristics, health factors and perceived barriers to employment. We found that most unemployed PLHA (74%) were thinking of returning to work, but perceived significant barriers such as loss of disability income benefits (73%), loss of publicly-funded health insurance (67%) and workplace discrimination (66%). Univariate analyses indicated that contemplating returning to work was significantly associated with sociodemographic characteristics, health factors and perceived barriers to employment in the following areas: (1) availability of health insurance, (2) personal health and physical ability, (3) health concerns related to working and the work environment, and (4) current job skills. Multivariate analyses indicated that: gender, age, race/ethnicity, health insurance type, health status and the belief that health will improve if employed were independently associated with contemplating returning to work. In summary, a substantial proportion of unemployed PLHA may contemplate re-entering the workforce. Assistance is needed to help PLHA address perceived barriers that may prevent them from seeking employment.

Measurement variability in upper extremity posture among VDT users.

Hand and arm posture while keying is frequently mentioned as a risk factor for upper extremity musculoskeletal disorders (UEMSDs) among video display terminal (VDT) operators. However, many epidemiologic studies have not included measures of posture of VDT operators, in part, because of the difficulty of assessing posture rapidly and reliably among large numbers of subjects. For a single measure of posture to be useful for estimating dose-response relationships between posture and risk of UEMSDs, the within-subject variability of the postural measure must be smaller than the between-subject variability of the postural measure. In addition, the measure must be stable over time. We estimate the ratio of between- to within-subject variability for manual goniometry by measuring six postural angles on six occasions among 19 subjects using VDTs. For each postural angle, between-subject variability was substantially and statistically significantly larger than within-subject variability. Stability of postural measures over time was sufficient to justify a single postural measurement in epidemiologic studies. We conclude that manual goniometry can provide useful information about upper extremity posture among VDT users for use in epidemiologic studies of UEMSDs.

Methodological limitations in the study of video display terminal use and upper extremity musculoskeletal disorders.

Upper extremity musculoskeletal disorders may occur as a result of work with keyboard-equipped video display terminals. Many studies of the associations between keyboard use and upper extremity disorders have appeared in both the human factors and occupational epidemiologic literature. Methodological limitations and inconsistent results have limited conclusions that can be made from these studies, however. Although exposure conditions can be carefully controlled, human factors studies are limited by relatively small sample sizes, short exposure durations, and reliance on outcome measures with unknown relevance to chronic adverse health effects. Epidemiologic studies have been limited by poor ascertainment of both exposure and health outcome. Many have failed to control for any potential confounding. An almost exclusive reliance on cross-sectional study designs has resulted in possible bias from selective survival, exposure-effect reversal, and poor estimates of exposures occurring prior to development of the disorder. Given the inconsistency in the literature and the growing controversy surrounding this issue, prospective study of this question using objective methods for assessment of exposure and health outcome is recommended. This design allows identification of incident cases and minimizes bias from selective survival. In addition, ergonomic and psychosocial variables prior to onset of symptoms can be ascertained periodically. Given estimates for up to 100 million video display terminals to be in use in the United States by the year 2000, clarification of the health effects of their use is critical.