Clinical implications of stigma in HIV/AIDS and other sexually transmitted infections.

This study sought to identify stigma differences between HIV/AIDS and other sexually transmitted infections (STIs). Interviewees from Alabama, USA (n = 537) rated two types of stigma (damage to social reputation and 'moral weakness') for seven infections ranging from 'nuisance' conditions (e.g. pubic lice) to life-threatening disease (e.g. HIV/AIDS). When asked which of the seven STIs would be most damaging to reputation, 74.8% of respondents chose HIV/AIDS. However, when asked to choose which STI represented moral weakness in infected persons, HIV/AIDS was rated as significantly lower than the other STIs, which suggests that HIV/AIDS is perceived differently than non-HIV STIs. This study addresses the possibility that advances in public awareness of HIV/AIDS have not necessarily been extrapolated into awareness of other STIs. Clinicians should be aware of these high levels of stigma as potential barriers to treatment for all STIs. Public health officials should consider the impact of undifferentiated stigma on STI prevention messages.

Secret encounters: black men, bisexuality, and AIDS in Alabama.

Black men suffer the highest rates of HIV infection in Alabama. However, little is known about the HIV risks of this sector of the population, primarily because the current public health focus is on women and children. The dearth of research on HIV risk among black men in Alabama is addressed by drawing on focus group, elicitation, and key informant data from an ongoing epidemiologic study on AIDS in that state. These hypothesis-generating qualitative interviews were used to identify three high-risk scenarios: "sex for money or drugs"; "prison sex"; and "sneaky sex" by married or nominally heterosexual men. It was found that covert and unprotected sex among bisexually active black men was commonplace for reasons that included prostitution, habituation to same-sex relations during incarceration, and the desire to maintain a facade of heterosexuality in homophobic communities. It was concluded that bisexual activity is highly correlated with secrecy and unprotected sex. The risks of bisexuality among black men are exacerbated by incarceration, homophobia, drug use, and the prison and public health focus on surveillance rather than prevention.

HIV risk and healthcare attitudes among detained adolescents in rural Alabama.

This qualitative study explored the dynamics of adolescent HIV risk through focus group interviews of male and female adolescents at an Alabama juvenile detention facility, key informant interviews, and through interviews of HIV-positive and -negative adults in institutional settings and public health clinics in Alabama. The interviews revealed that commodified or unprotected sex with multiple partners was a common risk activity for male and female adolescents, with a related high risk of sexually transmitted disease. The adolescents were aversive to condom use and lacked knowledge of the dynamics of HIV transmission. Bisexually behaving males who engaged in same-sex prostitution for money or drugs viewed female partners as the source of HIV infection. Illicit drug activity and risky sexual behavior were highly related to economic and status anxiety. Experiences of healthcare were often coercive or were undermined by negative perceptions of health professionals. These negative perceptions and avoidance or lack of access to healthcare compounded the already high risk of sexually transmitted disease for this group of adolescents.

Women's douching practices and related attitudes: findings from four focus groups.

PURPOSE: Vaginal douching is a common hygiene practice for many U.S. women, but is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. This qualitative study, consisting of four focus groups of 31 southern women, was conducted to gather in-depth information about attitudes and beliefs associated with douching. The focus groups consisted of separate groups of low-income and middle-income Caucasian and African-American women. RESULTS: The African-Americans and low-income Caucasians were more likely to douche than middle-income Caucasians. The participants reported douching after menstruation, after sexual intercourse, and at other times for cleanliness and odor control. Concern about odor and cleanliness was a recurrent theme, and douching was represented as an expected and necessary part of feminine hygiene. Several socioeconomic and racial differences were observed in douching practices and attitudes. CONCLUSIONS: This study provides preliminary information about women's douching practices and attitudes that may inform practitioners' educational efforts and future research.

Don't ask questions: a psychotherapeutic strategy for treatment of involuntary clients.

This article puts forth the proposition that asking questions is detrimental to successful therapy with unwilling clients. The utility of three commonly used approaches is examined by asking. Does continuing questioning impede therapy with involuntary clients? Are therapists asking questions primarily as a means of coping personally with sullen and silent, or angry and abrasive client behavior? Is it correct to assume that asking "why" is a particularly poor therapy intervention because it brings therapists and clients into a futile search for causation of behaviors? It is recommended that statements, instead of questions, should be introduced as the preferred therapeutic modality with reluctant and unwilling clients.

Improving HAART naturally.

AIDS: Herbal or supplemental medicines often are considered alternatives to traditional antiretroviral therapy, but they can actually enhance the effectiveness of highly active antiretroviral therapy (HAART). Before beginning treatment with these alternative therapies, one should make sure their gut is functioning well and identify any possible food allergies. For example, the use of amino acid supplement L-glutamine is helpful in healing the gut. In addition, the use of beta carotene and hyperthermia, natural methods for increasing CD4 counts, are described.^ieng

Dietary consideration and protease inhibitors.

AIDS: Protease inhibitor therapy requires that the patient have adequate liver function in order to detoxify the substance before it reaches toxic levels in the bloodstream. Liver functioning is described, as well as the effects of several drugs. Ritonavir, for example, inactivates the cP450 enzyme, which retards the liver's ability to filter out antihistamines and antidepressants, causing life-threatening levels. A healthy diet and avoidance of alcohol and tobacco products can help promote optimum liver functioning. Also, caffeine and cola should be used in limited quantities by those on protease inhibitor therapy.^ieng

Constructive feedback in organizational team-building.

Ways constructive feedback can help an organization achieve and maintain a competitive advantage within and without the workplace is the topic of this chapter. An approach called 360 feedback is detailed, by which an employee is rated by workers at various levels in the organizational hierarchy instead of by a single supervisor.

Psychoneuroimmunology and HIV.

AIDS: The field of psychoneuroimmunology has been evolving over the past thirty years and is based on connecting the mind and body using a concept known as hardiness. Hardiness generally consists of three main parameters: commitment, control, and challenge, but in working with HIV-infected patients, a fourth parameter, community, is added. Various mental health scales are used to assess how patients cope with stress; effects of stress on the immune system can also be assessed by determining proliferation of various types of lymphocytes. Various studies conducted on asymptomatic HIV-positive subjects prior to and following notification of HIV-1 antibody status measured immune system function in patients that were or were not involved in aerobic exercise or group, cognitive, or behavioral modification. Those who participated in interventions had lower or minimal decreases in immunologic parameters compared to controls. A University of Miami research team theorizes that in the absence of aerobic conditioning or behavioral restructuring, a cascade of events occurs which decreases the individual's immunologic endocrine and neuropathic functioning. The patients' hardiness is what keeps them from falling under a medical hex, that is, keeps them from allowing the person in power (the doctor) to take away their hope, which would cause the cascade to occur. Support groups are good ways to help patients develop hardiness within a trusting atmosphere.^ieng

Nutrition and HIV.

AIDS: Nutritional status directly affects immune competence; therefore, dietary supplements can be beneficial. Vitamin A, a fat-soluble nutrient obtained exogenously from animal protein or synthesized endogenously from carotenoids, is important in vision, epithelial tissue maintenance, reproduction, and growth. It is also an antioxidant, and can interfere with HIV-related oxidative destruction. Vitamin C, a water-soluble antioxidant important in hydroxylation reactions and required by erythrocytes for retrieving stored iron, can suppress HIV in vitro. However, this requires long-term administration, and its effect ceases upon termination of treatment. Vitamin E, fat-soluble tocopherols, can be found in plants, vegetable oils, milk, eggs, fish, meats, and cereals. A potent antioxidant because of its electron-donating ability, vitamin E reduces HIV replication. Deficiency reduces inhibition of tumor necrosis factor alpha (TNF-a) and protein kinase C, therefore limiting immunocompetence. Additionally, damaging side effects of AZT, normally reversed or minimized by vitamin E, may induce low leukocyte counts and anemia. Vitamin E acts synergistically with selenium, another antioxidant, to block the rate of lipid peroxidation. Its administration may reduce diarrhea, cramping, and weight loss, and may improve epithelial conditions and reduce the frequency of illness. N-acetylcysteine (NAC), a sulfur-containing amino acid, inhibits HIV replication by raising serum glutathione levels through inhibition of TNF-a. Finally, HIV-infected patients should consider gluten-free diets during times of acute gastric distress.^ieng