Patient-provider communication with HIV-positive women about abnormal Pap test results.

In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19-10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55-14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH's health literacy as an intermediate step to improving patient-provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

"Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV.

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Cervical Cancer Prevention Knowledge and Abnormal Pap Test Experiences Among Women Living with HIV/AIDS.

Cervical cancer prevention knowledge deficits persist among women living with HIV/AIDS (WLHA) despite increased risk of developing cervical dysplasia/cancer. We examined associations between WLHA's cervical cancer prevention knowledge and abnormal Pap test history. We recruited 145 urban and rural WLHA from Ryan White-funded clinics and AIDS service organizations located in the southeastern USA between March 2011 and April 2012. For this analysis, women who reported a history of cervical cancer (n = 3) or had a complete hysterectomy (n = 14) and observations with missing data (n = 22) were excluded. Stata/IC 13 was used to perform cross-tabulations and chi-squared tests. Our sample included 106 predominantly non-Hispanic Black (92%) WLHA. Mean age was 46.3 ± 10.9 years. Half (50%) had ≤ high school education. One third (37%) had low health literacy. The majority (83 %) had a Pap test <1 year ago, and 84 % knew that WLHA should have a Pap test every year, once two tests are normal. Many (68%) have had an abnormal Pap test. Abnormal Pap test follow-up care knowledge varied. While 86% knew follow-up care could include a repeat Pap test, only 56% knew this could also include an HPV test. Significantly, more women who had an abnormal Pap test knew follow-up care could include a biopsy (p = 0.001). For WLHA to make informed/shared decisions about their cervical health, they need to be knowledgeable about cervical cancer care options across the cancer control continuum. Providing WLHA with prevention knowledge beyond screening recommendations seems warranted given their increased risk of developing cervical dysplasia/neoplasia.

Assessing the influence of health literacy on HIV-positive women's cervical cancer prevention knowledge and behaviors.

Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥ 2 Pap tests during the year after HIV diagnosis (p=0.02), and less likely to have had a Pap test <1 year previously (p=0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.

HIV testing among Deep South residents with serious psychological distress.

OBJECTIVE: To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. METHODS: Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersen's behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. RESULTS: Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60%). Predisposing factors (age, race/ethnicity, and urbanization) were confounders of HIV testing among both males and females with serious psychological distress. Enabling factors (income, health care access) were only confounders of HIV testing among males with serious psychological distress. CONCLUSION: Future HIV prevention and management efforts should consider the potential role of concurrent serious psychological distress in impacting an individual's daily life and health activities such as self-care, caring for family, and maintaining employment.

HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data.

OBJECTIVE AND BACKGROUND: Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. METHODS: Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. RESULTS: More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship. CONCLUSIONS: Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.

Evaluating leadership training in African American HIV prevention organizations.

This article aimed to examine changes in the HIV prevention capacity of HIV prevention program managers who completed the Institute for HIV Prevention Leadership ("Institute") between 2002 and 2004, and who worked in community-based organizations that primarily served African Americans. Participants completed a survey at three points in time, in which they rated the frequency with which they conducted activities related to HIV prevention practice. Participants also rated their confidence in performing activities. Repeated measures ANOVA was conducted to detect differences at three time points (baseline, immediate posttest, and 6 months posttest). A significant overall positive trend was found in the frequency and confidence of participants to perform specific HIV prevention practices and an overall positive trend in the frequency of processes that support HIV prevention practice. Investment in long-term, intensive, capacity-building programs like the Institute is critical to address the increasing incidence of HIV in many African American communities.

Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework.

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.

Diversifying the academic public health workforce: strategies to extend the discourse about limited racial and ethnic diversity in the public health academy.

While public health has gained increased attention and placement on the national health agenda, little progress has been made in achieving a critical mass of underrepresented minority (URM) academicians in the public health workforce. In 2008, a telephone-based qualitative assessment was conducted with URM faculty of schools of public health to discuss this issue. As a result, we present successful strategies that institutional leaders can employ to extend the discourse about addressing limited diversity in the public health academy.

Cost savings threshold analysis of a capacity-building program for HIV prevention organizations.

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

Evaluation results of the CDC/ASPH Institute for HIV Prevention Leadership: a capacity-building educational program for HIV prevention program managers.

OBJECTIVE: The goal of this research was to evaluate changes over time in the capacity of participants of the CDC/ASPH Institute for HIV Prevention Leadership (Institute), a capacity-building program for HIV prevention program managers in minority-based, community-based organizations. Capacity was defined as the application of new skills and knowledge to participants' jobs and confidence in using those new skills and knowledge to strategically manage and apply "best practices" to their HIV prevention activities. METHODS: This is a longitudinal study involving measuring scholar capacity at three points in time: pre-Institute, post-Institute, and 6 months' post-Institute. Only responses from participants who completed all three surveys are included in this final analysis of the data (N = 94). RESULTS: Results indicate that participants from 3 years of the Institute (2002-2004) increased their capacity in HIV prevention programming and strategic planning and management. Significant changes were seen in the frequency and self-efficacy with which participants conduct several HIV prevention programming activities. Participants also reported conducting strategic planning activities at more appropriate intervals and were significantly more confident in conducting these activities. CONCLUSION: The Institute has positively and significantly increased the capacity of participants to conduct more effective HIV prevention programs on a national level.

Factors influencing help-seeking from informal networks among African American victims of intimate partner violence.

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be "stupid" for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans.

Development of a curriculum to enhance community-based organizations' capacity for effective HIV prevention programming and management.

Community-based organizations (CBOs), particularly minority-based CBOs, are instrumental in the delivery of HIV/AIDS prevention programs and services. Despite a tremendous need, many CBOs lack the capacity to plan, implement, and evaluate targeted prevention interventions to serve culturally diverse populations. This article describes a comprehensive, innovative curriculum for building capacity within CBOs providing HIV prevention programming. An overview of the process through which the Centers for Disease Control and Prevention/Association of Schools of Public Health Institute for HIV Prevention Leadership evolved is discussed. The development of the curriculum occurred in four phases: needs assessment, curricular design, implementation, and evaluation. A description of the Institute's evaluation strategies and procedures are described. Selected preliminary evaluation results from two cohorts of participants indicate significant knowledge gains and high levels of satisfaction with the Institute sessions, assignments, and faculty. The Institute's model shows promise for the provision of capacity building education at the individual and organizational level for community-based professionals implementing HIV prevention programs.

Emergency preparedness academy adds public health to readiness equation.

From November 2003 to May 2004, the University of South Carolina Center for Public Health Preparedness and the South Carolina Department of Health and Environmental Control co-sponsored a 6-month-long Academy for Public Health Emergency Preparedness. Six-member teams made up of public health staff and community partner representatives (N = 78) attended from their respective health districts. The Academy consisted of three 6-day training sessions designed to prepare the teams to complete a team-based covert biological bioterrorism tabletop exercise. Program evaluation results revealed increases in (1) public health emergency preparedness core competencies; (2) capacity to plan, implement, and evaluate a tabletop exercise; and (3) successful collaboration and partnership formation between participating Public Health District teams and their local partner agencies. Lessons learned are also described.

Coastal terrorism: using tabletop discussions to enhance coastal community infrastructure through relationship building.

The unique vulnerability of the nation's ports to terrorist attacks and other major disasters requires development of specialized training approaches that integrate and connect critical stakeholders. In 2003, the University of South Carolina Center for Public Health Preparedness developed and held its first Coastal Terrorism workshop in conjunction with the National Oceanic and Atmospheric Administration. Key federal, regional, state, and coastal agency leaders were invited to the 2-day event to explore, in a no-risk environment, the crucial role that public health agencies would play in a covert biological agent incident aboard a cruise ship. The incident began as a possible outbreak of a Norwalk-like viral agent; however, as the scenario unfolded, evidence of a terrorist plot emerged. This immediately shifted the scenario from a public health-dominated incident to one directed by law enforcement. Communication and coordination issues surfaced illustrating potential conflicts between disciplines and jurisdictions in terms of roles and responsibilities of responding agencies. The goals of the workshop were to facilitate communication and interagency networking among coastal stakeholders while assessing their training and research needs and increasing their familiarity with resources and protocols regarding a bioterrorist coastal event. Positive systems changes were observed.

Personal, social, and physical environmental correlates of physical activity in African-American women in South Carolina.

BACKGROUND: Little is known about the correlates of physical activity among African-American women living in the southeastern United States. The purpose of this study was to assess the relationship of personal, social, cultural, environmental, and policy variables with physical activity among women in ethnic minority groups. METHODS: The Women and Physical Activity Survey was used in a telephone interview of 917 African-American women living in two counties in South Carolina. The sample of women was selected by random-digit dialing. RESULTS: Approximately one third (34.1%) of the women met current recommendations for moderate or vigorous physical activity, 49.4% were insufficiently active, and 16.5% were inactive. Meeting the recommendations or engaging in insufficient activity (versus inactive) was related to attaining higher educational levels, being married or with a partner; being in excellent or very good health, having greater self-efficacy, seeing people exercise in the neighborhood, having more favorable ratings of women who exercise (social issues score), having lower social role strain, and reporting the presence of sidewalks or lighter traffic in the neighborhood. CONCLUSION: Multiple factors influence physical activity. Interventions to increase physical activity should use multilevel approaches that incorporate the personal, social environmental, and physical environmental factors related to participation in physical activity.