12 research outputs found
Social Determinants of Late Stage HIV Diagnosis and its Distributions among African Americans and Latinos: A critical literature review
ABSTRACT
This critical literature review was conducted to identify both individual- and environmental-level social determinants of health using an ecological framework as a way to contextualize risk for, and distributions of, late HIV diagnosis among African Americans and Latinos in the United States.
Background: Late diagnosis, defined as a diagnosis of AIDS simultaneously with or within one year of an initial HIV diagnosis,1 disproportionately affects African American and Latino communities;2,3 disparities in this health problem thus represent a preventable inequity. Such disparities affect not only late diagnosed individuals but also population levels of HIV incidence, as transmission is unhindered before diagnosis.4,5
Methods: A total of 26 unduplicated studies in 26 peer-reviewed articles were analyzed within a social ecological conceptual framework. Both quantitative and qualitative studies of factors influencing HIV testing were reviewed. To be included, studies had to have been conducted in the United States, published in English within the past 11 years, and to have focused on Latino or African American populations and/or on racial disparities between these and other populations.
Findings: The majority of studies on racial disparities in HIV testing and diagnosis have been either cross-sectional1,2,6–11 or focused on one racial or ethnic group, often in one geographic location.12–18 In all studies that compared racial and ethnic groups (n=17), Latinos and African Americans were more likely to receive a late diagnosis3,19 than non-Hispanic Whites or Asian Americans. 95.8% (n= 23) of the reviewed studies focused on individual level risk factors or investigated structural barriers via measurements at the individual level.
Next Steps: Both more quantitative and qualitative studies are needed that will enhance understanding of the social determinants of HIV testing behavior among at-risk groups by measuring variables at the appropriate rung of the ecological model, and not solely on the individual level. Studies that investigate barriers to and facilitators of HIV testing in partnership with communities will help further interventions that can reduce racial/ethnic disparities in late diagnosed HIV/AIDS
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An Ecological Community-Based Participatory Research Study of Late Diagnosed HIV/AIDS in Oakland, California: Investigating influential factors in racial/ ethnic health inequities
Nationwide, there is a racial/ethnic disparity in incidence of HIV infection and AIDS mortality, with African Americans and Latinos having disproportionately higher rates of both HIV and AIDS than Whites and Asian/ Pacific Islanders. The racial disparity in late diagnosis of HIV/AIDS reflects that of timely –diagnosed HIV, suggesting that late diagnosis may be one important driver of the widening racial disparities seen in the AIDS epidemic. Late HIV diagnosis is defined as a diagnosis of AIDS simultaneously with or within one year of an initial HIV diagnosis.This dissertation research was conducted in conjunction with a larger mixed –methods study to investigate late diagnosis of HIV among Latinos and African Americans in Oakland, and to collaboratively design, implement and evaluate two interventions to address the problem. To conduct a systematic and critical review of the literature on HIV/ AIDS diagnosis among Latinos and African Americans within the United States in order to identify the multi –level social determinants of racial/ ethnic inequities in late-stage HIV. The overarching goal of this dissertation research was to use a Community –Based Participatory Research (CBPR) approach to identify the individual, interpersonal, community, and societal factors, and their interactions, which facilitate or hinder timely HIV testing by at-risk populations among Latinos and African Americans living in Oakland, California. The dissertation had the following aims: 1) To conduct a systematic and critical review of the literature on HIV/ AIDS diagnosis among Latinos and African Americans within the United States in order to identify the multi-level social determinants of racial/ ethnic inequities in late-stage HIV. 2) To analyze qualitative data from the larger parent study in order to identify and examine multi-level factors that exacerbate or attenuate barriers to timely HIV testing and diagnosis among African Americans and Latinos in Oakland, California. 3) To use reflexive analysis and participant observation to examine the benefits and challenges of using a CBPR framework to guide academic/ community collaboration for research and action goals. In order to achieve these aims, I conducted the three studies included in this dissertation.In the first study, I found that the majority of studies on racial disparities in HIV testing and diagnosis have been either cross-sectional or focused on one racial or ethnic group, often in one geographic location. In all studies that compared racial and ethnic groups (n=17), Latinos and African Americans were more likely to receive a late diagnosis than non-Hispanic Whites or Asian Americans. Furthermore, 95.8% (n= 23) of the reviewed studies focused on individual level risk factors or investigated structural barriers via measurements at the individual level. However, in my second study I found that significant factors identified by participants as relating to the late diagnosis of HIV lay beyond the traditional individual –level elements of attitude, norms, control beliefs, and power, and were located within the interpersonal, community, and/or societal levels of the ecological model.In the third study, we found that use of a CBPR approach both benefited the study and presented challenges in four key areas: 1) inclusion/ exclusion; 2) bridging social capital and the role of bridge people; 3) education, status, race/ ethnicity, privilege and power imbalances; and 4) conflicting priorities. The findings from these three studies demonstrate the importance of including communities in investigations of late –stage HIV inequities. Community engagement added value to this study as all partners contributed to aligning every activity toward the dual goals of increased knowledge and improved practice. The study findings also demonstrated that disparities in HIV testing behaviors are shaped and maintained by ecological factors at multiple levels. Especially when investigating health disparities that cluster in marginalized and oppressed communities, community –academic collaboration and multi –level frameworks can enhance findings
Comparative Analysis of Self-Reported Wellness Levels of International Students within a University in India
This study explored the self-reported wellness of postgraduate students studying in an International University located in South Eastern India. From a large university population, with three distinct hostel arrangements, the one hostel with a co-educational population was purposively sampled. A questionnaire based on five dimensions of wellness was administered to predominantly postgraduate students (N=50) with an equal number of males (n=25) and females (n=25) and ages ranging from 30 to 45 years. The participants represented a diverse range of nationalities, including the majority from Nepal (n=16); Ethiopia (n=15); Afghanistan (n=7); Iran (n=5); Guyana (n=3); and 1 each from Botwana, Brazil, Rawana and South Africa (n=4). Results from the self-reported height and weight indicated the cohort was predominantly in the normal Body Mass Index range (n=32); some overweight (n=14); few underweight (n=3) and one person obese. All five individual dimensions of emotional, intellectual, physical, social and spiritual were skewed towards 'high' or 'good' levels of wellness. The amalgamated scores provided a comprehensive wellness score with 'highest level' (n=29) and 'good' (n=21). Implications of this study includes informing future programs to support the wellness and wellbeing of multicultural postgraduate students in international contexts
School climate and physical adolescent relationship abuse: differences by sex, socioeconomic status, and bullying
by S. Jain, A. K. Cohen, T. Paglisotti, Malavika Subramanyam, A. Chopel and E. Mille
Age-period-cohort decomposition of social security taxes and benefits in the USA and Japan
Age-period-cohort decomposition, Bayesian cohort model, Social security, C10, H55,
Caveat Emptor: The Dalai Lama’s Proviso and the Burden of (Scientific) Proof
A more complete understanding of the Dalai Lama’s intellectual milieu and mental framework serves to contextualize and appraise his contributions to the discourse on Buddhism and Science in general, and the so-called Mind and Life Dialogues in particular. In addition to providing indispensable background information, a fuller expression of his foundational views and motives sheds light upon the idiosyncratic way the Dalai Lama engages new fields of knowledge. Thanks to the Dialogues’ format and the transparency of the Dalai Lama’s scholastic mentality, the way in which Mind and Life participants meet various challenges in practice offers enough traction to retrieve and critically appraise real-time patterns of engagement and innovation. This should prove to be instrumental in determining the Dialogues’ measure of success, at least by its own standards and stated purpose. Following this approach, the Dalai Lama’s long-time use of a proviso derived from Tsongkhapa’s reading of Middle Way philosophy as a methodological distinction that delineates the scope of Science warrants specific attention