High acceptance rate of anal pap screening despite limited knowledge about anal dysplasia among HIV+ MSM

Anal cancer in the general population is more prevalent in women, but in most HIV populations, MSM have the highest risk. Data suggest that screening can prevent invasive carcinoma. Use of routine cervical pap smears resulted in an 80% reduction in cervical cancer rates. The current study examines the effectiveness of a clinical intervention designed to increase anal dysplasia education, screening, and treatment for HIV+ MSM

People with disabilities in Johnston County, North Carolina : an action-oriented community diagnosis : findings and next steps of action

During the 2004-2005 academic year, a team of six University of North Carolina-Chapel Hill School of Public Health graduate students conducted an Action-Oriented Community Diagnosis (AOCD) in Johnston County, North Carolina to learn more about what life is like there for people with disabilities. The students were guided by two field preceptors, who served as their liaisons to this community. The goal of an AOCD is to gather, analyze, and summarize the perspectives of community members and service providers in a community to create a complete vision of the community’s strengths, challenges, and existing resources. The AOCD process is designed to culminate in a community forum where all community stakeholders come together to create action steps to work towards change. The purpose of this document is to summarize the AOCD process, present findings, and suggest future action steps to improve life for people with disabilities in Johnston County. The AOCD process began with an overview of secondary data, which provided the team with a context of what life is like for people with disabilities living in Johnston County. The team also attended community meetings and events to gain a better understanding of disability issues in general and specifically in the county. Next, the team conducted 32 interviews and two focus groups with people in Johnston County, including community members with disabilities, family members of people with disabilities and service providers. The team then analyzed the interviews to identify themes that emerged frequently. The next step was to plan a community forum in which the team could share the findings from their interviews and focus groups with the Johnston County community. A Community Advisory Board (CAB) was formed to help plan the forum. The CAB prioritized six themes from the 18 that had emerged from the data. Approximately 100 Johnston County residents and other supporters attended the community forum held on April 28, 2005 in Smithfield. At the forum, the team presented an overview of the AOCD process and their findings on the six prioritized themes of transportation, schools, support for families, housing, awareness of services and knowledge of services. Next, forum attendees broke into discussion groups and came up with action steps around these themes. Afterwards, the group reassembled to share action steps and discuss their vision for the future in Johnston County for people with disabilities and their families. At the community forum, the great potential for change in Johnston County was apparent in the number of participants, their energy and the ideas and action steps they generated. Based on these action steps, the interviews, and observations, the team makes the following recommendations for the future: Continue to recognize the need to combine resources and work together in order to effect change; the team supports the suggestion of a community member that a forum become an annual event in the county. Continue to cooperate and share resources among service providers, family members and community members with disabilities in Johnston County. Develop a central location where community members can learn more about services and resources available in the county; Make a comprehensive list of resources and services for people with disabilities available at this center. Train and educate parents about available services and disability rights. Consider the needs of people with disabilities (housing, schools, recreation, and employment) in future planning efforts and county development. Create a plan to address the transportation needs of all residents. Continue to invest in the establishment and growth of The Arc of Johnston County, NC as they work to empower and improve the lives of children and adults with disabilities. The subcommittees of The Arc can be a valuable resource for future organizing efforts in the county. Develop a program in which key community members shadow people with disabilities to increase awareness and understanding. Build a village, an assisted living community in which adults with disabilities are able to live independently from their parents and pursue their goals in a supported environment. This document was written to serve as a resource to the people of Johnston County. The paper is divided into the following sections: secondary data, findings from the interviews and team observations, community forum, methodology, and conclusion and recommendations for the future. The team intends for this document to contribute to the work currently taking place in Johnston County around the issues facing people with disabilities and their families. The AOCD team further hopes that the action steps and energy generated during this project will build upon and enhance existing efforts in the community.Master of Public Healt

Health Status of HIV-Infected Women Entering Care: Baseline Medical Findings from the Women of Color Initiative

The WOC Initiative is a prospective study of 921 women of color (WOC) entering HIV care at nine (three rural, six urban) sites across the US. A baseline interview was performed that included self-reported limitation(s) in activity, health conditions, and the CDC's health-related quality of life measures (Healthy Days). One-third of the WOC reported limiting an activity because of illness or a health condition and those with an activity limitation reported 13 physically and 14 mentally unhealthy days/month, compared with 5 physically and 9 mentally unhealthy days/month in the absence of an activity limitation. Age was associated with a three- to fourfold increased risk of an activity limitation but only for WOC in the urban sites. Diabetes was associated with a threefold increased risk of a limitation among women at rural sites. Cardiac disease was associated with a six- to sevenfold increased risk of an activity limitation for both urban and rural WOC. HIV+ WOC reported more physically and mentally unhealthy days than the general US female population even without an activity limitation. Prevention and treatment of diabetes and cardiovascular disease will need to be a standard part of HIV care to promote the long-term health and HRQOL for HIV-infected WOC

Barriers and Facilitators to Testing, Treatment Entry, and Engagement in Care by HIV-Positive Women of Color

Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development

Experiences with HIV Testing, Entry, and Engagement in Care by HIV-Infected Women of Color, and the Need for Autonomy, Competency, and Relatedness

Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV

Health Status of HIV-Infected Women Entering Care: Baseline Medical Findings from the Women of Color Initiative

The WOC Initiative is a prospective study of 921 women of color (WOC) entering HIV care at nine (three rural, six urban) sites across the US. A baseline interview was performed that included self-reported limitation(s) in activity, health conditions, and the CDC's health-related quality of life measures (Healthy Days). One-third of the WOC reported limiting an activity because of illness or a health condition and those with an activity limitation reported 13 physically and 14 mentally unhealthy days/month, compared with 5 physically and 9 mentally unhealthy days/month in the absence of an activity limitation. Age was associated with a three- to fourfold increased risk of an activity limitation but only for WOC in the urban sites. Diabetes was associated with a threefold increased risk of a limitation among women at rural sites. Cardiac disease was associated with a six- to sevenfold increased risk of an activity limitation for both urban and rural WOC. HIV+ WOC reported more physically and mentally unhealthy days than the general US female population even without an activity limitation. Prevention and treatment of diabetes and cardiovascular disease will need to be a standard part of HIV care to promote the long-term health and HRQOL for HIV-infected WOC

Barriers and Facilitators to Testing, Treatment Entry, and Engagement in Care by HIV-Positive Women of Color

Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development

Experiences with HIV Testing, Entry, and Engagement in Care by HIV-Infected Women of Color, and the Need for Autonomy, Competency, and Relatedness

Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV