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This article discusses issues and strategies for program evaluation particularly useful for community-based organizations (CBOs) involved in the development and implementation of HIV preventing programs for women. The approach the authors present is an extension of a traditional public health paradigm suggested for use in the development and evaluation of violence prevention programs. This study incorporates Becker's Health Belief Model, which provides a framework for viewing the influence of various psychosocial variables on health-related behavior, into this development and evaluation paradigm. Factors influencing the successful development and evaluation of HIV prevention programs for women are reviewed and discussed. The purpose of this article is to provide some guidance to CBOs to strengthen their evaluation strategies and to encourage their use of evaluation during all phases of program development and implementation.
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PMID:Evaluation issues and strategies for community-based organizations developing women's HIV prevention programs. 1018 33

Comorbid substance abuse disorders have emerged as one of the greatest obstacles to the effective treatment of persons with schizophrenia. Estimates of the prevalence of such comorbidity vary, but as many as half of persons with schizophrenia may suffer from a comorbid drug or alcohol disorder. Younger age, male gender, and lower educational attainment are associated with greater risk for addiction. Persons with schizophrenia and comorbid addiction tend to have an earlier onset of schizophrenia than do those without comorbid addiction. Research does not support a link between specific symptoms of schizophrenia and choice of abused drugs. Rather, drug choice is correlated with the pattern of ambient drug use in the community. Comorbid substance disorders are associated with a variety of poorer outcomes, including increased psychotic symptoms, poorer treatment compliance, violence, housing instability and homelessness, medical problems (including human immunodeficiency virus infection), poor money management, and greater use of crisis-oriented services that result in higher costs of care. Considerable progress has been made over the past decade in understanding the need to integrate substance abuse treatment and mental health treatment to provide more effective care for this population.
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PMID:Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. 1019 Feb 30

Lesbians are visible to society, health care providers, and researchers as women, not as an identified sub-group of women. Lesbian invisibility contributes to their collective increased vulnerability, as evidenced by decreased societal and environmental resource availability, threats to social connectedness, and barriers in accessing health care. The factors that have led to increased vulnerability have shown up in risks of violence, cancer, HIV/AIDS, and chemical dependency among lesbians.
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PMID:Health problems of lesbian women. 1031 30

This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1%, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.
Violence Vict 1998
PMID:Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department. 1032 45

A mailed survey was conducted to assess the risky sexual behavior and substance abuse among an initial sample of 2071 young adults in Lexington, Kentucky, during the 1987-88 school year. The survey included specific items about peer relations, family attachment, self-esteem, sensation seeking, friends' drug use, impulsivity, physical health, health and mental health utilization, dieting, delinquency, violence, and risky sexual behavior. A total of 952 (400 males and 552 females) respondents were included in the final analysis. The findings indicate that earlier initiation of sexual activity is related to early involvement with drugs. Furthermore, male participants who used alcohol or marijuana at a younger age engaged in riskier sexual behavior than female participants. Female participants were more likely to use condoms regardless of their early substance use patterns; and those who had never experienced sex or who initiated sex later (ages 19 or 20) were less likely to report lifetime or current drug use. This study indicated that there is a relationship between the early occurrence of substance use and riskier sexual behavior. Recognizing the use of alcohol or marijuana during adolescence may raise practitioners' awareness, helping them identify HIV risk behavior among young adults more accurately.
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PMID:Risky sex behavior and substance use among young adults. 1034 Jan 65

The debate around the issues raised by HIV/AIDS and human rights has largely focused on the protection from rights violations of individuals or groups affected by the disease. The relationship between political and social conditions where human rights abuses are frequent and the spread of HIV infection has been less studied. Two countries in Southeast Asia, Burma and Cambodia, are currently undergoing serious and uncontrolled epidemics of HIV; both are marked by political cultures of state violence and corruption, chronic civil war and insurgency, and widespread human rights violations. This article attempts to investigate associations between rapid HIV spread and political and social crises, using Burma and Cambodia as case studies. The climate and context of rights abuses are seen as significant factors of national vulnerability to the epidemic spread of HIV/AIDS.
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PMID:Burma and Cambodia: Human Rights, Social Disruption, and the Spread of HIV/AIDS. 1034 69

Between 1984 and 1996, public health authorities in Israel maintained a secret policy of discarding blood donations made by Ethiopian-Israeli citizens and immigrants. Officials later attempted to justify this policy on the grounds that immigrants from Ethiopia were subject to high rates of infectious disease (especially HIV). In 1996, this led to an explosive and violent confrontation between Ethiopian-Israeli protestors and agents of the state, including police and public health authorities. This essay explores the cultural and political context of that confrontation, including the discourse of political violence which it occasioned. The conflict between Ethiopian-Israelis and the state was located within a wider set of political contexts, including the Israeli-Palestinian conflict, which was linked to it through a shared trope of "spilled blood" common to both. Cultural analyses which ignore this dynamic political context are in danger of seriously misrepresenting the meaning of the "Blood Affair" to its participants. At the same time, this essay also engages a critical analysis of the public health policies which led to the crisis. Public health and nationalist discourse reinforced one another at the expense of Ethiopian immigrants in general, and so-called "Feres Mura" Ethiopians in particular.
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PMID:"One people, one blood": public health, political violence, and HIV in an Ethiopian-Israeli setting. 1045 1

We aimed to determine the knowledge and attitudes towards HIV/STDs among women attending an STD clinic by interviewing 520 randomly selected women. Nearly all had heard of HIV/AIDS/STDs, with posters, pamphlets and the radio being the main source of their information. The years of schooling was the only predictive factor of knowing a preventive measure of HIV. Two-thirds thought they were at risk of contracting HIV from their regular partner. Knowledge of the sexual habits of their male partners was low with 260 (50%) of the women distrusting their partner. Only 52 (10%) of respondents admitted to sex in exchange for gifts or money. In the event of a positive HIV test result, the perceived partner response would be to blame the woman for introducing the infection into the relationship. After a positive HIV test result, only 3.5% would resort to using condoms while another 3.7% would try to pass on the disease to other people. The quality of their knowledge of the transmission of HIV was low in spite of the fact that most respondents have heard of HIV/AIDS/STDs. Violence against women was expected in relation to a positive test result. There is a need for better educative effort on the modes of transmission and prevention of HIV, also in 'low risk' populations.
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PMID:HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS. 1047 Nov 6

Women represent one of the fastest growing groups being diagnosed with HIV infection. Because of the circumstances under which they live, women at the highest risk for HIV infection may also be at risk for verbal, physical and sexual violence. The purpose of this study was to examine the frequency and type of violence experienced by women infected with HIV, and describe associations between reported violence, self-esteem and sense of competence. The study used a descriptive design and was conducted in the south-eastern United States. The sample consisted of 194 women infected with HIV. Women were primarily single, African-Americans residing in urban areas with an annual household income of less than $10,000 per year. Participants completed face-to-face interviews using a structured questionnaire which included a frequency of violence scale, Rosenberg's self-esteem scale, and Pearlin and Schooler's mastery scale. Approximately 15% of women reported at least one event of physical abuse and 55% at least one event of verbal abuse in the past 6 months. Verbal abuse experienced by women was the strongest net negative predictor of self-esteem and competence. These findings indicate that HIV-infected women are at risk for experiencing physical abuse and verbal abuse, and the experience of violence is associated with lower self-esteem and competence.
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PMID:Experiences of violence in HIV-seropositive women in the south-eastern United States of America. 1049 17

Rapid changes in the world market economy have served to destabilize many local institutions, widening the gap between the rich and the poor and undermining viability of key social and economic institutions such as family and household. Among those most deeply affected by this displacement are children and adolescents, many of whom are forced to leave family institutions before they have acquired the skills and maturity needed to become economically self-sufficient. Fending for themselves amid the vagaries of the underworld of virtually every major city in the world, these youths are at exceptional risk for a wide range of poor health outcomes and premature death. While perhaps a familiar sight in many non-Western countries, this phenomenon also has emerged in the industrialized world, a fact that accounts for the rise in exposure to violence and disease among street-involved youth and young adults in nations such as the United States. There are as yet few empirical data available about the nature of these youth populations or the constellation of behaviors that place them at increased risk for disease outcomes. In this report we construct a demographic and behavioral profile of the homeless youth population in New York City, particularly as behavioral patterns relate to risk associated with HIV infection.
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PMID:A demographic and behavioral profile of homeless youth in New York City: implications for AIDS outreach and prevention. 1050 14


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