Journal of the Association of Nurses in AIDS Care - Articles in Press

Speed of Processing Training With Middle-Age and Older Adults With HIV: A Pilot Study - Corrected Proof

2012-05-14

Adults with HIV are at risk for deficits in speed of processing that can interfere with performing instrumental activities of daily living. In this pilot study, 46 middle-age and older adults with HIV were assigned to 10 hours of computerized speed of processing training (n = 22) or to a no-contact control condition (n = 24). ANCOVAs were used to examine treatment effects on a neurocognitive battery and the Timed Instrumental Activities of Daily Living (TIADL) Test. Treatment effects were detected on the Useful Field of View Test, F(1, 43) = 4.29, p = .04 and the TIADL Test, F(1, 43) = 5.02, p = .03; those in the experimental condition improved on these measures. Many of the participants also indicated that they felt the training improved their cognitive functioning. This study demonstrated that speed of processing training may improve cognitive and everyday functioning in this growing population.

Pre-Exposure Prophylaxis: An Ethical Discussion - Corrected Proof

Stefan Rowniak, Carmen Portillo — 2012-05-14

Recent reports have indicated that HIV prevention in the United States is undergoing a paradigm shift. This has involved movement away from traditional behavior-change approaches to more medical and biological interventions such as microbicides, circumcision, and treatment as a prevention strategy (; ). One medical intervention that has generated optimistic appraisal is pre-exposure prophylaxis (PrEP; ). One published study found that among 2,499 randomly assigned, uninfected gay men and transwomen, a 44% reduction in transmission was seen among those who took pre-exposure chemoprophylaxis that consisted of emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). It was also reported that greater efficacy was seen with more consistent use of the medication (). Recently, Gilead Sciences, Inc., announced that it was seeking approval from the FDA to market FTC/TDF for PrEP, specifically with regard to sexual risk (). However, although PrEP might seem to be simply another tool in the battle against HIV, it is not without serious ethical questions. We will discuss those ethical concerns considering the established medical-ethical principles of beneficence, nonmaleficence, justice, and autonomy.

Training Multidisciplinary Teams to Deliver High-Quality HIV Care to Families in Resource-Limited Settings: The MTCT-Plus Initiative Experience - Corrected Proof

2012-05-07

The scarcity of trained clinicians is a significant barrier to the delivery of HIV services in resource-limited settings (RLSs) (). There are marked shortages of physicians and nurses in the countries with the highest HIV prevalence (), and there is evidence that the shortage of nurses in particular has a deleterious effect on maternal health (). In addition to the absolute scarcity of human resources for health, the fact that HIV is a relatively new health challenge means that few clinicians were taught to provide HIV prevention, care, and treatment services during pre-service or in-service trainings (). In response, the President’s Emergency Plan for AIDS Relief (PEPFAR) intends to train and retain more than 140,000 new health care workers by 2014 (). Additionally, national training curricula have been developed in many countries, as have other in-service training programs.

Multicentric Castleman's Disease: An Emerging Opportunistic Infection - Corrected Proof

Jane McCall, J. Craig Phillips — 2012-05-07

A 45-year-old, HIV-infected Caucasian gay male (PL) was admitted to the HIV unit of a tertiary-care hospital three times in the course of 6 months. He had been transferred from a small community hospital that was unable to determine his diagnosis. On his initial admission, he presented with complaints of shortness of breath, weakness, fatigue, joint pain, peripheral edema, and ascites. PL had generalized lymphadenopathy and cytopenia as well as purple-black lesions on his legs. He had a difficult hospital admission, with acute respiratory failure, requiring close follow-up by the Intensive Care Unit (ICU) outreach team.

Framingham Risk for PLWH in an Infectious Disease Practice - Corrected Proof

Viroj Wiwanitkit — 2012-05-07

The recent publication on cardiovascular risk assessment among persons living with HIV (PLWH) is very interesting (). described the systematic cardiovascular assessment using the Framingham Risk (FR) for PLWH in an infectious disease practice. Indeed, there is no doubt that the cardiovascular problem is a main problem for PLWH, similar to the general population. Focusing on using FR, there are several attempts to propose a newer and better technique for risk assessment although it is not well implemented and accepted at present (). Practitioners have to follow and update the knowledge on this aspect. In addition, the flaw of FR should also be mentioned. The big problem of using FR in scoring can be seen in the cases with diabetes mellitus (), which can be another common problem in PLWH.

Dr. Burke Responds - Corrected Proof

Emily Burke — 2012-05-07

evaluated the design and analysis of studies that examined whether additional predictors improved performance when added to the Framingham Risk Score (FRS) and concluded that, while many studies claimed to offer additional predictive value, most had flaws in their designs, analyses, and reporting. As Dr. Wiwanitkit suggests, the FRS does not account for disease states that have an inherently increased cardiovascular risk, such as diabetes mellitus (DM). However, the FRS calculation automatically places persons with DM in the highest risk category (>20%) with other disease processes that equate to cardiovascular risk equivalents such as a personal history of cerebrovascular incident, coronary artery disease, transient ischemic attack, abdominal aortic aneurysm, peripheral artery disease, or chronic kidney disease. Therefore, persons living with HIV (PLWH) and DM would have a risk of greater than 20% and a target low-density lipoprotein (LDL) goal of < 100 mg/dL according to the current Framingham risk model. However, while the FRS is a useful screening tool for providers serving PLWH, it may slightly under-predict cardiac risk through inability to account for antiretroviral therapy (ART) exposure and HIV disease itself (). It should be noted that there is no clear understanding of how untreated HIV disease affects the cardiovascular system. Development of models that require knowledge about HIV's effect on the cardiovascular system will be difficult, as most PLWH will receive ART, which negates the ability to study the effects of HIV alone on the cardiovascular system. One model that has been released but not yet validated, accounts for exposure to ART (). It is important that providers serving PLWH continue to use FRS to predict global cardiac risk and stay current with newer validated models as they become available.

Nondisclosure Prosecutions and HIV Prevention: Results From an Ottawa-Based Gay Men's Sex Survey - Corrected Proof

Patrick O'Byrne, Alyssa Bryan, Cory Woodyatt — 2012-05-03

In 1998, the Supreme Court of Canada ruled that people living with HIV had a legal obligation to disclose their serostatus prior to the onset of activities that posed a “significant risk” for HIV transmission. As part of this ruling, the indicated that nondisclosure prosecutions would not undermine HIV-prevention efforts. This ruling, however, was made without any research on the effect of the law on HIV prevention.

Cultural Influences on Antiretroviral Therapy Adherence Among HIV-Infected Puerto Ricans - Corrected Proof

2012-04-23

Adherence to antiretroviral therapy (ART) is integral to the successful treatment of HIV infection. Research has indicated that HIV-infected Latinos may have difficulty adhering to ART. While studies have demonstrated strong relationships between numerous psychosocial factors and ART adherence, no research has examined if cultural factors are also involved in ART adherence among Latinos. Our study examined the relationship between acculturation to mainstream U.S. culture, bicultural self-efficacy, and ART adherence among HIV-infected Puerto Rican adults living in the United States. Participants with ≥ 95% adherence scored higher on U.S.- and Latino-involvement acculturation scales and on a measure of bicultural self-efficacy compared to those with suboptimal adherence. Among bicultural HIV-infected Puerto Ricans, both acculturation and self-efficacy to navigate between cultures were positively related to adherence. Understanding the role of an individual’s sociocultural experience may help elucidate why HIV-infected Latinos have difficulties achieving optimal ART adherence and improve ART adherence interventions.

Creating a Paper-Based Personal Health Record for HIV-Infected Persons - Corrected Proof

Kathleen M. Nokes, Valery Hughes, Ryan Santos, Heejung Bang — 2012-04-19

A personal health record (PHR) contains information that a client believes is important to his/her health status; it can be either paper or Internet-based. The purposes of this action research were to determine the length of time an expert HIV nurse clinician needed to create a comprehensive PHR and to determine how hard it was for the patient to understand different components of a PHR. The average respondent (N = 9) was older, female, completed high school, African American, diagnosed with AIDS, and taking HIV medications for 11 years. The HIV nurse expert spent an average of 79 minutes preparing the PHR. Clients had the greatest difficulty understanding laboratory tests, medications, medical history, and immunizations. PHRs are evolving through the consumer-empowerment movement, technology, and a growing awareness of the consequences of medical errors. Nurses need to assist clients to create and use the PHR as an important tool in self-care management.

A Lifetime of Violence: Results From an Exploratory Survey of Mexican Women With HIV - Corrected Proof

2012-04-19

Despite recognition that traditional Mexican gender norms can contribute to the twin epidemics of violence against women and HIV, there is an absence of published literature on experiences of violence among Mexican women with HIV. We conducted a cross-sectional survey with 77 HIV-infected women from 21 of Mexico’s 32 states to describe experiences of violence before and after HIV-diagnosis. We measured lifetime physical, sexual, and psychological violence; physical violence from a male partner in the previous 12 months; and physical and psychological violence related to disclosing an HIV diagnosis. Respondents reported ever experiencing physical violence (37.3%) and sexual violence (29.2%). Disclosure of HIV status resulted in physical violence for 7.2% and psychological violence for 26.5% of the respondents. This study underlines the need to identify and address past and current gender-based violence during pre- and post-HIV test counseling and as a systematic and integral part of HIV care.

Reducing HIV in Michigan African American Young Adult Women - Corrected Proof

Frances Jackson, Laura Pittiglio — 2012-04-19

African American (AA) women are at disproportionate risk for contracting HIV, which has reached epidemic proportions, especially in women of color. Reducing the risk of exposure to HIV in AA women is a priority for health care providers. Despite the many studies conducted on HIV in the AA community, factors that influence sexual risk taking, such as non-condom use by AA women, have yet to be understood. The purpose of this study was to investigate how AA women define HIV risky behavior. Quantitative and qualitative data were collected from a convenience sample of AA women (N = 33) from three metropolitan regions within Michigan. The results offer important insight into how AA women define HIV risky behavior as well as highlight behaviors that are amenable to intervention.

The Effect of Automated Telephone Appointment Reminders on HIV Primary Care No-Shows by Veterans - Corrected Proof

Stephen Randal Henry, Matthew B. Goetz, Steven M. Asch — 2012-03-19

Appointment attendance for follow-up care and laboratory monitoring are central components of HIV treatment. In general, appointment reminders are an effective method of reducing outpatient no-shows; however, no single strategy has proven superior. This study tested the effectiveness of adding an automated telephone reminder for laboratory monitoring to the standard set of three appointment reminders to reduce subsequent HIV primary care no-shows. We conducted a quasi-experimental design study in three geographically and administratively affiliated Veterans Administration HIV clinics with one clinic serving as the intervention facility and two others as control facilities. The intervention lasted 6 months. The data show that patients who were not homeless, who were not diagnosed with depression, and who had five or more appointments scheduled in 6 months had significantly fewer no-shows after intervention. The intervention was not effective in reducing no-shows among homeless patients, racial/ethnic minorities, and patients with mental health disorders.

A Sexual Health Program for Vietnamese Parents of Adolescents: A Preliminary Report on Changes in Parental Knowledge, Communication, and Self-Efficacy for Condom Use - Corrected Proof

2012-03-16

As home to 60% of the world’s population, an increasingly generalized HIV epidemic, and rapid social and economic changes, Asia remains a significant source of concern in relation to the HIV pandemic. In Vietnam, HIV prevalence among 15- to 49-year-olds increased from 0.27% to 0.44% with rates over 1% in Ho Chi Minh City and northern coastal regions between 2000 and 2010 (). In addition to HIV, adolescents and young adults in Vietnam experience other adverse sexual health outcomes including unintended pregnancy, and reproductive tract and sexually transmitted infections (RTI/STI). A recent population-based study among married women (aged 18–49 years) in rural Vietnam indicated that 37% of women had had at least one RTI or STI. More specifically in terms of STIs, 8.3% of women had hepatitis B, 4.3% chlamydia, and 0.7% gonorrhea (). Another study found that younger and unmarried women were more likely to wait past the first trimester to visit a medical facility because of fear of being stigmatized and/or poor knowledge regarding indicators of pregnancy. Also, because of stigmatization, actual data on both STIs among young adults and pregnancies among unmarried women were difficult to obtain as those affected tended to use private rather than public health facilities where government reporting was required ().

Alcohol and Adherence to Antiretroviral Medications: Interactive Toxicity Beliefs Among People Living With HIV - Corrected Proof

2012-03-16

When taken without interruption, antiretroviral therapies (ART) effectively treat HIV infection. Alcohol is a well-known direct and indirect influence on ART adherence. Believing that drinking is harmful while taking ART (interactive toxicity beliefs) is also associated with poor adherence. The current study included 333 people living with HIV who were taking ART and actively using alcohol. Participants were recruited from health care providers and social services in a major southern U.S. city. Results showed that 52% of persons found non-adherent to ART stated that they stopped taking their medications when they were drinking. Multivariate analyses showed that interrupting treatment when drinking was related to current non-adherence, over and above several common correlates of non-adherence including frequency of alcohol use itself. These results confirm and extend past research, indicating an urgent need for medication adherence interventions designed for people living with HIV who drink.

Research Capacity–Building Program for Clinicians and Staff at a Community-Based HIV Clinic in Uganda: A Pre/Post Evaluation - Corrected Proof

2012-01-24

Developing capacity for HIV research and clinical practice is critically needed in resource-limited countries. The purpose of this study was to evaluate a research capacity–building program for community-based participants in the preparation and conduct of mobile phone–based technology interventions. A descriptive, cross-sectional design was used. Participants completed self-report surveys at three time points. Thirty-three participated in the situational analysis, and all (100%) felt that the research training was needed. For the interim evaluation, more than 96.8% (n = 30) reported increased knowledge and confidence and attributed this to the training. Fourteen participants completed the final evaluation. Dedicated time away from work was an important factor to facilitate recruitment and data collection, followed by financial incentives to commute to data collection sites. Expertise through supervision and mentorship for participants and sustained funding for research projects are critical to the innovation needed to improve HIV prevention and care outcomes.

“Doing It Blindfolded”—Successful Administration of Enfuvirtide by a Person Living With HIV and Blindness: A Case Study of Treatment Access and Disability - Corrected Proof

Elizabeth Crock, Judith Frecker — 2012-01-13

Derek, a 61-year-old man, was diagnosed with HIV infection in 1985. He became blind in both eyes in 1995 after an episode of herpes zoster ophthalmicus, and in 1999, he underwent a splenectomy for thrombocytopenia. Derek lives alone with his guide dog. Assistance from community services allows him to maintain his independence, which he values highly. He travels frequently and enjoys attending opera, theater, and films, and spending time with friends. He had a career as a nurse but stopped work in the mid-1980s when he first became unwell with HIV disease.

Factors Contributing to the Development of an HIV Ministry Within an African American Church - Corrected Proof

Jennifer M. Stewart, Barbara L. Dancy — 2012-01-04

Having an HIV ministry within a church depends on the religious culture of that church. However, little is known about how a church’s religious culture influences an HIV ministry. This study’s purpose was to examine how an African American church’s religious culture supported the development, implementation, and maintenance of an HIV ministry within the church. An ethnographic case study research design was used. Data were collected through interviews, nonparticipant and participant observations, review of pertinent documents, and survey of congregants. Results revealed the following as important for an HIV ministry: (a) a belief in helping others and treating everyone with respect and dignity, (b) feelings of compassion toward individuals infected with HIV, and (c) HIV education. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries.

The Role of Social Support and Negative Affect in Medication Adherence for HIV-Infected Men Who Have Sex With Men - Corrected Proof

Eva N. Woodward, David W. Pantalone — 2012-01-03

Combinations of medications that control HIV viral replication are called antiretroviral therapy (ART). Regimens can be complex, so medication adherence is often suboptimal, although high rates of adherence are necessary for ART to be effective. Social support, which has been directly and indirectly associated with better treatment adherence in HIV-infected individuals, influences negative affect, including depression and anxiety. Our study assessed whether current anxious and depressive symptoms mediated the relationship between general social support and recent self-reported medication adherence in HIV-infected men who have sex with men (N = 136; 65% White, 15% Black/African American). Results revealed no direct effect, but an indirect effect of depressive (95% CI [−.011, −.0011]) and anxious symptoms (95% CI [−.0097, −.0009]), between social support and medication adherence. Greater levels of social support were associated with lower levels of depression and anxiety, which in turn were associated with lower ART adherence.

Pilot Study to Assess Subjective and Objective Reporting of Potential Adverse Drug Reactions in Older Versus Younger HIV-Infected Patients Using Antiretroviral Therapy - Corrected Proof

2011-12-02

Limited data exist on tolerability of antiretroviral therapy (ART) in older HIV-infected patients compared to their younger counterparts. There is also concern for overlap of ART toxicities with concomitant conditions potentially leading to an increased burden of ART-related adverse drug reactions (ADRs). A prospective, descriptive–comparative study was conducted to compare incidence and severity of ADRs secondary to ART in older (≥50 years) versus younger (<50 years) HIV-infected patients. No differences were found in the presence or severity of subjective or objective ADRs between groups. The burden of intolerance appeared to be high for certain ADRs in both age groups. Regardless of age, subjects with certain concomitant illnesses had higher rates of potential ADRs. Providers need to be aware of patient characteristics that lead to increased rates of ART intolerance; for patients with an increased comorbidity burden, providers need to be attentive to the potential impact on ART tolerability.

Grappling With HIV Transmission Risks: Narratives of Rural Women in Eastern Kenya Living With HIV - Corrected Proof

2011-12-02

As people live longer and more productively with HIV infection, issues of agency in reducing HIV risk are particularly important for HIV-infected women living in high prevalence, underresourced countries such as Kenya. Because of their gendered lives, in that being masculine is associated with dominance and being feminine is associated with passiveness, women in rural Kenya must cope with continued HIV transmission risk even after knowing they are infected with HIV. In this narrative interview study, informed by theories of gender and postcolonial feminism, we examined personal accounts of HIV risk and risk reduction of 20 rural women in eastern Kenya who were living with HIV. From our analysis of the women’s narratives, two major themes emerged: gender-based obstacles even in the context of a known HIV diagnosis, and struggles with economic pressures amid HIV risks. Implications for policy, programs, and research are discussed.

Variations in Young Men’s and Women’s Attitudes and Intentions to Use Condoms With Different Types of Sexual Partners - Corrected Proof

Brandon J. Hill, Erick E. Amick, Stephanie A. Sanders — 2011-12-02

Currently, the most highly effective method for the prevention of unwanted pregnancy and sexually transmitted infections (STIs), including HIV, is the consistent and correct use of condoms (). Research examining the sexual behaviors and risks of adolescents and young adults is particularly important given that this is a time in psychosocial development when young people are becoming sexually active (). During this critical period, adolescents and young adults may be increasing the risks of STI and HIV infection by not using condoms (). It is estimated that roughly half of the new HIV infections in the United States are among young people under the age of 25 years ().

The Forms and Functions of Peer Social Support for People Living With HIV - Corrected Proof

2011-11-15

Peers may be important sources of coping assistance, but their impact can be better understood if we examine their influence across various contexts. Although social support studies focused on people living with HIV have examined peer support in various contexts, they do not comprehensively account for situations in which peer support might be provided. The specific aims of this study were to (a) describe the various forms and functions of peer support for people living with HIV and (b) validate the concept analysis of peer support within health contexts. Results indicate that peer support is a potentially important adjunct to clinical care for enhancing coping skills, thereby improving the psychosocial functioning of people living with HIV. It is important to (a) assess patient access to peer support, (b) provide opportunities for peer support in the clinical setting, and (c) enhance disclosure and support-seeking skills to facilitate this benefit.

Parental Support and Condom Use Among Transgender Female Youth - Corrected Proof

Erin C. Wilson, Ellen Iverson, Robert Garofalo, Marvin Belzer — 2011-11-15

Evidence suggests that transgender female youth (TFY), much like their adult transgender female peers, are at high risk for HIV. Yet little attention has been given to important developmental experiences of TFY that may impact HIV risk for this youth population. The overall purpose of this study was to explore HIV risk in TFY. A reoccurring theme from the qualitative data was the importance of parents. To better understand the impact of parents on HIV risk among TFY, in-depth individual interview data from 21 TFY in Los Angeles and Chicago were analyzed, suggesting a potential link between HIV-related risk behavior and parental support. Youth with parental support in this sample reported regular condom use, while those without such support reported inconsistent condom use. Implications for the unique research and interventions needs of TFY related to parental support and sexual risk behaviors are discussed.

A Qualitative Description of Women’s HIV Self-Management Techniques: Context, Strategies, and Considerations - Corrected Proof

Allison R. Webel, Mary A. Dolansky, Anna G. Henry, Robert A. Salata — 2011-11-15

Women living with HIV face unique challenges managing their disease. The purpose of this descriptive qualitative study was to describe self-management techniques reported by 48 women living with HIV in the United States. Participants were involved in one 90-minute, digitally recorded focus group exploring aspects of HIV self-management strategies. Descriptive statistics, qualitative description, and content analysis were used to analyze the data. Participants had been living with HIV for an average of 12 years, and most (69%) were engaged in routine HIV care (85%) and were currently receiving antiretroviral therapy. Participants reported using self-management techniques: taking personal time (n = 23; 48%), advocacy (n = 12; 25%), sleeping (n = 17, 35%), attending support groups (n = 10; 21%), and attending medical appointments (n = 8; 17%). Nurses can add strategies to enhance HIV self-management to routine clinical care, which may have a positive impact on the health of women living with HIV.

Personal Narratives, Coping, and Quality of Life in Persons Living With HIV - Corrected Proof

Kathryn R. Macapagal, Jamie M. Ringer, Shannon E. Woller, Paul H. Lysaker — 2011-10-28

Receiving a diagnosis of HIV can be a life-altering experience that results in significant psychosocial consequences, such as disruptions of one’s life trajectory and goals, sense of self, relationships with others, and participation in social and occupational activities. For many, adapting to these changes can be extremely challenging, yet little is known about the processes that influence how well or poorly individuals are able to recapture the ability to function in these areas.

HIV/STD Risk Behaviors Among In-School Adolescents in Post-conflict Liberia - Corrected Proof

2011-09-19

We conducted a randomized trial to address the health needs of in-school adolescents in Liberia, where we analyzed data from a behavioral survey administered to 820 students from eight urban schools. Our findings suggest that adolescents are at significant risk for HIV and other sexually transmitted diseases (STDs): 36% of respondents were sexually experienced, 34% of those had first sex at ages 14 or younger, 66% of first sexual encounters were unprotected, and 16% were described as “forced.” Also, females were more likely to have older boyfriends (Pearson’s chi square = 19.2, p = .0001) and sex resulting in pregnancies (Pearson’s chi square = 11.5, p = .01), while males were more likely to have a greater number of sexual partners (Pearson’s chi square = 5.6, p = .05) in the previous 3 months. We recommend further research to explore challenges associated with implementing behavioral-driven studies in post-conflict environments.

The Feasibility and Acceptability of a Motivational Interviewing Intervention for HIV-Infected Youth in an Urban Outpatient Clinic: A Pilot Study - Corrected Proof

2011-09-19

Youth living with HIV (YLH) are at an increased risk for nonadherence to medications and nondisclosure of an HIV diagnosis to their sexual contacts. Many factors unique to youth contribute to this risk including developmental stage, physical development, and social and cultural issues that surround the disease (). There are limited data for HIV-infected youth regarding how to improve medication adherence and disclosure of diagnosis, how to maintain healthy lives, and how to prevent the spread of the disease in their communities.

Pursuing Treatment and Moral Worth: HIV-Infected Women in a Northern Province of Vietnam Living With Antiretroviral Therapy - Corrected Proof

2011-09-19

There is a need to understand how social and cultural expectations of being a woman shape the challenges women face when trying to access antiretroviral therapy (ART) and to continue the treatment over time. Based on a 7-month prospective study of 15 HIV-infected women, the particular challenges met by these women in northern Vietnam are discussed in this article. We argued that, by taking ART to maintain their health and to fulfill their responsibilities to family and community, the women managed to reclaim the “moral worth” they had lost as a result of having HIV infection. At the same time, certain social and economic contingencies related to ART made it difficult for the women to uphold this moral position. The study demonstrated the importance of understanding the meanings and implications of ART in specific social contexts to understand how social support structures could be established to ensure treatment continuation.

The Experiences, Needs, and Internet Use of Women Recently Diagnosed With HIV - Corrected Proof

Elizabeth C. Walsh, Keith J. Horvath, Holly Fisher, Cari Courtenay-Quirk — 2011-09-19

Women constitute an increasing proportion of persons diagnosed with HIV in the United States. From September 2007 through June 2008, in-depth interviews were conducted with 20 women diagnosed with HIV in the previous 12 months to explore their experiences immediately following their diagnoses. Most women had at least a high school education (90%) and were African American (45%) or Hispanic (15%). Analysis of transcripts showed that: (a) many women were surprised by the diagnosis because they did not fit the profile of people at high risk for HIV, (b) obtaining social support immediately after an HIV diagnosis was a primary need, and (c) HIV had an impact on a woman’s role in her family. We concluded that strategies are urgently needed to identify women at risk for HIV in a timely manner, and addressing the unique experiences and needs of women recently diagnosed with HIV is critical to their well-being.

Providing Effective Medical and Case Management Services to HIV-Infected Youth Preparing to Transition to Adult Care - Corrected Proof

Mary E. Boudreau, Colleen M. Fisher — 2011-08-05

A key aspect of maintaining health for HIV-infected adolescents is the transition from pediatric care to adult medical care. Because young people who were infected with HIV as children were initially not expected to survive until adulthood, relatively little attention has been given to issues associated with this transition to adult care. With improved life expectancies, health professionals are increasingly faced with the new challenge of working with these young people as they grapple with the unique experience of being an HIV-infected adolescent transitioning into adulthood. This article discusses the unique developmental trajectories of young people infected with HIV as children, challenges for health care professionals who work with them, and strategies for practitioners to increase the competencies needed to develop effective partnerships with these youth as they transition into adult care.