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1.  Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa 
AIDS Care  2008;20(9):1105-1110.
Since the primary mode of HIV transmission in sub-Saharan Africa is heterosexual, research focusing on the sexual behaviour of men who have sex with men (MSM) is scant. Currently it is unknown how many people living with HIV in South Africa are MSM and there is even less known about the stigmatisation and discrimination of HIV-positive MSM. The current study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa. Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others. HIV-positive MSM reported experiencing greater social isolation and discrimination resulting from being HIV-positive, including loss of housing or employment due to their HIV status, however these differences were not significant. Mental health interventions, as well as structural changes for protection against discrimination, are needed for HIV-positive South African MSM.
PMCID: PMC3320098  PMID: 18608067
South Africa; men who have sex with men (MSM); HIV-positive; AIDS-related stigma; discrimination
2.  Disclosure of HIV status to sex partners and sexual risk behaviours among HIV‐positive men and women, Cape Town, South Africa 
The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive.
Anonymous surveys were completed by 413 HIV‐positive men and 641 HIV‐positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment.
Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV‐negative partners, partners of unknown HIV status and unprotected intercourse with non‐concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners.
HIV‐related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non‐disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.
PMCID: PMC2598581  PMID: 16790562
3.  Potential markers of female condom use among inner city African American Women 
AIDS care  2008;20(4):470-477.
Despite the availability of female condom (FC) and theoretically-based interventions to promote its use, studies have indicated low level acceptability of their use among women in most populations. We aimed to determine female condom use (FCU) prevalence, and the potential markers among African American women (AAW). In an intervention trial to test the efficacy of Information-Motivation-Behavioral Skills model in increasing condom use, we utilized the baseline data of 280 AAW and examined the potential predictors of FCU. Chi square statistic and unconditional logistic regression were used to test for group independence among users and non-users of FC and to assess the potential markers of FCU respectively. After adjustment for relevant covariates associated independently with FCU, the significant potential markers for FCU were age, multiple sexual relationships (MSR), knowledge of FC, and educational status. Women having MSR compared with monogamous relationship were 5 times more likely to use FC, while women with high school education were three times more likely to use FC, prevalence odds ratio, POR = 5.32, 95% CI=1.79-15.83 and POR = 3.01, 95% CI = 1.01-8.93. Women who were not knowledgeable of FC compared to those who were, were 81% less likely to use FC, POR = 0.19, 95% CI = 0.08-0.45. Among AAW in this sample, knowledge of FCU, age, educational status, and multiple sexual relationships were significant markers of FCU. This study is therefore suggestive of the need to educate AAW on FC, given the obstacles in male condom negotiation especially among the socio-economically challenged.
PMCID: PMC2614398  PMID: 18449825
4.  Late middle-aged and older men living with HIV/AIDS: race differences in coping, social support, and psychological distress. 
Although AIDS mental health research has recently devoted more attention to the psychosocial needs of older adults living with human immunodeficiency virus (HIV) disease, studies of this population have typically combined older African-American and white participants into one large sample, thereby neglecting potential race differences. The current study examined race differences in stressor burden, ways of coping, social support, and psychological distress among late middle-aged and older men living with HIV/AIDS. Self-administered surveys were completed by 72 men living with HIV/AIDS in New York City and Milwaukee, WI (mean age = 53.4 years). Older African-American and white men experienced comparable levels of stress associated with AIDS-related discrimination, AIDS-related bereavement, financial dilemmas, lack of information and support, relationship difficulties, and domestic problems. However, in responses to these stressors, older African-American men more frequently engaged in adaptive coping strategies, such as greater positive reappraisal and a stronger resolve that their future would be better. Compared to their African-American counterparts, HIV-infected older white men reported elevated levels of depression, anxiety, interpersonal hostility, and somatization. African-American men also received more support from family members and were less likely to disclose their HIV serostatus to close friends. As AIDS becomes more common among older adults, mental health-interventions will increasingly be needed for this group. The development of intervention programs for this group should pay close attention to race-related differences in sociodemographic, psychosocial, and behavioral characteristics.
PMCID: PMC2608530  PMID: 11052457
5.  Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education. 
African Americans are disproportionately affected by acquired immunodeficiency syndrome (AIDS). New treatments that slow the progression of human immunodeficiency virus (HIV) infection offer hope for individuals living with HIV/AIDS, but lack of access to care and poor treatment adherence remain significant obstacles to HIV treatment. This study investigated the association between education literacy to HIV treatment adherence and barriers to care among African Americans living with HIV/AIDS. A community-recruited sample of 85 African-American men and 53 women receiving HIV treatment completed measures of health literacy, health status, treatment adherence, emotional well-being, and barriers to care. Nearly one-third (29%) of the participants had < 12 years of education or were functionally illiterate, and those with low-education literacy were less likely to be adherent to HIV medications within the previous two days. Lower-education literacy also was related to reasons for missing medications and barriers to accessing medical care. Individuals of law-education literacy also were more emotionally distressed, lacked social support, and were less optimistic than those with higher education. These results indicate that education and health literacy are important factors in HIV-treatment adherence and access to medical care. Interventions are needed for improving treatment adherence among law-income minorities, and such interventions will need tailoring for individuals with limited reading ability.
PMCID: PMC2608436  PMID: 12656432
6.  HIV risk differences between African-American and white men who have sex with men. 
African-American men who have sex with men remain at disproportionately greater risk for contracting human immunodeficiency virus (HIV) infection. While high HIV seroincidence has been documented among homosexual African-American men, behavioral research has rarely studied the HIV risk issues confronting these men. This study assessed a sample of 253 men who have sex with men to determine if African-American (n = 79) and white (n = 174) men report different rates of HIV risk behaviors and differ in characteristics indicative of risk. African-American men who have sex with men were more likely to be HIV-seropositive, to report past treatment for gonorrhea and syphilis, and to have a recent unprotected sex partner known or believed to be HIV-seropositive. Multivariate analyses of covariance, controlling for group differences in age, education, and income, revealed that African-American men who have sex with men were less open about their sexual orientation, scored lower in HIV risk behavior knowledge, had more female sexual partners, and more frequently used cocaine in association with sex relative to white men who have sex with men. Human immunodeficiency virus prevention programs tailored to the needs and risk issues of African-American men who have sex with men are needed.
PMCID: PMC2608406  PMID: 10083778

Results 1-6 (6)