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Armenta RF, Kellogg D, Montoya JL, Romero R, Armao S, Calac D, Gaines TL. "There Is a Lot of Practice in Not Thinking about That": Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3566. [PMID: 33808175 PMCID: PMC8037532 DOI: 10.3390/ijerph18073566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
American Indians (AI) face significant disparities in HIV/STI morbidity and mortality, and historical, structural, interpersonal, and individual level barriers stymie prevention efforts. The objective of this paper is to examine barriers to HIV/STI prevention among reservation-based AI. We conducted face-to-face qualitative interviews with 17 reservation-based AI community leaders and community members in Southern California on HIV/STI knowledge and attitudes and barriers to prevention. The disruption of traditional coping mechanisms and healing processes were compromised by historical trauma, and this allowed stigmas to exist where they did not exist before. This impacted access to healthcare services and trust in medicine, and is linked to individuals adopting negative coping behaviors that confer risk for HIV/STI transmission (e.g., substance use and sexual behaviors). Most of the participants reported that HIV/STIs were not discussed in their reservation-based communities, and many participants had a misperception of transmission risk. Stigma was also linked to a lack of knowledge and awareness of HIV/STI's. Limited available services, remoteness of communities, perceived lack of privacy, and low cultural competency among providers further hindered the access and use of HIV/STI prevention services. These findings highlight the need to address the historical, structural, and interpersonal factors impacting individual-level behaviors that can increase HIV/STI transmission among reservation-based AIs. Prevention work should build on community strengths to increase HIV/STI knowledge, reduce stigma, and increase access to preventative care while using culturally grounded methodologies.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, California State University, San Marcos, CA 92078, USA
| | - Daniel Kellogg
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Jessica L Montoya
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Rick Romero
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Shandiin Armao
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Daniel Calac
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, La Jolla, CA 92093, USA;
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Anastario M, FireMoon P, Rink E. Sexual risk behaviors and the legacy of colonial violence among Northern plains American Indian youth: A mixed methods exploratory study. Soc Sci Med 2020; 258:113120. [PMID: 32574888 PMCID: PMC7971236 DOI: 10.1016/j.socscimed.2020.113120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/21/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this article, we honor the tribal remembering of two Northern Plains tribes to illustrate how the legacy of colonial violence frames the way in which substance use and mental health affect sexual risk behaviors among American Indian youth on the reservation today. METHODS We used a multi-phase, mixed quantitative and qualitative methods design within a community based participatory research framework to illustrate how the legacy of colonial violence frames epidemiological links between substance use, mental health, and sexual risk behavior among American Indian youth. We conducted semistructured interviews with 29 individuals and administered questionnaires to 298 American Indian youth living in a reservation environment. RESULTS Our findings explicate how a legacy of colonial violence underlies epidemiological links between mental health and substance use with sexual risk behavior among youth. Salient facets of colonial violence included systematically altered living arrangements, the boarding school era, eroded traditional practices, and the entry of extractive industries onto native lands. DISCUSSION The colonial violence enacted against the ancestors of Northern Plains tribal peoples materializes in the health of those living on the reservation today. Community interventions, which seek to address the role of substance use and mental health in sexual risk behavior, could benefit from delineating tribal perceptions regarding the legacy of colonial violence on public health outcomes through the use of a CBPR framework.
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Affiliation(s)
| | | | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA.
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Rosenstock S, Chambers R, Lee A, Goklish N, Larzelere F, Tingey L. Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents. AIDS Care 2019; 32:379-385. [PMID: 31775515 DOI: 10.1080/09540121.2019.1695726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N = 267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.
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Affiliation(s)
- Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Rachel Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Angelita Lee
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, USA
| | - Novalene Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, USA
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Whiteriver, USA
| | - Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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Tingey L, Chambers R, Rosenstock S, Larzelere F, Goklish N, Lee A, Rompalo A. Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth. J Prim Prev 2018; 39:401-420. [PMID: 30046947 DOI: 10.1007/s10935-018-0517-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13-19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.
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Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Francene Larzelere
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
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American Indians, substance use, and sexual behavior: do predictors of sexually transmitted infections explain the race gap among young adults? Sex Transm Dis 2015; 42:64-7. [PMID: 25585062 DOI: 10.1097/olq.0000000000000230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs. METHODS We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18-26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques. RESULTS Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19-2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08-2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46-4.11) were significantly associated with having an STI. CONCLUSIONS Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities.
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Jensen J, Baete Kenyon DY, Hanson JD. Preventing alcohol-exposed pregnancy among American-Indian youth. SEX EDUCATION 2015; 16:368-378. [PMID: 27429593 PMCID: PMC4942809 DOI: 10.1080/14681811.2015.1082070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research has determined that the prevention of alcohol-exposed pregnancies (AEP) must occur pre-conceptually with women, either by reducing alcohol intake in women planning pregnancy or at-risk for becoming pregnant, or by preventing pregnancy in women drinking at risky levels. One such AEP prevention programme with non-pregnant American Indian women is the Oglala Sioux Tribe (OST) CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) Programme, which shows promise in reducing AEP risk in American Indian women aged 18 or older. A community needs assessment was conducted with key informant interviews and focus groups with an emphasis on how to expand OST CHOICES. To identify interconnected themes, a content analysis methodology was used on the qualitative feedback from the focus groups and interviews. Altogether, key informant interviews were completed with 25 health and social service professionals. Eight focus groups were held with 58 American Indian participants, including adult women of child-bearing age, elder women, and adult men. Several sub-themes regarding the prevention of AEP with youth were identified, expanding the OST CHOICES curriculum into the schools, and the role of family and culture within AEP prevention.
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Markham CM, Craig Rushing S, Jessen C, Lane TL, Gorman G, Gaston A, Revels TK, Torres J, Williamson J, Baumler ER, Addy RC, Peskin MF, Shegog R. Factors Associated With Early Sexual Experience Among American Indian and Alaska Native Youth. J Adolesc Health 2015; 57:334-41. [PMID: 26299560 DOI: 10.1016/j.jadohealth.2015.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE American Indian and Alaska Native (AI/AN) youth experience disparities associated with sexual and reproductive health, including early age of sexual initiation. Identifying factors that are most proximally related to early sexual intercourse and that are modifiable through health promotion interventions may help to reduce these disparities. Using a multisystem approach, we assessed individual (biological, psychological, and behavioral), familial, and extrafamilial (peer behavioral) factors associated with lifetime sexual experience among AI/AN early adolescents living in three geographically dispersed U.S. regions. METHODS We analyzed cross-sectional data from 537 AI/AN youth aged 12-14 years, recruited from 27 study sites in Alaska, Arizona, and the Pacific Northwest. We used multilevel logistic regression models to estimate associations between independent variables and lifetime sexual intercourse (oral and/or vaginal sex) individually, within discrete systems, and across systems. RESULTS The analytical sample was 55.1% female, with a mean age of 13.2 years (standard deviation = 1.06 years); 6.5% were sexually experienced. In the final model, we found that lower next-year intentions to have oral or vaginal sex (psychological factors), avoidance of risky situations, and nonuse of alcohol (behavioral factors) were associated with lower odds of lifetime sexual intercourse (all p ≤ .01). No other variables were significantly associated with lifetime sexual intercourse. CONCLUSIONS Interventions that reduce sexual intentions, exposure to risky situations, and alcohol use may help to delay sexual initiation among AI/AN early adolescents.
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Affiliation(s)
- Christine M Markham
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas.
| | | | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, Alaska
| | - Travis L Lane
- Inter Tribal Council of Arizona, Inc., Phoenix, Arizona
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, Arizona
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, Oregon
| | - Taija Koogei Revels
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, Alaska
| | - Jennifer Torres
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Jennifer Williamson
- Alaska Native Tribal Health Consortium, Division of Community Health Services, Anchorage, Alaska
| | - Elizabeth R Baumler
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Robert C Addy
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Melissa F Peskin
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Ross Shegog
- Center for Health Promotion & Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Eitle D, Eitle TM. Factors Associated With American Indian and White Adolescent Drug Selling in Rural Communities. INTERNATIONAL JOURNAL OF LAW, CRIME AND JUSTICE 2015; 43:252-272. [PMID: 26120365 PMCID: PMC4480792 DOI: 10.1016/j.ijlcj.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Relatively few studies have examined the correlates of adolescent drug selling in America, with most of these studies focusing on urban settings. The present study examines the risk and protective factors associated with drug selling among American Indian and white adolescents residing in a rural Northwestern state in the United States. Using survey data collected in 2010-2012, we conduct logistic regression analyses exploring the correlates of drug selling (n=568). Generally, we found support for prior explanations of drug selling, but identified some important race-specific differences. Specifically, we found that stress exposure was a risk factor for American Indians, but not whites. Conversely, academic achievement served as a protective factor for white adolescents but not American Indians. Our findings suggest that the race gap in rural drug selling can be explained by considering differences in social bonds, stress exposure, and exposure to substance using family and friends.
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Affiliation(s)
- David Eitle
- Department of Sociology & Anthropology, Montana State University, Bozeman, MT, USA
| | - Tamela McNulty Eitle
- Department of Sociology & Anthropology, Montana State University, Bozeman, MT, USA
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Novins DK, Moore LA, Beals J, Aarons GA, Rieckmann T, Kaufman CE. A framework for conducting a national study of substance abuse treatment programs serving American Indian and Alaska native communities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 38:518-22. [PMID: 22931088 DOI: 10.3109/00952990.2012.694529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Because of their broad geographic distribution, diverse ownership and operation, and funding instability, it is a challenge to develop a framework for studying substance abuse treatment programs serving American Indian and Alaska Native communities at a national level. This is further complicated by the historic reluctance of American Indian and Alaska Native communities to participate in research. OBJECTIVES AND METHODS We developed a framework for studying these substance abuse treatment programs (n ≈ 293) at a national level as part of a study of attitudes toward, and use of, evidence-based treatments among substance abuse treatment programs serving AI/AN communities with the goal of assuring participation of a broad array of programs and the communities that they serve. RESULTS Because of the complexities of identifying specific substance abuse treatment programs, the sampling framework divides these programs into strata based on the American Indian and Alaska Native communities that they serve: (1) the 20 largest tribes (by population); (2) urban AI/AN clinics; (3) Alaska Native Health Corporations; (4) other Tribes; and (5) other regional programs unaffiliated with a specific AI/AN community. In addition, the recruitment framework was designed to be sensitive to likely concerns about participating in research. CONCLUSION AND SCIENTIFIC SIGNIFICANCE This systematic approach for studying substance abuse and other clinical programs serving AI/AN communities assures the participation of diverse AI/AN programs and communities and may be useful in designing similar national studies.
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Affiliation(s)
- Douglas K Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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Saad A, Rampal L, Sabitu K, AbdulRahman H, Awaisu A, AbuSamah B, Ibrahim A. Impact of a customized peer-facilitators training program related to sexual health intervention. Int Health 2012; 4:277-82. [DOI: 10.1016/j.inhe.2012.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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An HIV-STI risk reduction program among undergraduate students at a northern Nigerian university: a randomized controlled field trial. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0491-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Lowe J. A cultural approach to conducting HIV/AIDS and hepatitis C virus education among native American adolescents. J Sch Nurs 2008; 24:229-38. [PMID: 18757356 DOI: 10.1177/1059840508319866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pilot study tests the feasibility of using a Talking Circle approach and measures cultural values and beliefs within a HIV/AIDS and hepatitis C virus (HCV) prevention program conducted among a Native American (Cherokee) youth population. A descriptive correlation design was used to examine the relationship between Cherokee self-reliance and HIV/AIDS and HCV knowledge, attitudes, and behaviors. The study used three questionnaires that were administered before and after the prevention program to collect data from a convenience sample of 41 students at a public high school within the boundaries of the Cherokee Nation in Oklahoma. Statistical analysis revealed immediate differences between pretests and posttests related to knowledge, attitudes, and behavioral intentions concerning HIV/AIDS and HCV and the cultural dynamic of Cherokee self-reliance.
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Affiliation(s)
- John Lowe
- Christine E. Lynn College of Nursing, Florida Atlantic University, Davie, FL, USA
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Devries KM, Free CJ, Morison L, Saewyc E. Factors associated with the sexual behavior of Canadian Aboriginal young people and their implications for health promotion. Am J Public Health 2008; 99:855-62. [PMID: 18703435 DOI: 10.2105/ajph.2007.132597] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined factors associated with having ever had sex, having more than 1 lifetime sexual partner, and condom nonuse at last incident of sexual intercourse among Canadian Aboriginal young people. METHODS We conducted a secondary analysis of data from the 2003 British Columbia Adolescent Health Survey, a cross-sectional survey of young people in grades 7 through 12. RESULTS Of 1140 young Aboriginal men, 34% had ever had sex; of these, 63% had had more than 1 sexual partner, and 21% had not used a condom at their last incident of sexual intercourse. Of 1336 young Aboriginal women, 35% had ever had sex; of these, 56% had had more than 1 sexual partner, and 41% had not used a condom at their last incident of sexual intercourse. Frequent substance use, having been sexually abused, and having lived on a land reservation were strongly associated with sexual behavior outcomes. Feeling connected to family was strongly associated with increased condom use. CONCLUSIONS Sexual behavior change interventions for Aboriginal young people must move beyond the individual and incorporate interpersonal and structural dimensions. Interventions to reduce substance use and sexual abuse and promote feelings of family connectedness in this population should be explored. Young people living on land reserves need special attention.
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Affiliation(s)
- Karen M Devries
- Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel St, WC1E 7HT London, UK.
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Kaufman CE, Shelby L, Mosure DJ, Marrazzo J, Wong D, de Ravello L, Rushing SC, Warren-Mears V, Neel L, Eagle SJ, Tulloch S, Romero F, Patrick S, Cheek JE. Within the Hidden Epidemic: Sexually Transmitted Diseases and HIV/AIDS Among American Indians and Alaska Natives. Sex Transm Dis 2007; 34:767-77. [PMID: 17538516 DOI: 10.1097/01.olq.0000260915.64098.cb] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To review the epidemiology, research, and prevention programs for sexually transmitted diseases in American Indians and Alaska Natives (AI/ANs). STUDY DESIGN We reviewed the current national and regional trends in sexually transmitted diseases (STDs) for AI/ANs from 1998-2004, peer-reviewed studies from January 1996, through May 2006, and reports, unpublished documents, and electronic resources addressing AI/AN STD prevention and control. RESULTS STD prevalence among AI/ANs remains high. For example, the case rate of C. trachomatis in the North Central Plains AI/AN populations is 6 times the overall US rate. Trends for C. trachomatis also show sustained increases. Little research exists on STDs for this population, and most is focused on HIV/AIDS. Fear of compromised confidentiality, cultural taboos, and complex financial and service relationships inhibit effective surveillance, prevention, and management. CONCLUSIONS Recommendations for STD control in this population include improved local surveillance and incorporation of existing frameworks of health and healing into prevention and intervention efforts. Research defining the parameters of cultural context and social epidemiology of STDs is necessary.
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Affiliation(s)
- Carol E Kaufman
- American Indian and Alaska Native Programs, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado 80045, USA.
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Devries KM, Free C, Jategaonkar N. Factors associated with condom use among Aboriginal people: a systematic review. Canadian Journal of Public Health 2007. [PMID: 17278678 DOI: 10.1007/bf03405385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To review evidence on factors associated with condom use among Aboriginal people and the methodological quality of studies assessing these factors. METHODS A systematic review of published and unpublished literature was undertaken. Searches of databases and indexes were performed and authors were contacted directly. Studies reporting on associations between any independent variables and a condom use outcome were included. Data on the quality of each study was extracted, and the strength of evidence for associations between risk factors and condom use outcomes was assessed by counting the number of studies and sample size of each study. RESULTS Searches yielded 17 analyses on 10 independent samples that met the inclusion criteria. Most studies were cross-sectional and utilized small non-representative samples. Some evidence for a negative association between condom use and having a steady partner emerged; and a negative association between White male/Alaska Native female sex partner pairs was found. Evidence was insufficient to judge associations between other risk factors and condom use. CONCLUSIONS The quality and quantity of evidence regarding the predictors of condom use in Aboriginal populations is limited. A concerted effort in primary research on facilitators of and barriers to condom use which are specific to and appropriate for Aboriginal people is needed to inform effective condom promotion interventions for Aboriginal communities.
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Gilley BJ. 'Snag bags': adapting condoms to community values in Native American communities. CULTURE, HEALTH & SEXUALITY 2006; 8:559-70. [PMID: 17050386 DOI: 10.1080/13691050600891917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
HIV/AIDS researchers working among Native Americans have consistently noted resistance to discussions of sexuality and the distribution of condoms. This resistance is inspired by long held values about shame and public discussions of sexuality. Also, American Indians have been reluctant to welcome public discussions of HIV/AIDS and sexuality from external entities, such as governmental agencies. As a result, Native peoples have some of the lowest documented condom use rates. However, innovations in culturally integrating condoms and safe sex messages into Native cultural ideals are proving beneficial. One such innovation is the snag bag, which incorporates popular Native sexual ideology while working within local ideals of shame to distribute condoms and safe sex materials to sexually active young people and adults. Using snag bags as an example, this research proposes that an effective approach to HIV prevention among Native peoples is not cultural sensitivity but cultural integration. That is, HIV prevention strategies must move beyond the empty promise of merely culturally-sensitizing ideas about disease cause. Instead of simply 'translating' HIV/AIDS programming into Native culture, prevention strategies must be integrated by Native peoples into their own disease theories and contemporary culture.
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Marsiglia FF, Nieri T, Stiffman AR. HIV/AIDS protective factors among urban American Indian youths. J Health Care Poor Underserved 2006; 17:745-58. [PMID: 17242528 PMCID: PMC3038781 DOI: 10.1353/hpu.2006.0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This research examined how family and individual factors influence 3 HIV/AIDS risk behaviors: having more than 1 sexual partner in the last 3 months, substance use at last sexual intercourse, and condom non-use at last sexual intercourse. The sample includes 89 sexually active American Indian adolescents living in a large Southwestern U.S. city. Logistic regression results revealed that family communication acts as a protective factor against HIV risk through a lower reported substance use during last sexual intercourse, but it did not appear to affect the number of multiple recent sex partners. Family and personal involvement in American Indian cultural activities, both low on average in this urban sample, had no effect on outcomes. This study advances knowledge on sexual health risk and protective factors among American Indian adolescents, an understudied group, and provides implications for prevention intervention with American Indian youths and their families.
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Foley K, Duran B, Morris P, Lucero J, Jiang Y, Baxter B, Harrison M, Shurley M, Shorty E, Joe D, Iralu J, Davidson-Stroh L, Foster L, Begay MG, Sonleiter N. Using motivational interviewing to promote HIV testing at an American Indian substance abuse treatment facility. J Psychoactive Drugs 2005; 37:321-9. [PMID: 16295016 DOI: 10.1080/02791072.2005.10400526] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Alcohol and drug use are associated with increased risk of HIV/AIDS. American Indians and Alaska Natives (AI/AN) have high rates of alcohol and other drug use, as well as a high incidence of unsafe sex behaviors and injection drug use practices. Indicators of AI/AN HIV risks involving sexual activity include high rates of STDs, such as gonorrhea, chlamydia, and syphilis. Despite these facts, the prevalence of HIV infection among AI/AN is not well known. The present study is part of a HRSA-funded SPNS HIV/AIDS health initiative, one goal of which is to increase the number of HIV-positive individuals who know their HIV status. To meet the goal of the SPNS project, patients in an inpatient alcohol and drug treatment center were provided with an HIV prevention educational presentation followed by one-on-one HIV counseling. Motivational interviewing was used in the counseling sessions to aid participants in recognizing their risk status and making a decision to be HIV tested. Results show that of the 134 who agreed to one-on-one HIV counseling and 105 (78%) returned for their results.
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