What Front-Line CBO Staff Can Tell Us About Culturally Anchored Theories of Behavior Change in HIV Prevention for Asian/Pacific Islanders

Few rigorously tested primary prevention programs have been developed to prevent HIV infection among immigrant communities in the United States. This is in part because of the lack of culturally specific behavioral theories that can inform HIV prevention for immigrant communities in the United States. This article aims to develop such theories for a population—Asian/Pacific Islanders (A/PIs) immigrant communities—who have been overlooked in theory development and program evaluation. Frontline community-based organization (CBO) peer educators, an underutilized source of expertise regarding cultural factors specific to HIV infection among A/PI communities, are the sample of study Asian/Pacific Islander peer educators working at an urban AIDS service organization devoted to health promotion for this population; (N=35). They were interviewed to examine (1) detailed narratives describing instances of behavior change and (2) culturally anchored theories of behavior change which the narratives imply. Theories of the influence of positive cultural symbols on the taboo of HIV/AIDS, moderators of the effectiveness of social network influences on behavior change, and setting- and community-level processes predicting HIV risk behavior were implicit in the peer educators' narratives. Implications for future research, methodology and prevention practice are discussed.     

Youth Living with HIV as Peer Leaders

Community-based service providers often hire youth living with HIV (YLH) as peer leaders for delivering HIV education to uninfected adolescents. Life narratives were collected from 44 YLH during a hypotheses-generating two-year ethnographic study. About 30% of the youth were employed as peer educators. While 60% of the 44 youth had a lower-class background, only 23% of the peer leaders were lower class. One-fifth of the sample were female, but more than one-half of the peer leaders were female. After identifying and categorizing difficulties experienced by the peer leaders, a frequency count of each theme was conducted. Issues about professional boundaries were evident in 38.5% of the youth's narratives, indicating conflicts in their roles as peer leaders; 23% of the youth engaged in substance use and sexual behaviors that placed themselves and uninfected youth in their peer educator programs at risk; and 8% of the youth reported relapse while peer leaders. The observations suggest reconsideration or restructuring of existing peer-education models that employ YLH.     

剖析患者投诉

患者投 是患者就医过程中与医务人员或医疗单位的利益发生的表现形式,着重剖析了因医疗费用、服务质量、医疗质量等引起的投诉,分析了投诉的目的及管理投诉单位的反应,并从几个方面探讨了如何对待投诉,减少投诉、避免投诉。     

遗忘症患者外显与内隐记忆实验研究:语义性启动效应任务

采用ＷＭＳ—ＣＲ和ＭＭＳＥ对临床脑损伤患者进行了认知功能与记忆功能两方面的筛选,获得９名遗忘症患者。然后采用偏好和自由联想两项语义性启动效应任务进行测验,发现遗忘症患者在外显记忆受损情况下,的确存在语义性启动效应,且与正常对照相近。推论语义性启动效应任务与遗忘患者损伤的颞叶或间脑结构无关。同时还讨论了启动效应任务,认为偏好任务采用言语性材料不是理想的方法。     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

AIDS PREVENTION: IMPROVING NURSES' COMPLIANCE WITH GLOVE WEARING THROUGH PERFORMANCE FEEDBACK

A performance feedback procedure was used to increase glove wearing by nurses in a hospital emergency room in situations in which contact with body fluids was highly likely. Infection-control nurses provided biweekly performance feedback to staff nurses on an individual private basis to inform them of the percentage of contact opportunities in which they wore gloves. Observations made prior to (baseline) and during feedback in a multiple baseline design across 4 subjects indicated that substantial increases in glove wearing in target situations occurred after implementation of the feedback program and that increases occurred across most of the specific situations in which glove wearing was advised. Percentage increases in glove wearing ranged from 22% to 49% across subjects. The results are discussed in terms of prevention of acquired immune deficiency syndrome (AIDS) by use of universal precautions.     

Aids,myth, and ethics

The present paper is a commentary on an article by Larry Churchill [1]. Churchill has argued that the negative attitudes and adverse behavior we commonly encounter in connection with (suspected) AIDS patients may be understood in terms of a dualistic myth inspiring a ritual avoidance of dirt, of dirt as something that does not belong to a clean world order. The deep-seated mythical character of attitudes and behavior here makes them less accessible to the kind of rational argument commonly employed in ethics. Churchill also proposes a remedy for the (morally outrageous) dualistic mythical-ritual behavior he has focused — a remedy that may be overly intellectualistic.Three further comments are made: on the metaphorical meaning of myth, on a reductionist tendency in Churchill's deep-looking project, and on an ethically crucial ambiguity in the meaning of the other person's otherness. These (mildly critical) comments do not, however, detract from a positive overall evaluation of Churchill's basic idea that we will understand more about adverse attitudes and behavior in connection with AIDS if we think in terms of myth, ritual, dirt, and cleanliness.