UNCMalebrancheTalk_2010-1

UNCMalebrancheTalk_2 - HIV/AIDS IN THE BLACK COMMUNITY David Malebranche MD MPH Emory University Division of Medicine AIDS Principles Practices

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HIV/AIDS IN THE BLACK COMMUNITY David Malebranche, MD, MPH Emory University Division of Medicine AIDS: Principles, Practices & Politics University of North Carolina – Chapel Hill April 6, 2010
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Agenda Factors contributing to racial disparity Addressing bisexuality Project ADOFO Epidemiology Future Directions/Opportunities Conclusion
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Factors driving the racial disparity
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Convergence of factors
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Environmental/Structural Factors Geography/Location Racism Poverty Housing Quality of care Trauma Displacement Education Incarceration Culture Family Religion/Spirituality Gender role norms Oppression Sexual networks Mental health Substance use Gender & sexual discrimination
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Incarceration & Black America
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Incarceration in the United States 1 1 Bureau of Justice Statistics, 2009
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What’s the impact of incarceration? 1. Traumatizes and displaces Black men 2. Disrupts families 3. Increases risk for HIV and STI 4. Increases risk for other chronic diseases 5. Limits job/educational opportunities 6. Restricts voting rights 7. Impacts male: female ratio sexual concurrency and condom use 8. Deprives youth of male tangible male role models
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HIV Transmission Among Male Inmates in a State Prison System – Georgia, 1988–2005 1 73 Facilities – 44,990 male inmates (63% Black) Major findings: 856 of 44,990 (1.9%) were HIV-positive (0.43% in general population) 732/856 (86%) were Black 781/856 (91%) were infected before incarceration 1 CDC, 2006
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Additional Findings…. . July 1988–Feb 2005: 88 inmates became HIV-positive while in prison (59 Black) Case-control study: 65 HIV-positive and 70 HIV- negative inmates Factors associated with HIV conversion in prison (p ≤ .05) I Male-to-male sex in prison I Receipt of tattoo in prison I Body mass index of <24.5 kg/m 2 I Black race 1 CDC, 2006
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Susceptibility factors Area HIV prevalence Sexual networks STI prevalence Community and individual viral load Circumcision status of men Immune system Genetics
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Behavioral factors IV drug use Other substance use/abuse Condom use practices Sexual concurrency Late testing practices
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Convergence of factors
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Keep in mind… Condom use is not a “natural” act Sex without a condom is not always “risky” Risk for HIV is not static! Not JUST about individual behavior I Black Americans are NOT having sex without condoms more than people of other races/ethnicities
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Addressing bisexuality
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“Bisexual Bridge”? ? “riskier” behavior Role of gender & type of relationship Disclosure ≠ safer sexual practices HIV-positive status → safer sexual practices “Common” facilitators & barriers to condom use More studies needed Dodge et al., 2008; Harawa et al., 2006; Malebranche, 2008; Malebranche et al., 2008; Montgomery et al., 2003; Wohl et al., 2002; Millett et al., 2005
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“Brokeback Mountain” vs. “Cover”
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Bisexual Black Men and HIV Risk 1 Review of 3 databases (Psychinfo, Medline & AIDSline) Articles 1980 – June 2004
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This note was uploaded on 01/09/2011 for the course PUBH 420 taught by Professor Strauss during the Spring '09 term at UNC.

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UNCMalebrancheTalk_2 - HIV/AIDS IN THE BLACK COMMUNITY David Malebranche MD MPH Emory University Division of Medicine AIDS Principles Practices

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