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PROBLEM: Major barriers to care included a lack of culturally competent, accessible care despite the proximity of numerous health service agencies serving homeless youth. METHODS: A qualitative approach using semistructured focus groups was used to assess the perspectives of 54 homeless and drug-using youth, aged 18-24 years, recruited from street- and shelter-based settings. FINDINGS: Substance use was perceived as an adaptive response to psychological pain and survival on the streets as well as a health risk and barrier to care. CONCLUSIONS: Facilitators to care and suggestions for improved health delivery and quality of care included utilization of health "mentors" to assist in navigating the medical system, cultural competency enhancements, improved amenities in clinic wait areas, and expanded pharmaceutical services.

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The long-term purpose of this study was to assess the effectiveness of a problem-solving computerized bioterrorism education and training (CBET) program compared with a standard bioterrorism education and training (SBET) program. The content and delivery preferences of nurses employed in two major hospitals in Los Angeles and San Diego that would be relevant to the design of the SBET and CBET scenarios were assessed. During the focus groups, nurses also considered culturally sensitive delivery aspects. Notable findings from the focus groups are discussed in this study. Recommendations based on these findings are proposed as this project moves into subsequent phases.

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Thailand was the first Asian country hit by the AIDS epidemic, and in the 1990s reported the fastest spread of HIV/AIDS in the world. According to Thailand's Ministry of Public Health, women, primarily between the child-bearing ages of 15 and 49, are increasingly becoming infected with HIV. A number of factors contribute to the increasing AIDS epidemic, including the rise of the commercial sex industry in Thailand; social disparities that have existed between men and women throughout Thailand's history; and the gender-expectations faced by Thai women toward family and society. Thailand enjoys one of the oldest, reputedly successful primary health care delivery systems in the world; one that relies on community health workers to reach the most rural of populations. In the mid-1990s, day care centers were established at district hospitals by the Thai government to provide medical, psychological, and social care to people living with HIV/AIDS (PWA). Buddhist temples also provide a source of alternative care for PWAs. However, the AIDS policy of the Thai government relies on families to care for the country's sick. Although poor women are a vulnerable population in Thailand, they are changing the paradigm of AIDS stigma while providing a significant cost-savings to the Thai government in their caregiving activities. Based on existing nursing studies on Thailand, this chapter gives voice to poor Thai women living with HIV/AIDS, and examines how they make sense of their gendered contract with society and religion while being HIV/AIDS caregivers, patients, or both.

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In the United States, homeless youth are becoming increasingly entrenched in problem substance use, including high prevalence of alcohol abuse and injection use. A total of 54 substance-using homeless youth (18-25 years) participated in focus groups in order to provide their perspectives on barriers to and facilitators of seeking treatment. Participants were recruited from shelters in Hollywood, CA, and from a street-based, drop-in site in Santa Monica, CA. Participants identified personal barriers to treatment, but reported that facilitators of treatment tended to be more systematic. Homeless youth used and abused substances to dim the psychological effects of living on the streets. They appreciated programs that facilitated treatment and rehabilitation such as mentoring, support groups, and alternative choices to substance use. Implications point to the need for further development and research on culturally-appropriate, age-sensitive programs for homeless youth. The experiences of these youth underscore the need for strategic interventions.

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BACKGROUND: Among substance users, health seeking remains a major challenge for which few data are available. OBJECTIVES: We sought to investigate the perceptions of methadone-maintained heroin users who are also problem or heavy drinkers, their barriers and facilitators to seeking help for substance and general and chronic care treatment. METHODS: A qualitative design using a semistructured focus group approach was conducted with a convenience sample of 41 adult clients of a methadone maintenance facility in Los Angeles. RESULTS: Findings revealed that discrimination was a major challenge experienced as a result of their methadone status. Lack of primary care providers, limited access to health care facilities and access barriers were pervasive. Focus group participants expressed a desire for nonjudgemental and empathetic care that would foster respect and facilitate help-seeking behaviors through a comprehensive support system. CONCLUSIONS: The need to design culturally relevant training programs was evident which included an integration of treatment, communication and societal issues.

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