RESUMO
OBJECTIVES: To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study. STUDY DESIGN: Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests. RESULTS: Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8). CONCLUSIONS: The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches.
Assuntos
Consentimento Livre e Esclarecido , Competência Mental , Humanos , Adolescente , Competência Mental/psicologia , Estudos de Coortes , Uganda , Consentimento Livre e Esclarecido/psicologia , Pais , Tomada de DecisõesRESUMO
OBJECTIVES: Although the risk of HIV among New York City West Indian-born Black immigrants often is assumed to be high, population-based data are lacking, a gap we aimed to address. METHODS: Using 2006-2007 HIV/AIDS surveillance data from the New York City Department of Health and Mental Hygiene and population data from the US Census American Community Survey 2007, we compared the rate of newly reported HIV diagnoses, prevalence of people living with HIV/AIDS, and distribution of transmission risk categories in West Indian-born Blacks, 2 other immigrant groups, and US-born Blacks and Whites. RESULTS: The age-adjusted rate of newly reported HIV diagnoses for West Indian-born Blacks was 43.19 per 100 000 (95% confidence interval [CI] = 38.92, 49.10). This was higher than the rate among US-born Whites (19.96; 95% CI = 18.63, 21.37) and Dominican immigrants and lower than that among US-born Blacks (109.48; 95% CI = 105.02, 114.10) and Haitian immigrants. Heterosexual transmission was the largest risk category in West Indian-born Blacks, accounting for 41% of new diagnoses. CONCLUSIONS: Although much lower than in US-born Blacks, the rate of newly reported HIV diagnoses in West Indian-born Blacks exceeds that among US-born Whites. Additional work is needed to understand the migration-related sources of risk.
Assuntos
População Negra/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/epidemiologia , População Negra/etnologia , Distribuição de Qui-Quadrado , República Dominicana/etnologia , Feminino , Infecções por HIV/etnologia , Haiti/etnologia , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Razão de Chances , Vigilância da População , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Índias Ocidentais/etnologia , População Branca/estatística & dados numéricosRESUMO
To generate insights into how migration shapes sexual risk and protection, we interviewed 36 female and 20 male West Indian immigrants attending a public sexually transmitted disease clinic in Brooklyn, New York, between 2004 and 2005. Migration theory suggests that shifts in sexual partnership patterns, bi-directional travel and changes in sexual norms may alter risk. We found evidence of sexual mixing across ethnic groups: a large proportion of participants' partners were not born in the West Indies, despite what is expected among first generation immigrants. Recent travel 'home', another potential source of risk, was uncommon. In open-ended interviews, two themes around sexual and social networks emerged. First, immigrants believed that access to wider, more anonymous sexual networks in New York City (NYC) and the weakening of social controls that limit multiple partnerships (especially for women) promoted greater risk. Second, immigrants experienced greater opportunities for protection in NYC, both through exposure to safer sex messages and availability of condoms. Reported changes in their own condom use, however, were not attributed to migration. West Indian immigrants' risk in NYC may be driven by access to wider sexual networks but failure to alter reliance on 'networks of knowledge' for protection.
Assuntos
Emigrantes e Imigrantes/psicologia , Medição de Risco/métodos , Sexualidade/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Apoio Social , Adolescente , Adulto , Conscientização , Preservativos/estatística & dados numéricos , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Pesquisa Qualitativa , Fatores de Risco , Sexo Seguro , Índias Ocidentais/etnologia , Adulto JovemRESUMO
OBJECTIVES: We compared Black West Indian immigrants' and US-born Blacks' sexual and drug-use risk behaviors and their beliefs related to using condoms and informing partners of sexually transmitted infections (STIs) to identify possible differences in risk. METHODS: We drew data from the baseline assessment of a clinic-based intervention designed to increase partner STI notification. RESULTS: Black West Indian men were less likely than were US-born Black men to report nonregular partners. There were no differences in condom use. US-born Black women were more likely than were Black West Indian women to be extremely confident that they could convince their regular partners to use condoms (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.21, 4.76), whereas there were no differences between Black West Indian and US-born Black men on this measure (interaction P = .06). US-born Black women were more likely than were Black West Indian women to be extremely confident in their ability to discuss STI screening with their regular partners (OR = 1.89; 95% CI = 1.03, 3.47). CONCLUSIONS: Black West Indian women's lower levels of confidence that they can discuss STI screening with their regular partners and convince these partners to use condoms may increase their infection risk. Gender-sensitive interventions are warranted for Black West Indian immigrants, especially women.
Assuntos
Negro ou Afro-Americano/psicologia , Preservativos/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual/etnologia , Parceiros Sexuais/psicologia , Adolescente , Adulto , Negro ou Afro-Americano/classificação , Negro ou Afro-Americano/educação , Infecções por Chlamydia/etnologia , Infecções por Chlamydia/prevenção & controle , Centros Comunitários de Saúde , Busca de Comunicante , Emigrantes e Imigrantes/educação , Feminino , Gonorreia/etnologia , Gonorreia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Autoeficácia , Parceiros Sexuais/classificação , Transtornos Relacionados ao Uso de Substâncias/etnologia , Serviços Urbanos de Saúde , Índias Ocidentais/etnologiaRESUMO
Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.
Assuntos
Atitude Frente a Saúde/etnologia , Emigração e Imigração , Infecções por HIV/etnologia , Assunção de Riscos , Síndrome da Imunodeficiência Adquirida/etnologia , América Central/etnologia , Surtos de Doenças , Feminino , Identidade de Gênero , Promoção da Saúde , Humanos , Índia/etnologia , Masculino , México/etnologia , Cidade de Nova Iorque/epidemiologia , Comportamento Sexual , Índias Ocidentais/etnologiaRESUMO
Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.