Buy Approaches for Working with HIV-Positive African-American Youth: Clinical and Ethical Considerations for Health Care Providers now and save 20% off the purchase price. Use promo code HIVAAYOUTH at checkout to receive your discount. HFO Announcements New Affiliations: HFO has partnered with the Pennsylvania State Nurses Association (PSNA), an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC), to offer a discount on our PSNA-approved CE courses to PSNA members just in time to meet  ACT 58 requirements. Recently Updated Courses: Principles of Bioethics in Practice Experiencing Infertility: The Psychological Care of Individuals and Couples Call for Authors HFO is seeking competent and qualified academics/healthcare professionals to provide CE courses on topics relevant to behavioral medicine and health psychology. In particular, courses on Asthma, Autism, cultural competence, ethics, Fibromyalgia, healthcare disparities, and organ transplant are desired. Click here for more information about authorship opportunities and how to grow with HFO. HFO is pleased to have an ongoing alliance with Vericare, a national provider of mental health care services, as their resident recommended CE provider, offering their service providers a discount and the ability to track and file their CE progress for Vericare's accreditation. In addition, HFO has partnered with The International Academy of Behavioral Medicine, Counseling and Psychotherapy, Inc. (IABMCP) and the Pennsylvania State Nurses Association (PSNA) to offer members of these organizations a discount on CE courses. Click here for more information.   About the Author Ja’nét M. Seward, PsyD – Licensed Clinical Psychologist; Adjunct Faculty at Lewis University, IL. Dr. Seward's clinical work covers an array of treatment settings, including inpatient and outpatient clinics, community mental health centers, behavioral camps, and school systems. Having participated in numerous consultations and school interventions, she is experienced in the provision of individual, family, and group therapy, as well as psychological assessments for children, adolescents, and their families, with a subspecialty in working with culturally diverse populations. Interests: Effective treatment interventions for African American youth, trauma, depression, psychological assessments, school interventions.

African-American Youth: The Essential Treatment Components in the HIV Arena Approximately 54% of new HIV-positive cases in the U.S. occur among African Americans, with half of these new cases among people 13-25 years of age.1,2 AIDS is the 6th leading cause of death for young people ages 16-24, primarily because sexual activity coupled with homelessness, abuse and a general lack of understanding around the needs of this demographic group puts this special population at extreme risk for contact with HIV/AIDS.2,3 Given these astounding statistics, it is imperative that healthcare professionals are aware and prepared to work with African-American (AA) youth; entailing an understanding and integration of both developmental and cultural needs into patient care. Influencing health-related behavior in an adolescent population can be challenging as it is a time of great change and crises.4 Adolescents struggle with developing an identity and often exhibit irrational decision-making and dangerous at-risk behaviors in order to “try on” personas. Further, adolescents exhibit a personal fable, or belief that they are able to avoid bad things from happening to them, leading to impulsivity and a misperception of invincibility with respect to contracting sexually transmissible infections or diseases.2,5,6 This personal fable and sense of invincibility, particularly in the HIV/AIDS arena, may lead many adolescents to reject health protective/preventive actions or the need for any type of treatment, often making it extremely difficult for healthcare providers to implement proactive disease prevention protocols or effective treatment interventions. Psychoeducational groups are an excellent avenue for promoting safe sex practices with adolescents.7 Specifically, a user-friendly HIV prevention approach that consists of six systematic steps that account for adolescents' emotions, cognitive capabilities, and behavior changes within an HIV prevention framework has proven successful.  Table 1 below summarizes the steps and purpose for the group: Table 1:  6 STEPS FOR HIV PREVENTION GROUP Step One Explores patient’s feelings about sexual activity • What have they heard about sexual activity? • What would they like to know about it? Step Two Uses their HIV knowledge as an engagement tool • Dispel myths • Psychoeducation about HIV Step Three Addresses barriers to having safer sex • Lack of safe sex materials (i.e., condoms) • Why are they not practicing safe sex practices? Step Four Focuses on perceptions that might affect risk behaviors • Invincibility fable • Substance abuse Step Five Focuses on safer sex planning • Implementing condom use (including correct way to use a condom) Step Six Focuses on referral-making • For patients that may need additional training/sessions, or one-on-one attention Cultural factors also play a pivotal role for the developing adolescent.8,9 For example, with regard to developing sexual attitudes and practices in particular, AA families typically do not openly discuss sex and sexuality leaving AA teenagers to rely on outside influences (e.g., hip-hop culture, Internet) in a search for role models and a sense of belonging and importance.10,11 Not surprisingly, the limited availability of appropriate role models leave AA youth feeling rejected and misunderstood.2 With regard to healthcare per se, AA youth display a basic mistrust of health care providers and often deny any risk of serious illness, refuse treatment for serious illnesses, demonstrate nonadherence to available preventative care, and appear to have an overall lack of knowledge about dangers of at-risk behaviors (e.g., unprotected intercourse); possibly stemming from their personal fable.2, 12 One study explored the use of a psychoeducational group in a school setting to promote HIV prevention among urban, AA female teens.5 Specifically, the group was designed to enhance HIV-related knowledge, promote the uptake of risk-related behaviors, improve participant’s sense of self, and gain additional insight into the types of prevention programs needed in the AA community. Findings suggest that the ideal structure for such a group would be 8-10 45-minute sessions guided by 7 primary group objectives, briefly presented in Table 2 below as a guide to group facilitators for structuring the activities according to the group’s needs. Structured as such, this group can provide a safe forum for adolescents to discuss issues that pertain to sex and sexuality, HIV/AIDS, and safe sex practices.5 Moreover, it appears that an open discussion of these issues, in conjunction with safe sex practices, could help decrease the incidences of HIV/AIDS for AA adolescents. Table 2: PRIMARY OBJECTIVES OF A PSYCHOEDUCATION GROUP FOR AA ADOLESCENTS Group Objectives To assist the group members in identifying both strengths and weaknesses as they relate to decision-making and sexuality The use of a decision-making model may be useful Brainstorming about the pros and cons of sex and sexuality To provide a setting where group members can freely express their thoughts, feelings, and experiences This allows for empowerment of the group members and enables the facilitator to assess the structure of the intervention If some members are more sexually experienced than others, the facilitator can structure the group to meet the demands of all members To examine parental values, peer pressure, intimacy, and sociocultural factors as they influence sexuality Is sex and sexuality openly discussed in the family? What role does peer pressure play in sexuality? What cultural factors affect a person’s decision to be sexually active? To assist and guide the group members in defining their personal boundaries, sense of self, and inner control Discussion around the importance of self-esteem and choosing whether or not to become sexually active To dispel myths regarding HIV/AIDS What have they heard about it? How do they think it is spread? Opens the door for a discussion around safe sex practices To identify values and skills utilized by those who abstain from sexual intercourse For those who are abstinent, why? What helped them to make the decision to be abstinent, and how do they maintain that decision?

Featured Course

Approaches for Working with HIV-Positive African-American Youth: Clinical and Ethical Considerations for Health Care Providers

(4 CEs) by Ja’net Seward, Psy.D.

Despite the increasingly escalating number of AA youth diagnosed with HIV/AIDS, there appears to be a substantial number of healthcare providers who remain untrained and/or uncertain about the best course of action in providing effective healthcare to these individuals.² It appears that healthcare providers are not adequately trained to meet this growing demand and/or their comfort level around working with this particular population is minimal.^{13, 14}

As briefly discussed in the previous section, working with HIV-positive AA youth can introduce healthcare providers to a unique set of clinical and ethical challenges and, regardless of the health professional's discipline, there are specific culturally-specific guidelines that need to be considered. Toward this end, this course reviews the evidenced-based research pertaining to the provision of healthcare to HIV-positive AA youth. First, a brief overview of the African-American culture in relation to the medical context is presented, including the clinical challenges of working with AA youth in particular. Next, the course presents a brief discussion of the psychosocial impact of an HIV-positive diagnosis. The common errors that occur when working with HIV-positive AA youth are addressed and clinical tools to avoid them are reviewed. Lastly, treatment guidelines are provided to enable clinicians to better integrate culturally-sensitive approaches into the care of this important at-risk group.

References

1. Center for Disease Control (CDC) HIV/AIDS Surveillance Report (2004). Vol. 6. Atlanta: US Department of Health and Human Services, 1–46.
2. Bell, M. (2006). HIV treatment series: Care of the HIV positive adolescent; Developmental stages and provider sensitivity play a special role. Retrieved April 18, 2008 from http://www.thebody.com/content/art1141.html
3. Ebner, D. L. & Laviage, M. M. (2003). The parallel universe of homeless and HIV positive youth. Seminars in Pediatric Infectious Diseases, 14 (1), 32-37.
4. Futterman D.; Chabon, B. & Hoffman, N. (2000). HIV and AIDS in adolescents. Pediatric Clinics of North America; 47, 171-87.
5. Meece, J. (2002). Child and Adolescent Development for Educators, 2nd Edition. McGraw Hill.
6. Burson, J. (1998). AIDS, sexuality, and African American females. Child & Adolescent Social Work Journal, 15(5), 357-365.
7. Pinto, R. M. (2000). HIV prevention for adolescent groups: A six step approach. Social Work with Groups, 23(3), 81-99.
8. Barbarin, O., McCandies, T., Coleman, C, & Atkins, T. (2004). Ethnicity and Culture. In Paula Allen-Meares & Mark Fraser (Eds.), Intervention with Children and Adolescents: An Interdisciplinary Perspective (pp. 27-53). Boston, MA: Allyn and Bacon.
9. Barbarin, O. & McCandies, T. (2002 ). African American Families. In J. Ponzetti, R. R. Hamon, Y. Kellar-Guenther, P. K. Kerig, T. Laine Scales, and James M. White(Eds). International Encyclopedia of Marriage and Family, Second Edition. NY: McMillan Reference USA. 50-56.
10. Pluhar, E. I. & Kurilof, P. (2004). What really matters in family communication about sexuality? A qualitative analysis of affect and style among African American mothers and adolescent daughters. Sex Education, 4(3), 303-321.
11. Stephens, D. P. & Few, A. (2007). The affects of images of African American women in hip hop on early adolescent’s attitudes toward physical attractiveness and interpersonal relationships. Sex Roles, 56(3/4), 251-264.
12. Malat, J. (2003). African American preference for same-race healthcare providers: The role of perceived healthcare discrimination. Paper presented at the annual meeting of the American Sociological Association, Atlanta Hilton Hotel, Atlanta, GA.
13. Mignone, J., Washington, R. G., Ramesh, B. M., Blanchard, J. F. & Moses, S. (2007). Formal and informal sector health providers in southern India: role in the prevention and care in sexually transmitted infections, including HIV/AIDS. AIDS Care, 19(2), 152-158.
14. Panter, A. T., Huba, G. J., Melchior, L. A., Anderson, D., Driscoll, M., Rohweder, C., Henderson, H., Henderson, R. & Zalumas, J. (2000). Healthcare provider characteristics and perceived confidence from HIV/AIDS education. AIDS Patient Care & STDs, 14(11), 603-614.

© 2009 HealthForumOnline, LLC