Knowledge Center

Marginalized/Vulnerable Populations Marginalized Populations are defined as: diverse populations such as Lesbians, Gay, Bisexual, Transsexuals; Incarcerated and Newly Released; Migrants; Immigrants; Seniors; Pregnant Women; Homeless; English as a Second Language communities; Dually and Triply Diagnosed.

Table of Contents

• Adolescents
• African Americans/Blacks
• American Indians/Alaska Natives
• Arab Americans
• Asian Americans
• Health Literacy
• Hispanics/Latinos
• Homelessness and HIV/AIDS
• HIV and Intimate Partner Violence (IPV)
  
• Incarcerated Patients Living with HIV/AIDS
• Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)
  
• Men who have Sex with Men (MSM)
• Mental Health
• Migrant and Immigrant Communities
• Multimedia
• Muslim Americans
• Native Hawaiians/Pacific Islanders
• Over 50
• Pediatrics
• Physically Challenged
• Racial/Ethnic Minorities
• Substance Use/Abuse
• Veterans
• Women

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The following resources are available from the AETC Capitol Region Telehealth Project's Knowledge Center as well as repository locations of our collaborative partners. Materials are listed with most recent items first.

Adolescents

• Using culturally sensitive media messages to reduce HIV-associated sexual behavior in high-risk African American adolescents: results from a randomized trial
  The purpose of this study is to test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance HIV-preventive beliefs and behavior of high-risk African American adolescents.
  Source: Pubmed 2011
• Health care transition for youth living with HIV/AIDS
  This review discusses the unique transition challenges to consider for this population, including socioeconomic and health insurance status, the special role of the pediatric or adolescent provider as family, stigma and disclosure issues, cognitive development and mental health issues, medication adherence, and sexual, reproductive, and gender health concerns.
  Source: Pubmed 2011
• Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing
  This policy statement reviews the epidemiologic data and recommends that routine screening be offered to all adolescents at least once by 16 to 18 years of age in health care settings when the prevalence of HIV in the patient population is more than 0.1%. This statement addresses many of the real and perceived barriers that pediatricians face in promoting routine HIV testing for their patients.
  Source: Pubmed 2011
• Sexual Health of Adolescents and Young Adults in the United States Fact Sheet
  This fact sheet provides key data on sexual activity, pregnancy, contraceptive use, prevalence of STIs among teenagers and young adults, and access to reproductive health services
  Source: KFF 2011
  

African Americans/Blacks

• African-Americans' Perceptions of Health Care Provider Cultural Competence that Promote HIV Medical Self-Care and Antiretroviral Medication Adherence. 
  Findings of this study indicate the need for increased attention to the role of cultural competence in HIV/AIDS care. Understanding patient perceptions of provider cultural competence has the potential to improve HIV treatment adherence and health outcomes. Findings of this study indicate the need for increased attention to the role of cultural competence in HIV/AIDS care. Understanding patient perceptions of provider cultural competence has the potential to improve HIV treatment adherence and health outcomes. Source: PubMed 2013
• Fact Sheet: Black Americans and HIV/AIDS. This updated fact sheet highlights the epidemic's impact on Black Americans, providing current data and trends over time.
  Source Kaiser Family Foundation 2013
• Black Americans and HIV/AIDS Fact Sheet
  Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time
  Source: KFF July 2012
  
• Back of the Line: The State of AIDS Among Black Gay Men in America 2012
  Comprehensive report outlines the health crisis among Black MSM including health disparities, healthcare barriers and risks, and strategies for change going forward. The report includes data, a timeline of events, articles, interviews and more. Follow the link above to read the full report.
  Source: Black AIDS Institute
• HIV/AIDS Prevention Education: Developing Cultural Competent Programs for African Americans
  The purpose of this exploratory theory-based article is to discuss the extent of the HIV/AIDS epidemic in the African American community, variables that contribute to HIV/AIDS among African Americans, and culturally relevant program designs and instructional strategies that support African Americans' prevention needs and demonstrate respect for their cultural and family values. Source: PubMed 2012
• Black Americans and HIV/AIDS Fact Sheet
  Black Americans have been disproportionately affected by HIV/AIDS since the epidemic’s beginning, and that disparity has deepened over time
  Source: KFF 2011

American Indians/Alaska Natives

• American Indian gay, bisexual and two-spirit men: a rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention. 
  Epidemiological data indicate that HIV and AIDS are disproportionately affecting American Indians. Specific to American Indian men identifying as gay, bisexual, two-spirit or who have same-sex experiences, this study assessed HIV-risk behaviors and barriers to testing, prevention and treatment efforts. Barriers to treatment in the study included a mistrust of the current healthcare system, a perceived lack of support from the Indian Health Service for AIDS care and a lack of transportation to healthcare appointments. Lastly, participants discussed and supported culturally-sensitive treatment services. This study calls attention to the value of an American Indian-specific HIV/AIDS service organization, the presence of indigenous service providers in the community and culturally-sensitive healthcare providers. Source: PubMed 2011
• HIV/AIDS among American Indians/Alaska Natives living in Montana: a descriptive study
  This study examines the epidemiology of HIV among AI/ANs in Montana, barriers to HIV testing and motivations to test.
  Source: PubMed 2011
  
• Cross Culture Medicine
  The subtleties of interpersonal relationships (which, when understood by health professionals make them more successful in caring for patients) are particularly important among the Navajo.
  Source: IHS

Arab Americans

• Middle Eastern (Arab/Chaldean) Patient: A Culturally Relevant, Culturally Sensitive, and Culturally Competent Approach
  This is a power-point presentation on culture and patient care; presents the CLAS Standards; and overview of  Muslim/Middle Eastern family dynamic, and examines the expectations and perceptions Middle Eastern patients have of their health. Source: Michigan State University College of Osteopathic Medicine 2012
  
  
  
  

Asian Americans

• Gender power control, sexual experiences, safer sex practices, and potential HIV risk behaviors among young Asian-American women
  Researchers examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. Researchers also investigated the impact of gender power control on these domains. Source: PubMed, January 2012
• Asian American Health Research: What Community Agencies on the Front Line Need to Know
  This report shows that for some health promotion curricula that have proven effective among general populations, there is no evidence that these curricula will be as effective among Asian American populations, particularly those with limited English proficiency. Thus, to be most effective, community agencies working to improve the health of Asian Americans require a deep knowledge of their target community and have evidence-based programs and policies at their disposal. 
  Source: Project Muse 2012
• A forgotten population: Addressing comprehensive HIV prevention needs among American Asians and Pacific islanders.
  Source: PubMed July-August 2010
• Traditional Asian Health Beliefs & Healing Practices  DOC
  This article discusses the basic concepts behind the traditional medicines and healing practices of Asian cultures.
  Source: PubMed 2011

Health Literacy

• How Effective Healthcare Communication Contributes to Health Equity
  This video addresses provider health literacy, contribute to improving the quality of services for culturally and linguistically diverse populations as well as people with limited health literacy skills
  Source: PubMed 2012
  

Hispanics/Latinos

• National Latino AIDS Awareness Day: October 15
  The Latino Commission on AIDS (LCOA), the Hispanic Federation and many other organizations organize this day. Find NLAAD resources at http://www.nlaad.org/, including posters, graphics, PSAs and themed materials.
• Fact Sheet: Latinos and HIV/AIDS. This updated fact sheet highlights the impact of HIV/AIDS on Latinos in the United States, providing current data and trends over time.
  Source: Kaiser Family Foundation 2013
• Latinos and HIV/AIDS  Fact Sheet
  Latinos in the United States continue to be heavily impacted by HIV/AIDS, accounting for higher rates of new HIV infections, AIDS diagnoses, and people living with HIV than their white counterparts
  Source: KFF  July 2012
• Pyschosocial and cultural correlates of depression among Hispanic men with HIV infection: a pilot study.
  The purpose of this pilot study was to describe the relationships between depression and other psychosocial factors (self-esteem, Hispanic stress, substance abuse and violence) and cultural factors (familism and Hispanic stress) among a sample of Hispanic men with HIV infection.
  Source: PubMed February 2012
  
• Sociocultural and Structural Barriers to Care among Undocumented Latino Immigrants with HIV Infection
  This study offers insight into the unique sociocultural and structural barriers faced by undocumented Latinos with HIV infection. Understanding and addressing these barriers will prove vital in the development and implementation of strategies to promote early entry into HIV care.
  Source: Pubmed 2011
• Empowering Latino Church Leaders to Deal with the HIV-AIDS Crisis: A Strengths-Oriented Service Model
  This study explores ideology and attitudes of Latino church leaders in the United States toward HIV/AIDS.
  Source: Pubmed 2011
• Hispanic women's experiences with substance abuse, intimate partner violence, and risk for HIV
  This study supports the importance of addressing substance abuse, violence, and risk for HIV in an integrated manner and stresses the importance of addressing associated cultural factors (e.g., acculturation, machismo) in interventions targeting Hispanics.
  Source: Pubmed 2011
• Self-Reporting Assessment for Culturally and Linguistically Appropriate HIV Prevention Programs for Latino/Hispanic Populations
  This self-reporting assessment tool is designed to assist Community Based Organizations (CBO) to identify strengths and potential gaps in providing culturally and linguistically appropriate HIV prevention services to Latino/Hispanic populations in their service areas.
  Source: JSI

Homelessness and HIV/AIDS

• Improving the Health of the Homeless: Advice for Physicians.
  Homeless individuals suffer from a constellation of health issues, experience barriers to medical care that are both recognizable and hidden, and score worse on measures of health outcomes than the general population. The article   describes common conditions affecting homeless people and discusses how patient-centered comprehensive primary care, collaboration between health care providers and social service organizations, and innovative delivery of medical respite services can result in better care for this population. Source: PubMed 2012
• Addressing Cultural and Linguistic Competence in the HCH (Health Care Homeless) Setting: A Brief Guide. HCH providers are sensitive to their client's attitudes,beliefs, and behaviors, many of which are shaped by their direct experience of poverty and homelessness. 2019
• Use of Complementary & Alternative Therapies in Homeless Health Care. This issue of Healing Hands explains what is meant by CAM, describes the major theoretical systems and practices it comprises, and discusses therapies currently used by Health Care for the Homeless (HCH) practitioners—including nutritional supplements, acupuncture, and mindfulness-based stress reduction—and the extent to which their efficacy has been tested.

Incarcerated Patients Living with HIV/AIDS

• HIV-Related Research in Correctional Population: Now is the Time
  The overlapping epidemics of incarceration and HIV present a need for academic medical centers to collaborate with the criminal justice system to improve the health of incarcerated populations.
  Source: Pubmed 2011
• Consideration in HIV Prevention for Women Affected by the Criminal Justice System
  This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts.
• HIV Treatment in the Criminal Justice System: Critical
  Knowledge and Intervention Gaps
  This paper describes four major challenges to successful management of HIV in the criminal justice system: relapse to substance use, homelessness, mental illness, and loss of medical and social benefits.
  Source: Pubmed 2011
• Understanding the health needs of incarcerated men living with HIV/AIDS: a primary health care approach
  This article presents a review of the literature on the health needs of incarcerated men living with HIV/AIDS.
  Source: Pubmed 2011
• Addressing the HIV Care Needs of People With HIV in State Prisons and Local Jails
  Caring for HIV-infected patients who are incarcerated is a complex and challenging task. For many of these patients, the prison health service provides their first opportunity for access to consistent health care. This PDF discusses some of the issues relevant to the HIV-infected population in correctional settings
  Source: HRSA - Ryan White HIV/AIDS Program

Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)

• Health Equity Series: Responding to LGBT Health Disparities. Examines how LGBT individuals in Missouri and across the country experience poorer health outcomes than their heterosexual peers.
  Source: The Missouri Foundation for Health 2012
• Lesbian, Gay, Bisexual, and Transgender Health Fact Sheet 2012. This factsheet explains why Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives.
  Source Healthy People 2020
• Top Health Issues for LGBT Populations Information & Resource Kit informs health care providers and prevention specialists about the health experiences of LGBT populations. Understanding the health issues of LGBT individuals is a significant step in improving access to care and the quality of behavioral health services.
  Source: SAMHSA 2012
• Why Gather Data On Sexual Orientation and Gender Identity in Clinical Settings
  This report explains that gathering sexual orientation and gender identity data from patients is essential to providing appropriate health care to lesbian, gay, bisexual and transgender (LGBT) people, who face significant documented health disparities. It also helps providers to better understand these disparities.
  Source: The Fenway Institute 2012
• How to Gather Data On Sexual Orientation and Gender Identity in Clinical Settings
  This brief discusses two methods for gathering sexual orientation and gender identity from patients, by asking questions on the patient registration (intake) form, and by requiring that providers gather this information directly from patients during medical visits, recording responses in the electronic medical record.
  Source: The Fenway Institute 2012
• HIV and Transgender People
  Transgender communities in the United States are among the groups at highest risk for HIV infection. Transgender people are gender identity minorities. The term gender identity refers to a person’s basic sense of self, of identifying as male, female, or some other gender (e.g., transgender, bigender, intersex). Source: CDC
• Effective Response
  AIDS: the Early Years and CDC's Response
  Supplements
  October 7, 2011 / 60(04);64-69 MMWR (1). The article summarizes CDC response to AIDS from the initial 1981 MMWR description of five cases of Pneumocystis carinii pneumonia (PCP) among homosexual men in Los Angeles- the first published report about an illness that would become known as acquired immunodeficiency syndrome (AIDS)-to the first International Conference on AIDS held in 1985. The authors recommend applying lessons from these early years to the future: 1) the importance of surveillance, 2) rapid identification of the causal agent, 3) innovations in diagnostics and treatment, 4) emphasis on prevention, and 5) importance  of personal commitment to advocacy, research, and clinical care quality.
  Source: PubMed 2011
  
• Gay and Bisexual Men's Health CDC 2011
  This article addresses homophobia, stigma, and discrimination and its continued negative affect on the health and well-being of gay, bisexual, other men who have sex with men (MSM), and other members of the LGBT community. The article discusses how these issues affect health care access and service quality.
• The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
  The Institute of Medicine released this consensus report to develop a more complete picture of the health status of people who are LGBT and to identify research gaps.
  Source: Pubmed 2011
• When health care isn’t caring
  This survey is the first to examine refusal of care and barriers to health care among LGTB and HIV communities on a national scale.
  Source: Lambda 2011
• Challenges associated with HIV in transgender patients
  This article explores issues associated with transgenderism in the setting of HIV/AIDS, including the use of hormones along with antiretroviral agents and medications for treatment of opportunistic infections and a best practice model recommended to increase awareness among HIV providers and to improve cultural competency, sensitivity, and clinical capacity among all levels of HIV care providers.
  Source: deltaaetc.org 2011
• Identifying the Needs of LGBTQ Immigrants and Refugees in Southern Arizona
  This article presents findings on the quality of service provision provided to this very underserved community pertaining to health care.
  Source: PubMed 2011
  

Men who have Sex with Men (MSM)

• Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men
  The goal of this study was to explore church ideologies surrounding sexuality and health, and the relationship of these ideologies to church mobilization in response to HIV/AIDS among Black MSM.
  Source: Pubmed 2011
• MSM: resurgent epidemics
  The present review discusses the recent finding on behavioral risk factors for HIV transmission from cohort studies in MSM.
  Source: Pubmed 2011
• Mistaken assumptions and missed opportunities: correlates of undiagnosed HIV infection among black and Latino men who have sex with men
  This study identifies demographic, behavioral, and psychological variables associated with being HIV positive unaware among black and Latino men who have sex with men (MSM).
  Source: Pubmed 2011
  
• 'It's my inner strength': spirituality, religion and HIV in the lives of young African American men who have sex with men
  This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans.
  Source: Pubmed 2011
• Correlates of sexual, ethnic, and dual identity: a study of young Asian and Pacific Islander men who have sex with men
  Having a positive attitude toward one's own sexual and ethnic identity can improve psychological well-being and self-efficacy and may reduce vulnerability to HIV infection.
  Source: Pubmed 2011
• HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: Effects on HIV testing and risk behaviors
  This study investigates relationships between institutional mistrust (systematic discrimination, organizational suspicion, and conspiracy beliefs), HIV risk behaviors, and HIV testing in a multiethnic sample of men who have sex with men (MSM), and to test whether perceived susceptibility to HIV mediates these relationships for White and ethnic minority MSM.
  Source: Pubmed 2011

Mental Health

• Mental Health of Deaf People.
  In this article discrepancies are described  between a high burden of common mental health disorders and barriers to health care. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters. Source: PubMed 2012
• Assessing the Mental Health Needs and Barriers to Care among a Diverse Sample of Asian American Older Adults.
  The study sought to compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services. The findings of the study  not only highlighted the unmet mental health needs among older Asian Americans, but also illustrated significant variations among the various Asian subgroups. Source: PubMed 2011
• Language Concordance and Patient-physician Communication regarding Mental Health Needs.
  This article discusses language-related communication barriers between minority patients and their physicians may contribute to racial and ethnic disparities in mental health care. Accordingly, the current study sought to examine whether perceived mental health needs and discussion of these needs differed as a function of race or ethnicity and language concordance in older Latinos and Asian and Pacific Islanders (APIs). There were no significant differences in respondents' perceptions of their mental health needs across race or ethnicity or level of language concordance status (Ps > .41), although there were significant differences in whether respondents had discussed their mental health needs with their physicians according to participant race or ethnicity and language concordance status (adjusted odds ratio = 0.47, P = .04). These findings underscore the importance of overcoming language-related and cultural barriers to improve patient-provider discussions of older adults' mental health needs. Source: PubMed 2011

Migrant and Immigrant Communities

• 2012 East Coast Migrant Stream Forum: October 18 - 20, 2012
  This conference, to be held in Virginia Beach, is for health care providers and outreach workers serving migrant and seasonal farmworkers.
• Use of Commercial Sex Workers among Hispanic Migrants in North Carolina: Implications for the Spread of HIV
  This study examines commercial sex workers use among a randomly selected sample of foreign-born Hispanics in Durham, North Carolina
  Source: GI 2011

Multimedia: Videos to View

• Five Questions and Answers on HIV/STIs, Project Hope, 2013
• At AIDS 2012, Interview with Alicia Wilson from La Clinica del Pueblo, 2012
• Cultural Competency: Orientation to Adult HIV Care. 2012
• Culturally Competent Healthcare - SickKids Journey to Cultural Competence, 2012
• Healing Techniques of Traditional Chinese Medicine, 2012
  
• Older and Wiser: Many Faces of HIV - Part 1
  This video is about 50 and over patients with HIV
  
• Older and Wiser: Many Faces of HIV - Part 2
  This video is about 50 and over patients with HIV
  
• Hmong - Culture Matters
  
• Culturally Competent Care Muslim
  Video skits of nursing students showing lack of cultural knowledge in the nursing setting.
  

Muslim Americans

• American Muslim perceptions of healing: key agents in healing, and their roles.
  Culturally competent care for Muslim American patients requires understanding religious and cultural frameworks for the concepts of health and healing. The authors conducted 13 focus groups in Michigan mosques to gather qualitative data on participants’ conceptual frameworks. Results showed that religious concepts were central to participants’ understanding of health and the roles of healers, including physicians.
  Source: PubMed 2012
• Religious values and healthcare accommodations: voices from the American Muslim community. PubMed 2012
  The authors conducte 13 focus groups in Michigan mosques to gather qualitative data on culturally competence clinical care for Muslim Americans. Responses yielded three key recommendations for healthcare accommodations: gender-concordant care, halal food, and neutral prayer space. The authors state that these accommodations will facilitate trusting and respectful patient-provider relationships and improve patients’ healthcare experiences.
  Source: PubMed 2012
• Cancer: A Failure to Communicate - Reflection by Doha Raik Hamza
  The author presents a case study to illustrate issues with using family members as medical interpreters, especially issues of particular relevant to Muslim patients. The author discusses the need for outreach to the Muslim community.
  Source: PubMed 2012
  
• Confronting a Fetal Abnormality: Reflection by Doha Raik Hamza
  This case highlights two important issues relevant to providing care to Muslim patients: informed consent and the use of family members as interpreters.
  Source: PubMed 2012
  
• Cultural competence clinic: an online, interactive, simulation for working effectively with Arab American Muslim patients.
  This pilot study investigates the impact of an online, interactive simulation involving an Arab American Muslim patient on the knowledge, skills, and attitudes of 2nd-year medical students regarding culturally competent healthcare, both in general and specific to Arab American Muslim patients. Preliminary data suggest that the online, interactive simulation improves knowledge and skills beyond what is achieved by the basic cultural competence curriculum.
  Source: PubMed 2011
• Once-daily antiretroviral therapy among treatment-experienced Muslim patients fasting for the month of Ramadan
  This study evaluates once-daily antiretroviral therapy compared to twice daily ART among Nigerian Muslims patients fasting for the month of Ramadan.
  Source: Pubmed 2011
• Islam, medicine, and Arab-Muslim refugee health in America after 9/11
  This study assess how Islam as a religious system shapes medical practice, and how Muslims view and experience medical care in the USA.
  
• Meeting the healthcare Needs of American Muslims: Challenges and strategies for healthcare settings
  This report presents an overview of American Muslim health beliefs, describes how these beliefs impact healthcare-seeking practices, and recommends accommodations that can improve the healthcare experience of American Muslim patients.
  Source: ISPU 2011
  
• Cultural competence clinic: an online, interactive, simulation for working effectively with Arab American Muslim patients
  This pilot study investigates the impact of an online, interactive simulation involving an Arab American Muslim patient on the knowledge, skills, and attitudes of 2nd-year medical students regarding culturally competent healthcare, both in general and specific to Arab American Muslim patients.
  Source: Pubmed 2011
  
• Patient-centered Care for Muslim Women: Provider and Patient Perspectives.
  The purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care.  The findings of this study can guide future research aimed at ensuring high-quality, culturally appropriate, patient-centered healthcare for Muslim women in the United States and other western countries. Source: PubMed 2011
  
• Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective
  In an effort to explore the impact of Islam on the relationship between patients and providers, this study presents an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship.
  Source: Pubmed 2011
  

Native Hawaiians/Pacific Islanders

• American Indian gay, bisexual and two-spirit men: a rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention
  This study assessed HIV-risk behaviours and barriers to testing, prevention and treatment efforts specific to American Indian men identifying as gay, bisexual, two-spirit or who have same-sex experiences. Results confirmed the value of culturally specific services.
  Source: PubMed 2011
  
  

Over 50

• Top Health Issues for LGBT Populations Information & Resource Kit
  This publication informs health care providers and prevention specialists about the health experiences of LGBT populations. Source: SAMHSA 2012
• A systematic review of education for the prevention of HIV/AIDS among older Adults,  PubMed 2012
  Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk.
  Source: PubMed 2012
• Inclusive Services for LGBT Older Adults:  A Practical to Guide to Creating a Welcoming Agencies NRC on LGBT Aging
  This guide was created to answer these questions and help you as service providers to understand the unique barriers that LGBT older adults face, as well as the many ways to improve and expand the continuum of care and services available.
• A systematic review of education for the prevention of HIV/AIDS among older adults
  The authors conducted a systematic literature review on primary prevention of HIV/AIDS among adults aged 50 and older.  They summarize challenges to prevention, clinical guidelines, and HIV/AIDS education models. The authors conclude that additional research on effective prevention and additional outreach efforts are needed to provide adequate services to people in this age group.
  Source: PubMed 2012
• The National HIV/AIDS and Aging Awareness Day (NHAAAD), observed on September 18. National HIV/AIDS and Aging Awareness day focuses on the challenging issues facing the aging population with regards to HIV prevention, testing, care and treatment. In addition, there is an increased need for prevention, research, and data targeting the aging population, medical understanding of the aging process and its impact on HIV/AIDS. Resources: AIDS Institute. The AIDS Institute: Announces over twenty registered events for the 5th annual National HIV/AIDS and Aging Awareness Day (NHAAAD).
• HIV/AIDS and Older Adults: Fact Versus Fiction
  This article talks about the many myths and misconceptions surround HIV and AIDS, particularly for people over 50 living with the disease. HIV and AIDS have long been subject to many myths and misconceptions, many of which concern older adults. Thanks to recent advancements in HIV/AIDS treatments, particularly highly active antiretroviral therapies (HAART), many people living with HIV/AIDS are living long, healthy lives, transforming HIV into a chronic but manageable illness. Therefore, it is no surprise that research shows that adults age 50 and over comprise a significant—and growing—number of people living with HIV/AIDS (PLWHA), as well as those newly diagnosed with HIV and AIDS each year. Source: NRC-LGBT Aging 2011
• What's Hard About Living with HIV/AIDS When You're Over 50? 2011
  Source: PubMed 2011
• "I'm not going to die from the AIDS": resilience in aging with HIV disease
  This study seeks to examine the lived experiences of older adults with HIV/AIDS as it relates to strengths and resilience in dealing with this devastating disease.
  Source: Pubmed 2011
  
• HIV/AIDS interventions in an aging U.S. population
  HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. This article reviews the current interventions and proposes possible HIV/AIDS prevention effort for older adults.
  Source: Pubmed 2011
  
• Religion, spirituality, and older adults with HIV: critical personal and social resources for an aging epidemic
  This paper presents a model of barriers to successful aging with HIV, along with a discussion of how spirituality and religiousness may help people overcome these barriers. From this synthesis, implications for practice and research to improve the quality of life of this aging population are provided.
  Source: Pubmed 2011
  
• What do we know about older adults and HIV? A review of social and behavioral literature
  This review assesses the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV.
  Source: Pubmed 2011
  
• A Tool for Serving Diverse Communities US Administration on Aging
  This Toolkit provides the Aging Network and its partners with replicable and easy-to-use methods for providing respectful, inclusive, and sensitive services for any diverse community. Source: acl.gov

Pediatrics

• Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language.
  The study presents preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, which measured health-related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS.
  Source: PubMed July 2011
• Development of a culturally appropriate health-related quality of life measure for human immunodeficiency virus-infected children in Thailand
  The authors describe how they developed a reliable and valid self-report health-related quality of life (HRQOL) instrument for human immunodeficiency virus (HIV)-infected children in Thailand. Reliable and valid disease-targeted HRQOL measures for HIV-infected children are essential in the assessment of therapeutic effectiveness. The findings of this cross-sectional survey provide support for the reliability and validity of the ThQLHC as an HRQOL outcome measure for HIV-infected Thai children.
  Source: PubMed January 2011

Physically Challenged

• Addressing Intersections in HIV/AIDS and Mental Health: The Role of Organizations for d/Deaf and Hard of Hearing Individuals in South Africa.
  This article reveals  that deaf and hard of hearing South Africans, just like the general population, are at risk of acquiring HIV/AIDS and having mental disorders, resulting from barriers to communication and care. The need to focus on HIV/AIDS education, prevention, and mental health services were seen as activities to reduce communication barriers. Source: PubMed 2012
• Deaf Community Health Workers Provide Culturally Appropriate Education and Support to Deaf Patients, Improving Patient Knowledge and Engagement
  Under a program known as the Deaf Community Health Worker Initiative, trained deaf individuals assist members of the Minnesota Deaf community, including deaf immigrants, in understanding medical information and becoming active participants in their own care. Source: AHRQ 2012
• Assuring Health Equity for Minority Persons with Disabilities ACMH July
  Along with poorer health and higher use of health care, the NCD report documents that barriers to preventive services disproportionately affect people with disabilities: for example, persons with disabilities are less likely to receive counseling for smoking cessation than are persons without disabilities. Other barriers include health care provider stereotypes about disabilities; lack of appropriate provider training; and a lack of accessible medical facilities and examination equipment, sign language interpreters, and individualized accommodation
  Source: PubMed July 2011
  A handbook on best practices regarding HIV and AIDS for people with disabilities
  This handbook aims to increase awareness of disability and HIV, to share knowledge and to give examples of best practices. It also invites study of the impact of the AIDS epidemic on people with disabilities and seeks to incite a wider action to achieve universal access for people with disabilities to HIV prevention, treatment, care and support. Source: LVCT Health
• Assessing Deaf Cultural Competency of Physicians and Medical Students.
  This report suggests training medical students in deaf cultural competency can significantly increase their capacity to care for community members and reduce the health disparities experienced by deaf community. Source: PubMed 2011
• Impact of Communication on Preventive Services among Deaf American Sign Language Users.
  The goal of this study was to determine whether provider language concordance is associated with improved receipt of preventive services among deaf respondents.  Deaf American Sign Language (ASL) users face communication and language barriers that limit healthcare communication with their providers. Prior research has not examined preventive services with ASL-skilled clinicians. Source: PubMed 2011
• Role-reversal Exercise with Deaf Strong Hospital to Teach Communication Competency and Cultural Awareness.
  This paper discusses a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients. Source: PubMed 2011
• Sensitive Care for the Deaf: A Cultural Challenge.
  This article discusses the deaf community, their culturally based health care needs, and health care providers' (HCPs) lack of understanding and recognition of deafness as a distinct culture, which individually or cumulatively result in barriers to receiving culturally sensitive care that can lead to disparities in care. It suggests transcultural methods can be used to narrow the cultural divide. Source: PubMed 2011

Racial/Ethnic Minorities

• Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes. 
  Provider cultural competence was associated with the quality and equity of HIV care. These findings suggest that enhancing provider cultural competence may reduce racial disparities in healthcare quality and outcomes. Source: PubMed 2013
• The Medicaid Program at a Glance. This fact sheet provides an overview of the Medicaid program, the populations that it serves, the services that it covers and the expanded role it will play under the health reform law.
  Source: Kaiser Family Foundation 2013
• Role of Mobile Health in the Care of Culturally and Linguistically Diverse US Populations
  Emerging trends in the health-related use of cell phones include the proliferation of mobile health applications for the care and monitoring of patients with chronic diseases and the rise in cell phone usage by Latinos and African Americans in the United States. This article reviews public policy in four areas with the goal of improving the care of patients belonging to culturally and linguistically diverse populations.
  Source: AHiMA 2011 (Perspectives in Health Information Management)
• Disparities in Diagnoses of HIV Infection between Blacks/African Americans and other Racial/Ethnic Populations--37 states, 2005-2008
  Blacks/African Americans have been affected disproportionately by human immunodeficiency virus (HIV) infection since early in the epidemic. Despite representing a smaller proportion (13.6%) of the U.S. population, blacks/African Americans accounted for half of the HIV diagnoses in adolescents and adults in 37 states during 2005-2008.
  Source: CDC Morbidity and Mortality Weekly Report (MMWR). 2011

Refugees

• Identifying the needs of LGBTQ immigrants and refugees in Southern Arizona
  This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona. It is the first study of its kind in the United States. The most significant result of this study is that respondents perceived that providers lacked awareness of LGBTQ culture and did not provide culturally competent care.
  PubMed 2011
• Refugee resettlement to the United States: recommendations for a new approach
  This article compares outcomes of resettlement strategies for two Laotian immigrant populations: Hmong and Thai Dam. Authors discuss the prevalence of psychosocial challenges faced by many Hmong immigrants to the United States, including difficulties with acculturation, welfare dependency, psychiatric disorder, mistrust, malignant youth gangs, and violence. These issues are much less prevalence among members of the Thai Dam tribal group. Strategies used for resettlement of these two groups differed greatly. Based on these differences, the author recommends a refugee resettlement strategy aimed at improved mental health and optimal acculturation for future refugee groups.
  PubMed  Aug, 2011
  
• Overcoming health literacy barriers: a model for action
  A large influx of Indonesian immigrants seeking asylum from racial and religious persecution alerted providers in a New Hampshire community to the need for specific cultural knowledge about this ethnic group, in order to provide effective care. The providers sought to develop health education programs that provided knowledge and tools to overcome misunderstandings between providers and clients. The goal was to improve communication, improve health literacy, and prevent health disparities. A framework to understand factors that affect health literacy for local Indonesian asylum seekers guided community health education. Written educational materials for programs informed providers about health literacy barriers for this population. Community outreach engaged local pastors and interpreters as cultural brokers who collaborated with nurses to develop and implement culturally sensitive programs.
  PubMed  2011
  
• Barriers to health care access among refugee asylum seekers
  Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking. Authors conducted focus groups and interviews with 35 asylum seekers, and 15 care providers and advocates, mostly male and mostly from African countries.  The study identified several barriers to care, which they categorized as internal (mental illness, fatalism), structural (service availability, food, shelter, and employment insecurity), and social assimilation barriers (system navigation difficulty, inadequate community support). The authors make recommendations for improving access, including promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.
  PubMed May 2011
• Cultural competence among nurse practitioners working with asylum seekers
  Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. This study explores the cultural competencies that nurse practitioners working with asylum seekers thought were important. Results showed that participants thought providers should have knowledge of several key factors in the country of origin: the political situation, judicial context, and common diseases. In addition, providers should understand the effects of refugeehood on health, be able to deal with asylum seekers' traumatic experiences, and be able to explain the host country's health care system. Using interpretation services was also reported to be critical.
  Source: PubMed Nov 2010
• Screening for HIV-Infection During the Refugee Domestic Medical Examination
  This paper summarizes Centers for Disease Control and Prevention (CDC) guidelines regarding HIV screening for refugees.  Since January 4th, 2010 refugees are not screened for HIV prior to arrival in the U.S. Current CDC guidelines recommend that all persons between 13 and 64 years of age be screened for HIV in health care settings. CDC also encourages screening for people of all ages. CDC recommends screening for HIV-2 for refugees who test positive for HIV and who may have been exposed in identified high-risk African countries. CDC recommends opt-out screening as part of the domestic screening examination. Guidelines emphasize the importance of cultural and linguistic competence in providing testing, diagnostic, treatment, and referral services.
  CDC April, 2012

Substance Use/Abuse

• The urgency of providing comprehensive and integrated treatment for substance abusers with HIV
  Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. This article explains the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment--both for HIV and for substance abuse.
  Source: Pubmed 2011
• Alcohol use among patients with HIV infection
  Source: Pubmed
  This study evaluates alcohol use in patients with HIV infection, assesses ethnic and social associations, and describes outcomes.Source: Pubmed
  Source: Pubmed 2011
• Alcohol/drug exposure, HIV-related sexual risk among urban American Indian and Alaska Native Youth: evidence from a national survey
  Migration of the native populations from reservations to the urban areas has resulted in mixed ethnicities of American Indian/Alaskan Native (AIAN) children. Minority youth require special attention and services in urban schools as they disproportionately experience poverty, low educational attainment, unemployment, and single-parent status.
  Source: Pubmed 2011
• Unmet Needs Assessment Report: Ryan White Part A New Haven-Fairfield Counties Transitional Grant Area
  This report was developed to help determine service gaps and barriers in the continuum of care for Persons Living with HIV/AIDS (PLWH/A). Results of this client-centered activity are used to establish service priorities, document the need for specific services, determine barriers to accessing care, provide baseline data for comprehensive planning, including capacity building, and help providers improve the access and quality of service, especially to Severe Need Groups (SNGs)1 including IDUs.
  Source: The New Haven-Fairfield Ryan White-HIV Health Services Planning Council and Yale University
• CIRA Research Summary
  A summary of the major findings of many CIRA affiliated research projects in “user-friendly” language regarding barriers to care for substance abuse patients living with HIV as well as other HIV prevention research for drug users.
  Source: Yale University in New Haven, The Institute for Community Research (ICR) and the Hispanic Health Council (HHC), both in Hartford, Connecticut

Veterans

• Websites Focused on Veterans:
  • Make the Connection: Shared Experiences and Support for Veterans. This site provides customized information for veterans, national guard and reserve, family and friends of the military, those in active duty, and clinicians.
  • National Coalition for Homeless Veterans is the resource and technical assistance center for a national network of community-based service providers and local, state and federal agencies that provide emergency and supportive housing, food, health services, job training and placement assistance, legal aid and case management support for hundreds of thousands of homeless veterans each year.
  • U.S. Department of Veterans Affairs: Mental Health Resources provides information on veteran servises, suicide prevention, substance abuse, sexual trauma, depression, Posttraumatic Stress Disorder (PTSD), and information for providers.
• National HIV/AIDS Strategies
  The National HIV/AIDS Strategy Operational Plan was designed to promote a coordinated effort between Federal agencies, community organizations, and other health care settings to respond to the domestic HIV epidemic. The three primary goals of the strategy include:  Reducing the n umber of Veterans who become infected with HIV; Increasing access to care and improving health outcomes for Veterans living with HIV; and reducing HIV-related health disparities.
  

Women

• Addressing the Intersection of HIV/AIDS, Violence against Women and Girls, & Gender–Related Health Disparities. This interagency federal working group report outlines recommendations that explore HIV/AIDS, violence against women and girls, and gender-related health disparities.
  Source: White House 2013.
• Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges. To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards.
  Source: Kaiser Family Foundation 2013
• Fact Sheet: Women and HIV/AIDS in the United States. This updated fact sheet highlights the impact of HIV/AIDS on women in the United States, providing current data and trends over time.
  Source: Kaiser Family Foundation 2013
• Confronting the Crisis 2012: Women and HIV Conference: November 1 - 2, 2012
  Rutgers University, Student Center; New Brunswick, NJ
  This conference will provide education and networking opportunities for women living with HIV/AIDS, care providers, researchers, and policy makers. Focus topics include: care and treatment, prevention, policy/advocacy, social and reproductive justice, co-morbidities, and wellness.
• Women and HIV/AIDS in the United States  Fact Sheet
  Women have been affected by HIV/AIDS since the beginning of the epidemic, an impact that has grown over time. Women of color, particularly Black women, have been especially hard hit and represent the majority of new HIV infections and AIDS diagnoses among women, and the majority of women living with the disease
  Source: KFF July 2012
• National Women & Girls HIV/AIDS Awareness Day is March 10.
  Women have been affected by HIV/AIDS since the beginning of the epidemic, an impact that has grown over time. HIVinfo.nih.gov
• Care for women with HIV: gender perspectives
  When women face social and cultural inequality they inevitably bear increased HIV infection risks. The success of antiretroviral therapies in suppressing HIV's viral load and prolonging patient lives has made HIV a treatable chronic disease. Given the same follow-up treatments, research shows no significant differences between men and women in terms of either clinical, immunological or virological parameters at baseline or mortality after one year of antiretroviral therapy. Gender equality is essential to effective HIV prevention. Nurses must take all appropriate measures to eliminate discrimination against women in HIV prevention, treatment and care programs in order to ensure equal gender access to critical healthcare services.
  Source: PubMed December 2011
• YOUR Blessed Health: an HIV-prevention program bridging faith and public health communities.
  African American faith-based institutions are not necessarily equipped to balance their moral and spiritual missions and interpretation of religious doctrine with complex health issues such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). YOUR Blessed Health (YBH) is a faith-based, six-month pilot project designed to increase the capacity of faith-based institutions and faith leaders to communicate about and address HIV/AIDS and sexually transmitted infections (STIs) in 11- to 19-year-old African Americans. In addition to increasing the knowledge and skills of young people, the intervention seeks to change churches' norms to provide more open settings where young people can talk with faith leaders about sex, relationships, STIs, and HIV/AIDS. YBH expands the roles of adult faith leaders, particularly pastors' spouses, to include health education as they implement the intervention in their congregations and communities. The intervention includes a flexible menu of activities for faith leaders to select from according to their institutional beliefs, doctrines, and culture.
  Source: PubMed January-February 2011
  
• Efficacy of a Health Educator-Delivered HIV Prevention Intervention for Latina Women: A Randomized Controlled Trial
  This study developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women.
  Source: Pubmed 2011
• Keeping Our Hearts from Touching the Ground: HIV/AIDS in American Indian and Alaska Native Women
  HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse. S
  ource: Pubmed 2011
• Women and HIV/AIDS in the United States KFF Fact Sheet 2011
  Women of color, particularly Black women, have been especially hard hit and represent the majority of new HIV infections and AIDS diagnoses among women
  Source: KFF 2011