Conversation With An at-Risk Population

Conversation With an at-Risk Population was made possible by a Grant
from the Office of Minority Health, State of Missouri for Black Church
Week of Prayer for the Healing of Aids March 2-8, 2003

Concept Creator:
Reverend Alan L. Joplin, Director
Wesley Foundation@Lincoln University
Jefferson City, Missouri 65109

Dr. Violet Kanonuhwa, Grant Contact/Office of Minority Health
Elizabeth Miller, Program Host, Conversation With an at-Risk Population /American Red Cross
Larry Thomas, Cameraman/Department of Health, State of Missouri

Student Participants

Shara Kennedy, Student Lincoln University 230-9808
Darryl B. Manning, Student Lincoln University 638-6495
Jameel R. Malone, Student Lincoln University
Stephanie R. Price, Student Lincoln University 638-6396
Katari Key, Student Lincoln University 638-6474
Tanisha O’Neal, Student Lincoln University 636-9656
Kristin Turner, Student Lincoln University 636-6328
Marcio Jackson, Student Lincoln University 638-6618
DaSha Wade, Student Lincoln University 638-6334
Kelsey Favor, Student Lincoln University 638-6618

Introduction and Philosophical Overview
Acquired Immunodeficiency Syndrome (AIDS), virtually unknown twenty years ago, has become a leading cause of death among America’s largest minority groups. In less than two decades the AIDS pandemic has reached such levels among African Americans that it is silently stealing the next generation. The pattern of infection and disease within minority communities clearly indicates that colleges and universities have a role and responsibility to address the concerns of students from these communities.
Even though African Americans comprised only 12 percent of the total United States population in 2000, the Centers for Disease Control and Prevention report that of the more than 700,000 AIDS cases reported through 1999, African Americans accounted for:
• 30 percent of all reported acquired immunodeficiency syndrome (AIDS) cases in the United States.. While the total number of reported AIDS cases historically has been highest among whites, racial/ethnic minority groups in the United States have always been overly represented in proportion to population size, and the numbers continue growing.

• Racial and ethnic disparities in AIDS incidence are more striking for women and children than they are for men:

• Of adult and adolescent blacks reported with AIDS in the United States, 21 percent are female. In comparison, among the general U.S. adult/adolescent population, 12 percent of people reported with AIDS cases are female.

• Six of every ten U.S. children with parentally acquired AIDS are black. More than 2,500 AIDS cases have been reported among black U.S. children under the age of 13, and 95 percent of them acquired HIV infection from their mothers during pregnancy or at birth.
The data on STD/HIV infection unequivocally show the youthful trend in the STD/HIV and AIDS pandemic, with the consequences for women much more serious than for men. It is my conviction that the academic community has a responsibility to students from these communities.. In analyzing social and cultural issues we must recognize there is no monolithic or homogeneous African American community in the United States. The diversity within these communities is considerable and one must be mindful of internal differences as well as broad similarities. Campus professionals must be careful not to make sweeping generalizations that perpetuate unfortunate stereotypes. We must also understand that a trend or pattern typical of a group may not apply to any particular individual from that group.
Campus professionals are very likely to encounter resistance or resentment from students who fear being stigmatized by negative connotations of race and substance abuse as well as suspicions they may be potential carriers of a dreaded disease. Any statement or attitudes confirming such fears may elicit a passive or perhaps hostile reaction. Campus leaders can build strong ties to African American students through full disclosure and effective communication.
Developing Prevention Approaches on a University Campus
Campus programs that reach out to African Americans must be fully cognizant of the social and cultural contexts of the groups and combine that knowledge with an awareness of the internal heterogeneity of each group. Such programs must also reflect the unique culture and structure of the institution. These emphases mean that student affairs professionals face daunting challenges as they endeavor to deal with one of the most critical issues facing the African American communities.
The basic goal of the programs should be to promote healthy behaviors among college students -- including the reduction in risk-behaviors related to HIV and AIDS. This should include knowledge about testing for STD/HIV and AIDS and information about treatment for students who may be positive.
The most effective and sustained campus-based STD/HIV and AIDS prevention programs must be integrated into the entire campus through partnerships between Student Affairs, campus constituencies and community organizations. These partnerships can be developed in a variety of venues including:
• Community organizations -- Within the surrounding communities, such organizations as the, the Red Cross; The office of Minority Health for the State of Missouri; NAACP; 100 Black Men, are promoting heightened emphases on STD/HIV and AIDS knowledge and prevention. Campus professionals can build coalitions with such groups in planning programs for students. The result can be greater access of the academy to the general community as well as stronger campus programs.

• Greek organizations -- Delta Sigma Theta, an African American sorority, has made STD/HIV and AIDS prevention a central issue. In addition, members of the fraternity Alpha Phi Alpha have expressed concerns to us. Both organizations have asked us to provide seminars and workshops on STD/HIV and AIDS prevention for their members.

• Women student groups -- Awareness of the rapid spread of STD/HIV and AIDS has heightened the concerns of women about the possibility of infection. Programs that not only educate, but also empower women students will have a broad impact on the campus.
In these efforts all of the educational materials must be carefully designed and tailored for the specific African American on campus, with an intuitive sense of the stigma as well as racialized context of the programs. When such understanding is present it will contribute to a vigorous response by students. Lack of such understanding can lead to more obstacles and barriers.
The dramatic rise in STD/HIV and AIDS in the academy and the African American community, along with heightened knowledge of the disease and fears of infection, have created a critical opportunity for the academy. The conditions are very favorable for programs that will promote healthy behavior and STD/HIV and AIDS prevention among students. However, creating effective programs will require leadership that has a clear vision and an extraordinary level of sensitivity and understanding.
Cooperative programs can be built with administration, faculty, students and external communities. The fear of stigma can be overcome and the code of silence broken through thoughtful strategies that are centered in the campus environment. The profound need as well as the community desires, make this an opportunity that should not be missed.
Approach
There has been an increasing awareness in the health professions that many of the major health issues facing college students stem from lifestyle choices and behaviors, such as diet and exercise, consumption of alcohol and other drugs, and in this case unsafe sexual practices. This awareness has led to a greater focus on prevention efforts as a means for insuring good health. Prevention efforts are generally much less expensive than providing treatment later.
Young adults are at the centre of the STD/HIV /AIDS epidemic. The extent to which the services and information they receive, their behavior can help determine the quality of life of millions of people. Young adults are particularly susceptible to HIV infection. In the African American community, AIDS is shattering there opportunities for healthy adult lives. Nevertheless, it is young adults who offer the greatest hope for changing the course of the epidemic. More than half of those newly infected with HIV/AIDS are 15 to 24 years old, making young adults an essential focus of any HIV prevention efforts. We must also in a meaningful manner engage them in the fight against STD/HIV /AIDS.
Many prevention efforts in colleges and universities integrate peer involvement. In their "Bridges to Healthy Communities" for example: College service learning activities involve peer education programs to encourage students to adopt healthier lifestyles. Peer’s providing information about STD/HIV /AIDS is the focus of this project. TV is a powerful educational tools and this project will utilize it to expose students to the reality of HIV, AIDS, and other STDs. Community outreach and service-learning are two ways in which students can be educated about this issues.
By moving into more intensive and integrated efforts for health promotion such as peer education, and service learning opportunities, we are attempting to incorporate peer education as a focus of our programming efforts.
Building Community Coalition

(Wesley Foundation, Lincoln University, American Red Cross and the
Office of Minority Health for the State of Missouri).
The purpose is to develop a coordinated community response to STD/HIV /AIDS. The Coalition will fosters collaboration among service providers and university students in assessing and prioritizing unmet needs, sharing resources, and developing strategies for HIV prevention through the use of a video production, Conversation With An At-Risk Population.
The goals of this Video is:
• To prevent the spread of STD/HIV infection.

• To reach at risk populations identifying at risk populations and effective strategies for HIV prevention.

• To promotes an effective strategy for reaching underserved African Americans university students, with prevention education.

• To provide a forum in which students can work together to maximize the use of scarce resources to address the complex prevention issues and needs surrounding STD/HIV /AIDS.


HIV Prevention Fact Sheets

Does HIV Cause AIDS?
Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, false information or statements that are not supported by scientific findings continue to be shared widely through the Internet or popular press.
HIV and Its Transmission
Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, false information or statements that are not supported by scientific findings continue to be shared widely through the Internet or popular press. Therefore, the Centers for Disease Control and Prevention (CDC) has prepared this fact sheet to correct a few misperceptions about HIV.
How HIV is Transmitted
HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.
In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker's open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States.
Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.
All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence.
The following topics specifically address some of the
common misperceptions about HIV transmission.

What body fluids transmit HIV?
These body fluids have been proven to spread HIV:
• blood
• semen
• vaginal fluid
• breast milk
• other body fluids containing blood
These are additional body fluids that may transmit the virus that health care workers may come into contact with:
• fluid surrounding the brain and the spinal cord
• fluid surrounding bone joints
• fluid surrounding an unborn baby
HIV in the Environment
Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See page 3, Saliva, Tears, and Sweat.) To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limited laboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed--essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have unnecessarily alarmed some people.
Results from laboratory studies should not be used to assess specific personal risk of infection because (1) the amount of virus studied is not found in human specimens or elsewhere in nature, and (2) no one has been identified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, therefore, it does not spread or maintain infectiousness outside its host.
Households
Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as described in previously published guidelines, should be taken in all setting "including the home" to prevent exposures to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown. For example,
• Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit.
• Cuts, sores, or breaks on both the care giver's and patient's exposed skin should be covered with bandages.
• Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately.
• Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided.
• Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers.
Kissing
Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to contact with blood during open-mouth kissing.
Biting
In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.
Saliva, Tears, and Sweat
HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.
Insects
From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.
The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person's or animal's blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces.
There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors serve to explain why this is so--first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest this blood meal.
Businesses and Other Settings
There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments (see information on survival of HIV in the environment). Food-service workers known to be infected with HIV need not be restricted from work unless they have other infections or illnesses (such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, should be restricted. CDC recommends that all food-service workers follow recommended standards and practices of good personal hygiene and food sanitation.
In 1985, CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from a personal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.
CDC knows of no instances of HIV transmission through tattooing or body piercing, although hepatitis B virus has been transmitted during some of these practices. One case of HIV transmission from acupuncture has been documented. Body piercing (other than ear piercing) is relatively new in the United States, and the medical complications for body piercing appear to be greater than for tattoos. Healing of piercings generally will take weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person's blood or other infectious body fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.
Safe Sex
There is a theoretical risk of HIV infection from any behavior that study has failed to show resulted in HIV infection, but in which a body fluid which is known to contain HIV comes in contact with a partner's mucous membranes or blood stream. There is a known risk of infection wherever a behavior has been documented to result in HIV transmission by case series or prospective, epidemiological study.
There is a low risk of infection when prospective, cohort-style studies have failed to demonstrate a statistically significant relationship between the behavior and infection, but case reports continue to suggest a correlation. There is a high risk of infection when prospective cohort-style study has established a relationship and the risk is deemed substantial by the Subcommittee.
Effectiveness of Condoms
Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA). Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection.
There are many different types and brands of condoms available--however, only latex or polyurethane condoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores and are therefore not recommended for disease prevention (they are documented to be effective for contraception). Women may wish to consider using the female condom when a male condom cannot be used.
For condoms to provide maximum protection, they must be used consistently (every time) and correctly. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.
When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection.
How long does it take for HIV to cause AIDS?
Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors.
Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure AIDS itself. As with other diseases, early detection offers more options for treatment and preventative health care.
Why do some people make statements that HIV does not cause AIDS?
The epidemic of HIV and AIDS has attracted much attention both within and outside the medical and scientific communities. Much of this attention comes from the many social issues--homosexuality, drug use, poverty--related to this disease. Although the scientific evidence is overwhelming and compelling that HIV is the cause of AIDS, the disease process is not yet completely understood.. This incomplete understanding has led some persons to make statements that AIDS is not caused by an infectious agent or is caused by a virus that is not HIV. This is not only misleading, but may have dangerous consequences.
Before the discovery of HIV, evidence from epidemiologic studies involving tracing of patients’ sex partners and cases occurring in persons receiving transfusions of blood or blood clotting products had clearly indicated that the underlying cause of the condition was an infectious agent. Infection with HIV has been the sole common factor shared by AIDS cases throughout the world among homosexual men, transfusion recipients, persons with hemophilia, sex partners of infected persons, children born to infected women, and occupationally exposed health care workers. Recommendations to prevent HIV involve guidance to avoid or modify behaviors that pose a risk of transmitting the virus as well as the use of tests to screen donors of blood and organs.
The inescapable conclusion of more than 15 years of scientific research is that people, if exposed to HIV through sexual contact or injecting drug use, may become infected with HIV. If they become infected, most will eventually develop AIDS.