Ethnicity and HIV : Prevention and care in Europe and the USA

Ethnicity and HIV : Prevention and care in Europe and the USA

Fauchald, Sally K

Ethnicity and HIV : Prevention and care in Europe and the USA

Edited by Jo T. Erwin, Dawn K. Smith, Barry S. Peters

Figure 1. Ethnicity and HIV: Prevention and care in Europe and the USA book cover.

ISBN 1-901769-10-0, 248 pages, $35.00 paperback ($20.00)

International Medical Press, London, England and Atlanta, GA, USA.

Ethnicity and HIV: Prevention and Care in Europe and the USA, edited by Jo T. Erwin, Dawn K. Smith, and Barry S. Peters (2003), addresses a broad range of clinical, social, and political issues of the HIV/AIDS epidemic in Europe and the United States. Many of the populations affected by the epidemic are vulnerable groups, such as migrants and ethnic minorities. In addition to addressing the significant barriers to HIV/AIDS prevention and care, Ethnicity and HIV: Prevention and Care in Europe and the USA suggests strategies to deliver comprehensive and effective prevention and care services to diverse populations through contributions by a wide variety of expert clinicians, public health specialists, academics, and individuals working in non-governmental HlV organizations.

“I don’t know how I can concentrate on getting better when there is so much to worry about” (Erwin, Woods, & Lennard, 2003, p. 238) is a common statement not only among asylum-seeking HIV-positive individuals but (also) among minority groups and vulnerable populations affected with HIV worldwide. “At its worst, the HIV epidemic has exacerbated difference and exploited social fault lines. At its best, the response to AIDS has built a great social movement that extends solidarity and human dignity across all barriers” (Piot, 2003, p. v).

Ethnicity and HIV: Prevention and Care in Europe and the USA was written to address some of the major issues facing minority groups with HIV infection, specifically in Europe and the USA. This broad approach successfully widens the scope of the audience to include clinicians, academics, researchers, and individuals who work day-to-day with people living with HIV/AIDS (PLWHA). The book is divided into four major sections: (a) epidemiology, (b) disease progression, (c) service provision and prevention strategies, and (d) access to HIV services.

The first three chapters of the book deal with the epidemiology of HIV within specific populations such as minority populations in the USA, ethnic minorities in the United Kingdom (UK), and migrants and ethnic minorities in Europe. The evolution of HIV/AIDS and current trends in each country/region are well presented. Each chapter contains text and charts/graphs illustrating categories such as minority children with AIDS, risk exposure groups, minority men, minority women, and minority adolescents and young adults with AIDS. Geographical origination and distribution of AIDS cases by racial and ethnic groups, case reporting, prevalence reports, and mortality rates for persons with HIV/AIDS are included in each chapter. A discussion of challenges and future directions for minority communities as well as the individuals providing prevention and care to these communities is presented at the end of each chapter.

The second section of the book presents information on disease progression including the incidence, presentation, diagnosis, and outcome of the various manifestations of HIV infection. These factors are then related to ethnic and minority groups. Further evidence is provided to relate disease progression to ethnicity. Issues such as differences in laboratory markers (i.e., CD4+ cell counts and viral loads) are discussed.

Brief descriptions of HIV-related infections are well presented by the authors who also relate information on the incidence, presentation, diagnosis, symptoms, prevention, treatment, and outcomes for a variety of HIV-related infections. Subsequently, data on HIV disease progression and ethnicity are summarized by country or region, which include the USA, Europe, and Africa. Genetic factors and HIV disease progression according to ethnicity, ethnic differences in clinical manifestations of HIV infection, and effectiveness and toxicities of anti-retroviral therapy are concisely explained both in the text and with an extensively prepared chart.

This section of the book concludes with a discussion of the relationships among ethnicity, gender, and laboratory markers of HIV disease progression. These markers are broken down into immunological markers and virological markers. Possible explanations for differences based on ethnicity are offered. A variety of confounding issues and implications are identified. Although research-based information guides this section, the authors conclude that there is “a real need for well-designed studies of the effect of ethnicity on HIV RNA levels using the new generation RNS assays” (Sabin, 2003, p. 114).

The first two sections of the book provide the foundation for the final two sections of the book, which explain how services are provided to minority groups and migrants. The services included in these final chapters are: (a) costs of different aspects of HIV services, and (b) issues facing service providers, particularly in relation to prevention and testing for at-risk groups.

Chapter seven begins with an overview of the health care systems in both the USA and the UK. Spending for HIV care, provision of care, and hospital service utilization in both countries are well summarized. Chapters eight and nine focus on the delivery of HIV prevention services to HIV-positive individuals. Patient factors impacting their risk behaviors, societal and cultural factors, and provider factors are presented in a clear and concise format. Components of successful counseling and testing services are documented. Models of successful testing strategies and trends describing issues in HIV testing are well communicated to the reader.

The legal framework necessary for all providers is well described in the final section of the book. Case histories are provided as supplements to the studies presented in this section. Policies affecting HIV care and prevention services, including immigration policies for both the USA and the UK are extensively described. Communication, legal, and socioeconomic barriers to care in Europe and examples of strategies that provide increased access to care in the USA are presented. The “changing face of the HIV epidemic” (Peters, 2003, p. vii) and its impact on the needs of cultural groups is a pragmatic conclusion to this section. Case studies from both the USA and UK provide vivid examples of prevention and care interventions necessary for migrant and minority individuals with HIV/AIDS.

The book concludes with a selection of the key issues addressed in each of the prior chapters, with lessons learned and suggested strategies that could be adopted to increase prevention and care for migrant and minority populations affected by the HIV/AIDS epidemic. This critical summary of the main issues raised throughout the book suggests ways to improve the understanding and management of HIV/AIDS across cultural and ethnic settings. Imbedded in these lessons are suggestions regarding how individually tailored programs of care, shaped by cultural awareness, can be devised in order to provide essential services to migrant and ethnically diverse populations in an effective manner. It is emphasized that most of these services could be provided in a relatively inexpensive way and rely mostly on increased awareness of vulnerable groups, not on increased delivery costs.

Ethnicity and HIV: Prevention and Care in Europe and the USA provides vital information for clinicians, academics, researchers, and other providers working with HIV- positive and at-risk populations, particularly migrant and other vulnerable groups, in a clearly written and concise format. A variety of examples are presented such as prevention interventions and counseling models which add to the practicality of the book. The text is well supplemented with charts and graphs. The extensive reference lists at the end of each chapter and at the conclusion of the book provide the reader with additional resources if further information is desired. This book addresses a broad range of clinical, social, and political issues of the HIV/AIDS epidemic in Europe and the United States with the goal of appealing to a wide group of professionals and providers. Ethnicity and HN: Prevention and Care in Europe and the USA has achieved this goal.

REFERENCES

Erwin, J. T., Smith, D. K., & Peters, B. S. (Eds.). Ethnicity and HIV: Prevention and care in Europe and the USA (pp. 229-240). London: International Medical Press.

Erwin, J. T., Woods, S., & Lennard, D. (2003). Black Africans living in the UK living with HIV. In J. T. Erwin, D. K. Smith, & B. S. Peters (Eds.), Ethnicity and HIV: Prevention and care in Europe and the USA (pp. 229-240). London: International Medical Press.

Peters, B. S. (2003). Introduction. In J. T. Erwin, D. K. Smith, & B. S. Peters (Eds.), Ethnicity and HIV: Prevention and care in Europe and the USA. (pp. vi-vii). London: International Medical Press.

Piot, R (2003). Foreword. In J. T. Erwin, D. K. Smith, & B. S. Peters (Eds.), Ethnicity and HIV: Prevention and care in Europe and the USA. (pp. v). London: International Medical Press

Sabin, C. (2003). The relationships between ethnicity and laboratory markers of HIV disease progression. In J. T. Erwin, D. K. Smith, & B. S. Peters (Eds.), Ethnicity and HIV: Prevention and care in Europe and the USA. (pp. 103-120). London: International Medical Press.

Reviewed by:

Sally K. Fauchald, PhD, RN

Assistant Professor

Department of Nursing

The College of St. Scholastica

Duluth, Minnesota

Copyright Riley Publications, Inc. Center for the Study of Multiculturalism and Health Winter 2005

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