Journal of urban health : bulletin of the New York Academy of Medicine
-
Owing to the ongoing health crisis among injection drug users in Vancouver, Canada, there have been repeated calls for the establishment of supervised injection sites (SIS) since the early 1990s. In April 2003, a group of advocates and drug users opened an unsanctioned SIS in Vancouver's Downtown Eastside. ⋯ During the operation of the SIS, volunteers supervised over 3,000 injections by a high-risk injection drug using population. The SIS provided a sterile environment for injection drug use without measured negative consequences and demonstrated the feasibility of a peer-driven low-threshold SIS.
-
Coccidioidomycosis is a disease caused by Coccidioides immitis, a soil-inhabiting fungus endemic to the desert climate of the southwestern United States and Central and South America. We report a case of disseminated coccidioidomycosis in a previously healthy person living in New York City, who was initially thought to have tuberculosis. The incidence of coccidioidomycosis has been increasing in both endemic and nonendemic areas, but diagnosis is often delayed or missed in nonendemic areas, resulting in extensive and unnecessary medical workup for other diseases or progression to serious disease. Therefore, clinicians should increase their awareness and consideration of this disease in patients with chronic systemic illness.
-
Contemporary discourse contains numerous examples of use of the concept of culture by social and behavioral scientists. Simple reification, where the speaker makes culture into a thing capable of action exemplifies one usage in public discourse. Some quantitative social scientists attempt to characterize people's cultural identities by means of a single categorical variable, which often "lumps" people into categories such as "Hispanic" or "Black" that in fact have numerous culturally bounded subcategories. ⋯ Examples in which investigators make appropriate use of cultural characterizations demonstrate their utility in investigating health disparities in Haitian American women, injecting and noninjecting drug users, Hispanic youth, and adult Hispanics at risk of HIV infection. Focus on culture in the study of health disparities can identify entanglements between structural factors such as poverty and lack of education and cultural factors such as beliefs about health. Qualitative methods coupled with quantitative methods have great potential to improve investigators' grasp of cultural nuance while capturing the distribution of qualitatively derived behaviors.
-
The increase in the incidence of HIV/AIDS among minorities in the United States and in certain developing nations has prompted new intervention priorities, stressing the adaptation of efficacious interventions for diverse and marginalized groups. The experiences of Florida International University's AIDS Prevention Program in translating HIV primary and secondary prevention interventions among these multicultural populations provide insight into the process of cultural adaptations and address the new scientific emphasis on ecological validity. An iterative process involving forward and backward translation, a cultural linguistic committee, focus group discussions, documentation of project procedures, and consultations with other researchers in the field was used to modify interventions. ⋯ This experience demonstrates the importance of integrating culturally relevant material in the translation process with intense focus on language and nuance. The process must ensure that the level of intervention is appropriate for the educational level of participants. Furthermore, the rights of participants must be protected during consenting procedures by instituting policies that recognize the socioeconomic, educational, and systemic pressures to participate in research.