BackgroundAfrican American women have higher rates of breast cancer mortality than their white counterparts. Studies have suggested that this is partly caused by discovery of cancer at a later stage, highlighting the importance of encouraging early detection of breast cancer in this population. To guide the creation of a breast cancer education intervention and help focus other health educators' and clinicians' health promotion efforts, this study explored whether a cohort of African American women living in San Diego would demonstrate the possession of adequate baseline knowledge about breast cancer screening and adherence to widely recommended screening guidelines.MethodsAfrican American women (N = 1,055) from San Diego, California participated in a beauty salon-based survey about breast cancer knowledge, attitudes, and screening practices. Women's ages ranged from 20 to 94 years, with average age of 42.20 (SD = 13.53) years. Thirty-four percent reported completing college and/or some graduate school training, and 52% reported having some college or post high school formal training. Seventy-five percent of the sample reported working outside their home. Participating cosmetologists and their salons were recruited to the study through word-of-mouth referral by highly respected African American community leaders.ResultsSalon clients reported low rates of adherence to recommended breast cancer screening guidelines. Of the 1,055 participants, 31% reporting performing breast self-exam every month. Of those participants 40 and older, 57% reported having had a clinical breast exam and 43% reported having had a mammogram in the past year. Knowledge of breast cancer was associated with adherence to screening guidelines. While women recognized the serious health threat that breast cancer poses and that early detection of breast cancer is important, only 30% of women reported feeling well informed about the disease. Many participants demonstrated a lack of basic knowledge about breast cancer. The Health Belief Model postulates that access to such information is an essential element in the progression toward engaging in screening behaviors.ConclusionData from this study reflect a continuing need for increased breast cancer education for African American women. In light of the considerable mainstream information available related to breast cancer, these data reinforce the need for more breast cancer education programs that are clearly intended to attract the attention of African American women.

Sexual abuse was associated with HIV-risk-related attitudes and behaviors among adolescents in psychiatric treatment. Clinicians should thus view a history of sexual abuse as a marker for sexual behavior that puts adolescents at risk for HIV.

Most infections by genus Bartonella in immunocompromised patients are caused by B. henselae and B. quintana. Unlike immunocompetent hosts who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including those living with HIV/AIDS and posttransplant patients, are more likely to develop different and severe life-threatening disease. This paper will discuss Bartonella's manifestations in immunosuppressed patients and will examine Bartonella's interaction with the immune system including its mechanisms of establishing infection and immune escape. Gaps in current understanding of the immunology of Bartonella infection in immunocompromised hosts will be highlighted.

Current strategies are insufficient to contain the growing tuberculosis (TB) epidemic in areas of high HIV prevalence such as sub-Saharan Africa. Due to the increased risk of morbidity and mortality among those coinfected, early detection is critical. However,strategies dependent on passive, facility-based case finding have failed due to severe limitations in the HIV-positive population.There is growing evidence from multiple clinical trials that early initiation of antiretroviral therapy (ART) in patients coinfected with HIV and TB reduces mortality. Integration of community-based distribution of ART and TB medicines should be considered for coinfected patients to help improve retention in care and to off-load busy health systems. Several models of integration of HIV and TB care in sub-Saharan Africa have been successful. This review article examines the concepts of HIV and TB integration of testing and treatment at the community level.

The world faces a global health workforce shortage of almost 4 million professionals, with the most severe gaps in sub-Saharan Africa [1]. Improvements in health, including meeting the health-related Millennium Development Goals, are linked with the density of skilled health workers [2]. In the U.S., the reauthorizing bill for the President's Emergency Plan for AIDS Relief (PEPFAR) requires the U.S. to support training of 140,000 new health workers in PEPFAR focus countries. The participation of U.S. academic medical centers (AMCs) will greatly help to close the workforce gap and expand training of health professionals in low-and middleincome countries.Many partnerships have developed between AMCs and ministries of health in resource-limited countries. These programs range in depth, longevity, and sustainability. While some U.S. academic medical institutions focus on sending trainees abroad for electives, others have more comprehensive programs encompassing the tripartite mission of patient care, medical education, and research. Examples of robust, long-term partnerships include the University of Indiana-Moi University partnership, the Muhimbili University-UCSF project, and the Botswana-UPenn Partnership (BUP). Our experience with the BUP program has led us to believe it can serve as a useful model for such relationships because it possesses the qualities of successful international collaborations. Auspicious BeginningsThe University of Pennsylvania (Penn) School of Medicine's involvement in Botswana began in 2001 at the request of ACHAP (African Comprehensive HIV AIDS Partnership), a collaboration involving the Government of Botswana, the Bill and Melinda Gates Foundation, and the Merck Company Foundation. The Government of Botswana had decided to make antiretroviral drugs available to its citizens. Doctors with experience using these drugs were needed to help train the local health care workers. The circumstances that led to the formation of BUP highlight an important principle: partnerships that develop at the invitation of the host country rather than at the request of the AMC are more likely to succeed.A memorandum of agreement is critical for an ongoing relationship between an AMC and a developing country. Such an agreement establishes the legality of the program and sets parameters for the collaboration. In our experience, developing a memorandum of agreement helps to define the focus of the collaboration, which for