Ethnic minorities are expected to experience a greater demand for family caregiving than non-Latino Whites due to their projected population growth. Although the consensus of researchers on caregiving and culture finds that the caregiving experience differs significantly among cultural/ethnic groups, the question remains as to how cultural values and norms influence the caregiver experiences. We conducted an interpretative, phenomenological qualitative analysis of focus group transcripts from four groups (African American, Asian American, Hispanic American, and European American) for cultural influences on caregiving. Data were collected in Nevada between December 7, 2009, and August 20, 2010. Thirty-five caregivers participated in this study. We found commonalities among all of the cultural/ethnic groups in their experiences of the difficulties of caregiving. However, there were some significant differences in the cultural values and norms that shaped the caregiving experience. We categorized these differences as: (a) cultural embeddedness of caregiving, (b) cultural determinants of caregiving responsibilities or taxonomy of caregiving, and (c) cultural values and norms underlying the decision to provide care. The significance of this study is that it highlights the culturally perceived mandate to provide care in the African, Asian, and Hispanic American cultures.

Summary Background There is a dearth of effective community-based interventions to increase HIV testing and uptake of antiretroviral therapy (ART) among pregnant women in hard–to-reach resource-limited settings. We assessed whether a faith-based intervention, the Healthy Beginning Initiative (HBI), would increase uptake of HIV testing and ART among pregnant women as compared to health facility referral. Methods This trial was conducted in southeast Nigeria, between January 20, 2013, and August 31, 2014. Eligible churches had at least 20 annual infant baptisms. Forty churches (clusters), stratified by number of infant baptisms (<80 vs. >80) were randomized 1:1 to intervention (IG) or control (CG). Three thousand and two (3002) self-identified pregnant women aged 18 and older participated. Intervention included heath education and onsite laboratory testing implemented during baby shower in IG churches, while participants in CG churches were referred to health facilities. Primary outcome (confirmed HIV testing) and secondary outcome (receipt of ART during pregnancy) were assessed at the individual level. Findings Antenatal care attendance was similar in both groups (IG=79.4% [1309/1647] vs. CG=79.7% [1080/1355], P=0.8). The intervention was associated with higher HIV testing (CG=54.6% [740/1355] vs. IG =91.9% [1514/1647]; [AOR= 11.2; 95% CI: 8.77-14.25, P-value=<0.001]. Women in the IG were significantly more likely to be linked to care prior to delivery (P<0.01) and more likely to have received ART during pregnancy (P=0.042) compared to those in the CG. Interpretation Culturally-adapted, community-based programs such as HBI can be effective in increasing HIV screening and ART among pregnant women in resource-limited settings. Funding National Institute of Health and President's Emergency Plan for AIDS Relief

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Clark County, Nevada had a 52% increase in newly diagnosed HIV infections in young people age 13-24 with 83% of the new diagnoses in this age group being men who have sex with men (MSM). HIV testing and counseling is critical for HIV prevention, care and treatment, yet young people are the least likely to seek HIV testing. The purpose of this study was to identify barriers and facilitators to HIV testing experienced by young MSM in Clark County, Nevada. We conducted a qualitative focus group discussion to identify barriers and facilitators to HIV testing among eleven young MSM in March, 2015. The primary barrier to HIV testing identified by the group was a lack of awareness or knowledge about testing for HIV. Other barriers within the person included: fear of results, fear of rejection, and fear of disclosure. Barriers identified within the environment included: access issues, stigma, and unfriendly test environments for young people. In addition to increasing awareness, intervention to increase HIV testing among MSM young people should incorporate access to testing in environments where the adolescents are comfortable and which reduces stigma. HIV testing sites should be convenient, accessible and young person/gay friendly.

There is little research examining disparities among subcategories of lesbian, gay, bisexual, transgender, and queer people who identify as transgender. The purpose of this study is to elucidate health disparities regarding access to and utilization of health care and experiences with discrimination within the transgender community. Methods: The United States Transgender Survey (USTS) was conducted online between January and December of 2015. The survey included questions about health care access, utilization, and discrimination. Chi-squared tests were used to identify differences in demographic variables among transfeminine (TF), transmasculine (TM), and nonbinary (NB) participants. Logistic regression was used to analyze differences in health care access, utilization, and discrimination between the three groups. Results: A total of 27,715 transgender-identifying people participated in the survey. TF and TM individuals were more likely to report postponement of health care utilization due to fear of discrimination and had experienced discrimination in the health care setting than NB respondents. NB respondents were more likely to delay care due to cost. Conclusions: Results from this USTS analysis indicate the need for medical education, policy implementation, and intersectional research to establish health equity for transgender people.