In Ethiopia, approximately 7.5% of the urban population is HIV-positive, and countrywide 1.5 million people are living with HIV. Between 1990 and 2000, immigration into the United States by African-born immigrants increased by 130%. Of this immigrant population, individuals from Ethiopia make up a significant portion. Although there is a rich literature addressing the beliefs regarding HIV and risk perception among some immigrant populations in the United States, few studies target Ethiopian-born residents. Thus, a survey-based study addressing demographics, acculturation, awareness, beliefs and risk perception, attitudes toward susceptibility for infection, and risk behaviors targeted Ethiopian-born residents of San Diego, California. Results indicate a separation between understanding of HIV transmission and personal risk perception for infection in a young, highly educated, predominantly male participant pool. As an initial study of HIV beliefs and risk perception in the immigrant Ethiopian population, our results provide information on specific areas warranting further investigation.

Background: Global health field assignments for medical and nursing professionals include a wide variety of opportunities. Many placements often involve individuals practicing in settings very different from their home environments, relying on their professional experience to help bridge cultural and clinical divides.Objectives: There is limited information about the individual factors that might lead to successful longer-term global health experiences in non-disaster settings. In this paper, we report on one cohort of health professionals' experiences of culture shock, stress, and resiliency as volunteers within the Global Health Service Partnership (GHSP), a public-private collaboration between Seed Global Health, the US Peace Corps, and the US Presidents Plan for Emergency Aids Relief (PEPFAR) that placed American medical and nursing educators in five African countries facing a shortage of health professionals.Methods: Using the tools of Project PRIME (Psychosocial Response to International Medical Electives) as a basis, we created the GHSP Educator Support Survey to measure resiliency, stress, and culture shock levels in a cohort of GHSP volunteers during their year of service.Findings: In our sample, participants were likely to experience lower levels of resiliency during initial quarters of global health placements compared to later timepoints. However, they were likely to experience similar stress and culture shock levels across quarters. Levels of preparedness and resources available, and medical needs in the community where the volunteer was placed played a role in the levels of resiliency, stress, and culture shock reported throughout the year. Conclusion:The GHSP Educator Support Survey represented a novel attempt to evaluate the longitudinal mental well-being of medical and nursing volunteers engaged in intense, longterm global health placements in high acuity, low resource clinical and teaching settings. Our findings highlight the need for additional research in this critical area of global health.

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Program/Project Purpose: Maldistribution of health care workers is a global health challenge that exacerbates health disparities especially in resource-limited settings. Interventions to assuage the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. Within this context, the Kilimanjaro Christian Medical University College introduced a 13-week clerkship rotation in rural hospitals for third-year medical (MD3) students in 2012. To assess students' perceptions, and attitudes toward rural practice after graduation, we surveyed them after their rural rotation. Structure/Method/Design: Anonymous questionnaires were administered to MD 3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR) at 95% Confidence Interval (CI), and 5% level of significance. Binary logistic regression analysis was used to determine predictors accepting rural practice after graduation with Adjusted Odds Ratio (AOR) at 95% CI, and variation assessed with Nagelkerke R2. Outcomes & Evaluation: One hundred and eleven MD3 students participated; 62% male; 62% < 25 years; and 72% direct from secondary school students. Overall, 81% MD3 students were satisfied with rural rotations,(sCns¼ 83%). Likelihood of accepting to be deployed in rural practice after graduation was predicted by being satisfied with the rural rotation program (AOR, 4.32; 95% CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95% CI, 1.09-6.84; p, 0.032). Also, being an in-service student increased the likelihood of accepting rural practice after graduation by 300% compared to enrolment direct from school, although the difference was not significant (AOR, 4.99; 95% CI, 0.88-28.41; p, 0.070). 29% of variation was explained these variables (Nagelkerke R2, 0.289). However, students who joined school after health-related practice were almost 3X more likely to be satisfied than students direct from school, with no significant difference (COR, 2.6; 95% CI, 0.7-9.4; p, 0.310). Likewise, in-service students were more 2X more likely to be satisfied than direct from school students with insignificant difference (COR, 2.4; 95% CI, 0.9-6.4; p, 0.073). No significant difference was exhibited for students born in rural or urban areas. Going Forward: The rural rotation program increased the likelihood of rural practice after graduation. More effort should be undertaken to further improve the program to increase student satisfaction with rural rotations, and hence likelihood for rural practice after graduation.