Articles: community-health-services.
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Based on a framework (i.e., research and evaluation, prevention and services, and advocacy and policy), the goal of this article is to profile six community-based HIV prevention programs targeting Asian and Pacific Islander (API) Americans, especially among men who have sex with men. These six programs were chosen based on one or more of the following three criteria: (a) epidemiological profiles of AIDS cases among Asian and Pacific Islander Americans, (b) ethnic diversity, and (b) community development among Asian and Pacific Islander Americans in the fight against HIV. The six programs are (a) the Kokua Kalih Valley Health Center, Honolulu; (b) the Asian and Pacific Islander Wellness Center, San Francisco; (c) the Asian Pacific AIDS Intervention Team, Los Angeles; (d) the Asian and Pacific Islander Coalition on HIV and AIDS, New York City; (e) the AIDS Services in Asian Communities, Philadelphia; and (f) the Massachusetts Asian AIDS Prevention Project, Boston. ⋯ In addition to a paucity of epidemiological, surveillance, and empirical data, most reported that barriers fall into one or two interrelated categories: (a) structural (e.g., lack of governmental or private funding) or (b) cultural (e.g., denial of risk, homophobia, fear of confidentiality). These findings suggest that HIV prevention activities and services for Asian and Pacific Islander Americans should be based on empirical and cultural data, and that API Americans should become more actively involved in social and political activities. Asian and Pacific Islander American agencies are challenged to integrate HIV with other health and social issues pertinent to the communities.
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To qualitatively assess the referral system at district level from the consumers' point of view and assess implications it had on efficiency and effectiveness of service delivery. ⋯ In general, the community did not fully comprehend the purposes and intentions of the new user fees policy of January 1994 which was meant to rationalise the referral system. Generally, communities are seldom consulted in time to ensure effective policy implementation and realisation of the intended impact. Impressions generated on the impact of the problem of the referral system on resource use at hospital level show that it has been considerable, although this study did not quantify it. Unnecessary overloading of referral centres negatively affected the care of referral cases, which actually required hospital care, due to competition with primary care cases.
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There are a large number of free services for people who are blind or vision impaired. ⋯ General practitioners are well placed to provide information to patients about these services. Appropriate support from blindness agencies can enable people who are blind or vision impaired to live independent lives.
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Because minority physicians are more likely to practice in minority or medically underserved communities, meeting the health care needs of underserved populations requires that programs not only train such physicians but train minority faculty to act as teachers and role models. The Faculty Development Center in Family Medicine at Cook County Hospital has had more than 120 graduates, most of whom are teaching and practicing in underserved settings. ⋯ The curriculum is specifically geared to prepare faculty to work in underserved settings and nurture future physicians for these settings. Workforce diversity can be achieved only by major changes in the institutional culture of medical education, which federal policy can encourage by setting high standards for grant funding preferences and supporting centers of excellence for training minority physicians and faculty.