Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women

This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women.     

Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women.

Findings from a study comparing partner abuse in African American women suicide attempters (n?=?148) and nonattempters (n?=?137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse–suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acculturation, alcohol consumption and AIDS-related risky sexual behavior among African American women

The present study examined the relationship between acculturation, alcohol consumption and AIDS-related risky sexual behavior in a national probability sample of 533 African American women. Results indicated that women who were the heaviest drinkers were also the least acculturated. However, women most likely to engage in risky sexual behavior, including having multiple partners, being nonmonogamous or in a nonmonogamous relationship, and being nonmonogamous or in a nonmonogamous relationship and not using a condom consistently, were high in acculturation rather than low. Alcohol use proved related to risky sexual behavior when considered in conjunction with respondents' level of acculturation. Women at risk for contracting AIDS were not low acculturated African American women who drank heavily, but high acculturated African American women. Findings from this study extend our understanding of risk and contain implications for research and prevention efforts in the area of alcohol use and AIDS-related sexual behavior among African American women.     

Psychosocial correlates and predictors of AIDS risk behaviors, abortion, and drug use among a community sample of young adult women.

Examined relations among latent constructs of Social Conformity, Sensation Seeking, Polydrug Use, Sexual Experience, Abortion, and Risky AIDS Behavior among a community sample of women (N?=?438, mean age 25.5 yrs) using confirmatory factor analysis (CFA) and predictive structural equation models (SEMs). In the CFA, Risky AIDS Behavior was strongly related to more Polydrug Use and less Social Conformity and modestly related to Sexual Experience and Abortion. In SEMs, Social Conformity significantly predicted less Risky AIDS Behavior and less Polydrug Use but did not predict Abortion. Prior Sexual Experience predicted more Polydrug Use and Abortion. The same psychological processes and predispositions that relate low social conformity to drug use and other unhealthy behaviors may also influence AlDS-risk behaviors, even among a community sample of women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of HIV interventions among women drug users

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms--standard and a standard-plus-innovative intervention--was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups.     

Contraceptive behavior among intravenous drug users at risk for AIDS.

Examined factors associated with practicing contraception among 319 street-recruited iv drug users in New York City. The Ss were administered a structured interview covering AIDS risk behaviors, drug use history, and sexual behavior. Slightly over half of Ss (52%) were practicing contraception, primarily with condoms and birth control pills. Among 220 male Ss, contraception was associated with being non-Hispanic, being unmarried, having a home, and AIDS-related changes in drug injection behavior. Among 99 female Ss, it was associated with having multiple sexual partners. Although concern about AIDS was evident in Ss' behavior, there are multiple determinants (ethnic group membership, situational practicalities, and concern about AIDS) in practicing contraception, and the level of contraception among this group will still result in many unwanted pregnancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV sex and drug risk behavior and behavior change in a national sample of injection drug and crack cocaine using women

This paper describes HIV sex and drug risk behavior and behavior change of injection drug and crack cocaine using women enrolled in a national multi-site Cooperative Agreement program. Baseline data on the 1,403 women who were randomly assigned to a two session intervention that was standardized across sites indicate that sex and drug risk behavior for becoming infected with HIV was considerable. Six-month post intervention follow-up data for the same sample of women show that significant reductions in sex and drug risk behavior were observed for the entire sample of women for the risk variables under study. Significant reductions were also demonstrated for various sub-groups of women enrolled in the study on most of the sex and drug risk variables. Given these findings, it appears that the standard intervention was effective in assisting drug using women reduce their behaviors that put them at risk of becoming infected with HIV. Further research in needed on the development and evaluation of HIV interventions that target specific risk behaviors and various HIV risk behavior profiles of women.     

Risk and protective factors for suicidal behavior in abused African American women.

This study examined risk and protective factors that differentiate low-income, abused African American women (N=200) who attempted suicide from those who had never made a suicide attempt. Results from multivariate analyses revealed that numerous and/or severe negative life events, a history of child maltreatment, high levels of psychological distress and depression, hopelessness about the future, and alcohol and drug problems were factors associated with attempter status. Protective factors associated with nonattempter status included hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining material resources. Culturally competent intervention approaches for abused women should target increasing their protective factors and reducing their risk factors to decrease the likelihood that these women engage in suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with AIDS and AIDS-risk reduction efforts among gay men

Because AIDS has been identified as a major source of stress among gay men, coping models may contribute to an understanding of factors related to changes in and failure to change sexual behavior. Gay men in Long Beach, California, were surveyed to determine whether appraisal and coping are factors in efforts to reduce transmission risk for the human immunodeficiency virus (HIV). Factor analysis of the appraisal and coping items yielded factor structures similar to those reported by earlier coping investigators and that were differentially associated with reported reductions in risk for HIV transmission and with reported intent to engage in high- and low-risk sexual behaviors. Risk-reduction efforts and intent were associated with health-threat (to self or to partner) primary appraisals, secondary appraisals that respondents could change or do something about AIDS, and the coping factors of self-control, seeking social support, and confrontive coping (expression of anger). In addition, intent to engage in relatively high-risk behavior was associated with passive coping (acceptance). These results are discussed in terms of their relevance for risk-reduction education programs and for future research.     

Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.     

AIDS and the African American woman: the triple burden of race, class, and gender

The disproportionate impact of human immunodeficiency syndrome (HIV) disease on African American women is devastating to their lives, their families, their communities, and our society. Among AIDS cases in women, 52.5% are black. African American women with HIV disease constitute one of the least powerful and most burdened segments of society. The African American woman whose behavior places her at risk for HIV infection must be the focus of increased prevention and treatment efforts. This article will describe risk factors for HIV infection and AIDS educational needs of women at risk. The interaction of race, gender, and social class will be explored. The controversy over medical manifestations of HIV will be addressed within the context of the social reality of African American women at risk. Reproductive rights and public policy issues will be discussed. Health educators must overcome their fear, class prejudice, and racial bias in order to form the interracial coalition necessary to lead our nation in the struggle to stop the devastation of AIDS among African American women and children.     

Does hardiness contribute to mental health during a stressful real-life situation? The roles of appraisal and coping.

Israeli recruits (N?=?276) completed questionnaires on hardiness, mental health, cognitive appraisal, and ways of coping at the beginning and end of a demanding, 4-month combat training period. Path analysis revealed that 2 components of hardiness—commitment and control measured at the beginning of the training—predicted mental health at the end of the training through the mediation of appraisal and coping variables. Commitment improved mental health by reducing the appraisal of threat and the use of emotion-focused strategies and by increasing secondary appraisal. Control improved mental health by reducing the appraisal of threat and by increasing secondary appraisal and the use of problem-solving and support-seeking strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping and depressive symptoms among young people with AIDS.

This study examined coping behaviors of people with AIDS, using a large sample (N?=?736) that was both geographically and sociodemographically diverse. In-person interviews were conducted with people receiving AlDS-related medical or social services; follow-up interviews were conducted approximately 11 mo later. Factor analyses of 16 coping behaviors revealed 3 factors: positive coping, seeking social support, and avoidance coping. Respondents with a history of injected drug use, as compared with gay or bisexual men, had higher scores for avoidance coping and lower scores for positive coping. Each coping scale was significantly related to depressive symptoms in cross-sectional analyses. In longitudinal analyses that controlled for prior depressive symptoms, positive coping was significantly related to decreases in symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for inner-city African American men.

Interventions to reduce HIV risk behavior have shown promise but have demonstrated inconsistent effects with heterosexual men. This article reports a cognitive-behavioral HIV risk reduction intervention designed for heterosexually active African American men. Men (N?=?117) recruited from a public clinic were randomly assigned to either (a) a 6-hr video-based small group motivational-skills intervention, or (b) a 6-hr video-based contact-matched HIV education comparison group. Results showed men in the motivational-skills intervention reported lower rates of unprotected vaginal intercourse and higher rates of condom use at the 3-month follow-up. However, because of increased condom use in the comparison condition, differences between groups dissipated 6 months following the intervention. These findings are among the first to demonstrate effects from a motivational-skills intervention for reducing HIV risk in men who have sex with women using a model designed to facilitate transferring prevention technology to community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laser-Doppler flowmetry in neurosurgery

It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high-risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high-risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.     

The specificity of maternal parenting behavior and child adjustment difficulties: A study of inner-city African American families.

The specificity of the association between 2 parenting behaviors (warmth and supervision) and 2 indicators, aggressive behavior and depressive symptoms, of major child outcomes (externalizing problems and internalizing problems) was examined among 196 inner-city African American mothers and their school age children. Given the growing number of African American families affected by HIV/AIDS and demonstrated compromises in parenting associated with maternal infection, the moderating role of maternal HIV/AIDS was also examined. Findings from longitudinal analyses supported the specificity of maternal warmth but not of maternal supervision. Maternal warmth was a stronger predictor of decreases in child aggressive behavior than of decreases in depressive symptoms. In addition, maternal warmth was a stronger predictor of decreases in aggressive behavior than was maternal supervision. Parenting specificity was not moderated by maternal HIV/AIDS. Clinical implications and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between drug use and other problem behaviors in urban adolescents.

Tested the generality of R. Jessor and S. L. Jessor's (1977) problem behavior theory, which states that a variety of problem behaviors constitute a behavioral syndrome in normal adolescents. Relationships among 5 adolescent problem behaviors (cigarette use, alcohol use, marijuana use, delinquency, and sexual intercourse) were examined in 7th-grade boys (n?=?556) and girls (n?=?715), and 9th-grade boys (n?=?481) and girls (n?=?485) in an urban school system in which the majority of students were African American and from low-income families. Measures of problem behavior frequency were positively correlated with each other and negatively correlated with several measures of conventional behavior. Confirmatory factor analyses replicated findings of previous studies that a single common factor underlies adolescent problem behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stimulant abuse treatment as HIV prevention

In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use.