Risk Factors for HIV/AIDS Among American Indian/Alaska Native Women

Abstract

This article illuminates the main risks that American Indian/Alaska Native women face for contracting the human immunodeficiency virus, and their challenges in living with HIV disease, by presenting a case study of one Native woman's experiences. The woman, a member of a Midwestern Indian tribe, was a participant in a larger in-depth qualitative longitudinal study of 55 women living with HIV. The findings about her path to healing provide insights for understanding and serving this neglected ethnic population, and her words eloquently articulate the struggles of women of color living in dignity with HIV. The article explores potential venues for reaching Native women with culturally relevant prevention and intervention methods, emphasizing the importance of Native culture and Spirituality.     

Respecting the circle of life: one year outcomes from a randomized controlled comparison of an HIV risk reduction intervention for American Indian adolescents

Potential for widespread transmission of HIV/AIDS among American Indian (AI) adolescents exists, yet no evidence-based interventions (EBIs) have been adapted and evaluated with this population. Intensive psychoeducation may improve knowledge and decision-making which could potentially translate to reductions in HIV risk behaviors. A peer group randomized controlled comparison of an adapted EBI vs. control was delivered over an eight-day summer basketball camp in one reservation-based tribal community to adolescents ages 13–19. Outcome data were gathered immediately post-camp and at 6 and 12 months follow-up. Self-selected peer groups were randomized to intervention (n = 138) or control (n = 129) conditions for a total sample of 267 participants (56.2% female), mean age 15.1 years (SD = 1.7). Intervention participants had better condom use self-efficacy post-camp (Adjusted Mean Difference [AMD] = ?0.75, p < 0.005) and at 6 (AMD = ?0.44, p < 0.005) and 12 months (AMD = ?0.23, p < 0.05) follow-up. Intervention participants also had higher HIV prevention and transmission knowledge (post-camp: AMD = 0.07, p < 0.01; 6 months: AMD = 0.06, p < 0.01) were more likely to believe condoms prevent sexually transmitted infections (post-camp: RR = 1.41, p < 0.005; 6 months: RR = 1.34, p < 0.05), to talk with an adult about HIV/AIDS (post-camp: RR=1.78, p < 0.005; 6 months: RR = 1.14, p < 0.005), had higher partner negotiation efficacy related to substance use during sex (post-camp: AMD = 0.37, p < 0.01), and were more likely to intend to use a condom (post-camp: RR = 1.39, p < 0.01). The adapted intervention had short- and medium-term impacts on AI adolescent risk for HIV/AIDS, but attenuated at 12 months. Intervention delivery through a community-based camp is feasible and acceptable with strong retention. Additional study is needed to evaluate the adapted intervention's impact on sexual risk behaviors and if booster sessions and parent involvement translate to long-term impacts.     

Exploring sexual risk taking among American Indian adolescents through protection motivation theory

This paper examines decision-making around sexual behavior among reservation-based American Indian youth. Focus group discussions were conducted with youth ages 13–19 years old. Through these discussions, we explored youth’s knowledge, attitudes and behaviors related to sexual risk taking through the lens of the protection motivation theory to inform the adaptation of an evidence-based HIV prevention intervention. Findings suggest that condom use self-efficacy and HIV prevention knowledge is low, vulnerability to sexually transmitted infections is lacking and alcohol plays a significant role in sexual risk taking in this population. In addition, parental monitoring and peer influence may contribute to or protect against sexual risk taking. Results suggest that future HIV prevention interventions should be delivered to gender-specific peer groups, include a parental component, teach sexual health education and communication skills, integrate substance-use prevention, and work to remove stigma around obtaining and using condoms.     

The Respecting the Circle of Life trial for American Indian adolescents: rationale,design, methods,and baseline characteristics

This paper describes the rationale, design, methods, and baseline results of a randomized controlled trial to evaluate the impact of an adapted evidence-based intervention (EBI), “Respecting the Circle of Life” (RCL) to reduce behavioral risks for HIV/AIDS among American Indian (AI) adolescents. A participatory approach shaped intervention adaptation and study design. A total of 267 participants (aged 13–19) were randomized by peer groups of the same sex to receive the RCL intervention or a control condition. Self-report assessments were administered at four intervals. The sample was predominately female (57%), had low HIV knowledge prevention scores, early sexual initiation (mean 14.6 years), and 56% reported intention to use a condom at next sex. Baseline characteristics were evenly distributed between groups with the exception of age and extrinsic reward scores. This is the first rigorous evaluation of an adapted EBI for HIV/AIDS prevention among AI adolescents, an at-risk and understudied population.     

Understanding Perceptions of HIV Risk Among Adolescents in KwaZulu-Natal

Risk perception has been theorized to be an important antecedent for adopting protective behavior. It is a key construct of research applying the Health Belief Model and other behavior change models. In relation to HIV, risk perception is an indicator of perceived susceptibility to infection, a measure for one's understanding of AIDS transmission as well as willingness to consider behavioral changes. However, there remains much we do not know about what drives risk perception, especially among youth. This study identifies factors that influence the calculation of HIV-risk perception among a group of adolescents in South Africa. Data, collected in 1999 from 2,716 adolescents aged 14-22, are used to explore factors predicting risk perception. Logistic regression models suggest connectedness to parents and community for males and females, self-efficacy to use a condom among males, and living in a household with a chronically ill member for females are associated with HIV risk perception. We conclude that a greater understanding of the connection of adolescents to their communities and adults in their lives is needed, and ways in which programs can alter the environments in which adolescents form opinions, make choices, and act should be incorporated into program design.     

Sexual HIV Risk Behavior Levels Among Young and Older Gay Men Outside of AIDS Epicenters: Findings of a 16-City Sample

Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS.     

The Utility of the PRECEDE Model in Predicting HIV Risk Behaviors Among Puerto Rican Injection Drug Users

The PRECEDE model for health promotion proposes three types of influences on health behaviors: Predisposing, Enabling, and Reinforcing factors. This model was used to examine a range of influences on HIV risk behaviors (sharing syringes and other injection-related paraphernalia) among Puerto Rican injection drug users (IDUs). A total of 698 IDUs were interviewed (438 in East Harlem, New York, and 260 in Bayamón, Puerto Rico). Both types of risk behaviors were more prevalent in Puerto Rico. Similarities in influences on syringe sharing behaviors were found in the two sites and included self-efficacy (for reducing injection-related sharing) and norms. Influences on the sharing of other injection-related paraphernalia were primarily Enabling factors in both communities, and purchasing drugs with others was the strongest predictor of paraphernalia sharing. The need to address risks associated with joint drug purchasing in both locations and to enhance efforts to reduce risks among IDUs in Puerto Rico is indicated.     

HIV Risk Reduction Among African-American Women Who Inject Drugs: A Randomized Controlled Trial

A community-based HIV intervention for African-American women who are active injection drug users (IDUs) was evaluated. Seventy-one women (aged 20–54 years) were randomly assigned to one of two enhanced gender- and culturally specific intervention conditions or to the NIDA standard condition. Substantial decreases (p < .001) were found in the frequency of drug use and the frequency of drug injection as well as in the sharing of injection works or water and the number of injections. Trading sex for drugs or money, having sex while high, as well as other sexual risk behaviors were also reduced significantly. Furthermore, women in both enhanced intervention conditions were more likely to reduce their drug-using and sexual risk behaviors than were women in the standard condition. Results indicate the value of including additional components in interventions designed to reduce the risk of infection with HIV among women who inject drugs.     

Advantages of Video Questionnaire in Estimating Asthma Prevalence and Risk Factors for School Children: Findings From an Asthma Survey in American Indian Youth

Objectives. The aims of the present study were to estimate the prevalence and risk factors of asthma among a sample of American Indian youth and to evaluate survey instruments used in determining asthma prevalence and risk factors. Methods. Three hundred and fifty-two adolescents aged 9 to 21 years enrolled in an Indian boarding school completed an asthma screening. The survey instruments were a written questionnaire and a video-illustrated questionnaire prepared from the International Study of Asthma and Allergies in Childhood (ISAAC), school health records, and a health questionnaire. Participants also underwent spirometry testing. Results. The prevalence of self-reported asthma varied from 12.7% to 13.4% depending upon the instrument used and the questions asked. A history of hay fever, respiratory infections, and family history of asthma were found to be risk factors for asthma by all instruments. Female gender and living on a reservation were significantly associated with asthma by some, but not all, instruments. Airway obstruction was highly associated with one asthma symptom (wheeze) shown in the video questionnaire. Associations for most risk factors with asthma were strongest for the video questionnaire. Conclusions. The prevalence of self-reported asthma among these American Indian youth was similar to rates reported for other ethnic groups. The video-based questionnaire may be the most sensitive tool for identifying individuals at risk for asthma.     

Living Well with Living Wills: Application of Protection Motivation Theory to Living Wills Among Older Caucasian and African American Adults

Using protection motivation theory, we examined racial differences in intent to complete a living will, rational problem solving (e.g., information seeking), and maladaptive coping responses (i.e., wishful thinking) to a health crisis. Sixty healthy, older adults without living wills responded to written vignettes, including information about living wills as an effective coping mechanism to avoid a health crisis. Use of adaptive coping responses predicted intent to execute a living will. A significant race-by-threat interaction predicted use of rational problem solving, with Caucasians more likely to seek information in response to perceived threat in comparison with African Americans. A significant race-by-adaptive-coping interaction predicted maladaptive coping, indicating that Caucasians were more variable in their maladaptive responses. The effectiveness of health care messages regarding living wills for older adults may be enhanced by focusing on racial differences in response to perceived health threat and perceived adaptive coping information.     

HIV/STD Risk and Sexual Strategies Among Women Family Planning Clients in New York: Project FIO

This report describes among 360 family planning clients in an HIV epicenter, women's HIV/STD risk characteristics, the barriers and facilitators of condom use within the context of relationships, and the use of alternative strategies for protection. Women attending the clinic were recruited for an HIV/STD preventive intervention and interviewed at baseline. At least 1 risk factor was reported by 77%, including a diagnosis of an STD within the last year for 30%. Recent STD diagnosis was associated with having a risky partner, but not with number of current partners. Women reporting consistent condom use had higher quality of couple communication, stronger intentions to prevent pregnancy, more positive reactions to condoms themselves and from their partners. Alternative risk reduction strategies, including using a barrier method other than condoms, refusing sex, engaging in nonpenetrative sex, leaving a relationship due to STD concerns, or undergoing mutual HIV testing had been used by 39% of women in the past 3 months.     

The Influence of Power on HIV Risk Among Pregnant Women in Rural Haiti

Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationship power, abuse history, and sexual communication) on sexual behavior (e.g., two or more partners in the year prior to pregnancy, condom use, condom-use intentions, and STI diagnosis) among 196 pregnant women recruited from five community dispensaries in rural Haiti. Results showed that gender and power factors significantly related to sexual behavior. Gender and power factors were most significant for condom use and intention to use condoms, accounting for 18 and 25% of the variance above and beyond HIV knowledge and demographic covariates, respectively. These results suggest the need to create prevention interventions that restore power imbalances, provide support for women suffering abuse, and strengthen communication skills.     

Isolating the Nexus of Substance Use,Violence and Sexual Risk for HIV Infection Among Young Adults in the United States

Adults aged 18 to 29 are at significant sexual risk for HIV infection. Substance use and violence are known to be associated with sexual risk in certain groups, but few studies have examined these relationships in the general population of young adults. No studies have tested whether the contributions of substance use and violence to sexual risk are independent, and few have looked at whether drug use associations with risk are specific to certain substances. Using structural modeling techniques, we examined data for 3,437 adults aged 23–24, testing for associations between three measures of sexual risk for HIV, various forms of substance use, victimization and partner violence. Alcohol use and victimization predicted high risk sex in independent samples of single and married/cohabiting adults. Marijuana use, problem drug use, and partner violence were inconsistently related to sexual risk across measures and subsamples. HIV-prevention interventions designed for young adults in the general population should target individuals who use alcohol frequently and who are victims of violence, and should address both factors, in addition to sexual risk behavior.     

Holistically speaking: A content analysis of spiritual interventions to inform the development of culturally relevant interventions for African American women living with HIV

Abstract

Psychosocial interventions are a key component to improved quality of life for women living with HIV. Spirit-level interventions are shown to buffer psychosocial distress experienced by HIV positive persons. This article will review published spiritually-oriented interventions and compare, contrast, and critique the various components, sample, and intervention methods. Using a summative approach to content analysis, this article will offer the applicability and replicability of these interventions as a basis for increasing treatment options for co-morbid African American women.     

Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia

AIDS and Behavior - HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate...     

The Influence of Gender on Factors Associated with HIV Transmission Risk Among Young Russian Injection Drug Users

HIV infection rates are dramatically increasing in the Russian Federation. Epidemiological studies indicate that the greatest rise of HIV incidence has been among injection drug users (IDU). Young adults (N = 188) who reported injecting drug use completed surveys and interviews that assessed injection drug use behavior, sexual behavior, and HIV‐related knowledge. The average age of participants was 21.3 years. Multiple linear regression analysis found male gender and younger age at sexual debut was positively and significantly associated with having multiple sexual partners. Gender moderated the effects of sexual debut and number of times injected drugs were used in the past month. Males who initiate sex at a younger age were more likely to report multiple sex partners and females who reported higher frequency of drug use were more likely to report multiple sex partners. Gender is an important factor, as well as moderator of risk behavior among Russian injection drug users. Delaying sexual debut, particularly for males, may be an effective strategy to reduce subsequent risk behavior. Prevention efforts among IDUs need to address sexual risk behavior in conjunction with injection risk behavior.     

Predictors of HIV Risk Among Hispanic Farm Workers in South Florida: Women Are at Higher Risk Than Men

This study examined factors associated with being at risk of sexually acquiring HIV among a community sample of 244 Hispanic migrant and seasonal farm workers. Bilingual staff interviewed respondents anonymously at worksites, camps, and other public venues in South Florida during the 2002 winter/spring growing season. The following variables were positively associated with being at risk of sexually acquiring HIV in multivariable analyses: being female; being married; having "some" or "a lot" of knowledge about HIV transmission, having ever used marijuana, having two or more sex partners in the last 12 months, and having had a sexually transmitted infection. The findings heighten the importance of recognizing women's elevated risk of HIV infection and conducting further studies to examine the factors associated with this increased risk. The study is an important first step toward developing tailored HIV prevention interventions for this at-risk, understudied population.     

Pathways of Risk: Race, Social Class, Stress, and Coping as Factors Predicting Heterosexual Risk Behaviors for HIV Among Women

African-American women and Latinas as well as women of lower socioeconomic status are disproportionately represented among women with AIDS; therefore, understanding the factors associated with HIV risk behavior for these women is of particular concern. With a diverse sample of women, the current study examined the validity of a theoretical model that proposed that stress and coping mediated the relationships of race/ethnicity and social class to sexual risk behaviors. Structural equation modeling indicated that although social class demonstrated direct and indirect associations with HIV risk behavior, race did not. Women with lower income had higher levels of stress and riskier sexual partners. However, women with higher income were more likely to engage in unprotected intercourse, often within a committed relationship. Coping style did not mediate the relationship of race, social class, and/or stress with risky sexual behaviors. These findings indicate that social class may be a more important factor than race in predicting individual HIV risk behaviors and that assumptions about race and social class must be empirically tested to understand these complex associations. Pathways to risk and prevention are discussed.     

Impact of Marriage on HIV/AIDS Risk Behaviors Among Impoverished, At-Risk Couples: A Multilevel Latent Variable Approach

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle-sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle-sharing.