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1.
Front Public Health ; 12: 1336184, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38873288

RESUMO

Introduction: Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities. Methods: Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains. Results: Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines. Discussion: This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.


Assuntos
Negro ou Afro-Americano , COVID-19 , Doenças Cardiovasculares , Infecções por HIV , Hispânico ou Latino , Pesquisa Qualitativa , Determinantes Sociais da Saúde , Humanos , Feminino , Masculino , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Pessoa de Meia-Idade , Infecções por HIV/psicologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Entrevistas como Assunto , SARS-CoV-2 , Acessibilidade aos Serviços de Saúde , Idoso
2.
Am Psychol ; 78(4): 563-575, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37384508

RESUMO

This article describes the nearly half a century career of Dr. Gail E. Wyatt, PhD, and her development of novel methodologies and measures of sexual trauma, specifically the Wyatt Sex History Questionnaire and the University of California, Los Angeles, Life Adversities Screener. These approaches broke the silence around experiences of sexual violence, particularly among African Americans, identifying their effects on sexual functioning and mental health. These novel methods are designed without assuming sexual literacy of respondents, knowledge of anatomy, or that discussing sex is easy or common; they include topics that are considered private and may evoke emotions. Trained professionals administering face-to-face interviews can serve to establish rapport and educate the participant or client while minimizing possible discomfort and shame around the disclosure of sexual practices. In this article, four topics are discussed focusing on African Americans, but they may also be relevant to other racial/ethnic groups: (a) breaking the silence about sex, (b) sexual harassment: its disclosure and effects in the workplace, (c) racial discrimination: identifying its effects as a form of trauma, and (d) the cultural relevance of promoting sexual health. Historical patterns of abuse and trauma can no longer be ignored but need to be better understood by psychologists and used to improve policy and treatment standards. Recommendations for advancing the field using novel methods are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Negro ou Afro-Americano , Anamnese , Racismo , Trauma Sexual , Humanos , Negro ou Afro-Americano/história , Negro ou Afro-Americano/psicologia , Revelação , Emoções , Comportamento Sexual , Trauma Sexual/etnologia , Trauma Sexual/história , Trauma Sexual/psicologia , Estados Unidos , Anamnese/métodos , Inquéritos Epidemiológicos/história , Inquéritos Epidemiológicos/métodos , Racismo/etnologia , Racismo/história , Racismo/psicologia
3.
Am J Public Health ; 113(S2): S110-S114, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37339413

RESUMO

The Women-Centered Program for Women of Color, a culturally congruent sexual health intervention, was implemented in 2018 in Los Angeles County, California, according to the principles of community-based participatory research: enhancing community capacity, establishing sustainable programs, and translating research findings to community settings. Participants exhibited significantly increased knowledge of and interest in preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) over time, but no significant change in condom use was evident. Booster sessions are needed to maintain interest in PrEP and PEP given concerns about reproductive and sexual health. (Am J Public Health. 2023;113(S2):S110-S114. https://doi.org/10.2105/AJPH.2023.307296).


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Saúde Sexual , Masculino , Humanos , Feminino , Homossexualidade Masculina , Infecções por HIV/prevenção & controle , Los Angeles , Pigmentação da Pele
4.
Front Psychol ; 14: 1031602, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36844351

RESUMO

Race-based trauma has been linked to multiple adverse health and mental health outcomes, including hypertension, post-traumatic stress, anxiety, and depression. While the possibility of post-traumatic growth (PTG) has been investigated following other types of trauma, relatively less work has been done on PTG following race-based trauma. In this article, we present a theoretical framework integrating three areas of research: race-based trauma, PTG, and racial identity narratives. Based on the work on Black and Asian American identity and integrating theory and research on historical trauma and PTG, this framework posits that the transformation of externally imposed narratives into more authentic, internally generated ones can serve as an important influence that sparks PTG after racial trauma. Based on this framework, strategies and tools that enact the cognitive processes of PTG, including writing and storytelling, are suggested as ways to promote post-trauma growth in response to racial trauma.

5.
Traumatology (Tallahass Fla) ; 27(1): 60-69, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34025223

RESUMO

The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.

6.
Am J Orthopsychiatry ; 90(5): 614-622, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584076

RESUMO

That racial/ethnic discrimination has adverse physical and psychological consequences, including stress, anxiety, depression, and their attendant health effects, is well documented. However, the particular dimensions within the broad construct of discrimination and their role in mental health are less well understood. This study investigates the dimensions of discrimination and explores their relation to depression and posttraumatic stress (PTS) symptoms. Using the Brief Perceived Ethnic/Racial Discrimination Questionnaire-Community Version, discrimination experiences were assessed among a community sample of African American and Latinx participants (N = 500). Factor analyses revealed 4 dimensions: Social Rejection, Stereotyping, Direct Threats/Attacks, and Police Mistreatment. In multivariate analyses, full regression models were significantly related to PTS and depression symptoms. Among the individual predictors, Social Rejection and ethnicity (Latinx) uniquely contributed to PTS symptoms in men, whereas Stereotyping and Direct Threat/Attack were associated with PTS symptoms for women. In regards to depressive symptoms, income, ethnicity (Latinx), and Social Rejection were significant predictors for men, while Social Rejection had an independent contribution for women. Thus, social rejection emerged as a significant unique predictor in 3 of the four models, suggesting that social ostracism may be a particularly harmful aspect of discrimination. Implications of these findings include the use of proactive and intervention strategies that emphasize a sense of belonging and mitigate the effects of exclusion and rejection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Negro ou Afro-Americano/psicologia , Depressão/epidemiologia , Hispânico ou Latino/psicologia , Racismo/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distância Psicológica , Fatores Sexuais , Isolamento Social , Estereotipagem , Inquéritos e Questionários , Estados Unidos/epidemiologia , População Urbana
7.
Prog Cardiovasc Dis ; 63(2): 101-108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32109483

RESUMO

Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality among people living with HIV (PLWH) now that HIV is a manageable chronic disease. Identification and treatment of comorbid medical conditions for PLWH, including CVD and its risk factors, typically lack a critical component of care: integrated care for histories of trauma. Experiences of trauma are associated with increased HIV infection, CVD risk, inconsistent treatment adherence, and poor CVD outcomes. To address this deficit among those at greatest risk and disproportionately affected by HIV and trauma-i.e., Black and Latinx individuals-a novel culturally-congruent, evidence-informed care model, "Healing our Hearts, Minds and Bodies" (HHMB), has been designed to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Further, in recognition of the need to ensure that PLWH receive guideline-concordant cardiovascular care, implementation strategies have been identified that prepare providers and clinics to address CVD risk among their Black and Latinx PLWH. The focus of this paper is to describe the hybrid Type 2 effectiveness/implementation study design, the goal of which is to increase both patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV service organizations in Southern California. This study is expected to produce important information regarding the value of the HHMB intervention and implementation processes and strategies designed for use in implementing HHMB and other evidence-informed programs in diverse, resource-constrained treatment settings, including those that serve patients living in deep poverty. Clinical trials registry: NCT04025463.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Negro ou Afro-Americano/psicologia , Doenças Cardiovasculares/prevenção & controle , Assistência à Saúde Culturalmente Competente/organização & administração , Infecções por HIV/tratamento farmacológico , Sobreviventes de Longo Prazo ao HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispânico ou Latino/psicologia , Saúde Mental/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Serviços Preventivos de Saúde/organização & administração , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/psicologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Nível de Saúde , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Fatores de Proteção , Fatores Raciais , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Adulto Jovem
8.
Am J Orthopsychiatry ; 89(3): 321-328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070417

RESUMO

This article defines and discusses 6 beliefs, attitudes, and practices that can erode or undermine self-esteem and self confidence in student-scholars from underrepresented and marginalized groups in academic settings. Specifically, the beliefs and practices are reactions to implicit bias, color blindness, imposter syndrome, internalized racism, stereotype threat, and code-switching. Mentors need to know how to discuss these reactions because they can also influence the mentoring process and academic performance. To minimize incidents or interactions that might result in scholars not being able to find their place in these settings, recommendations for basic mentoring strategies and individual- and systemic-level approaches to address institutional racism are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Atitude , Pesquisa Biomédica , Tutoria/métodos , Mentores , Grupos Minoritários , Estudantes/psicologia , Humanos , Racismo/etnologia , Autoimagem , Universidades
9.
Am J Orthopsychiatry ; 89(3): 337-342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070419

RESUMO

Students of color in higher education face myriad challenges that supersede the academic, including feelings of isolation, lack of belongingness, and overt discrimination that confer stress on top of their academic workload. One avenue to tackle these issues and reduce the negative outcomes associated with these stressors is the effective mentoring of scholars of color. Research has typically focused on African American and Latino scholars. Asian American scholars have received less attention despite studies showing high levels of anxiety, depression, isolation, and reported experiences of targeted microaggression and discrimination among this population. This article highlights the cultural issues that need to be raised and considered in the mentorship of Asian American scholars. In particular, mentors need to be aware that stereotypes of Asian Americans are pervasive, insidious, and harmful, even those that may be thought of as positive stereotypes, and to examine their own beliefs about them. Second, mentors should be aware of the cultural values that predominate in Asian American cultures-in particular, hierarchical collectivism and a high-context communication style-that may be at odds with the mentor's cultural values or pose as obstacles that negatively influence the mentoring process. Finally, broad considerations and recommendations for mentoring Asian Americans scholars are offered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Asiático/psicologia , Cultura , Tutoria/métodos , Comportamento Estereotipado , Estudantes/psicologia , Atitude do Pessoal de Saúde , Discriminação Psicológica , Humanos , Universidades
10.
Psychol Trauma ; 10(5): 491-498, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29154595

RESUMO

OBJECTIVE: Somatic symptoms are often reported among victims of trauma, and place a significant burden on primary care health providers. We examined the relationship between lifetime histories of trauma and adversity, including aspects not previously studied (i.e., perceived discrimination), and somatic symptoms, as well as the mediating role of posttraumatic stress symptoms (PTSS) and depressive symptoms. METHOD: A multiethnic community sample of 500 male and female participants (230 African American and 270 Latino) completed measures of demographic characteristics, the University of California, Los Angeles Lifetime Adversities Screener (LADS), depressive symptoms, PTSS, and somatic symptoms. RESULTS: An ordinary least-squares regression analysis controlling for age, gender, and race/ethnicity indicated that higher levels of lifetime adversity and trauma were significantly associated with more severe somatic symptoms (b = 6.95, p < .0001). Formal mediation tests indicated that there was a significant indirect effect of LADS on somatic symptoms via PTSS and depressive symptoms, indirect effect = 2.64 (95% confidence interval [CI] [1.2, 4.1]) and 2.19 (95% CI [1.3, 3.3]), respectively. Even after PTSS and depressive symptoms were taken into account, the LADS remained significantly associated with somatic symptoms (b = 2.13, p < .05), suggesting partial mediation. CONCLUSION: Exposure to traumatic and adverse events (the LADS) was associated with somatic symptom severity. Furthermore, although PTSS and depressive symptoms partially accounted for the association between the LADS and somatic symptoms, the LADS remained significant, suggesting that both exposure to trauma and adversity and the resultant development of PTSS and depressive symptoms influence the development of somatic symptoms. (PsycINFO Database Record


Assuntos
Sintomas Inexplicáveis , Adulto , Negro ou Afro-Americano/psicologia , Depressão/diagnóstico , Depressão/etnologia , Feminino , Hispânico ou Latino/psicologia , Humanos , Análise dos Mínimos Quadrados , Masculino , Prognóstico , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etnologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/etnologia
11.
S Afr Med J ; 105(11): 934-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26632322

RESUMO

BACKGROUND: Termination of pregnancy (TOP) remains a controversial issue, regardless of legislation. Access to services as well as psychological effects may vary across the world. OBJECTIVES AND METHODS: To better understand the psychological effects of TOP, this study describes the circumstances of 102 women who underwent a TOP from two socioeconomic sites in Johannesburg, South Africa, one serving women with few economic resources and the other serving women with adequate resources. The relationship between demographic characteristics, resilience and symptoms of post-traumatic stress disorder (PTSD) and depression before, 1 month after and 3 months after the procedure was also examined. RESULTS: Time since TOP, age, chronic burden, resilience and the interaction of site with religion and site with chronic burden were significant. In addition, site differences were found for religion and chronic burden in predicting depression scores. Women from both sites had significant decreases in depression scores over time. The interaction of time with site was not significant. Higher chronic burden scores correlated with higher depression scores. No variables were significant in the bivariate analysis for PTSD. CONCLUSION: Resilience, religion and chronic burden emerge as significant variables in women undergoing a first-trimester TOP, and warrant further assessment in studies of this nature.

12.
Psychol Assess ; 27(3): 965-74, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25984638

RESUMO

The high burden of exposure to chronic life adversities and trauma is quite prevalent, but assessment of this risk burden is uncommon in primary care settings. This calls for a brief, multiple dimensional mental health risk screening tool in primary care settings. We aimed to develop such a screening tool named the University of California, Los Angeles (UCLA) Life Adversities Screener (LADS). Using pooled data across 4 studies from the UCLA Center for Culture, Trauma, and Mental Health Disparities, 5 domains of mental health risk including perceived discrimination, sexual abuse histories, family adversity, intimate partner violence, and trauma histories, were identified. Regression models for depression (Centers for Epidemiology Studies Depression Scale) and posttraumatic stress disorder (Posttraumatic Diagnostic Scale), controlling for demographic factors, were fitted to develop a weighted continuous scale score for the UCLA LADS. Confirmatory factor analysis supported the 5-domain structure, while item response theory endorsed the inclusion of each item. Receiver operating characteristic analysis indicated that the score was predictive for classifying subjects as reaching clinical threshold criteria for either depression (Beck Depression Inventory-II ≥ 14 or Patient Health Questionnaire-9 ≥ 10) or anxiety (Patient Health Questionnaire-13 ≥10). An optimal cut of 0.33 is suggested based on maximizing sensitivity and specificity of the LADS score, identifying patients at high risk for mental health problems. Given its predictive utility and ease of administration, the UCLA LADS could be useful as a screener to identify racial minority individuals in primary care settings who have a high trauma burden, needing more extensive evaluation.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Exposição à Violência/psicologia , Violência por Parceiro Íntimo/psicologia , Trauma Psicológico/diagnóstico , Racismo/psicologia , Adolescente , Adulto , Idoso , Abuso Sexual na Infância/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Programas de Rastreamento , Saúde Mental , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Trauma Psicológico/psicologia , Medição de Risco , Sensibilidade e Especificidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
13.
Psychol Trauma ; 7(3): 243-51, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25961869

RESUMO

This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Negro ou Afro-Americano/psicologia , Hispânico ou Latino/psicologia , Transtornos Mentais/etnologia , Estresse Psicológico/etnologia , Violência/psicologia , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Ansiedade/etnologia , Depressão/etnologia , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Pobreza/etnologia , Pobreza/psicologia , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Violência/etnologia
14.
Psychol Trauma ; 6(2): 152-158, 2014 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-25202437

RESUMO

The Healing Our Women Program, an 11-week integrated trauma/HIV intervention designed for HIV-positive women with child sexual abuse histories, has been found to reduce psychological distress in treatment groups compared to wait-list controls (Chin et al., 2004; Wyatt et al., 2011). This study examines the characteristics of participants who improved vs. those who did not improve among participants who received the active intervention (N=78) at post, three-, and six-month follow-up. Logistic regression analyses conducted post-intervention and at three- and six-month followups examined demographic characteristics, treatment attendance, AIDS diagnosis, and total trauma burden as possible predictors of improvement. Results indicated that at post-test, total trauma burden was significantly associated with improvement. At three-month follow-up, none of the variables discriminated the groups. At six-month follow-up, total trauma burden was again significantly related to improvement. The results suggest that the intervention is most appropriate for women with high trauma burdens. Future HIV interventions should go beyond the "one size fits all" approach" and consider the "fit" between intervention and participants.

15.
Womens Health Issues ; 21(6 Suppl): S255-60, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22055676

RESUMO

Experiences of past and current gender-based violence are common among HIV-positive women in the United States, who are predominantly from ethnic minority groups. However, culturally congruent, feasible interventions for HIV-positive women who have experienced past and/or current violence are not widely available. The Office on Women's Health Gender Forum has made several recommendations for responding to the National HIV/AIDS Strategy Implementation Plan, including recommendations to incorporate gender-based violence prevention into a comprehensive, gender-responsive national strategy. This paper draws on an example of a community-based project for HIV-positive women, the Healing Our Women Project, to illustrate how violence prevention can be achieved within peer-led and community-based programming. Strong community partnerships, responsiveness to community needs and local cultural norms, a trained workforce, and culturally competent care are programmatic cornerstones of gender-responsive services. HIV-positive women with histories of gender-based violence and risk factors for current and future violence deserve the highest quality gender-responsive services to ensure that they can address their health needs within contexts of safety and respect.


Assuntos
Participação da Comunidade , Soropositividade para HIV , Necessidades e Demandas de Serviços de Saúde , Estupro/prevenção & controle , Maus-Tratos Conjugais/prevenção & controle , Saúde da Mulher , Competência Cultural , Etnicidade , Feminino , Guias como Assunto , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Grupos Minoritários , Grupo Associado , Características de Residência , Fatores de Risco , Segurança , Estados Unidos
16.
AIDS Educ Prev ; 21(5): 415-29, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19842826

RESUMO

HIV may be particularly stigmatizing in Asia because of its association with "taboo" topics, including sex, drugs, homosexuality, and death (Aoki, Ngin, Mo, & Ja, 1989). These cultural schemata expose salient boundaries and moral implications for sexual communication (Chin, 1999, Social Science and Medicine, 49, 241-251). Yet HIV/STD prevention efforts are frequently conducted in the public realm. Education strategies often involve conversations with health "experts" about condom use, safe sex, and partner communication. The gap between the public context of intervention efforts and the private and norm-bound nature of sex conversation is particularly challenging. Interviews with 32 market workers in eastern China focused on knowledge, beliefs, and values surrounding sexual practices, meanings, and communication. Sex-talk taboos, information seeking, vulnerability, partner communication, and cultural change emerged as central to understanding intervention information flow and each theme's relative influence is described. Findings illustrate the nature of how sexual communication schemata in Chinese contexts impact the effectiveness of sexual health message communication.


Assuntos
Comunicação , Cultura , Infecções por HIV/prevenção & controle , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , China , Emprego , Feminino , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto/métodos , Masculino , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Vigilância da População/métodos , Preconceito , Comportamento Sexual , Infecções Sexualmente Transmissíveis/etnologia , Inquéritos e Questionários , Adulto Jovem
17.
AIDS Behav ; 10(2): 191-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16479413

RESUMO

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.


Assuntos
Abuso Sexual na Infância/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Assunção de Riscos , Comportamento Sexual/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , California/epidemiologia , Área Programática de Saúde , Criança , Etnicidade , Feminino , Humanos , Índice de Gravidade de Doença
18.
AIDS Behav ; 10(1): 13-26, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16421649

RESUMO

Previous research suggests that writing about stressful experiences results in better health and psychological well-being. In the present study, a multi-ethnic sample of 79 HIV-positive women and men participated in a structured interview, and wrote about either their deepest thoughts and feelings about living with HIV (expressive writing) or their activities in the last 24 hr (control). Sixty-two participants returned for the 2-month follow-up and 50 returned for the 6-month follow-up interview. Oral fluid samples of beta2-microglobulin were taken at the baseline and follow-up assessments to examine the immunological effects of writing. No effects of writing condition were found, but expressive writing participants who included increasing insight/causation and social words in their writing had better immune function and reported more positive changes at follow-up. Results suggest that cognitive processing and changes in social interactions may be critical to the benefits of writing.


Assuntos
Infecções por HIV/imunologia , Infecções por HIV/psicologia , Ajustamento Social , Redação , Adulto , Atitude Frente a Saúde , Cognição , Feminino , Seguimentos , Humanos , Relações Interpessoais , Masculino , Saliva/química , Apoio Social , Revelação da Verdade , Vocabulário , Microglobulina beta-2/análise
19.
AIDS Behav ; 10(1): 93-104, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16385391

RESUMO

Using the AIDS risk reduction model as our conceptual framework and structural equation modeling as our analytic tool, we tested psychosocial antecedents of sexual risk reduction among heterosexually active men and women who use illegal drugs. With baseline sexual risk behavior controlled, stronger commitment to safer sex predicted less sexual risk behavior for both men and women. For men but not women, greater AIDS knowledge predicted safer sex commitment. For women but not men, higher self-efficacy predicted stronger commitment to safer sex, and peer norms favoring sexual risk reduction predicted higher self-efficacy. Intervention for men should focus on increasing safer sex commitment and AIDS knowledge. Intervention for women should promote safer sex commitment by raising self-efficacy for sexual risk reduction.


Assuntos
Serviços Preventivos de Saúde/organização & administração , Comportamento de Redução do Risco , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Demografia , Análise Fatorial , Feminino , Soronegatividade para HIV , Promoção da Saúde , Heterossexualidade , Humanos , Drogas Ilícitas , Masculino , Autoeficácia , Fatores Sexuais , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos
20.
AIDS Behav ; 8(4): 453-62, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15690118

RESUMO

Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on "intent to treat'' analyses of pre-post changes are reported here. Additional analyses explored whether the observed effects might depend on "intervention dose,'' i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medication adherence in preventive interventions for women.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Abuso Sexual na Infância/estatística & dados numéricos , Terapia Cognitivo-Comportamental/métodos , Soropositividade para HIV/terapia , Comportamento de Redução do Risco , Apoio Social , Adulto , Antígenos CD4/imunologia , Antígenos CD8/imunologia , Criança , Abuso Sexual na Infância/etnologia , Terapia Combinada , Cultura , Ensaio de Imunoadsorção Enzimática , Feminino , Soropositividade para HIV/etnologia , Soropositividade para HIV/imunologia , Humanos , Cooperação do Paciente/estatística & dados numéricos , Serviços Preventivos de Saúde/provisão & distribuição , Serviços de Saúde da Mulher/provisão & distribuição
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