Resilience, Self-Efficacy, and Symptoms of Anxiety and Depression in Older Adults during COVID-19 Confinement.

OBJECTIVE: This study examined the relationship between resilience, self-efficacy, anxiety, and depression to test whether self-efficacy affected anxiety and depression and compared how the participants in different age groups experienced anxiety, as well as the differences in anxiety between employed and unemployed participants. METHOD: A cross sectional web-based survey study that included adults aged 60 years or older living in Puerto Rico was performed during April and May 2020. RESULTS: A total of 299 older adults completed the online questionnaire (14% men, 83.6% women). Of the total sample, 25.4% reported having moderate to severe symptoms of anxiety, while 20.8% reported having moderate to severe symptoms of depression. Our path analysis model suggested that while self-efficacy did not directly affect anxiety, it had an impact on resilience, thereby reducing anxiety symptoms. The participants who were 71 years old or older had lower anxiety levels than their younger counterparts did. We also confirmed that work might serve as a protective factor against anxiety. CONCLUSION: Our findings underscore the importance of resilience, self-efficacy, and working later in life to promote well-being and successful aging.

Qualitative analysis of an educational intervention with HIV-discordant heterosexual Latino couples.

OBJECTIVE: This qualitative analysis elucidates the potential elements of the intervention that may be effective in terms of a) increasing knowledge about HIV/ AIDS in the members of this population; b) increasing the use of male condoms and the practice of mutual masturbation; and c) changing opinions toward male condom use and mutual masturbation. METHODS: Five heterosexual HIV-discordant couples participated in the adapted intervention, which consisted of four three-hour-long sessions. One month after the intervention, we conducted a qualitative semi-structured interview with every participant to evaluate issues related to the process and content of the activities comprising the intervention, the impact of the intervention, logistics, and recruitment and retention as well as to make a more general evaluation. The information was submitted to qualitative content analysis. RESULTS: After the intervention, participants reported having better attitudes regarding safer sex, particularly in terms of condom use. A reason given by the participants to feel more positive toward condom use and mutual masturbation was that these practices could prevent the infection of the HIV-negative partner. CONCLUSION: This study provides important evidence of an intervention that promises to be efficacious in preventing some high-risk sexual behaviors among Latino HIV-discordant heterosexual couples. The evidence presented seems to suggest that an intervention that includes basic relevant information about HIV/AIDS, that explains the benefits of condom use and other safer sex options, and that provides effective negotiation and communication strategies could significantly reduce HIV transmission among these couples.

Internet Study about Risk Factors Associated with HIV among Heterosexuals in Puerto Rico.

OBJECTIVE: Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context. METHODS: We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software. RESULTS: Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men. CONCLUSION: Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.

Barriers and facilitators of HIV prevention with heterosexual Latino couples: beliefs of four stakeholder groups.

Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men's involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed.

Impact of relationship dynamics and gender roles in the protection of HIV discordant heterosexual couples: an exploratory study in the Puerto Rican context.

BACKGROUND: Most of the HIV/AIDS prevention efforts have not taken into consideration the context of the relationship and the gender constructs that influence relationship dynamics. These efforts have failed to view HIV prevention as a collaborative process between partners. Therefore, it is important to explore how relationship dynamics and gender constructs influence how men and women involved in an HIV discordant heterosexual relationship, visualize their role in the protection of their partners in order to design more effective prevention interventions. METHODS: Five Puerto Rican HIV discordant heterosexual couples were interviewed via a qualitative semi-structured interview. The taped interviews were transcribed and analyzed using content analysis according to a set of defined categories. RESULTS: Women visualized their role as one of convincing their partners to use protection as well as being strong and firm in the demand of its use. Men viewed their role as one of being more supportive and willing to use protection, but recognized their resistance towards the use of condoms. Relationship dynamics such as communication and support promoted protection. CONCLUSIONS: Traditional and non-traditional gender roles were assumed by both men and women. Traditional gender roles inhibited protection but were also used in positive ways to promote it. Men showed a greater initiative to break with traditional gender norms. A positive relationship, marked by communication and support could serve as a facilitator in the protection and in the transformation of traditional gender norms. This points out to the need of viewing HIV/AIDS prevention as a collaborative rather than individualistic process.

Men's role in HIV/AIDS prevention for women: exploring different views.

OBJECTIVE: Explore the role male partners should play in interventions that emerge from an empowerment perspective for the prevention of HIV/AIDS in women. Explore the social and cultural context, rationale and format for interventions if male partners are incorporated. BACKGROUND: Heterosexual women have become the most at risk group for HIV infection. Most of the HIV/AIDS prevention efforts have excluded the participation of male partners. Interventions with women have not been as affective as desired since the negotiation of safer sex method, such as the male condom, is not under their control. METHODS: Thirteen focus groups were conducted in Puerto Rico, Dominican Republic and Mexico. Groups were conducted with HIV/AIDS prevention researchers, service providers, and heterosexual men and women who participated in HIV/AIDS prevention interventions. The taped conversations were transcribed and analyzed using content analysis according to a set of defined categories and subcategories. RESULTS: The majority of participants agreed that men must be incorporated in HIV prevention efforts with women. Many conditioned this participation, while some expressed their opposition. Regarding the ways of participation many favored working with men and women separately at the beginning and integrating at the end. They recommended considering working at a group level. CONCLUSIONS: The HIV/AIDS epidemic has put in the forefront the need to consider non-traditional approaches to promote behavior change. A group-base intervention with couples may be an effective way to prevent the HIV/AIDS epidemic.

Health and support service utilization patterns of American Indians and Alaska Natives diagnosed with HIV/AIDS.

The purpose of this analysis is twofold: to examine the types of health and support services provided by CARE Act funded providers to American Indians/Alaska Natives and to compare the characteristics and service utilization patterns for this group with those of individuals from other racial/ethnic groups. We present an analysis of the demographic characteristics, service utilization, and health outcomes of all HIV-infected clients who received services in five geographic areas at agencies that were funded through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Standard chi-square tests were used to test for statistically significant differences (p <.05) between the demographic characteristics and service utilization patterns of matched pairs of HIV-positive American Indian/Native Alaskans with HIV-positive individuals of other racial and ethnic backgrounds. Individuals were matched on gender, age, insurance, AIDS diagnosis, and site. Other data examined include client characteristics (income, homelessness, HIV exposure category, and source of health care), health indicators (CDC-defined disease stage, CD4+ counts, substance abuse and psychiatric illness) and service utilization (medical care; mental health treatment/counseling; substance abuse treatment/counseling; case management; dental care; housing, food, emergency financial, and transportation assistance, and buddy/companion and client advocacy services). There were no statistically significant differences between the two groups for HIV exposure category, CD4 count, substance abuse problem, and being homeless and in their likelihood to receive medical care, mental health or substance abuse treatment/counseling, dental care, food, emergency financial, and transportation assistance, as well as buddy/companion and client advocacy services. They were more likely (55% vs. 46%) to receive case management services than the matched individuals from other racial/ethnic groups. They were also more likely to receive housing assistance (35% vs. 25%). The analysis provides evidence that when individuals are matched on key demographic and health characteristics, few differences remain between HIV-positive American Indians/Native Alaskans and other racial/ethnic groups. The two exceptions are case management and housing assistance. The significantly higher use of case management is not surprising, given the emphasis by American Indians/Alaska Natives on traditional Native American case management case management. In contrast, the significantly higher use of housing assistance by American Indians/Alaska Natives was unexpected. Exploring the potential need for housing assistance among all American Indians/Alaska Natives served by the Ryan White CARE Act needs to be considered.

A Pilot Intervention to Promote Safer Sex in Heterosexual Puerto Rican Couples.

Although the sexual transmission of HIV occurs in the context of an intimate relationship, preventive interventions with couples are scarce, particularly those designed for Hispanics. In this article, we present the effect of a pilot intervention directed to prevent HIV/AIDS in heterosexual couples in Puerto Rico. The intervention was theory-based and consisted of five three-hour group sessions. Primary goals included increasing male condom use and the practice of mutual masturbation as a safer sex method, and promoting favorable attitudes toward these behaviors. Twenty-six couples participated in this study. Fifteen were randomly assigned to the intervention group and eleven to a control group. Retention rates at post-intervention and follow-up were 82% for the whole sample. Results showed that there was a significant increase in the use of male condoms with main partners in the intervention group when compared with the control group. Couples in the intervention group also had better scores on secondary outcomes, such as attitudes toward condom use and mutual masturbation, HIV information, sexual decision-making, and social support. We found that these effects persisted over the three month follow up. A significant effect was also observed for the practice of mutual masturbation, but not for sexual negotiation. These results showed that promoting male condom use in dyadic interventions among heterosexual couples in Puerto Rico is feasible. Our findings suggest that because vaginal penetration has been constructed as the sexual script endpoint among many Hispanic couples, promoting other non-penetrative practices, such as mutual masturbation, may be difficult.

FACTORES RELACIONADOS CON EL USO EXCESIVO DE ALCOHOL EN ADULTOS JÓVENES EN PUERTO RICO / FACTORS RELATED TO EXCESSIVE ALCOHOL USE AMONG YOUNG ADULTS IN PUERTO RICO

El propósito de este estudio fue identificar los factores relacionados con el uso excesivo de alcohol en personas jóvenes en Puerto Rico. Se realizó un estudio exploratorio de tipo cualitativo mediante el cual se entrevistó a 20 adultos jóvenes (10 hombres y 10 mujeres), entre las edades de 21 y 29 años. Los datos fueron analizados mediante la técnica de análisis de contenido cualitativo. Los y las jóvenes identificaron más factores sociales y culturales que individuales. Algunos de los factores sociales más mencionados incluyen la familia y las campañas publicitarias que se transmiten por los medios de comunicación. Con respecto a la familia, indicaron que en esta se comienzan a transmitir valores de aceptación y uso del alcohol. Sobre las campañas publicitarias, mencionaron que van dirigidas a resaltar la necesidad de consumir alcohol como una condición imprescindible para pasarla bien. También mencionaron que hay jóvenes que usan alcohol como un mecanismo para lidiar con los problemas que enfrentan. Esta investigación documenta algunos de los factores más relevantes relacionados con el uso de alcohol en jóvenes. Los esfuerzos de prevención deben ir dirigidos a minimizar esos factores de riesgo presentes en la cultura puertorriqueña y posiblemente latinoamericana.

The purpose of this study was to identify the factors related to excessive alcohol use in young people in Puerto Rico. A qualitative exploratory study was carried out in which 20 young adults (10 men and 10 women) between the ages of 21 and 29 years were interviewed. The data were analyzed using the qualitative content analysis approach. Young people identified more social and cultural factors than individual ones. Some of the most mentioned social factors include the family and the advertising campaigns that are transmitted by the media. They indicated that the values of acceptance and use of alcohol start to be transmitted thorough the family. They mentioned that the advertising campaigns are aimed at highlighting the need to consume alcohol as an essential condition to have fun. They also mentioned that there are young people who use alcohol as a mechanism to deal with the problems they face. This study documents some of the most relevant factors related to alcohol use in young people. Prevention efforts should be aimed at minimizing those risk factors present in the Puerto Rican and possibly Latin American culture.

Estereotipos Sexuales y su Relación con Conductas Sexuales Riesgosas,.

Sexual stereotypes are beliefs that are generally accepted and are thought to define how men and women should express their sexuality. The objectives of this study were to identify how many heterosexual Puerto Rican men and women endorsed certain stereotypes about male and female sexuality and to explore the relationship between the endorsement of these sexual stereotypes and the attitudes towards condom use, as well as actual condom use during intercourse. We conducted a cross-sectional study in which we administered two scales, one about male sexuality and the other about female sexuality, to a group of 429 heterosexual participants. We found that men endorsed significantly more male and female sexual stereotypes than women and that these tended to have a more conservative view of female sexuality than what they had of male sexuality. Women, on the other hand, tended to view female and male sexuality in a less stereotypical way. We also found that the more men and women endorsed male and female sexual stereotypes, the worse the attitudes toward condom use. However, endorsement of male and/or female sexual stereotypes was not related to condom use. These findings contradict the literature that suggests that these sexual stereotypes result in high-risk sexual conduct, which has important implications for the development and implementation of prevention programs.

[Barriers and Facilitators in the Recruitment and Retention of Heterosexual Couples for Preventive Interventions.] / Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA.

El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes.

Desarrollo de una intervención grupal para la prevención del VIH en parejas heterosexuales.

HIV preventive efforts with heterosexual couples are almost nonexistent. We designed a group intervention based on the Information-Motivation-Behavioral Skills model with the aim of increasing male condom use and promoting the practice of mutual masturbation as a safer sex alternative. We carried out a pilot study with four couples to evaluate the feasibility of the intervention and the aspects of content and format that needed to be modified. Findings reflect that participants were very satisfied with the intervention and they found it entertaining and innovative. They were very comfortable with its format, as well as with the activities. The findings confirm the feasibility of this intervention and the need to direct preventive efforts to this population.

Modeling HIV Prevention Strategies among Two Puerto Rican Samples.

The Information-Motivation-Behavioral Skills model examines factors that are used to initiate and maintain sexual and reproductive health promotion behaviors. The present study evaluated the association among these constructs as it is applied to sexually active heterosexual adults with steady partners, using a Structural Equation Modeling approach. At the same time, it was analyzed if the same model structure could be generalized to two samples of participants that produced the results following two different formats for data collection. Two-hundred ninety one participants completed the Information-Motivation-Behavioral Skills Questionnaire (Spanish version), and 756 participants completed an Internet version on the instrument. The proposed model fits the data for both groups, supporting a predictive and positive relationship among all of the latent variables, with Information predicting Motivation, and Motivation therefore predicting Behavioral Skills. The findings support the notion that there are important issues that need to be addressed when promoting HIV prevention.

[Sexual Behavior and Self-Efficacy for the Negotiation of Safer Sex in Heterosexual Persons.] / Comportamiento Sexual y Autoeficacia para la Negociación de Sexo Más Seguro en Personas Heterosexuales.

Self-efficacy has been defined as one of the factors that may facilitate or impede safer sex. Studies reveal that peoples in steady relationships practice safer sex less often that those in casual relationships. We conducted a study with 447 sexually active heterosexual adults. A self-administered questionnaire was designed to study the sexual behavior, the male condom use and the practice of mutual masturbation, and the self-efficacy toward these practices. Results show that most men are sexually active and that there is a low frequency of male condom use and the practice of mutual masturbation as safer sex. The majority of those who use the male condom are engage in casual relationships. However, participants have high levels of self-efficacy toward these practices. Although self-efficacy is one of the factors that influence in deciding to practice safer sex, it is not sufficient to reach this goal.

Modeling HIV prevention strategies among two Puerto Rican samples / Modelacion de estrategias para la prevención del VIH en dos muestras puertorriqueñas

The Information-Motivation-Behavioral Skills model examines factors that are used to initiate and maintain sexual and reproductive health promotion behaviors. The present study evaluated the association among these constructs as it is applied to sexually active heterosexual adults with steady partners, using a Structural Equation Modeling approach. At the same time, it was analyzed if the same model structure could be generalized to two samples of participants that produced the results following two different formats for data collection. Two-hundred ninety one participants completed the Information-Motivation- Behavioral Skills Questionnaire (Spanish version), and 756 participants completed an Internet version on the instrument. The proposed model fits the data for both groups, supporting a predictive and positive relationship among all of the latent variables, with Information predicting Motivation, and Motivation therefore predicting Behavioral Skills. The findings support the notion that there are important issues that need to be addressed when promoting HIV prevention.(AU)

El modelo de Información-Motivación-Destrezas (IMB) evalúa factores que facilitan la promoción de practicas sexuales de menor riesgo. El presente estudio examinó la aplicación de este modelo en una muestra puertorriqueña utilizando la modelación de ecuaciones estructurales con adultos heterosexuales con al menos una pareja estable. A la vez, evaluamos si el modelo podía ser aplicado a más de una muestra. La primera muestra (N= 291) completó la versión en papel y lápiz de el instrumento, mientras la segunda muestra (N= 756) completó la versión electrónica del mismo. Los resultados reflejan que existe una asociación de predicción entre los componentes del modelo IMB, donde el tener información sobre el VIH/SIDA predijo el nivel de motivación para tener sexo más seguro, y este factor a la vez predijo el nivel de autoeficacia para la negociación sexual (destrezas). Estos resultados apuntan la necesidad de identificar múltiples factores que facilitan las prácticas sexuales de menor riesgo.(AU)

Comportamiento sexual y autoeficacia para la negociación de sexo más seguro en personas heterosexuales / Sexual behavior and self-efficacy for the negotiation of safer sex in heterosexual persons

La autoeficacia se le ha identificado como uno de los factores que puede facilitar o dificultar llevar a cabo sexo más seguro. Estudios revelan que las personas que están el relaciones estables usan métodos de protección menos frecuente que quienes tienen parejas casuales. Realizamos un estudio con 447 personas heterosexuales activas sexualmente. Les administramos un cuestionario dirigido a medir el comportamiento sexual, el uso del condón masculino y la práctica de la masturbación mutua, y la autoeficacia para llevar a cabo estas conductas. Los resultados reflejan que los hombres están más activos sexualmente y que el uso del condón y la práctica de la masturbación mutua como alternativa de sexo más seguro es muy baja. En los casos donde se usa el condón esta práctica es realizada en su mayoría por las personas que se encuentran en una relación de pareja casual. No obstante, los/las participantes tienen altos niveles de autoeficacia hacia ambas prácticas. Aunque la autoeficacia es uno de los factores que incide en decidir llevar a cabo sexo más seguro, ésta no es suficiente para que esta meta se logre.(AU)

Self-efficacy has been defined as one of the factors that may facilitate or impede safer sex. Studies reveal that peoples in steady relationships practice safer sex less often that those in casual relationships. We conducted a study with 447 sexually active heterosexual adults. A self-administered questionnaire was designed to study the sexual behavior, the male condom use and the practice of mutual masturbation, and the self-efficacy toward these practices. Results show that most men are sexually active and that there is a low frequency of male condom use and the practice of mutual masturbation as safer sex. The majority of those who use the male condom are engage in casual relationships. However, participants have high levels of self-efficacy toward these practices. Although self-efficacy is one of the factors that influence in deciding to practice safer sex, it is not sufficient to reach this goal.(AU)