Bearing (Aguantando) With Intimate Partner Violence: A Grounded Theory Study of Self-Silencing Among Hispanic Women Who Experienced Intimate Partner Violence.

Hispanic women who experience intimate partner violence (IPV) face unique disparities. They have poorer health outcomes and are less likely to seek help than their non-Hispanic counterparts. When women remain in relationships where IPV occurs and refuse to disclose or seek treatment, they may resort to self-silencing, which can also worsen health outcomes. The purpose of this study was to develop a theory that explains how self-silencing evolves among Hispanic women who experience IPV. Participants were recruited from two research studies focused on Hispanic women's health, and from snowball sampling, which involved referrals by previously registered participants. Data were collected via Zoom® and included individual interviews. A total of 25 women participated in this study. Analysis followed constructive grounded theory levels of analysis described by Charmaz and constant comparative methods described by Glaser and Strauss. A grounded theory entitled Bearing (Aguantando) With Intimate Partner Violence emerged from the data. The theory explains the main strategy Hispanic women use to deal with violence while remaining in a relationship where IPV occurs. The theory is constructed of four categories with subcategories. The results of this study provide an initial framework to understand the self-silencing process among Hispanic women who experience IPV. In addition, this study identifies different levels of interventions that can be useful for researchers and healthcare providers to promote Hispanic women's ability to become empowered, use their voices, and seek help.

Disparities in Resource Availability, Psychological Intimate Partner Violence, and Depression Among Hispanic Women.

This study aims to analyze the relationship between the availability of resources, exposure to psychological intimate partner violence (P-IPV), and depression in Hispanic women in South Florida. This secondary data analysis used cross-sectional baseline data from SEPA (Salud, Educación, Prevención y Autocuidado) III. SEPA III was a randomized controlled trial that tested the SEPA intervention with 320 cisgender, sexually active Hispanic women. Descriptive analysis, logistic, and multiple regressions were conducted. Lower sexual relationship power and attending religious services were associated with higher odds of P-IPV. Reporting a history of P-IPV in the last 3 months predicted depression scores and higher depression scores were associated with higher odds of experiencing P-IPV. Participants with higher depressive scores reported less education, increased emergency room utilization, and less sexual relationship power. P-IPV is highly prevalent among Hispanic women living in South Florida. The availability of personal and community resources can buffer the risk of P-IPV and its mental health consequences. Nurses can strengthen women's resources to prevent Hispanic women from exposure to P-IPV.

Interventions for Hispanic/Latino gay, bisexual, and men who have sex with men: Critical appraisal.

OBJECTIVE: Some interventions have been developed and tested to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and men who have sex with men (MSM). The purpose of this paper is to critically appraise published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM. DESIGN/SAMPLE/MEASUREMENT: A critical appraisal of published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM was conducted. Using guidelines established by the Johns Hopkins Nursing Evidence-Based Practice Rating Scale published research articles were categorized and evaluated using these guidelines. RESULTS: The critical appraisal identified nine intervention studies that met all inclusion criteria. The critical appraisal of these interventions highlighted strengths and weaknesses of these interventions which should be considered when developing future interventions to decrease high risk sexual practices among Hispanic/Latino gay, bisexual, and MSM. CONCLUSION: While several interventions have been created to specifically address HIV infection among Hispanic/Latino gay, bisexual, and MSM, these interventions were varied. Suggestions for future intervention development to decrease high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM based on the findings of the critical appraisal of the literature are included.

A Concept Analysis of Self-Silencing.

Self-silencing describes the phenomenon of "loss of voice." A clear and comprehensive definition of self-silencing is relevant for nursing research and practice to promote a better understanding of detrimental health outcomes that may result from self-silencing. This concept analysis used a modified version of Walker & Avant's method to identify attributes, antecedents, and consequences of self-silencing. Self-silencing has psychological and sociocultural dimensions that may result in negative health consequences. Directions for research, practice, and policy are included.

Impulsivity, Sexual Compulsivity, and Sexual Risk Behaviors among Hispanic Men Who Have Sex with Men in a US-Mexico Border City.

Hispanic men who have sex with men (HMSM) experience HIV risk-related and mental health disparities. The relationship of mental health (i.e., depressive symptoms and anxiety) on sexual risk behaviors of HMSM has been reported. However, little is known about the influence of impulsivity and compulsivity on sexual risk behaviors. A cross-sectional study explored these factors among 150 HMSM in the El Paso, Texas area utilizing standardized measures, in a cross-sectional study. Regression analysis determined the influence of sexual impulsivity and compulsivity, and demographic variables on sexual risk behaviors, indicating interventions should target these behaviors to mitigate sexual risk among HMSM.

Hispanic Mother-Daughter Communication About the Risks of Sex, Drugs, and Alcohol: Influences and the Strategies Mothers Use.

PURPOSE: U.S. Hispanic adolescents are at risk for negative health outcomes due to risk-taking behaviors involving sex, drugs, and alcohol. Mother-daughter communication can reduce these risk-taking behaviors and reinforce parents' expectations. The purpose of this study was to explore mothers' descriptions of their communication about risk-taking behaviors with their early adolescent Hispanic daughters. DESIGN AND METHODS: This qualitative descriptive study involved focus groups with 21 Hispanic mothers of 7th grade (12-14 years old) girls. Conventional content analysis was conducted to identify the strategies they used during these conversations. RESULTS: Strategies mothers used included warning, focusing on negative consequences, creating opportunities to express maternal expectations, and stressing the importance of positive influences. Communication was also influenced by daughters' physical development and social media. CONCLUSIONS: The mothers were concerned about their daughters' exposure to risk-taking behaviors but were unsure about how to talk to their daughters about how to avoid them, particularly regarding topics related to sex. PRACTICE IMPLICATIONS: Our study results have implications on how to facilitate parent-child conversations about risk-taking behaviors and to equip mothers and parents to teach their children how to avoid engaging in these behaviors.

Psychological Trauma in the Context of Intimate Partner Violence: A Concept Analysis.

A comprehensive understanding of psychological trauma in the context of intimate partner violence (IPV) is relevant for nurses and other healthcare providers to provide better care for individuals and families confronting this issue. A concept analysis based on Walker and Avant was conducted to fully understand this concept and its impact on physical and mental health. This concept analysis demonstrates that psychological trauma in the IPV context is an intricate multi-faceted concept that can have a significant long-term effect on individuals who have experienced IPV. The concept's attributes, antecedents, and consequences identified in this concept analysis will contribute to guiding practice, research, education, and policy development aimed to address the trauma affecting individuals and families in the context of IPV.

End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model.

BACKGROUND: Conceptual ambiguities prevent advancements in end-of-life decision making in clinical practice and research. PURPOSE: To clarify the components of and stakeholders (patients, caregivers, healthcare providers) involved in end-of-life decision making in the context of chronic life-limiting disease and develop a conceptual model. METHOD: Walker and Avant's approach to concept analysis. FINDINGS: End-of-life decision making is a process, not a discrete event, that begins with preparation, including decision maker designation and iterative stakeholder communication throughout the chronic illness (antecedents). These processes inform end-of-life decisions during terminal illness, involving: 1) serial choices 2) weighed in terms of potential outcomes 3) through patient and caregiver collaboration (attributes). Components impact patients' death, caregivers' bereavement, and healthcare systems' outcomes (consequences). DISCUSSION: Findings provide a foundation for improved inquiry into and measurement of the end-of-life decision making process, accounting for the dose, content, and quality the antecedent and attribute factors that collectively contribute to outcomes.

The Relationship of Hispanic Cultural Factors and Sexual Behaviors of Hispanic Men who have Sex with Men.

Background/Significance: Hispanics are the largest ethnic minority group in the U.S., and account for 21% of new cases of HIV infection. Previous researchers have examined the relationship of Hispanic cultural factors and the sexual behaviors of Hispanic men who have sex with men (HMSM). However, the exact influence of Hispanic culture factors on the sexual behaviors of these men is currently unclear. Objective: The purpose of this study was to investigate the relationship of selected Hispanic cultural factors and the sexual behaviors of a sample of HMSM. Method: A descriptive, cross-sectional design was used to collect data from 125 Hispanic men in Miami-Dade County, FL. Participants completed standardized measures of Hispanic cultural factors, sexual behaviors, and a demographic questionnaire. Results: Statistically significant positive correlations were noted between age and total cultural constructs, familism, personalism, and machismo. Statistically significant negative correlations were noted between education and total cultural constructs, and education and fatalism. No statistically significant correlation coefficients were noted between total cultural constructs and total sexual behaviors. However, statistically significant positive correlations were noted between condom use and personalism, and assertiveness and personalism. A statistically significant negative correlation was noted between familism and anal sex. Implications: Nurses and other clinicians providing care for HMSM need awareness of certain Hispanic cultural factors (personalism and familism) that may be related to sexual behaviors among HMSM. More research is needed to understand how personalism and familism may be used as protective factors to decrease sexual risk of HMSM.

Suicide Lethality: A Concept Analysis.

PURPOSE: Suicide is a significant health problem internationally. Those who complete suicide may have different behaviors and risk factors than those who attempt a non-fatal suicide. The purpose of this article is to analyze the concept of suicide lethality and propose a clear definition of the concept through the identification of antecedents, attributes, and consequences. METHODS: A literature search for articles published in the English language between 1970 and 2016 was conducted using MEDLINE, the Cochrane Library, Pubmed, Psychlit, Ovid, PsycINFO, and Proquest. The bibliographies of all included studies were also reviewed to identify additional relevant citations. A concept analysis was conducted on the literature findings using six stages of Walker and Avant's method. FINDINGS: The concept analysis differentiated between suicide, lethality, suicidal behavior, and suicide lethality. Presence of a suicide plan or a written suicide note was not found to be associated with the majority of completed suicides included in the definition of suicide lethality. There are a few scales that measure the lethality of a suicide attempt, but none that attempt to measure the concept of suicide lethality as described in this analysis. CONCLUSIONS: Clarifying the concept of suicide lethality encourages awareness of the possibility of different suicidal behaviors associated with different suicide outcomes and will inform the development of future nursing interventions. A clearer definition of the concept of suicide lethality will guide clinical practice, research, and policy development aimed at suicide prevention.

Negotiated safety - components, context and use: an integrative literature review.

AIM: The aim of this study was to examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept. BACKGROUND: There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood. DESIGN: Integrative review of empirical and theoretical literature. DATA SOURCES: The Cumulative Index for Nursing and Allied Health Literature (CINAHL) MEDLINE and PsychINFO electronic databases were accessed. REVIEW METHODS: Articles were read to gain a historical context of the term and identify varying interpretations of the concept. Factors warranting consideration in association with NS were identified and clinical and public health implications were noted. RESULTS: Forty-eight studies were reviewed. Negotiated safety included the following components: (i) HIV sero-negative concordant men within a primary relationship; (ii) joint HIV screening and mutual disclosure of their HIV status; (iii) explicit relationship boundaries which establish either nonexclusively that allows for the dispensing of condoms within the primary relationship and consistent condom use for extra-dyadic sex; or dispensing of condoms within a primary partnership and exclusivity; and (iv) a breach clause that allows communication to re-establish the agreement if needed. CONCLUSION: Negotiated safety is a prescriptive approach to HIV risk reduction among couples. Researchers and practitioners could benefit from promoting this approach to HIV prevention.

HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida.

OBJECTIVES: Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. DESIGN AND SAMPLE: A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. MEASURES: Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. RESULTS: Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. CONCLUSIONS: More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk.

The Impact of Parental Reaction to Sexual Orientation on Depressive Symptoms and Sexual Risk Behavior Among Hispanic Men Who Have Sex with Men.

PURPOSE: This study examined the relationship of parent reaction to sexual orientation with depressive symptoms and safer sex among Hispanic adult men who have sex with men (MSM). We also examined men's acculturation to the U.S. (Americanism) in relation with these variables. METHOD: Cross-sectional data collected from July 2011 to December 2012, from 125 MSM with a mean age of 43.02years. Instruments included the Perceived Parent Reaction Scale, the Centers for Epidemiological Studies Depression Scale, the Safer Sex Behavior Questionnaire and the Bidimensional Acculturation Scale. Data was analyzed using Hierarchical generalized linear models (GZLM). RESULTS: Among men whose parents knew of their sexual orientation, rejection of son's sexual orientation from mother (p=0.032) and from father (p=0.004) was related to higher number of depressive symptoms. Parent reactions were not directly related to safer sex behaviors. Americanism was associated with lower depressive symptoms (p=0.001) but was not related to safer sex behaviors. CONCLUSIONS: Current parent attitudes about their sons' sexual orientation had an effect on the sons' emotional wellbeing and acculturation may play a protective role. Mental health and primary care clinicians working with Hispanic MSM should assess for level of family support and provide resources to assist with disclosure and family acceptance of sexual orientation as indicated, particularly among recently immigrated men who may be at higher risk.

A Comparison of Sexual Relationships among Hispanic men by Sexual Orientation: Implications for HIV/STI Prevention.

Background: Hispanic men experience high rates of HIV infection and other sexually transmitted infections (STIs) when compared to non-Hispanic whites. Many factors contribute to HIV/STI risk among Hispanic men. Some researchers have suggested that primary relationships may be a source of HIV/STIs because some men engage in sexual relationships outside of the primary relationship. However, little is known about this among Hispanic men, and less is known about how sexual relationships differ by sexual orientation. Purpose: The purpose of this study was two-fold: 1) to determine if Hispanic men engage in sexual relationships outside of primary relationships; and 2) to compare sex outside of primary relationships by sexual orientation. Methods: Data for this study were obtained from a larger study that investigated health risks of Hispanic men residing in the U.S.-Mexico border community. Participants were recruited from agencies that provided services to Hispanic men. Participants completed a structured interview that included questions about primary relationships and sex outside of primary relationships. The sample consisted of 103 Hispanic men (50 heterosexual, 43 gay, and 10 bisexual Hispanic men), but two participants refused to answer relationship questions, resulting in a sample of 101 Hispanic men. Results: About one-third of the participants (n =29) reported sex outside of the primary relationship, but no differences were found between the gay/bisexual and heterosexual men, X 2 (2, N = 101) = 9.91, p = .128. More gay/bisexual men reported sex with the primary partner and another person at the same time than heterosexual men, X 2 (2, N = 101) = 13.32, p = .010. More gay/bisexual men reported open relationships when compared to heterosexual men, X 2 (2, N = 101) = 17.23, p = .008, and more gay/bisexual men reported sex outside the primary relationship without the primary partner's knowledge, X 2 (2, N = 101) = 15.09. p = .020. However, more heterosexual men reported that condoms were not used for sex outside the primary relationship when compared to gay/bisexual men, X 2 (2, N = 101) = 14.01, p = .029. Implications for Practice: Sex outside of primary relationships presents some implications for HIV/STI prevention among Hispanic men. Because gay/bisexual men experience higher rates of HIV/STI, more attention needs to be focused on all forms of relationships to prevent acquisition of HIV/STIs. Among heterosexual Hispanic men more attention needs to be given to reinforcement of safer sex practices both outside the primary relationship, and within the primary relationship if high risk sex is occurring outside the primary relationship. More research is needed on the reasons for sex outside the primary relationship among Hispanic men, as well as research to promote safer sex practices when sex occurs outside of the primary relationship.

The contribution of stress, cultural factors, and sexual identity on the substance abuse, violence, HIV, and depression syndemic among Hispanic men.

OBJECTIVES: The purpose of this study was to confirm the substance abuse, violence, HIV, and depression syndemic among Hispanic men, and to test whether stress and sociocultural factors, including acculturation, family support, and sexual orientation, predict this syndemic. METHOD: A cross-sectional survey was administered to 164 Hispanic men using standardized measures for Hispanic Stress (Cervantes, Padilla, & Salgado de Snyder, 1991), substance abuse (Kelly et al., 1994), violence (Peragallo et al., 2005), risk for HIV (González-Guarda, Peragallo, Urrutia, Vasquez, & Mitrani, 2008), and depression (Center for Epidemiologic Studies Scale, CES-D; Radloff, 1977). RESULTS: Results from Structural Equation Modeling (SEM) supported the syndemic factor among Hispanic men. While family/cultural stress and homosexual identity were risk factors for the syndemic factor, family support was protective. CONCLUSIONS: More longitudinal research is needed to identify influences on the syndemic factor among diverse Hispanic communities. Interventions that address stress and enhance family supports may show promise in addressing and preventing syndemics among Hispanic men. (PsycINFO Database Record

Physical, psychosocial, and social health of men who identify as bears: a systematic review.

AIMS AND OBJECTIVES: This article examines the existing qualitative and quantitative research on physical, psychosocial and social health of men who identify as Bears, a subcultural group in the gay community. BACKGROUND: During the 1980s, one of the first Bear communities emerged in San Francisco. Using the United States as an example, other Bear communities were created throughout the world. Today, Bear-related organizations and events are found globally. METHODS: A systematic review was conducted exploring the health of men who identify as Bears. DESIGN: To identify articles addressing the health outcomes of men who identify as Bears, the researcher systematically reviewed articles indexed through CINAHL, PsycINFO, Humanities International Index, Cochrane Library, Medline, and LGBT Life. RESULTS: The major findings across the 11 articles were systematically grouped into physical, psychosocial, and social health categories. Men identifying as Bears were more likely to have a higher body mass index, engage in risky sexual behaviours and have a lower self-esteem. CONCLUSIONS: Future implications for research and practice regarding the health of men who identify as Bears are addressed. RELEVANCE TO CLINICAL PRACTICE: Men who identify as Bears have unique health care needs and respond to health care providers who are sensitive towards their needs. Health care providers should understand and acknowledge the unique health needs of men who identify as Bears to better care for these men.

Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

BACKGROUND: Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. PURPOSE: The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. METHOD: A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. RESULTS: Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). CONCLUSIONS: Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol.

Integration versus disintegration: a grounded theory study of adolescent and young adult development in the context of perinatally-acquired HIV infection.

Adolescents/young adults with perinatally-acquired HIV infection experience a number of issues that impact developmental tasks. No study to date has described the process by which this occurs. The purpose of this grounded theory study was to describe the process by which HIV infection impacts adolescent/young adult development. Interviews were conducted and analyzed with 25 participants age 18 to 24. Six core categories emerged that were used to generate a theory, integration versus disintegration, that describes how perinatal HIV impacts participants' development. The results of this study provide unique clinical considerations for pediatric and adult clinicians providing care for this population.

Multidimensional Frailty, Quality of Life and Self-Management in Aging Hispanics Living With HIV.

An observational cross-sectional study was conducted to examine multidimensional frailty and its potential impact on quality of life (QOL) in aging Hispanic people living with HIV (PLWH) and assess the extent to which HIV self-management moderates this association. The sample included 120 Hispanic PLWH aged 50 years and older (M = 59.11; SD = 7.04). The structural equation modeling analyses demonstrated that multidimensional frailty was significantly related to QOL in its two dimensions, physical and mental (p < .001). The relationship between multidimensional frailty and mental and physical QOL remained significant even after controlling for confounders (age and gender). The moderator analyses indicated no statistically significant moderator effect of HIV self-management on multidimensional frailty and mental or physical QOL. These study results have practical implications that highlight the need for early screening for frailty with a multidimensional focus. Age-appropriate and culturally tailored interventions to prevent or mitigate multidimensional frailty may improve QOL.

Feasibility and acceptability of SEPA+PrEP: An HIV prevention intervention to increase PrEP knowledge, initiation, and persistence among cisgender heterosexual Hispanic women.

The HIV epidemic disproportionately affects Hispanics in the U.S., with Hispanic women (HW) accounting for 18% of new HIV diagnoses in 2019 despite comprising only 16% of the female population. The imbalance of power related to cultural values and HW's lack of knowledge and low perception of risk for HIV interferes with prevention efforts (e.g., condom use, HIV testing, and Pre-Exposure Prophylaxis [PrEP]). It is estimated that in 2019, only 10% of women in the U.S. who could benefit from PrEP were given prescriptions for it. This number is estimated to be significantly lower among HW. PrEP is highly effective for preventing HIV, reducing the risk of acquiring HIV from sexual activity by about 99%. To respond to this need, we developed SEPA+PrEP, a biobehavioral HIV prevention intervention that adapted and integrated SEPA (Salud/Health, Educación/Education, Prevención/Prevention, Autocuidado/Self-Care), an empirically validated behavioral HIV prevention intervention, with the evidence-based biomedical strategy of PrEP. This study aimed to investigate the feasibility and acceptability of SEPA+PrEP among cisgender heterosexual Hispanic women (HW). We used a mixed methods approach to gather data from 44 HW living in the City of Homestead and its surrounding communities in Miami-Dade County, Florida. None of the participants knew about PrEP prior to participating in the study, and the majority (70.5%, n = 23) had not used condoms when engaging in vaginal sex during the previous three months. Overall, study results suggest that SEPA+PrEP is an acceptable and feasible intervention to prevent HIV among HW, with a focus on PrEP knowledge, initiation, and maintenance.