Dorothy Chin

Does a History of Trauma Contribute to HIV Risk for Women of Color? Implications for Prevention and Policy

OBJECTIVES We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. METHODS Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. RESULTS Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. CONCLUSIONS Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.

The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories.

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’’ analysesof pre–post changes are reported here. Additional analyses explored whether theobserved 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 medicationadherence in preventive interventions for women.

Child Sexual Abuse: Associations with the Sexual Functioning of Adolescents and Adults

Abstract As we move into the 21st century, information about sex is widespread and more accessible to the general public than ever before. This interest in sex also increases the focus on symptoms and patterns associated with sexual problems. However, the etiology of sexual dysfunction is multifaceted and poorly understood. One factor that has received growing attention is the role that early sexual abuse plays in sexual development and later sexual functioning, and how these associations differ between males and females. Despite high prevalence rates of child sexual abuse (CSA), which occurs to approximately 1 in 3 females and 1 in 10 males under the age of 18, we do not completely understand the complexities of how and to what extent CSA affects sexual functioning. Nonetheless, the research highlights the need to recognize the potentially powerful influence that abusive childhood experiences contribute to sexual health, performance, and satisfaction. We review research on the relationship between CSA and adolescent and adult sexual functioning. We use a developmental framework to guide our understanding of the effects of CSA, as well as gender and ethnic differences, on the sexual functioning of male and female survivors.

Examining Patterns of Vulnerability to Domestic Violence Among African American Women

The study discussed in this article explored the relationship between child abuse and neglect, other traumatic events, background variables, and HIV status as they relate to the continuum of conflict in adulthood, specifically verbal conflict and physical abuse that can increase womens risk for domestic violence. The sample included 135 African American women, ages 19 to 61, of mixed HIV serostatus. Almost half of the women reported both physical and verbal conflict and moderate to severe levels of physical abuse with current or recent intimate partners. Simple correlations and multiple regressions revealed that women with histories of child abuse were more likely to experience partner violence as adults. Other traumatic events were not associated with partner violence. Income and HIV status were related to specific patterns of partner violence. The influence that early experiences have on African American women eventually entering abusive adult intimate relationships is discussed.

Factors Affecting HIV Contraceptive Decision-Making Among Women

We examined contraceptive decision-making among African American, Latina, and European American women ages 18–50 years. Logistic regressions examined relationships between demographic and religious factors, unintended pregnancies, sexually transmitted diseases (STDs), reasons for sex, and contraceptive decision-making. Women who were older, single, African American, used pregnancy prevention, and had histories of STDs and unintended pregnancies made contraceptive decisions alone. Older and African American women were more likely to choose no contraception. Among contraceptive users, African Americans used effective methods of pregnancy, but not disease, prevention. Women with STD histories, and younger, more educated women were more likely to use methods that prevent against both pregnancy and disease. Theoretical implications about contraceptive choices among ethnically diverse women are discussed.

Severity of Child Sexual Abuse, Post- Traumatic Stress and Risky Sexual Behaviors Among HIV-Positive Women

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.

Cumulative Burden of Lifetime Adversities: Trauma and Mental Health in Low-SES African Americans and Latino/as

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.

Psychosocial and contextual predictors of educational and occupational self-efficacy among Hispanic inner-city adolescents

This study investigated psychosocial and contextual predictors of self-efficacy beliefs about educational and occupational attainment among Hispanic adolescents living in the inner-city. Participants were 107 adolescents ages 10 to 13 (mean=11.3 years) recruited from two inner-city elementary schools in Los Angeles via active parental and student consent. Three psychosocial predictors (previous performance; vicarious experience; social persuasion), based on Bandura’s theory ofself-efficacy, and two contextual predictors (neighborhood resources and neighborhood safety) were hypothesized to predict self-efficacy beliefs. Results showed that social persuasion most strongly predicted both educational and occupational expectations. Previous academic performance, represented by reading score, was related to educational but not occupational expectations. Vicarious experience in the form of family attainment did not predict educational nor occupational expectations. Contextual predictors were also unrelated to both domains of expectations. Results suggest that self-efficacy beliefs of adolescents growing up in inner-city environments can be influenced by the messages they receive from significant others as well as by their prior experiences.

Violence prevention among HIV-positive women with histories of violence: healing women in their communities.

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 Womens 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.

Pathways to Sexual Risk Reduction: Gender Differences and Strategies for Intervention

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.