Gladys E. Ibañez

Sex Differences in Symptoms of Posttraumatic Stress: Does Culture Play a Role?

If gender differences in posttraumatic stress disorder follow from culturally-defined roles and rules, they should be greater in societies that foster traditional views of masculinity and femininity than in societies that adhere to these traditions less rigidly. Data were collected 6 months after Hurricanes Paulina (Acapulco; N = 200) and Andrew (Miami; White n = 135; Black n = 135). In regression analyses predicting scores on the Revised Civilian Mississippi Scale, Sex × Cultural Group interactions emerged for the total scale and for subscales of Intrusion, Avoidance, and Remorse. Only a sex main effect (women higher) emerged for Arousal. Overall, the results indicated that Mexican culture amplified, whereas African American culture attenuated, differences in the posttraumatic stress of male and female disaster victims.

Sexual risk substance use and psychological distress in HIV-positive gay and bisexual men who also inject drugs.

Objectives:Gay and bisexual men and injection drug users (IDU) are the two main groups at risk of HIV exposure in the United States, but few studies have focused on the intersection of these two groups. Little is known about HIV-positive gay and bisexual IDU. The aim of this study is to identify and compare differences in HIV transmission risk behaviors and psychological distress in HIV-positive gay and bisexual men by injection versus non-injection drug use. Methods:Data were from the baseline assessment of a randomized controlled trial of an HIV prevention intervention for HIV-positive gay and bisexual men. Results:Of the 1168 men, 236 (20%) reported injection drug use, 500 (43%) reported only non-injection drug use, and 422 (36%) reported no drug use. More of the IDU reported having sex with women, and identified themselves as ‘barebackers’ (i.e. men who intentionally have unprotected anal intercourse). IDU reported more unprotected sexual behaviors than men who did not use drugs, but their sexual risk behaviors were similar to those of men who used non-injection drugs. IDU, compared with other drug users, reported more use of non-injected methamphetamine, amphetamine, barbiturates, and gamma hydroxybutyrate. More IDU, compared with the other two groups, reported sexual abuse, anxiety, and hostility. Conclusion:HIV-positive gay and bisexual IDU are a distinct group from other HIV-positive gay and bisexual men. Prevention case management and interventions that help men cope with multiple health concerns and prevent HIV transmission are needed for this population.

Ecological and Ethical Perspectives on Filial Responsibility: Implications for Primary Prevention with Immigrant Latino Adolescents

This article considers processes from an ecological-ethical viewpoint that may help explain the high rate of school failure and dropout of immigrant Latino adolescents. Drawing from research on filial responsibility and risk and protective processes in this population, a conceptual model is presented that accounts for both negative and positive developmental outcomes. For example, it is speculated that different stressors linked to immigration (e.g., poverty, discrimination) occasion a marked increase in filial responsibility (e.g., assuming the role of interpreter and liaison to the English speaking community, working to earn money for the family) that may compete with other sociocognitive tasks, such as schooling and peer involvement. Yet, Latino youths who perform major caregiving tasks in the family also appear to derive an increased sense of personal and interpersonal competence. The implications of the model for research and prevention programming are discussed.

Acculturative Stress and Diminishing Family Cohesion Among Recent Latino Immigrants

This study investigates a theorized link between Latino immigrants’ experience of acculturative stress during their two initial years in the United States (US) and declines in family cohesion from pre- to post-immigration contexts. This retrospective cohort study included 405 adult participants. Baseline assessment occurred during participants’ first 12 months in the US. Follow-up assessment occurred during participants’ second year in the US. General linear mixed models were used to estimate change in family cohesion and sociocultural correlates of this change. Inverse associations were determined between acculturative stress during initial years in the US and declines in family cohesion from pre-immigration to post-immigration contexts. Participants with undocumented immigration status, those with lower education levels, and those without family in the US generally indicated lower family cohesion. Participants who experienced more acculturative stress and those without family in the US evidenced a greater decline in family cohesion. Results are promising in terms of implications for health services for recent Latino immigrants.

Qualitative analysis of coping strategies among mexican disaster survivors

This study describes the various coping strategies reportedly used by survivors after a disaster. Using unstructured interviews, 27 Mexicans (16 women, 11 men) were asked to recount how they coped with a specific disaster and its aftermath. Interviews were carried out in three cities: Guadalajara, Jalisco (n=10), Homestead, Florida (n=6) and Puerto Angel, Oaxaca (n=11). Guadalajara experienced a neighbourhood sewer explosion, whereas Homestead and Puerto Angel experienced Hurricane Andrew and Hurricane Paulina, respectively. Analysis of common themes revealed seeking support, seeking meaning, problem solving, and avoidance as primary coping strategies in all three cities. Seeking support was the most commonly cited coping strategy. Seeking support may be a universal coping strategy for disaster survivors, whereas other coping strategies varied by context-specific factors such as type of disaster, resource availability, and stage of disaster recovery. Implications for future coping research and interventions are discussed.

Alcohol use severity and depressive symptoms among late adolescent Hispanics: testing associations of acculturation and enculturation in a bicultural transaction model

Research has indicated that Hispanics have high rates of heavy drinking and depressive symptoms during late adolescence. The purpose of this study was to test a bicultural transaction model composed of two enthnocultural orientations (acculturation and enculturation); and stressful cultural transactions with both the U.S. culture (perceived ethnic discrimination) and Hispanic culture (perceived intragroup marginalization) to predict alcohol use severity and depressive symptoms among a sample of 129 (men=39, women=90) late adolescent Hispanics (ages 18-21) enrolled in college. Results from a path analysis indicated that the model accounted for 18.2% of the variance in alcohol use severity and 24.3% of the variance in depressive symptoms. None of the acculturation or enculturation domains had statistically significant direct effects with alcohol use severity or depressive symptoms. However, higher reports of ethnic discrimination were associated with higher reports of alcohol use severity and depressive symptoms. Similarly, higher reports of intragroup marginalization were associated with higher depressive symptoms. Further, both ethnic discrimination and intragroup marginalization functioned as mediators of multiple domains of acculturation and enculturation. These findings highlight the need to consider the indirect effects of enthnocultural orientations in relation to health-related outcomes.

Racial residential segregation and risky sexual behavior among non-Hispanic blacks, 2006–2010

Sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) have disproportionately affected the non-Hispanic black population in the United States. A persons community can affect his or her STI risk by the communitys underlying prevalence of STIs, sexual networks, and social influences on individual behaviors. Racial residential segregation-the separation of racial groups in a residential context across physical environments-is a community factor that has been associated with negative health outcomes. The objective of this study was to examine if non-Hispanic blacks living in highly segregated areas were more likely to have risky sexual behavior. Demographic and sexual risk behavior data from non-Hispanic blacks aged 15-44 years participating in the National Survey of Family Growth were linked to Core-Based Statistical Area segregation data from the U.S. Census Bureau. Five dimensions measured racial residential segregation, each covering a different concept of spatial variation. Multilevel logistic regressions were performed to test the effect of each dimension on sexual risk behavior controlling for demographics and community poverty. Of the 3643 participants, 588 (14.5%) reported risky sexual behavior as defined as two or more partners in the last 12 months and no consistent condom use. Multilevel analysis results show that racial residential segregation was associated with risky sexual behavior with the association being stronger for the centralization [aOR (95% CI)][2.07 (2.05-2.08)] and concentration [2.05 (2.03-2.07)] dimensions. This suggests risky sexual behavior is more strongly associated with neighborhoods with high concentrations of non-Hispanic blacks and an accumulation of non-Hispanic blacks in an urban core. Findings suggest racial residential segregation is associated with risky sexual behavior in non-Hispanic blacks 15-44 years of age with magnitudes varying by dimension. Incorporating additional contextual factors may lead to the development of interventions that promote healthier behaviors and lower rates of HIV and other STIs.

Disclosure of their HIV status to perinatally infected youth using the adapted Blasini disclosure model in Haiti and the Dominican Republic: preliminary results.

Objectives:To assess the safety, acceptability, and preliminary efficacy of a culturally-adapted disclosure intervention for perinatally HIV-infected combined antiretroviral therapy patients in Haiti and the Dominican Republic. Design:A quasi-experimental trial was conducted comparing caregiver–youth pairs who completed the intervention [adapted Blasini disclosure model (aBDM)] to pairs who discontinued aBDM participation before disclosure. aBDM consists of five components: structured healthcare worker training; one-on one pre-disclosure intervention/education sessions for youth (describing pediatric chronic diseases including cancer, diabetes and HIV) and for caregivers (strengthening capacity for disclosure); a scheduled supportive disclosure session; and one-on-one postdisclosure support for caregivers and youth. Methods:Caregivers of nondisclosed combined antiretroviral therapy patients aged 10.0–17.8 years were invited to participate. Data were collected by separate one-on-one face-to-face interviews of caregivers and youth by study staff and medical record review by pediatricians at enrollment and 3 months after disclosure or after intervention discontinuation. Results:To date, 65 Dominican Republic and 27 Haiti caregiver–youth pairs have enrolled. At enrollment, only 46.4% of youth had viral suppression and 43.4% of caregivers had clinically significant depressive symptomatology. To date, two serious study-related adverse events have occurred. Seven of the 92 (7.6%, 6 in the Dominican Republic) enrolled pairs discontinued participation before disclosure and 39 had completed postdisclosure participation. Median plasma HIV-RNA concentration was lower in youth who completed aBDM than in youth who discontinued participation before aBDM disclosure (<40 versus 8673 copies/ml; P = 0.027). Completers expressed considerable satisfaction with aBDM. Conclusion:Preliminary results suggest safety, acceptability, and possible effectiveness of the aBDM.

‘Love and trust, you can be blinded’: HIV risk within relationships among Latina women in Miami, Florida

ABSTRACT Objectives: Latina women are disproportionately affected by HIV in the US, and account for 30% of all HIV infections in Miami-Dade County, Florida. The main risk for Latina women is heterosexual contact. Little is known about the relational and cultural factors that may impact women’s HIV risk perception. This study aims to describe Latina women’s perception of their HIV risk within a relational, cultural, and linguistic context. Design: Eight focus groups of Latina women (n = 28), four English speaking groups and four Spanish speaking groups, were conducted between December 2013 and May 2014. Women were recruited from a diversion program for criminal justice clients and by word of mouth. Eligibility criteria included the following: self-identify as Hispanic/Latino, 18–49 years of age, and self-identify as heterosexual. A two-level open coding analytic approach was conducted to identify themes across groups. Results: Most participants were foreign-born (61%) and represented the following countries: Cuba (47%), Honduras (17.5%), Mexico (12%), as well as Nicaragua, Puerto Rico, Colombia, and Venezuela (15%). Participant ages ranged between 18 and 49, with a mean age of 32 years. Relationship factors were important in perceiving HIV risk including male infidelity, women’s trust in their male partners, relationship type, and getting caught up in the heat of the moment. For women in the English speaking groups, drug use and trading sex for drugs were also reasons cited for putting them at risk for HIV. English speaking women also reported that women should take more responsibility regarding condom use. Conclusion: Findings emphasize the importance of taking relational and cultural context into account when developing HIV prevention programs for Latina women. Interventions targeting English speaking Latina women should focus on women being more proactive in their sexual health; interventions focused on Spanish speaking women might target their prevention messages to either men or couples.

Condom use preferences among Latinos in Miami-Dade: emerging themes concerning men’s and women’s culturally-ascribed attitudes and behaviours

Among Latinos, cultural values such as machismo and marianismo may promote inconsistent condom use representing a significant risk factor for HIV infection. Yet there continues to be a need for additional research to explore the influence these cultural values have on Latino men and women’s condom use attitudes and behaviours given increasing HIV rates of HIV infection among Latinos. The purpose of this study was to explore further Latino traditional culturally-ascribed attitudes and behaviour for emerging themes toward condom use among a diverse group of adult Latino men and women living in Miami-Dade County, Florida, USA. The study used a qualitative study-design and collected data from 16 focus groups with a total of 67 Latino men and women. Findings from the focus groups described attitudes and behaviours that counter traditional gender roles towards sex and expected sexual behaviours informed by machismo and marianismo. Common attitudes noted in the study include men’s classification of women as dirty-clean to determine condom use and women’s assertiveness during sexual encounters negotiating condom use – in favour and against it. As the findings of this study suggest, the process differ greatly between Latino men and women, having an impact on the risk behaviours in which each engage.