Hector F. Myers

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.

Drug Use and Medication Adherence among HIV-1 Infected Individuals

This longitudinal study examined the impact of drug use and abuse on medication adherence among 150 HIV-infected individuals, 102 who tested urinalysis positive for recent illicit drug use. Medication adherence was tracked over a 6-month period using an electronic monitoring device (MEMS caps). Over the 6-month study drug-positive participants demonstrated significantly worse medication adherence than did drug-negative participants (63 vs. 79%, respectively). Logistic regression revealed that drug use was associated with over a fourfold greater risk of adherence failure. Stimulant users were at greatest risk for poor adherence. Based upon within-participants analyses comparing 3-day adherence rates when actively using versus not using drugs, this appears to be more a function of state rather than trait. These data suggest that it is the acute effects of intoxication, rather than stable features that may be characteristic of the drug-using populace, which leads to difficulties with medication adherence.

A Multidimensional Measure of Cultural Identity for Latino and Latina Adolescents

Many scales are available to measure acculturation. Unfortunately, most rely on a single indicator scale and fail to consider biculturality. Therefore, the multidimensional and multifaceted aspects of the complex phenomenon of cultural identity have not been adequately appreciated or assessed. Latino(a) college students (N = 130) responded to multiple items regarding language use, values/attitudes, behavior, and familiarity with aspects of American and Latino/a culture. Using exploratory factor analyses with oblique factor rotation, 10 interpretable and reliable factors were identified and compared to other criteria. The cultural identity scales included: Three for language, four for behavior/familiarity, and three for values/attitudes. Behavior and language differentiated between highly bicultural individuals, Latino/a identified, American identified, and low-level biculturals.

Ethnicity- and socio-economic status-related stresses in context: an integrative review and conceptual model

There continues to be debate about how best to conceptualize and measure the role of exposure to ethnicity-related and socio-economic status-related stressors (e.g. racism, discrimination, class prejudice) in accounting for ethnic health disparities over the lifecourse and across generations. In this review, we provide a brief summary of the evidence of health disparities among ethnic groups, and the major evidence on the role of exposure to ethnicity- and SES-related stressors on health. We then offer a reciprocal and recursive lifespan meta-model that considers the interaction of ethnicity and SES history as impacting exposure to psychosocial adversities, including ethnicity-related stresses, and mediating biopsychosocial mechanisms that interact to result in hypothesized cumulative biopsychosocial vulnerabilities. Ultimately, group differences in the burden of cumulative vulnerabilities are hypothesized as contributing to differential health status over time. Suggestions are offered for future research on the unique role that ethnicity- and SES-related processes are likely to play as contributors to persistent ethnic health disparities.

Race, racism and health: disparities, mechanisms, and interventions

The goals of this special section are to examine the state-of-the-science regarding race/ethnicity and racism as they contribute to health disparities and to articulate a research agenda to guide future research. In the first paper, Myers presents an integrative theoretical framework for understanding how racism, poverty, and other major stressors relate to health through inter-related psychosocial and bio-behavioral pathways. Williams and Mohammed review the evidence concerning associations between racism and health, addressing the multiple levels at which racism can operate and commenting on important methodological issues. Klonoff provides a review and update of the literature concerning ethnicity-related disparities in healthcare, and addresses factors that may contribute to these disparities. Brondolo and colleagues consider racism from a stress and coping perspective, and review the literature concerning racial identity, anger coping, and social support as potential moderators of the racism-health association. Finally, Castro and colleagues describe an ecodevelopmental model that can serve as an integrative framework to examine multi-level social–cultural influences on health and health behavior. In aggregate, the special section papers address theoretical and methodological issues central to understanding the determinants of health disparities, with the aim of providing direction for future research critical to developing effective interventions to reduce these disparities.

Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: A small randomized controlled trial

UNLABELLED Mindfulness meditation training has stress reduction benefits in various patient populations, but its effects on biological markers of HIV-1 progression are unknown. The present study tested the efficacy of an 8-week Mindfulness-based stress reduction (MBSR) meditation program compared to a 1-day control seminar on CD4+ T lymphocyte counts in stressed HIV infected adults. A single-blind randomized controlled trial was conducted with enrollment and follow-up occurring between November 2005 and December 2007. A diverse community sample of 48 HIV-1 infected adults was randomized and entered treatment in either an 8-week MBSR or a 1-day control stress reduction education seminar. The primary outcome was circulating counts of CD4+ T lymphocytes. Participants in the 1-day control seminar showed declines in CD4+ T lymphocyte counts whereas counts among participants in the 8-week MBSR program were unchanged from baseline to post-intervention (time x treatment condition interaction, p=.02). This effect was independent of antiretroviral (ARV) medication use. Additional analyses indicated that treatment adherence to the mindfulness meditation program, as measured by class attendance, mediated the effects of mindfulness meditation training on buffering CD4+ T lymphocyte declines. These findings provide an initial indication that mindfulness meditation training can buffer CD4+ T lymphocyte declines in HIV-1 infected adults. CLINICAL TRIALS REGISTRATION clinicaltrials.gov, Identifier: NCT00600561.

Development of the Multidimensional Acculturative Stress Inventory for adults of Mexican origin.

The Multidimensional Acculturative Stress Inventory (MASI), a 36-item stress measure that was developed to assess acculturative stress among persons of Mexican origin living in the United States, was tested on a community sample of 174 adults (117 women, 57 men). Principal-components analyses yielded 4 stable and internally consistent factors: Spanish Competency Pressures (7 items), English Competency Pressures (7 items), Pressure to Acculturate (7 items), and Pressure Against Acculturation (4 items). These 4 factors accounted for 64.4% of the variance and correlated in the expected directions with criterion measures of acculturation and/or psychological adjustment. Further reliability and validity testing of the MASI is discussed as well as the utility of this measure in assessing acculturative stress among adults of Mexican origin.

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.

Family or Friends: Who Plays a Greater Supportive Role for Latino College Students?.

This study compared the relative contribution of perceived family and friend support to psychological well-being and distress and examined whether family or friend support moderated the effects of stress on psychological adjustment in 338 Latino (228 Mexican American, 110 Central American) college students from a predominantly Latino university. Two multiple regressions, controlling for gender, socioeconomic level, acculturation level, and stresses (generic college, acculturative, and minority status), showed that friend support made a slightly greater contribution to well-being than family support, and friend support and not family support protected against psychological distress. Neither family nor friend support moderated the effects of stress on psychological adjustment. Further examination of these variables that assess common-specific stresses within a culture-specific theoretical framework is recommended.

Correlates of suicidal behaviors among Asian American outpatient youths.

Medical record abstraction was conducted at an ethnic-specific mental health outpatient clinic to identify correlates of suicidal behaviors in a sample of 285 Asian American youths. Some risk factors, such as parent-child conflict and age, which have been associated with suicidality in majority group youths, predicted suicidality in this sample, whereas other risk factors, such as gender, did not generalize to this sample. Acculturation interacted with the risk factor of parent-child conflict to predict suicidality. Less acculturated Asian youths were at proportionally greater risk for suicidality under conditions of high parent-child conflict than were their more acculturated counterparts. This finding underscores the importance of culture as a context for determining the relevance of stressors for potentiating psychopathology.