Jennifer Vargas Carmona

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 prevalence and circumstances of child sexual abuse: changes across a decade

OBJECTIVE This study reports the prevalence of child sexual abuse of African American and European American women and compares the circumstances of these incidents to data collected a decade ago. METHOD Stratified probability sampling was used to recruit comparable samples of African American and European American women in Los Angeles County for a larger study of womens sexual decision making. Incidents of contact abuse were obtained from women 18 to 36 years old in 1994 and compared to women with those demographic characteristics from a comparable 1984 dataset. The prevalence of abuse, characteristics of the victim, assault, alleged perpetrator, disclosure, and long-term effects by ethnic group affiliation were assessed. RESULTS Of the total sample, 34% reported at least one incident prior to age 18. Ethnic differences were found with respect to prevalence, location of abuse, and number of incidents of rape. While comparisons made with the 1984 dataset revealed no significant difference in prevalence rates over the 10 year period, changes in circumstances were noted. CONCLUSIONS Although the prevalence of child sexual abuse in Los Angeles County remained fairly stable, several circumstances of abuse underwent change. These characteristics are discussed in relation to how sexual abuse among ethnically diverse samples in Los Angeles County has changed over a decade and how these differences can help better tailor prevention messages to different communities.

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.

Acculturation, Sexual Risk Taking, and HIV Health Promotion among Latinas.

Latinas are nearly 3 times more likely to acquire AIDS than other women in the United States. It is critical to understand this vulnerability and to identify predictors of risk. Structural equation models were used to test predictors mediators (including components of the health belief model) and sex-related outcomes and behavior. Interview data were collected from a random cross-sectional community sample of 227 sexually active Latinas (M age = 32 years). Acculturation was associated with higher HIV-related risks within primary relationships. Older Latinas were less likely than younger Latinas to make behavior changes or use barrier methods of contraception to prevent HIV and they had higher rates of unintended pregnancies. Marriage was related to greater relationship risk and less behavior change. Theoretical models must account for ethnicity race and culture to understand better unwanted sexual outcomes for Latinas including HIV risks. Strategies are needed that specifically address these issues in HIV prevention and counseling programs. (authors)

The Prevalence and Circumstances of Child Sexual Abuse among Latina Women

This study examined the prevalence and circumstances of child sexual abuse in a community sample of Latina women, 18 to 50 years of age. Chi-square tests of independence and t-test procedures were used to assess the prevalence, characteristics of the victim, assault, perpetrator, disclosure, and long-term effects. One in three Latina women reported incidents of sexual abuse, regardless of acculturation or citizenship status. More than one third of the women also experienced revictimization, with more than 80% of initial incidents occurring from the age of 7 years. The majority of the experiences occurred in private locations, by young male perpetrators, known to the victim. Four women were forced to marry perpetrators of their abuse. Treatment implications and community-based interventions for Latina survivors of child sexual abuse are 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.

Childhood sexual abuse severity and disclosure predict posttraumatic stress symptoms and biomarkers in ethnic minority women.

Objective: Adult posttraumatic stress symptoms and a biomarker index of current health risk in childhood sexual abuse (CSA) survivors were investigated in relation to CSA severity, disclosure, and other peri- and post-trauma factors. Method: A community sample of 94 African American and Latina female CSA survivors was assessed. Results: Severe CSA predicted posttraumatic stress symptoms overall, avoidance/numbing symptoms, and greater biomarker risk and was not mediated by post-trauma variables. Moderate CSA severity was mediated by post-trauma disclosure, predicted reexperiencing symptoms, but was unrelated to biomarker risk. No overall ethnic differences were found. Conclusion: Results suggest targets for interventions to improve the well-being of minority women CSA survivors