Joseph P. De Santis

HIV Infection Risk Factors Among Male-to-Female Transgender Persons: A Review of the Literature

Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.

Development of a protocol for transitioning adolescents with HIV infection to adult care.

As HIV infection in childhood and adolescence has evolved from a terminal to a chronic illness, new challenges are posed for both medical and psychosocial teams serving these clients. Although specialized programs for transition to adult care have been reported for persons with cystic fibrosis, diabetes mellitus, sickle cell disease, and other chronic illnesses, there are few published reports of integral programs designed to transition adolescents who were infected with HIV during the adolescent period to adult HIV services. This article describes a model of transition from a University-based, federally funded adolescent HIV program to adult HIV services, addresses barriers to transition, and provides strategies and recommendations for improving adherence to the transition process.

The relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly hispanic sample of men who have sex with men

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM (M = 37 years of age, SD = ±8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.

La Mancha Negra: Substance Abuse, Violence, and Sexual Risks Among Hispanic Males

Hispanics are disproportionately affected by substance abuse, intimate partner violence, and HIV. Although the relationship between these conditions has been documented in the literature, few studies have explored the intersection of these health problems and their culture-related risk factors in an integrative manner. The purpose of this study is to explore the experiences that Hispanic heterosexual males in South Florida have with substance abuse, violence, and risky sexual behaviors. Three focus groups with a total of 25 Hispanic adult men are completed and analyzed using grounded theory. Three core categories emerge from the data. These include la cuna de problemas sociales (the cradle of social problems), ramas de una sola mata (branches from one same tree), and la mancha negra (the black stain). This study suggests that substance abuse, violence, and risky sexual behaviors are linked conditions with common cultural and socioenvironmental risk factors and consequences.

Exploring the Concept of HIV‐Related Stigma

BACKGROUND.  HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE.  Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS.  Search engines were employed to review the existing knowledge base of this concept. CONCLUSION.  After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included.BACKGROUND HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS Search engines were employed to review the existing knowledge base of this concept. CONCLUSION After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included.

Acculturation, Depression, Self-Esteem, and Substance Abuse among Hispanic Men

The demographics of the United States are rapidly changing as a result of immigration from Latin America. Predictions indicate that by the year 2050, one of every four persons in the United States will be of Hispanic ethnicity. If health disparities relating to substance abuse and related mental health conditions among Hispanics are not fully understood and addressed, these will continue grow along with this population. The purpose of this pilot study was to describe the relationships among acculturation, depression, self-esteem, and substance abuse among a community sample of Hispanic men in South Florida (N = 164, 82 heterosexual men and 82 men who have sex with men). Standardized instruments measuring acculturation, depression, self-esteem, and substance abuse were administered in English or Spanish in a face-to-face interview format. Descriptive statistics and multiple logistic regression were used to illustrate participant characteristics and test relationships among the variables. Despite the fact that the majority of participants were more acculturated to the Hispanic culture than US culture, reported low levels of education and income, were depressed, and used substances, this group of men reported high levels of self-esteem. However, age and depression were the only predictors of substance abuse. Acculturation and self-esteem were not predictors of substance abuse. Clinicians need to be aware of the high rates of depression and substance abuse in this population and screen frequently for signs and symptoms of depression and substance abuse during health care encounters.

Motivation, Management, and Mastery A Theory of Resilience in the Context of HIV Infection

BACKGROUND: Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection. METHOD: Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached. RESULTS: A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data. CONCLUSION: Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection.

Using structural equation modeling to identify predictors of sexual behaviors among Hispanic men who have sex with men.

Hispanic men who have sex with men (MSM) are at risk for HIV and other sexually transmitted infections related to high-risk sexual behaviors. The aim of this study was to test a model that predicts the sexual behaviors of Hispanic MSM that is based on an epidemiologic framework. The results of this study provide some important new information regarding the predictors of sexual behaviors among Hispanic MSM. The final model suggests that mental health is a significant predictor of sexual behaviors in this sample. Major implications for the development of interventions to address high-risk sexual behaviors highlight the need for health care providers and researchers to be cognizant of the influence of mental health issues on sexual behaviors.

Living in Silence: A Grounded Theory Study of Vulnerability in the Context of HIV Infection

Clients with HIV infection have been conceptualized as a vulnerable population. Although some researchers have examined vulnerability with clients with HIV infection, a theory of vulnerability in the context of HIV infection is non-existent. The purpose of this study was to describe, using qualitative methodology, the process by which vulnerability occurs in the context of HIV infection. Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews of adults with HIV infection. Data were collected until data saturation was reached. A theory that describes the process by which vulnerability occurs in the context of HIV infection, Living in Silence, emerged from the data. Living in Silence consists of four categories: Confronting Mortality and Illness, Struggling with Change, Encountering a Lack of Psychosocial Support, and Experiencing Vulnerability. Clients living with HIV experience vulnerability. Nursing interventions to decrease the risks of vulnerability should be directed toward the holistic needs of clients and toward increasing psychosocial support.

How do the sexual behaviors of foreign-born hispanic men who have sex with men differ by relationship status?

High-risk sexual behaviors may result in acquisition of sexually transmitted infections including HIV. Hispanic men who have sex with men (MSM) experience a disproportionate incidence of these infections. Various risk factors, cultural aspects, and relationship factors may influence the sexual behaviors of this subgroup of MSM. The purpose of this study was to describe the sexual behaviors of a sample of foreign-born Hispanic MSM and to compare these sexual behaviors in terms of condom usage, risky sexual behaviors, avoidance of body fluids, and sexual negotiation when stratified by relationship status. Using a cross-sectional, descriptive research design, a convenience sample of 135 foreign-born Hispanic MSM, the majority of whom were Cubans, was recruited and surveyed from the South Florida area. The majority of participants reported engaging in the high-risk sexual behaviors of sex without condoms, substance abuse before or during sex, anal sex, contact with body fluids, and did not negotiate safer sex behaviors. Differences in sexual behaviors when compared by relationship status were found only in terms of certain risky sexual behaviors but not in terms of condom usage, contact with body fluids, or sexual negotiation. Despite participation in a number of high-risk activities and finding few differences among those men in relationships and those not in primary relationships, factors that promote or inhibit participation in high-risk sexual behaviors among Hispanic MSM in various types of relationships need further exploration.High-risk sexual behaviors may result in acquisition of sexually transmitted infections including HIV. Hispanic men who have sex with men (MSM) experience a disproportionate incidence of these infections. Various risk factors, cultural aspects, and relationship factors may influence the sexual behaviors of this subgroup of MSM. The purpose of this study was to describe the sexual behaviors of a sample of foreign-born Hispanic MSM and to compare these sexual behaviors in terms of condom usage, risky sexual behaviors, avoidance of body fluids, and sexual negotiation when stratified by relationship status. Using a cross-sectional, descriptive research design, a convenience sample of 135 foreign-born Hispanic MSM, the majority of whom were Cubans, was recruited and surveyed from the South Florida area. The majority of participants reported engaging in the high-risk sexual behaviors of sex without condoms, substance abuse before or during sex, anal sex, contact with body fluids, and did not negotiate safer sex behaviors. Differences in sexual behaviors when compared by relationship status were found only in terms of certain risky sexual behaviors but not in terms of condom usage, contact with body fluids, or sexual negotiation. Despite participation in a number of high-risk activities and finding few differences among those men in relationships and those not in primary relationships, factors that promote or inhibit participation in high-risk sexual behaviors among Hispanic MSM in various types of relationships need further exploration.