Michael V. Relf

Battering Victimization Among a Probability-Based Sample of Men Who Have Sex With Men

OBJECTIVES This study measured the prevalence of battering victimization (i.e., experience of psychological/symbolic, physical, and sexual battering) among men who have sex with men (MSM) and identified characteristics of these men. METHODS A probability-based sample of 2881 MSM living in 4 cities completed telephone interviews between 1996 and 1998. RESULTS Prevalence estimates were 34% for psychological/symbolic battering, 22% for physical battering, and 5% for sexual battering. The strongest demographic correlate independently associated with all forms of battering was age 40 or younger, whereas education and HIV serostatus were associated with physical and psychological/symbolic violence. CONCLUSIONS Rates of battering victimization among urban MSM are substantially higher than among heterosexual men and possibly heterosexual women. Public health efforts directed toward addressing intimate partner battering among these men are needed.

Gay Identity, Interpersonal Violence, and HIV Risk Behaviors: An Empirical Test of Theoretical Relationships among a Probability-Based Sample of Urban Men Who Have Sex with Men

The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.

Battering and HIV in Men Who Have Sex With Men: A Critique and Synthesis of the Literature

Recent empirical evidence demonstrates the relationship between HIV and battering victimization in men who have sex with men (MSM). Although there is an abundance of literature examining domestic violence among heterosexual couples, there is minimal empirical evidence regarding battering among same-sex male couples. To obtain an understanding of the current state of the science, this literature review provides a critique and synthesis of the identified battering and HIV literature in MSM. After an examination of the relationship between HIV and battering, the prevalence of battering in MSM from the literature is critically reviewed. To establish a framework for understanding battering in MSM, the identified correlates of battering for both the victim and the perpetrator are examined. This critique and synthesis concludes with implications for clinical nursing practice.

Maintaining normalcy: a grounded theory of engaging in HIV-oriented primary medical care.

Despite advances in the medical treatment of HIV disease, marginalized populations continue to shoulder a disproportionate burden of HIV/AIDS-related morbidity and mortality. This study explored the process by which clients at HIV-oriented primary care clinics transition from being sporadic users of care to engaging as regular users of care. A model illustrating how participants were striving to maintain normalcy, manage perceptions, and develop life mastery skills contributes to an understanding of living with HIV disease in a social context. Elements of the model are sensitive to nursing interventions aimed at improving health outcomes and reducing health disparities among persons at highest risk.

HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study.

A first step in ensuring that HIV-infected persons practice the safer sexual behaviors that reduce disease transmission is to make certain that they receive accurate information about the relationship between sexual risk behaviors and HIV transmission. Health care providers can play a pivotal role in preventing secondary transmission of HIV; federal agencies and professional guidelines encourage providers to counsel HIV-infected patients about safer sex practices and transmission risks, particularly since the health care encounter may be the only time that HIV-infected persons receive information about prevention and risk reduction interventions. Yet research indicates that these opportunities are often missed. Prior to implementing a prevention demonstration project in an urban HIV and STD clinic, we conducted a qualitative investigation with providers, including physicians, nurse practitioners, physician assistants, and nurses. The purpose of this investigation was to examine the current status of prevention education and counseling efforts at the clinic, examine the barriers and facilitators to providing prevention counseling, and identify key areas where providers believed that they needed additional training.

Health literacy of HIV-positive individuals enrolled in an outreach intervention: results of a cross-site analysis.

This article examines health literacy among a group a HIV-positive persons at risk for receiving suboptimal health care due to histories of substance abuse, mental illness, incarceration, and unstable housing or homelessness. Participants receiving services from three outreach programs funded as part of a multisite demonstration project were screened for health literacy using the Test of Functional Health Literacy in Adults (TOFHLA) at program enrollment. The goal of this analysis was to identify demographics, risk factors, and health indicators associated with different levels of health literacy. Results indicated that although fewer than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, health professionals can use other potential venues for health literacy assessment and intervention including substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers also must become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.

Childhood Sexual Abuse in Men Who Have Sex With Men: The Current State of the Science

The experience of childhood sexual abuse (CSA) among men, particularly men who have sex with men (MSM), is poorly understood. Consequently, the long-term psychological and behavioral consequences of this phenomenon are unclear. This article provides a critique and synthesis of the existing literature on childhood sexual abuse in MSM. After an examination of prevalence estimates reported in the literature, the mental health and substance abuse behaviors in MSM that were the victims of CSA will be examined. In addition, the relationship between CSA and sexual identity development and HIV risk behaviors is critically evaluated. Finally, implications for nursing practice are explored.

Illuminating meaning and transforming issues of spirituality in HIV disease and AIDS: an application of Parse's theory of human becoming.

Although numerous supportive therapies are available to challenge human immunodeficiency virus (HIV) disease and acquired immunodeficiency syndrome (AIDS), no cure exists. Those with HIV disease and its sequelae must confront the reality of living with a complex, chronic illness. When addressing the many challenges associated with HIV disease and AIDS, individuals may experience issues associated with spirituality. The article synthesizes the concept of spirituality and identifies the possible issues associated with spirituality for individuals living with HIV disease and AIDS. Additionally, nursing strategies based on Parses theory of human becoming are proposed.

A Randomized Controlled Trial of the Efficacy of a Stigma Reduction Intervention for HIV-Infected Women in the Deep South

The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.

Using an intersectional approach to study the impact of social determinants of health for African American mothers living with HIV.

Heightened awareness of the social determinants of health by health scientists and clinicians has failed to translate into significant progress in the amelioration of those social determinants contributing to health inequities. The purpose of this article is to broaden the discussion about conceptual approaches nurse scientists can use to address health and health inequities. We will apply an intersectional approach to the study of the social determinants of health for African American mothers living with human immunodeficiency virus and through this explore the utility of an intersectional approach to generate knowledge in nursing.