Monica S. Ruiz

Women's Self-Disclosure of HIV Infection: Rates, Reasons, and Reactions

A survey of 65 ethnically diverse women at 2 outpatient HIV clinics revealed relatively low rates of disclosure of HIV-positive serostatus to extended family members, somewhat higher rates for immediate family members, and highest rates for lovers and friends. Spanish-speaking Latinas were less likely to disclose their serostatus or to discuss HIV-related worries with others than English-speaking Latinas, African Americans, and Anglo Americans. Reasons for disclosure and nondisclosure varied by target. In general, targets reacted positively to disclosure. Implications for clinicians treating women with HIV infection are discussed.

Culturally Sanctioned Secrets? Latino Men's Nondisclosure of HIV Infection to Family, Friends, and Lovers

Spanish-speaking Latino men (n = 107) were more likely than English-speaking Latinos (n = 85) and Whites (n = 206) to withhold their HIV-positive serostatus and their gay or bisexual orientation from significant others, especially family members. Similar effects were observed when Latinos were divided by birthplace and when analyses controlled for sociodemographic and medical factors. Reasons for revealing or concealing an HIV diagnosis varied across targets. Although both Latinos and Whites were more likely to withhold their diagnosis from their parents to prevent worrying them than to avoid personal rejection, this tendency was somewhat stronger among Latinos. Our findings suggest that some traditional values may deter Latinos from seeking HIV-related social support in times of need.

Self-disclosure of HIV infection: preliminary results from a sample of Hispanic men.

We examined self-disclosure of HIV infection among 101 seropositive Hispanic men residing in Los Angeles. Results indicated that disclosure was highly selective and presumably influenced by the social, psychological, and material consequences of informing others about ones medical condition. Subjects tended to inform significant others such as parents, friends, and lovers than less significant others such as employers, landlords, and religious leaders. There was a relatively high rate of disclosure (75%) to doctors/dentists who were not treating subjects for HIV infection. Gay and bisexual subjects (89% of the sample) were more inclined to disclose their HIV serostatus to homosexual or bisexual others than to heterosexuals and to inform those who were aware of their sexual orientation. Disclosure increased with severity of disease independently of length of time since testing seropositive. Self-rated negative changes in appearance correlated with disclosure to less significant others. The role of cultural attitudes and values in self-disclosure of HIV infection is discussed.

Assessing Microbicide Acceptability: A Comprehensive and Integrated Approach

A safe, effective, and acceptable microbicide is needed in order to decisively impact the global AIDS pandemic. As such, microbicide acceptability research is of paramount importance. In order to best utilize limited financial resources and save precious development time, acceptability studies should be fully integrated into preclinical and clinical trial contexts where candidate products are being developed and tested. An integrated approach for examining theoretically valid and relevant variables is needed so that data across studies and products can more effectively advance the field. We propose an approach for measuring factors related to microbicide acceptability in each phase of product development, and dependent on what product-specific knowledge is already established in the field. We discuss the roles that behavioral and social science methodologies should play in all phases of microbicide development, as well as the challenges faced when conducting acceptability research in the context of preclinical and clinical trial settings.

Effectiveness of an HIV Prevention Intervention in Prison Among African Americans, Hispanics, and Caucasians

Prisons and prison inmates present important targets for HIV/AIDS prevention interventions. Inmates often have histories of high-risk behavior that place them in danger of contracting HIV/AIDS, and rates of HIV/AIDS tend to be much higher in this population. The goal of this studywas to assess the effectiveness of a prison-based HIV/AIDS intervention to change attitudes toward HIV prevention, norms supporting HIV prevention, perceived behavioral control (i.e., self-efficacy) for HIV prevention behaviors, and intentions to engage in HIV prevention behaviors postrelease. The intervention also had the goal of encouraging inmates to become HIV/AIDS peer educators. The intervention appeared most successful at influencing beliefs and behaviors related to peer education and somewhat successful at influencing beliefs and intentions related to condom use. Analyses also showed some significant differences in effectiveness by race/ethnicity. Results are discussed from the perspectives of both research and practice with regard to prison-based HIV prevention efforts.

Language Acculturation and Screening Practices of Elderly Hispanic Women The Role of Exposure to Health-Related Information from the Media

The present study examined the hypothesis that language acculturation of Hispanics in the United States increases their exposure to media-based health information which, in turn, increases medical screening practices and knowledge of cancer symptoms. We interviewed 598 elderly Hispanic women (55-92 years of age) residing in Los Angeles. Language acculturation was measured with items on understanding of English and language preference for interpersonal communication, reading materials, television, and radio. Recency of screening (physician breast exam, Pap smear, routine physical exam, mammogram) and exposure to media-based health information were assessed with Likert-type scales; knowledge of symptoms of breast, cervical, colorectal, and oral cancers was assessed through open-ended questions. The results of multiple regression analyses provide support for the hypothesis. First, language acculturation predicted media exposure after controlling for demographic variables. Second, media exposure predicted screening and symptom knowledge after controlling for language acculturation and the demographic factors. The findings suggest that cancer prevention programs should use Spanish-language media to reach a wider Hispanic audience, especially those who are monolingual.

Correctional facilities as partners in reducing HIV disparities.

Abstract:The United States now has the highest incarceration rate in the world. The majority of prison and jail inmates come from predominantly nonwhite and medically underserved communities. Although incarceration has adverse effects on both individual and community health, prisons and jails have also been used successfully as venues to provide health services to people with HIV who frequently lack stable health care. We review demographic trends shaping the difficulties in providing care to incarcerated people with HIV and recommend the Centers for AIDS Research Collaboration on HIV in Corrections as a model of interdisciplinary collaboration in addressing those difficulties.

Introduction: paving the way for biomedical HIV prevention interventions in youth.

The HIV epidemic among youth continues to grow at alarming proportions throughout the world. Efficacious and comprehensive biomedical prevention interventions are desperately needed for this vulnerable population if a reduction in global HIV incidence is to be achieved. To succeed at enrolling youth in studies of such modalities, communities whose youth will be participating must be highly engaged throughout the spectrum of research concept development to implementation and later translation into programs. In this process, there are numerous challenges, both intrinsic and extrinsic to the youth themselves. Intrinsic ones include developmental considerations in physiology, pharmacology, and behavior; extrinsic considerations are those in the community, ethical, legal, and regulatory arenas and those in designing clinical trials for youth to feasibly participate. We convened a consultative meeting to deliberate over these considerations among a variety of experts representing youth and their community, advocacy groups, academia, industry, regulators, and others in the federal government. Broad recommendations aimed at many stakeholders in the adolescent HIV prevention research agenda were made and were to improve the timely inclusion of youth in this research to ensure that prevention agents can be used safely by youth as soon as they become available to adults.

How far will they go?: assessing the travel distance of current and former drug users to access harm reduction services

BackgroundPrior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC.FindingsA geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March and April 2014. We calculated the walking distance from the centroid point of home residence zip code to the mobile exchange site where PWID presented for services. An independent samples t-test was used to examine differences in walking distance measures between current and former PWID. Differences in mean walking distance were statistically significant with current and former PWID having mean walking distances of 2.75 and 1.80 miles, respectively.ConclusionsThe results of this study suggest that former PWID who are engaging with SEPs primarily for non-needle exchange services (e.g., medical or social services) may have decreased access to SEPs than their counterparts who are active injectors. This research provides support for expanding SEP operations such that both active and former PWID have increased access to harm reduction providers and associated health and social services. Increasing service accessibility may help resolve unmet needs among current and former PWID.

The evidence does not speak for itself: The role of research evidence in shaping policy change for the implementation of publicly funded syringe exchange programs in three US cities

BACKGROUND A breadth of literature exists that explores the utilization of research evidence in policy change processes. From this work, a number of studies suggest research evidence is applied to change processes by policy change stakeholders primarily through instrumental, conceptual, and/or symbolic applications, or is not used at all. Despite the expansiveness of research on policy change processes, a deficit exists in understanding the role of research evidence during change processes related to the implementation of structural interventions for HIV prevention among injection drug users (IDU). This study examined the role of research evidence in policy change processes for the implementation of publicly funded syringe exchange services in three US cities: Baltimore, MD, Philadelphia, PA, and Washington, DC. METHODS In-depth qualitative interviews were conducted with key stakeholders (n=29) from each of the study cities. Stakeholders were asked about the historical, social, political, and scientific contexts in their city during the policy change process. Interviews were transcribed and analyzed for common themes pertaining to applications of research evidence. RESULTS In Baltimore and Philadelphia, the typological approaches (instrumental and symbolic/conceptual, respectively) to the applications of research evidence used by harm reduction proponents contributed to the momentum for securing policy change for the implementation of syringe exchange services. Applications of research evidence were less successful in DC because policymakers had differing ideas about the implications of syringe exchange program implementation and because opponents of policy change used evidence incorrectly or not at all in policy change discussions. CONCLUSION Typological applications of research evidence are useful for understanding policy change processes, but their efficacy falls short when sociopolitical factors complicate legislative processes. Advocates for harm reduction may benefit from understanding how to effectively integrate research evidence into policy change processes in ways that confront the myriad of factors that influence policy change.