Natalia Villegas

Unique factors that place older Hispanic women at risk for HIV: intimate partner violence, machismo, and marianismo.

&NA; Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV‐related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal‐postmenopausal‐related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses’ roles in educating OHW regarding IPV and HIV prevention.

Predictors of Self-Efficacy for HIV Prevention Among Hispanic Women in South Florida

&NA; Self‐efficacy is a critical element for HIV prevention, however little is known about the predictors of self‐efficacy for HIV prevention among Hispanic women. In this cross‐sectional study we assessed if age, living with a partner, employment status, HIV knowledge, self‐esteem, and intimate partner violence (IPV) predicted self‐efficacy for HIV prevention in 548 Hispanic women in South Florida who participated in a randomized controlled trial (SEPA). The majority of Hispanic women reported high levels of self‐efficacy for HIV prevention. Women who were older, living with a partner, had less HIV knowledge, and had a history of IPV reported significantly lower levels of self‐efficacy for HIV prevention. HIV knowledge was the most important predictor of self‐efficacy for HIV prevention. Employment was not a significant predictor of self‐efficacy for HIV prevention. Predictors identified in the study can be used to identify high‐risk Hispanic women who are in need of HIV prevention interventions.

HIV susceptibility among Hispanic women in south Florida.

Hispanic women (HW) are disproportionately affected by HIV, however, little is known regarding their perceived susceptibility for acquiring HIV (SAHIV). We studied predictive factors for perceiving SAHIV among HW. Participants (88.5%) reported not feeling SAHIV. Women who felt SAHIV, had a significant probability of reporting a higher chance for acquiring HIV from their partners actions (OR 9.75), and a higher probability of not being tested for HIV (OR 2.05). Educational strategies to increase perception of SAHIV and HIV testing knowledge would be beneficial giving emphasis to women who do not perceive to be at risk from their partners actions.

Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions.

The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/As prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/As prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.

The development, feasibility and acceptability of an Internet‐based STI–HIV prevention intervention for young Chilean women

Background Young Chilean women between 18 and 24 years of age are at high risk of contracting sexually transmitted infection (STI) and human immunodeficiency virus (HIV). The literature shows a shortage of STI–HIV prevention interventions focused on this specific high-risk population and a unique set of barriers to receiving prevention messages. Internet-based interventions are promising for delivering STI–HIV prevention interventions and avoiding barriers to services. Aims The study aimed to develop a culturally informed Internet-based STI–HIV prevention intervention for Chilean women between 18 and 24 years of age, to investigate its feasibility and acceptability, and to compile recommendations on what would make the intervention more acceptable and feasible for these women. Methods The development of the Internet intervention was facilitated by a process that featured consultation with content and technology experts. A pre-post test design was used to test the acceptability and feasibility of the intervention with 40 young Chilean women between 18 and 24 years of age. Results The intervention website consisted of four modules of content and activities that support learning. The intervention was feasible and acceptable for young Chilean women between 18 and 24 years of age. Discussion and conclusion This study demonstrated the value of engaging multiple expert panels to develop culturally informed and technology-based interventions. The results of this study support the feasibility and acceptability of conducting an Internet-based intervention with multiple sessions, yielding high participation rates in a population in which there are barriers to discussion of STI–HIV prevention and sex-related content. Implications for nursing and health policy The outcomes have implications for nursing education and clinical practice and they can be used for the legal and judicial systems to promote or reinforce policies that encourage STI–HIV prevention strategies among women.BACKGROUND Young Chilean women between 18 and 24 years of age are at high risk of contracting sexually transmitted infection (STI) and human immunodeficiency virus (HIV). The literature shows a shortage of STI-HIV prevention interventions focused on this specific high-risk population and a unique set of barriers to receiving prevention messages. Internet-based interventions are promising for delivering STI-HIV prevention interventions and avoiding barriers to services. AIMS The study aimed to develop a culturally informed Internet-based STI-HIV prevention intervention for Chilean women between 18 and 24 years of age, to investigate its feasibility and acceptability, and to compile recommendations on what would make the intervention more acceptable and feasible for these women. METHODS The development of the Internet intervention was facilitated by a process that featured consultation with content and technology experts. A pre-post test design was used to test the acceptability and feasibility of the intervention with 40 young Chilean women between 18 and 24 years of age. RESULTS The intervention website consisted of four modules of content and activities that support learning. The intervention was feasible and acceptable for young Chilean women between 18 and 24 years of age. DISCUSSION AND CONCLUSION This study demonstrated the value of engaging multiple expert panels to develop culturally informed and technology-based interventions. The results of this study support the feasibility and acceptability of conducting an Internet-based intervention with multiple sessions, yielding high participation rates in a population in which there are barriers to discussion of STI-HIV prevention and sex-related content. IMPLICATIONS FOR NURSING AND HEALTH POLICY The outcomes have implications for nursing education and clinical practice and they can be used for the legal and judicial systems to promote or reinforce policies that encourage STI-HIV prevention strategies among women.

Pilot Testing an Internet-Based STI and HIV Prevention Intervention With Chilean Women.

PURPOSE The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is high among young Chilean women, and there are no STI or HIV prevention interventions available to them that incorporate technology. The purpose of this study was to investigate the preliminary efficacy of an Internet-based STI and HIV prevention intervention (I-STIPI) for Chilean young women on measures of STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors. DESIGN This is a pretest-posttest study. Forty young Chilean women between 18 and 24 years of age participated in an investigation of the I-STIPIs preliminary efficacy on STI and HIV prevention-related outcomes between baseline and a postintervention assessment. The intervention consisted of four online modules. Data collection was conducted in Santiago, Chile. Paired-samples t test analysis was used to determine whether there were significant differences in each of the outcome variables. FINDINGS After receiving I-STIPI, women reported a significant increase in levels of STI- and HIV-related knowledge, attitudes toward the use of condoms and perceived self-efficacy, and a reduction of risky sexual behaviors with uncommitted partners. CONCLUSIONS The I-STIPI showed promise as an Internet-based intervention that can reduce barriers to accessing preventive interventions and increase STI and HIV preventive behaviors in young Chilean women. CLINICAL RELEVANCE The study provided important information about the ability of an Internet-based intervention to reduce young womens risk factors and to provide positive preliminary efficacy on STI- and HIV-related outcomes. Internet-based interventions can eliminate many barriers to receiving prevention interventions and may prove to be cost effective.

Impact of Mano a Mano-Mujer, an HIV prevention intervention, on depressive symptoms among Chilean women.

Worldwide, and in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low-income Chilean women. Depressed people are less willing to participate in behaviours that protect them against HIV. The aim of this study is to analyze the impact of Mano a Mano-Mujer (MM-M), and HIV prevention intervention, on depressive symptoms among Chilean women. A quasi-experimental design was used for this study. The research was conducted in Santiago, Chile; a total of 400 women participated in the study (intervention group, n=182; control group, n=218). The intervention was guided by the social-cognitive model and the primary health care model. The intervention consists of six 2-h sessions delivered in small groups. Sessions covered: HIV prevention, depression, partners communication, and substance abuse. Face-to-face interviews were conducted at baseline and at 3-month follow-up. Chilean women who participated in MM-M significantly decreased, at 3 months follow up, their reported depressive symptoms. MM-M provided significant benefits for womens depression symptoms. In this study nurses participated as leaders for the screening of depressive symptoms and as facilitators of community interventions.

Development and psychometric evaluation of a condom use self-efficacy measure in Spanish and English

Background: Condom self-efficacy is an important construct for HIV/STI prevention and intervention. A psychometrically sound measure of the self-efficacy for using condoms that has been designed for Hispanic women to respond in Spanish or English is needed. Objectives: The goal of this study was to develop and evaluate a brief self-report measure of condom use self-efficacy. Methods: We developed a 15-item measure of condom use self-efficacy based on expert knowledge of measurement and HIV/STI prevention with Hispanic women using a translation-back translation approach. Participants were 320 Hispanic women from the Southeastern US. Results: Internal consistency of the full measure was 92. A short form of the instrument with a subset of five items also had acceptable internal consistency, alpha = .80, and was significantly correlated with the full scale, rs = .93, p < .001. A single latent factor explained 9–48% of the variation in these items. Evidence of construct validity of the short form was provided by correlations of the scale with two self-report measures of condom use: rs = .34** with condom use, rs = .37** with condom use during vaginal sex. Conclusions: Either the full measure or the five-item measure could be used in studies where condom use is an important behavioral outcome, such as evaluating prevention interventions, with Hispanic women. Future studies should examine the performance of this measure with other groups, including Hispanic men and members of other ethnic and language groups.

Social Determinants of Health for HIV Among Hispanic Women

Population health outcomes are influenced by complex, integrated, and overlapping social structures and economic systems. From the time people are born, they are placed at a particular level of social status. These concepts are included in what the World Health Organization (WHO; 2014) defines as the Social Determinants of Health (SDH): “Conditions, in which people are born, live, grow, work and age” (para. 1). In other words, health is determined in part by the social, economic, political, cultural, and environmental contexts in which people live. Oftentimes, individuals are not able to directly control their SDH (WHO, 2014). The SDH are defined or shaped by money, power, and other resources at multiple levels, from local to global, affecting a wide range of individuals (Mumtaz & Salway, 2009; WHO, 2014). The WHO has recognized that dealing with these social determinants is a fundamental priority in order to improve the health of people and to decrease inequalities (WHO, 2010a). For instance, while HIV prevention for Hispanic women has been a challenge for health care workers and policymakers, the conceptualization of SDH helps recognize HIV among Hispanic women in the context of sociocultural and economic inequalities (e.g., level of education, financial constraints, immigration, culture, substance abuse, and access to health care; Raphael, 2004; WHO, 2010a). A particular concern for both health care workers and policymakers is that relative to other races/ethnicities, Hispanic women are disproportionately affected by HIV (Centers for Disease Control and Prevention [CDC], 2014). Disparities have persisted in the rate of new HIV infections among Hispanic women for some time; in 2010, for example, the rate of new HIV infections for Hispanic women was 4.2 times that for White women (CDC, 2013a). According to a study by the Kaiser Family Foundation (2009), women of color fare worse on a variety of measures of health and health care access than do their White counterparts. Specifically, being HIV positive is one of the indicators associated with greater disparity (Kaiser Family Foundation, 2009). While Hispanics represent diverse nationalities and demographics, they share SDH, which present challenges for HIV prevention, contributing to the rise of HIV infection among Hispanic women across nationalities (CDC, 2009a, 2009b).

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel:

Purpose: To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting. Design: Randomized controlled trial. Setting: Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami. Participants: Three hundred twenty Hispanic women. Intervention: The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology. Measures: Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use. Analysis: Differences at baseline by group were assessed using Wilcoxon rank sum test, χ2, and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables. Results: Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%). Conclusion: The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.