Nilda Peragallo

A Randomized Clinical Trial of an HIV-Risk- Reduction Intervention Among Low-Income Latina Women

BackgroundHIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. ObjectivesThe purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. MethodsMexican and Puerto Rican women (18–44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. ResultsThe intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DiscussionThe efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.

Hispanic women's experiences with substance abuse, intimate partner violence, and risk for HIV.

Hispanic females are disproportionately affected by substance abuse, intimate partner violence, and HIV. Despite these disparities, research describing the cultural and gender-specific experiences of Hispanic women with regard to these conditions is lacking. The purpose of this study is to describe the experiences that Hispanic community-dwelling women have with regard to substance abuse, violence, and risky sexual behaviors. Eight focus groups with 81 women were conducted. A bilingual, bicultural moderator asked women open-ended questions regarding the experiences that Hispanic women have with these conditions. Focus groups were audiotaped, transcribed, translated, verified, and then analyzed using qualitative content analysis. Participants discussed substance abuse, violence, and risky sexual behaviors interchangeably, often identifying common risk factors associated with these. Nevertheless, intimate partner violence was the most salient of conditions discussed. Three major themes emerged from the analysis: Transplantadas en otro mundo (Uprooted in another world), El criador de abuso (The breeding ground of abuse), and Rompiendo el silencio (Breaking the silence). This study supports the importance of addressing substance abuse, violence, and risk for HIV in an integrated manner and stresses the importance of addressing associated cultural factors (e.g., acculturation, machismo ) in interventions targeting Hispanics.

HIV Risks, Substance Abuse, and Intimate Partner Violence Among Hispanic Women and Their Intimate Partners

Hispanic women in the United States are disproportionately affected by HIV infection. Substance abuse and intimate partner violence (IPV) are conditions that have been associated with risk for HIV in the general population. However, few studies have explored the intersection of these three conditions within one integrated framework. The purpose of this exploratory study was to describe the relationships between HIV risks, substance abuse, and IPV among Hispanic community‐dwelling women. A total of 82 structured interviews were conducted with Hispanic women between the ages of 18 and 60. Data regarding the participants and her partners histories of sexually transmitted infections, substance abuse, risky sexual behaviors, and IPV were collected. Relationships between the participants history of sexually transmitted infections, her partners substance abuse, risky sexual behaviors, and IPV were explored. Results from this study support the importance of targeting HIV, substance abuse, and IPV prevention among Hispanics within one integrated framework.

Intimate partner violence, depression, and resource availability among a community sample of hispanic women

This study investigated the relationships among resource availability, IPV, and depression among Hispanic community-dwelling women. The Vulnerable Populations Conceptual Framework (15) was used to conceptualize and test relationships among these variables. Cross-sectional questionnaires assessed resource availability (i.e., income, education, employment, insurance status, and self-esteem), depressive symptoms (CES-D), and intimate partner violence (IPV) by a current/recent partner. Linear and logistic regressions were conducted to explore relationship among variables. Although most of the relationships among resource availability, IPV, and depression supported the conceptual framework, the importance of incorporating additional cultural, relationship, and social factors are stressed.

Substance abuse, violence, HIV, and depression: an underlying syndemic factor among Latinas.

Background:Evidence from the literature suggests that substance abuse, violence, HIV risk, depressive symptoms, and underlying socioeconomic conditions are tied intrinsically to health disparities among Latinas. Although these health and social conditions appear to comprise a syndemic, an underlying phenomenon disproportionately accounting for the burden of disease among marginalized groups, these hypothesized relationships have not been formally tested. Objectives:The aim of this study was to assess (a) if substance abuse, violence, HIV risk, and depressive symptoms comprised a syndemic and (b) if this syndemic was related to socioeconomic disadvantage among Latinas. Methods:Baseline assessment data from a randomized controlled community trial testing the efficacy of an HIV risk reduction program for adult Latinas (n = 548) were used to measure demographic variables, substance abuse, violence, risk for HIV, and depressive symptoms. Structural equation modeling was used to test a single underlying syndemic factor model and any relation to socioeconomic disadvantage. Results:The results of this study support the idea that HIV risk, substance abuse, violence, and depressive symptoms comprise a syndemic, &khgr;2(27) = 53.26, p < .01 (relative &khgr;2 = 1.97, comparative fit index = .91, root mean square error of approximation = .04). In addition, in limited accord with theory, this factor was related to 2 measures of socioeconomic disadvantage, percentage of years in the United States (b = 7.55, SE = 1.53, p < .001) and education (b = −1.98, SE = .87, p < .05). Discussion:The results of this study could be used to guide public health programs and policies targeting behavioral health disparity conditions among Latinos and other vulnerable populations. Further study of the influence of gender-role expectations and community-level socioeconomic indicators may provide additional insight into this syndemic.

BREAST CARE AMONG LATINO IMMIGRANT WOMEN IN THE U.S.

Although the U.S. is recognized as a developed country, knowledge of how to perform a breast self-examination (BSE) and the availability and accessibility screening mammography are not evenly distributed across ethnic, racial, and socioeconomic groups. Some U.S. organizations have decreased their emphases on BSE and are strongly promoting technological advances such as mammography. Disparities in obtaining breast health care are found worldwide. In this article we present the findings of a study that was conducted in a large urban area in the Midwest of the United States, to identify factors associated with breast care in Latino immigrant women (n = 111). Limited knowledge about breast care, unemployment, and short period of residence in the U.S. were all found to be related to inadequate breast care in this group of women. These findings have global implications for health care practitioners in directing attention toward discovering factors that promote and inhibit early breast cancer detection.

Practice variations in treating urban minority asthmatics in Chicago

This study explores provider adherence to national guidelines in treating Latino and African-American asthmatics. We hypothesized that there would be more variations in asthma treatment existing for minorities as a result of variation in physicians adherent to the guidelines. A 96-item survey was administered to 138 Latino and African-American asthmatics attending a hospital emergency department. Data were obtained on demography, severity, access, patient satisfaction, and patients assessment of physician asthma management. Results were analyzed by ethnicity, gender, practice site of regular provider, and severity. Variation in physician practice was found in these variables. Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines. Regression analyses showed that Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity. African-Americans expressed less dissatisfaction in obtaining services, while both groups expressed high degrees of satisfaction with their providers.

The context of risky behaviors for Latino youth.

Background and significance: Alarming numbers of Latino teens continue to engage in behaviors that place them at risk for pregnancy and sexually transmitted infections including HIV. Design: This study includes data from six focus groups with 38 Latinas. The primary purpose of the focus groups was to elicit antecedents to unsafe sex to guide the development of an HIV-prevention intervention for adult Latinas. The data were reanalyzed using the rich content that had been elicited about community teens. Findings: Six major themes were identified surrounding teen issues and concerns. These are (a) the culture of risky behaviors; (b) romance: illusion and reality; (c) parental involvement: a protective factor; (d) HIV: knowledge versus ignorance; (e) HIV among youth: fear, stigma, and anger; and (f) saving our youth. Implications: A multimodal approach is required to help teens adopt healthy life styles, remain in school, and have a positive relationship with their parents.

Mano a Mano-Mujer: An Effective HIV Prevention Intervention for Chilean Women

The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.

Use of herbal therapies among midlife Mexican women.

The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cats claw), and yerba buena (spearmint).The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cats claw), and yerba buena (spearmint).