Patria Rojas

The HIV/AIDS epidemic in the Dominican Republic: key contributing factors.

This article reviews HIV/AIDS epidemiological data and recent research conducted in the Dominican Republic, with a focus on explaining the variability in estimated seroincidence and prevalence within the country. HIV seroprevalence estimates range from 1.0% (in the general population) to 11.0% among men who have sex with men (MSM). Some have indicated that the highest HIV seroprevalence occurs in Haitian enclaves called bateyes (US Agency for International Development [USAID], 2008), which are migrant worker shantytowns primarily serving the sugar industry in the Dominican Republic. Others report higher or comparable rates to the bateyes in areas related to the tourism and sex industries. As in other Caribbean and Latin American countries, reported HIV transmission in the Dominican Republic is predominantly due to unprotected heterosexual sex and the infection rate has been increasing disproportionally among women. The Dominican Republic represents two thirds of the Hispaniola island; the western one third is occupied by Haiti, the nation with the highest HIV prevalence in the western hemisphere. Although data is limited, it shows important differences in seroprevalence and incidence between these two countries, but commonalities such as poverty, gender inequalities, and stigma appear to be pivotal factors driving the epidemic. This article will discuss these and other factors that may contribute to the HIV epidemic in the Dominican Republic, as well as highlight the gaps in the literature and provide recommendations to guide further work in this area, particularly in the role of governance in sustainable HIV prevention.

Latina Mother-Daughter Dyads: Relations Between Attachment and Sexual Behavior Under the Influence of Alcohol or Drugs

Associations among mother–daughter attachment, mother and daughter substance abuse, and daughter’s sexual behavior under the influence of drugs and alcohol were investigated among 158 adult U.S. Latina daughters. Latina daughters were sampled from four mother–daughter dyad types: substance abusing mother and daughter, substance abusing mother only, substance abusing daughter only, and non-substance-abusing mother and daughter. Substance abusing daughters with substance abusing mothers, and daughters who were less strongly attached to their mothers, reported more sex under the influence of drugs. Age, marital status, substance abuse, and mother’s substance abuse all influenced the daughter’s sex under the influence of alcohol. An unexpected positive association between attachment and sex under the influence of alcohol was found for daughters who were more closely attached to a substance abusing mother. Implications for future research, and HIV/AIDS and drug prevention and treatment programs for Latinas are discussed.

Mother-Daughter Attachment and Drug Abuse among Latinas in the United States

Although the risks and protective processes influencing substance use behaviors of adult Latinos have been increasingly examined in the literature, substance abuse among adult Latinas remains a relatively understudied area. This study examined associations between mother-daughter attachment and substance abuse among 158 Latina mothers and their adult daughters (N = 316). Dyads of mothers and daughters were categorized into four groups: (a) mother/daughter both drug or alcohol abusers (Dyad 1), (b) mother abuser and daughter non-abuser (Dyad 2), (c) mother non-abuser and daughter abuser (Dyad 3), and (d) mother/daughter both non-abusers (Dyad 4). Dyad 1 participants reported lower levels of attachment to each other than all other types of dyads. Participants born in the U.S. reported more substance abuse than their non-U.S. born counterparts. Future longitudinal research is recommended to determine the presence of a mother-daughter attachment threshold that, if established early and maintained, may act as a protective mechanism against the intergenerational co-occurrence of substance abuse among adult Latinas.

Pre- to postimmigration alcohol use trajectories among recent Latino immigrants.

The escalation of alcohol use among some Latino immigrant groups as their time in the United States increases has been well documented. Yet, little is known about the alcohol use behaviors of Latino immigrants before immigration. This prospective longitudinal study examines pre- to postimmigration alcohol use trajectories among a cohort of recent Latino immigrants. Retrospective preimmigration data were collected at baseline from a sample of 455 Cuban, South American, and Central American Latinos ages 18-34 who immigrated to the United States less than 1 year prior. Two follow-up assessments (12 months apart) reported on their postimmigration alcohol use in the past 90 days. We hypothesized (a) overall declines in pre- to postimmigration alcohol among recent Latino immigrants and (b) gender/documentation specific effects, with higher rates of alcohol use among males and undocumented participants compared to their female and documented counterparts. Growth curve analyses revealed males had higher levels of preimmigration alcohol use with steeper declines in postimmigration alcohol use compared to females. Declines in alcohol use frequency were observed for documented, but not undocumented males. No changes in pre- to postimmigration alcohol use were found for documented or undocumented females. This study contributes to the limited knowledge of pre- to postimmigration alcohol use patterns among Latinos in the United States. Future research is needed to identify social determinants associated with the alcohol use trajectories of recent Latino immigrants, as it may inform prediction, prevention, and treatment of problem-drinking behaviors among the largest and fastest growing ethnic minority in the United States.

Validating the Multidimensional Measure of Cultural Identity Scales for Latinos among Latina mothers and daughters.

The psychometric properties of the Multidimensional Measure of Cultural Identity Scales for Latinos (MMCISL; Félix-Ortiz, Newcomb, & Myers, 1994) have never been examined in an adult Latina sample representing various levels of nativity and nationality. The rationale for the study was to confirm the factor structure and psychometric properties of the MMCISL with a predominantly immigrant sample of Latina mothers and daughters (n = 316). Adequate reliability estimates were found for 6 of the original 10 scales. Confirmatory factor analyses provided evidence of construct validity for the reliable scales. The Preferred Latino Affiliation scale was the only scale to meet strict measurement invariance criteria across mothers and daughters. Criterion validity was evidenced by relations between the Familiarity with Latino Culture scale and all criterion variables. Implications for acculturation and cultural identity research involving the MMCISL are discussed.

A Comparison of African American and Cuban American Adolescent Juvenile Offenders: Risky Sexual and Drug Use Behaviors

SUMMARY Racial and ethnic disparities exist in HIV seroconversion rates, with African American and Hispanic youth in the 13–19-year-old age group representing 61% and 21% of new AIDS cases, respectively. The aim of this study was to examine sexual and drug use behaviors among a sample of 138 African American and Cuban American juvenile offenders. Cuban American adolescents showed higher levels of unprotected sex, higher levels of sex while using drugs, and higher levels of drug/alcohol use in the three and six months prior to confinement. These differences may be explained by multiple factors, including differences in acculturation levels among the Cuban American adolescents, differences in health messages targeted at the two groups, and family mores and norms.

Immigration Stress and Alcohol Use Severity Among Recently Immigrated Hispanic Adults: Examining Moderating Effects of Gender, Immigration Status, and Social Support.

OBJECTIVE Identifying and understanding determinants of alcohol use behavior among Hispanic immigrants is an increasingly significant public health concern. Although prior research has examined associations of cultural stressors with alcohol use among Hispanics, few studies have tested these associations among recent adult immigrants. As such, this study aimed to examine (a) the association of immigration stress on alcohol use severity among recently immigrated Hispanic adults (≤ 1 year in the United States) and (b) the moderating effects of gender, immigration status, and social support. METHOD A hierarchical multiple regression and moderation analyses were conducted on a sample of 527 participants in South Florida. RESULTS Results indicated that, after controlling for demographic variables, preimmigration drinking behavior, and dimensions of social support, the association of higher immigration stress with higher alcohol use severity was statistically significant. Moderation analyses indicated that immigration stress had a statistically significant association with alcohol use severity among men, but not women. Also, dimensions of social support consistently reduced the deleterious effect of immigration stress on alcohol use severity. CONCLUSION This study adds to the scarce literature on cultural stressors and alcohol use among recent Hispanic immigrants. Findings suggest that it may be important to design gender-specific interventions and that increasing levels of social support may offset the effects of immigration stress on alcohol use.

Sociocultural Determinants of Risky Sexual Behaviors among Adult Latinas: A Longitudinal Study of a Community-Based Sample

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother–daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.

Spatial Disparity of HIV/AIDS Service Providers: The Case of Miami-Dade County

This paper examines the spatial disparity between the HIV/AIDS service providers and the HIV/AIDS patients. The empirical focus is on Miami-Dade, a large metropolitan county in the United States with a Latino population majority and a high AIDS incidence rate. This exploratory study contributes to the existing literature on geographical access to health providers. Geographic Information System (GIS) is used to examine the spatial disparity between the service providers and the patients. The study reveals that aggregate-level analysis masks the reality of the spatial disparity. Miami Dade Countys Health Department focuses on aggregate zones for prioritizing its resources. At this level, there is little spatial disparity. However, evidence of spatial disparity emerges at the ZIP-code–level analysis. The major lesson from the study is that health policies need to be based on a finer-grained analysis to address spatial disparity.

Intergenerational associations between a consensual childhood sexual experience and adult substance abuse among Latina mothers and daughters

Purpose: Early onset of sexual activity has been linked to later substance abuse. Our study aimed to further describe the associations between Latina mothers’ and daughters’ early sexual activity and adult substance abuse. Methods: A survey was conducted with 92 Latina mother–daughter dyads whose members never experienced sexual abuse. Childhood sexual experience was defined as the occurrence of a consensual sexual encounter at the age of 15 years or younger. Substance abusers were identified by the extent of substance use during the 12 months prior to the interview. Path analysis was used to fit our conceptual models to the data. Main findings: Daughters’ current, adult substance abuse was associated independently with: their own childhood sexual experience (odds ratio [OR] = 6.0) and mothers’ current, adult substance abuse (OR = 2.0). Compared with daughters who first experienced sex after the age of 19, the odds of using substances were 17.7 times higher among daughters who had childhood sexual experience and 3.8 times higher among daughters who first experienced sex between the age of 16–19 years. Explicitly, sexual experiences between the ages of 16–19 years were also risk factors for later adult substance abuse. Mothers’ childhood sexual experience (OR = 7.3) was a strong predictor for daughters’ childhood sexual experience. Conclusions: Our study supported a link between mother and daughter childhood sexual experience among Latinas, and indicated it is a correlate of adult substance abuse. Family based substance abuse prevention efforts and future longitudinal studies should consider maternal childhood sexual experience as a potential indication of risk for Latina daughters.