HIV/AIDS stigma: measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women

Despite the increased interest in HIV/AIDS stigma and its negative effects on the health and social support of people living with HIV/AIDS (PLWHA), little attention has been given to its assessment among Latino gay/ bisexual men and transgender women (GBT) living with HIV/AIDS. The purpose of this paper is twofold: to develop a multidimensional assessment of HIV/AIDS stigma for Latino GBT living with HIV/AIDS, and to test whether such stigma is related to self-esteem, safe sex self-efficacy, social support, and alcohol, and drug use. The sample included 170 HIV+ Latino GBT persons. The results revealed three dimensions of stigma: internalized, perceived, and enacted HIV/AIDS stigma. Enacted HIV/AIDS stigma comprised two domains: generalized and romantic and sexual. Generalized enacted HIV/AIDS stigma was related to most outcomes. Internalized HIV/AIDS stigma mediated the associations between generalized enacted HIV/AIDS stigma and self-esteem and safe sex self-efficacy. In addition, romantic and sexual enacted HIV/AIDS stigma significantly predicted drug use. Perceived HIV/AIDS stigma was not associated with any outcome. These findings expand the understanding of the multidimensionality of stigma and the manner in which various features impact marginalized PLWHA.

Work stress and depression among direct support professionals: the role of work support and locus of control

BACKGROUND

Although work stress can impede the capacity of direct support professionals and contribute to mental health challenges, external (i.e. work social support) and internal resources (i.e. an internal locus of control) have been shown to help DSPs cope more actively. We examined how work stress was associated with depression, with a particular focus on the role of resources.

METHOD

Direct support professionals (n = 323) who serve adults with intellectual and developmental disabilities from five community-based organisations completed a cross-sectional, self-administered survey which measured work stress, work support, locus of control, and depression.

RESULTS

Multiple regression analyses demonstrated that work stress was positively associated with depression, while resources were negatively associated with depression. In particular, work support moderated the effects of client disability stress, supervisory support lessened the effects of role conflict, and locus of control moderated the effects of workload.

CONCLUSIONS

Such findings suggest the importance of external and internal resources for staff mental health. This research underscores the need for strong work social support systems and interventions to help staff manage work stressors.

Researching special populations: retention of Latino gay and bisexual men and transgender persons in longitudinal health research

Few studies have sought to assess predictors of retention of racial/ethnic or sexual minorities in longitudinal health research. The purpose of this study is to investigate predictors of retention of Latino gay and bisexual men and transgender (GBT) research participants after the baseline interview. Data come from a sample of 643 Latino GBT individuals in two cities (Chicago and San Francisco). We assessed potential predictors of retention (operationalized as successful re-contact) using binary logistic regression of retention on five factors (sociodemographic/health, residential stability, acculturation/attachment to the United States, gay community attachment/stigmatization and research process/design). Our overall follow-up rate was 83 and 80% at 3 and 6 months, respectively. We found that traditional factors (e.g. education, income) were not associated with retention among Latino GBT. The strongest predictors of successful retention were the number of pieces of contact information provided by participants and city of residence (San Francisco). Furthermore, successful methods of contact (i.e. telephone, email) varied by city. We conclude that a largely immigrant urban population of Latino GBT individuals can be successfully followed in longitudinal research. The strong relationship between study design variables and successful retention indicates that collection of thorough contact information is vital to successful follow-up with this population.

The protective effects of community involvement for HIV risk behavior: a conceptual framework

This paper presents a conceptual framework of the protective effects of community involvement in HIV/AIDS-related groups and organizations for HIV sexual risk behavior among gay and bisexual men. The framework delineates hypotheses for future research, and provides a guide for prevention programs based on the active and direct involvement of participants, particularly communities of color. The framework (1) argues that community involvement moderates the association between three socio-structural risk factors (i.e. poverty, homophobia and racism) and sexual risk behavior; (2) posits that community involvement in HIV/AIDS reduces sexual risk behavior via its effects on four mediating factors (i.e. peer norms, self-efficacy, positive self-identity and alienation); (3) proposes five socio-cultural barriers to and facilitators of community involvement in HIV/AIDS (i.e. motives for participation, poverty, acculturation, stigma and perceived opportunities); and (4) addresses burnout as one potential negative consequence of community involvement in HIV/AIDS-related organizations and groups. The conceptual framework advances the understanding of HIV sexual risk behavior by integrating both its socio-structural risk and protective factors. It contributes to health education by specifying how interventions based on collective action (e.g. community involvement) for social change may be effective in generating healthy behaviors at individual and community levels.

"I was not invited to be a [CHW] ... I asked to be one": motives for community mobilization among women community health workers in Mexico

Despite health educators' revitalized interest in community mobilization for health, little attention has been given to participants' motives for mobilizing. The purpose of this article is to contribute to the understanding of community mobilizing by analyzing the motives for mobilization among a group of women community health workers (CHWs), members of a community-based organization in Mexico. The study is guided by critical feminist and social constructivist theories. It aims at identifying the categories of motives used by women CHWs and exploring how these motives are created while presenting women's own voices. Women's motives fall into four categories: getting out, serving, learning, and women's betterment. These motives blend personal andpublic motives. The analysis suggests that mobilization for health may be enhanced by addressing both the personal satisfaction of individuals and the accomplishment of public goods. The study of motives may be useful for the recruitment and retention of participants in community mobilization efforts.

Women, the welfare state, and their transnational dimension: the case of Mexico's community health worker programs

Feminist scholarship has shown that the welfare state is not only a set of agencies and policies to distribute services, but is engaged in the promotion of normative concepts of the female through its structural arrangements and the content of its programs and policies. Yet, this scholarship conceptualizes the state as a national entity and free from external influences, ignoring its transnational dimension. States are embedded in an international network consisting of other states, international agencies, and corporations that influence the practices and discursive frame of the welfare state. To uncover the process by which the welfare state institutionalizes and promotes female identities and the transnational dimension of this process, the author analyzes the case of community health worker programs conducted by the Mexican state from the 1970s to the early 1990s. The analysis corroborates the gender practices of the welfare state and suggests a reconceptualization that takes into account the transnational dimension of the state practices. The implications for feminist theories on the welfare state and for analyses of health promotion policies and programs are discussed.

Changing women: the narrative construction of personal change through community health work among women in Mexico

A major premise of health education is that people can and do change their lives. Personal changes and the events that precipitate them are often told in a form of narrative and are accompanied by a new sense of oneself. This research draws on the study of narratives and women's community activism to explore processes of personal change in women's activism as community health workers in Mexico. The research is a case study based on in-depth semistructured interviews. Two major categories of narratives of change emerged: change of the self and little or no change. Within these categories, changes are defined as development of the self, becoming a new and different person, actualization of the self, and little or no change. Although women experience significant changes, their changes are based on normative female identities. Implications for the study of narratives and personal change in health education are discussed.

Promoting health, promoting women: the construction of female and professional identities in the discourse of community health workers

Community health worker (CHW) programs are implemented in the third world and among racial minorities in the U.S. by public health professionals with the goal of improving people's access to basic health services. There is a shared view that women's roles as mothers make them effective CHWs because most health practices are located within the realm of the family. The objective of this paper is to inquire how and what concepts of woman are constructed and promoted in CHW programs. Viewing CHW as a discourse, I examine literature on CHWs using a critical feminist perspective and insights from narrative and rhetorical analyses. I argue that CHW positions women living in the third world and non-white Hispanic women in the U.S. as the "other" woman. The natural attributes of this other woman include mother, care giver, oppressed, child-like, and victim of patriarchy, religion, poverty, and diseases. These attributes are used to define categories of the female such as "the third world woman" and "Hispanic woman". These categories, in turn, define two unnamed opposite categories: "the first world woman" and "the public health professional". I conclude that CHW is a colonizing discourse and that public health professionals and feminists need to practice reflexivity.

Sexual risk behavior among youth: modeling the influence of prosocial activities and socioeconomic factors

Sexual activity among high-school-aged youths has steadily increased since the 1970s, emerging as a significant public health concern. Yet, patterns of youth sexual risk behavior are shaped by social class, race, and gender. Based on sociological theories of financial deprivation and collective socialization, we develop and test a model of the relationships among neighborhood poverty; family structure and social class position; parental involvement; prosocial activities; race; and gender as they predict youth sexual risk behavior. We employ structural equation modeling to test this model on a cross-sectional sample of 370 sexually active high-school students from a midwestern city; 57 percent (n = 209) are males and 86 percent are African American. We find that family structure indirectly predicts sexual risk behavior through neighborhood poverty, parental involvement, and prosocial activities. In addition, family class position indirectly predicts sexual risk behavior through neighborhood poverty and prosocial activities. We address implications for theory and health promotion.

An HIV/AIDS prevention project for Mexican homosexual men: an empowerment approach

In this intervention, participants design and implement an HIV/AIDS prevention project for Mexican homosexual men. The intervention is consistent with, and contributes to, empowerment theory because it enhances collective action, provides opportunities to develop knowledge and skills, creates needed resources, and includes shared control with professional and among participants. The intervention described provides an illustration of an empowering process and distinguishes itself from empowerment outcomes. An evaluation of the project is also described, but the outcomes were HIV/AIDS-related behaviors rather than psychological empowerment of the participants. The results suggest that the participants' HIV/AIDS knowledge and preventive behavior improved when compared to individuals who did not participate in the intervention. In addition, the intervention generated community change initiated by participants. Implications for designing interventions using an empowerment approach are discussed.

The development of a measure of enculturation for Native American youth

Enculturation is the process by which individuals learn about and identify with their ethnic minority culture. It is distinguished from acculturation which refers to the process by which an ethnic minority individual is assimilated into the majority culture. Three studies with Native American youths are reported that describe the development of a measure of enculturation for Native American youths. Development of a measure of enculturation provides a foundation upon which to build a body of literature that focuses on strengths in a youth's life rather than on deficits. Results of the first study (n = 120), a confirmatory factor analysis, indicated that cultural affinity, native American identity, and family involvement in traditional activities adequately represent the construct of ecnulturation. The study also provides some convergent validity for this interpretation. The second study examines factor invariance for enculturation among youths with data from over 2 years (n = 69). The factor structure was similar across time. The third study replicates the factor structure and validity analyses with a new sample (n = 42). Usefulness of the measure for assessing protective factors and stressing ethnicity over simple assessment of race categories is discussed.