Search

African American women are disproportionately at risk for HIV infection. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV. Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care–related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention. Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p <.01) and in a typical week (p <.05); reduced PTS symptoms (p <.05); increased HIV knowledge (p <.0001) and awareness of PrEP (p <.001); and greater consideration of using PrEP (p <.001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained. The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women. [ABSTRACT FROM AUTHOR]

In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made. [ABSTRACT FROM AUTHOR]

The Women-Centered Program for Women of Color, a culturally congruent sexual health intervention, was implemented in 2018 in Los Angeles County, California, according to the principles of community-based participatory research: enhancing community capacity, establishing sustainable programs, and translating research findings to community settings. Participants exhibited significantly increased knowledge of and interest in preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) over time, but no significant change in condom use was evident. Booster sessions are needed to maintain interest in PrEP and PEP given concerns about reproductive and sexual health. (Am J Public Health. 2023;113(S2):S110–S114. https://doi.org/10.2105/AJPH.2023.307296) [ABSTRACT FROM AUTHOR]

The authors share perspectives on mentoring others to conduct research with underserved populations. They discuss the importance of studying within-group differences and patterns rather than fostering potentially erroneous and harmful across-group differences, interrogating the bidirectional relationship between the production of research and academic career development, and embracing cultural humility as a fundamental research instance.

This article describes the nearly half a century career of Dr. Gail E. Wyatt, PhD, and her development of novel methodologies and measures of sexual trauma, specifically the Wyatt Sex History Questionnaire and the University of California, Los Angeles, Life Adversities Screener. These approaches broke the silence around experiences of sexual violence, particularly among African Americans, identifying their effects on sexual functioning and mental health. These novel methods are designed without assuming sexual literacy of respondents, knowledge of anatomy, or that discussing sex is easy or common; they include topics that are considered private and may evoke emotions. Trained professionals administering face-to-face interviews can serve to establish rapport and educate the participant or client while minimizing possible discomfort and shame around the disclosure of sexual practices. In this article, four topics are discussed focusing on African Americans, but they may also be relevant to other racial/ethnic groups: (a) breaking the silence about sex, (b) sexual harassment: its disclosure and effects in the workplace, (c) racial discrimination: identifying its effects as a form of trauma, and (d) the cultural relevance of promoting sexual health. Historical patterns of abuse and trauma can no longer be ignored but need to be better understood by psychologists and used to improve policy and treatment standards. Recommendations for advancing the field using novel methods are provided. [ABSTRACT FROM AUTHOR]

Couples-based behavioral HIV prevention interventions have demonstrated efficacy, but few are routinely available in community-based settings in the United States. The Eban intervention, designed for heterosexual African American serodiscordant couples and proven efficacious in a cluster randomized trial, was implemented in community-based HIV service organizations in two cities disproportionately affected by the HIV epidemic. This article reports primarily on the effectiveness results related to condom use and results related to retention challenges within a Hybrid Type 2 implementation/effectiveness trial. Ninety-one individuals enrolled at baseline; 39 completed the posttest, and 30 completed the 3-month follow-up. Although condom use did not monotonically increase from baseline to posttest and 3-month follow-up, it did increase from baseline (44%) to posttest (73%), and from baseline to 3-month follow-up with an overall positive slope of Time 0.13 to 0.14 (p < .001). There was a significant increase in the number of people who used condoms 100% of the time from baseline (36.3%) to posttest (56.4%; p = .04) but not from baseline to 3-month follow-up (46.7%; p = .2907). Challenges with resources as basic as housing, food, and transportation complicated participation (and therefore implementation) and may have impeded couples' maintenance of risk reduction strategies beyond the intervention. In light of couples' numerous observed vulnerabilities, we constructed a composite score of "critical vulnerability" and found that depression was persistently related to critical vulnerability and that retention was higher among those with less vulnerability. These findings highlight the important yet underaddressed role of patient-level factors in the process and outcomes of hybrid implementation/effectiveness research. [ABSTRACT FROM AUTHOR]

Lack of condom use by married or cohabiting couples in populations with high rates of HIV infection has become a significant public health issue. This study investigated whether an HIV risk-reduction intervention (RRI) would increase condom use when delivered to serodiscordant couples as a unit. Of the 62 couples that were screened, 30 serodiscordant couples were enrolled in the study, and randomized 2:1 to an immediate intervention-waitlist control study. The 12-week intervention focused on communication, problem-solving, and negotiation skills. Participants were assessed at baseline, three and six months after the intervention. The main outcome measures were consistent condom use, HIV seroconversion and fidelity to the programme. The use of condoms increased for both the intervention and control groups after receiving a 12-week RRI. Group comparisons showed a significant difference at three months, with a significantly higher mean proportion of condom-protected sex acts (p = 0.0119) between the control and intervention groups, the later showing an increase in condom use. No seroconversion was detected, and the overall retention rate of participants was 83.33%. Counselling heterosexual couples as a unit prompted an increase in condom use, but sustained condom use remains a challenge. [ABSTRACT FROM AUTHOR]

This issue is a call for more culturally congruent mentorship training, support, and research on the effectiveness of mentoring strategies. The role of mentoring is fundamental to professional growth and success. Importantly, one size does not fit all. A repertoire of mentoring strategies and formats is necessary to include the talent, skills, and contributions of the next generation of diverse researchers in public health and biomedical sciences. It is incumbent on us now to grow a comprehensive knowledge base so we may best promote health and well-being for all citizens through innovative and effective strategies to support mentoring and research that eliminates health disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

This article defines and discusses 6 beliefs, attitudes, and practices that can erode or undermine self-esteem and self confidence in student-scholars from underrepresented and marginalized groups in academic settings. Specifically, the beliefs and practices are reactions to implicit bias, color blindness, imposter syndrome, internalized racism, stereotype threat, and code-switching. Mentors need to know how to discuss these reactions because they can also influence the mentoring process and academic performance. To minimize incidents or interactions that might result in scholars not being able to find their place in these settings, recommendations for basic mentoring strategies and individual- and systemic-level approaches to address institutional racism are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

This article articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos—2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual model of gender, ethnicity, and HIV risk and resilience is presented. Third, a historical backdrop of gender and ethnic disparities is provided, with attention to key moments in history when notions of the intersections between gender, ethnicity, and HIV have taken important shifts. Finally, new frontiers in psychology are presented, with recommendations as to how psychology as a discipline can better incorporate considerations of gender and ethnicity as not only HIV risk factors but also as potential avenues of resilience in ethnic families and communities. Throughout the article, we promulgate the notion of a syndemic intersectional approach, which provides a critical framework for understanding and building the conditions that create and sustain overall community health by locating gendered lived experiences and expectations within the layered conceptual model ranging from the biological self to broader societal structures that define and constrain personal decisions, behaviors, actions, resources, and consequences. For ethnic individuals and populations, health disparities, stress and depression, substance abuse, and violence and trauma are of considerable concern, especially with regard to HIV risk, infection, and treatment. The conceptual model poses new frontiers for psychology in HIV policy, research, interventions, and training. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the extent to which current United States based human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages. Method: A comprehensive literature review was conducted to determine which published human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions incorporated aspects of cultural beliefs. Results: This review of 166 human immunodeficiency virus (HIV) prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts. Conclusion: human immunodeficiency virus (HIV) interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual''s risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices. [Copyright &y& Elsevier]

I describe 4 protective strategies that African Americans employ that may challenge current HIV prevention efforts: (1) an adaptive duality that protects identity, (2) personal control influenced by external factors, (3) long-established indirect communication patterns, and (4) a mistrust of "outsiders." I propose the Sexual Health Model as a conceptual framework for HIV prevention interventions because it incorporates established adaptive coping strategies into new HIV-related protective skills. The Sexual Health Model promotes interconnectedness, sexual ownership, and body awareness, 3 concepts that represent the context of the African American historical and cultural experience and that enhance rather than contradict future prevention efforts. [ABSTRACT FROM AUTHOR]

People of color are disproportionately affected by HIV/ AIDS, yet African American HIV/AIDS researchers are in short supply. Complex historical, structural, sociocultural, and personal barriers can prevent African Americans from becoming well-trained biomedical, behavioral, and social HIV/AIDS researchers. Institutional factors that influence the numbers of African Americans conducting HIV/AIDS research include the limitation of early-career decisions and a lack of exposure to research, research socialization, and mentoring. Two individual-level factors that influence the submission of federally funded research proposals are the limited availability of support for culturally congruent HIV research and African Americans' negative perceptions of their own competence and ability to contribute to society. We discuss progress toward eliminating disparities experienced by African American HIV/AIDS researchers at the individual, academic institution, and sociopolitical levels. (Am J Public Health. 2009;99: S48-S53. doi:10.2105/AJPH.2007.131094) [ABSTRACT FROM AUTHOR]

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men’s Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an “intent to treat” analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time. [ABSTRACT FROM AUTHOR]

The rate of HIV/AIDS among women in India is expected to rise yet few studies have examined factors related to HIV risk among Indian women. The objective of this prospective, cross-sectional study was to characterize similarities and differences in the relationships, psychological well-being, and sexual behaviors among Indian women (N = 459). Both HIV positive (N = 216) and negative (N = 243) women from urban and rural areas in India were included in this study. Chi-square, analysis of variance, and logistic regression analyses revealed that in both geographic groups, HIV-positive women were significantly more likely to report marital dissatisfaction, a history of forced sex, domestic violence, depressive symptoms and husband's extra marital sex when compared to the HIV-negative women. Findings also indicate that specific factors related to the quality of the marital relationship such as domestic violence, martial dysfunction, and depressive symptoms may be related to HIV-related risks for women. Implications for future research and culturally relevant interventions are discussed. [ABSTRACT FROM AUTHOR]

This qualitative study examined sociocultural and behavioral factors including sexual health, sexual identity, and sexual risk among HIV-seropositive African American and Latino men who have sex with men (MSM) who also have a history of sexual abuse. Twenty-three men participated in 4 focus groups, responding to conceptually organized questions regarding the relationship between histories of violence and sexual and drug- related HIV risk behaviors for reinfection and transmission. Consensual qualitative research methods were used to analyze audiotaped transcriptions. Seven domains focusing on consensual and nonconsensual sexual practices, cultural and gender-bound beliefs, and social expectations were identified. Implications of these psychosocial issues for HIV-seropositive gay- and non-gay-identifying African American and Latino MSM with histories of sexual abuse in future interventions are discussed. [ABSTRACT FROM AUTHOR]

This qualitative study examined sociocultural and behavioral factors including sexual health, sexual identity, and sexual risk among HIV-seropositive African American and Latino men who have sex with men (MSM) who also have a history of sexual abuse. Twenty-three men participated in 4 focus groups, responding to conceptually organized questions regarding the relationship between histories of violence and sexual and drug-related HIV risk behaviors for reinfection and transmission. Consensual qualitative research methods were used to analyze audiotaped transcriptions. Seven domains focusing on consensual and nonconsensual sexual practices, cultural and gender-bound beliefs, and social expectations were identified. Implications of these psychosocial issues for HIV-seropositive gay- and non-gay-identifying African American and Latino MSM with histories of sexual abuse in future interventions are discussed. [ABSTRACT FROM AUTHOR]

Risky and precautionary sexual behaviors were examined in a community sample of 260 single and married/cohabitating White women. Structural equation modeling was used to assess the ability of age, socioeconomic status (SES), marital status, religiosity, and 9 health belief constructs to predict risky sexual behavior with one's partner, using a barrier method of birth control, unintended pregnancies, and number of sexual partners in the past year. The pattern of results suggests that single White women appear to feel more vulnerable to HIV and STD infection and more likely to engage in risky sexual behavior than do married White women. The discussion focuses on the importance of sociocultural factors in understanding risk behaviors within the social context of relationship status, the complexity of the concept of risk reduction, and the need for going beyond the health belief model in order to develop different HIV prevention strategies for single and married White women. [ABSTRACT FROM AUTHOR]

Objectives. We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. Methods. Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. Results. Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. Conclusions. Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk. (Am J Public Health. 2002:92:660-665) [ABSTRACT FROM AUTHOR]

Presents information on a study which examined HIV contraceptive decision-making among African-American, Latina and European American women. Factors influencing contraceptive decision-making; Theoretical implications about contraceptive choices among ethnically diverse women; Discussion and conclusion.

Objective: This study reports the prevalence of child sexual abuse of African American and European American women and compares the circumstances of these incidents to data collected a decade ago. Method: Stratified probability sampling was used to recruit comparable samples of African American and European American women in Los Angeles County for a larger study of women's sexual decision making. Incidents of contact abuse were obtained from women 18 to 36 years old in 1994 and compared to women with those demographic characteristics from a comparable 1984 dataset. The prevalence of abuse, characteristics of the victim, assault, alleged perpetrator, disclosure, and long-term effects by ethnic group affiliation were assessed. Results: Of the total sample, 34% reported at least one incident prior to age 18. Ethnic differences were found with respect to prevalence, location of abuse, and number of incidents of rape. While comparisons made with the 1984 dataset revealed no significant difference in prevalence rates over the 10 year period, changes in circumstances were noted. Conclusions: Although the prevalence of child sexual abuse in Los Angeles County remained fairly stable, several circumstances of abuse underwent change. These characteristics are discussed in relation to how sexual abuse among ethnically diverse samples in Los Angeles County has changed over a decade and how these differences can help better tailor prevention messages to different communities. [ABSTRACT FROM AUTHOR]

Provides information on a study which examined the prevalence and circumstances of child sexual abuse in a community sample of Latina women. Method; Results and discussion.

Describes differing aspects of risks of emotional distress to the interviewer in clinical interviews for child and adult violence. Three cases in which interviewers experienced a negative response to trauma-oriented clinical research interviews; Reasons for the negative impact on the interviewer; Approaches in minimizing and managing emotional stress on the part of the interviewer.

Investigates ethnic differences in the prevalence, forms and outcomes of sexual harassment in a variety of work and public and private social settings in a stratified community sample of African American and white American women. Sexual harassment at work; Sexual harassment in social settings.

Describes the demographic characteristics of private physicians and the prevalence of abortions performed in their offices in Los Angeles County, California. Factors influencing physicians' decisions to provide service; Demographic characteristics of women who obtained office abortions.

This study examined the relationship between social, structural, and economic variables that increased HIV-related sexual risk taking in a random community sample of 835 African American, Latina of Mexican origin, and White women, aged 18-50 years. Multivariate analyses tested relationships between women's family constellations, HIV/AIDS-related sexual risk-taking, perceptions of susceptibility to become infected with HIV, and condom use. The findings identified different patterns of sexual risk taking for each ethnic group. Latinas' risks increased within a committed relationship, and White women's risks were increased by sex outside of their current relationship and by their sexual practices. African Americans' risks increased due to economic instability and being single. Women's sexual risk taking illustrates how relationship building and family formation increase HIV-related risks regardless of ethnicity and current relationship status. [ABSTRACT FROM AUTHOR]

Focuses on societal myths about female sexuality. Women's sexual decision-making; Sexual behaviors; Stereotyping women's sexuality; Sexual awareness.

This article presents a brief discussion of the history of sexuality and rape in Colonial America and then describes a study designed to understand ethnic and cultural factors that may be associated with disclosure, consequences and expectations of rape among African American and White women. The findings indicate that, contrary to surveys based upon police reports, which identify Black women as most at risk for rape, no significant ethnic differences in the prevalence of rape incidents were noted. The discrepancy between those reports and the present data is probably a result of the demographic characteristics of the samples. In this study, women of both ethnic groups reported an average of 13 years of education and their income was comparable except for women below the poverty level. Most rapes reported to police involve women of lower socioeconomic status who tend to be single. Thus, when other variables were controlled, Black women in Los Angeles County were not more at risk for rape than White women.

Previous research highlights the need to better understand the complex relationships between factors marginalizing Black men who have sex with men and women (MSMW) living with HIV, including HIV stigma, trauma, and hegemonic masculinity. We examined associations between gender role conflict (GRC), trauma, and HIV stigma in Black MSMW living with HIV. 117 participants completed the UCLA Life Adversities Screener (LADS), measures of GRC, and HIV stigma. A multivariate model with age, gender role, and the LADS as predictors of stigma was statistically significant F (4, 110) = 12.81, p <.0001. The LADS was significantly associated with stigma (b = 11.06, t = 4.17, p <.0001) and moderated by GRC (b = 12.19, t = 2.25, p <.05); stigma increased significantly at high, but not low GRC. High GRC heightens the relationship between trauma and HIV stigma in Black MSMW. Future research must investigate associations among trauma burden, stigma, and GRC among vulnerable populations. [ABSTRACT FROM AUTHOR]

We utilised a cross-sectional survey design to examine the moderating roles of dimensional psychological capital (PsyCap) and pre-displacement stressors on the relationship between psychological morbidity and severity of PTSD symptoms among internally displaced (IDP) women from terrorist activity. Participants were 631 IDP women (mean age = 31.18 years, SD = 8.59 years) displaced by Boko Haram insurgents in North-East Nigeria. Structural equation modelling (SEM) of the data from self-report measures suggested that the PsycCap resources of hope and general self-efficacy seemed to mitigate the impacts of pre-displacement stressors and psychological morbidity on severity of PTSD symptoms. Clinical interventions utilising therapies oriented towards increasing the hope and general self-efficacy of IDP women may mitigate worsening of PTSD symptoms. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, reports of domestic violence across the United States increased from 21% to 35%. Stay-at-home orders, designed to protect the public against the spread of COVID-19, along with heightened societal stressors as a result of the global pandemic, inadvertently increased rates of illicit drug and alcohol use, job loss, and isolation, resulting in increased stress and nonphysical (e.g., psychological, emotional, economic, technological) abuse that often escalated to physical violence. These processes were exacerbated in marginalized communities. These risks were heightened among Black women and Latinas, who experience high rates of domestic violence, long-standing distrust in law enforcement, and compromised self-reporting or anonymous reporting of abuse. We make recommendations for training key stakeholders (e.g., law enforcement, mental health clinicians, and public health care professionals) to facilitate the safety and well-being of domestic violence survivors and to better manage prevention or intervention efforts targeted at domestic violence. We make public health policy suggestions for individuals, communities, and governing structures. (Am J Public Health. 2023;113(S2):S149–S156. https://doi.org/10.2105/AJPH.2023.307289) [ABSTRACT FROM AUTHOR]

Introduction: Substantial unmet need for mental health services (MHS) exists in the United States, with pronounced disparities among people of color. Research highlights the need to identify facilitators and barriers to MHS utilization among Black and Latinx individuals to better promote overall health. We tested an expanded model of MHS use based on Andersen's (1995) conceptual framework of health care utilization. Associations were examined between sociodemographic variables, trauma and adversity burden, living with HIV, and unmet need for MHS in a community sample of underresourced Black and Latinx individuals. Barriers to MHS utilization are described. Methods: Five-hundred participants completed the UCLA Life Adversities Screener (LADS), sociodemographic measures, and items assessing need for and barriers to MHS. Results: 228 (46%) participants reported a need for MHS; of these, 115 (51%) reported receiving MHS. A binomial logistic regression model estimated the relative contribution of the LADS on need for MHS. Severity of LADS, younger age, and living with HIV predicted unmet need for MHS. Barriers to MHS included financial and time constraints and health system-related issues. One-way analysis of variance (ANOVA) tests revealed differences in mental health symptoms by MHS need. Discussion: The unmet need for MHS in this sample of Black and Latinx individuals highlights the importance of addressing the systemic roots of trauma and adversity burden, and eliminating structural barriers to treatment to reduce existing health and mental health inequities. Public Significance Statement: Substantial unmet need for mental health services (MHS) exists in the U.S. and disproportionately affects people of color. Using an extended conceptual model of health care use, this study examined the role of trauma and adversity burden in predicting need for MHS, and identified predictors of and barriers to MHS utilization among a sample of underresourced Black and Latinx individuals. The findings suggest that despite high rates of trauma and adversity and MHS need, approximately half of those who perceived a need for MHS did not receive it. Care-seeking in this sample was compromised by known systemic barriers such as financial burdens, competing life demands, difficulty navigating the health care system, childcare needs, stigmatization, and low mental health care literacy. National policies and programs that target systemic inequities and structural barriers to MHS for populations impacted by disparities are needed to eliminate health and mental health inequities. [ABSTRACT FROM AUTHOR]

Abstract: Experiences of past and current gender-based violence are common among HIV-positive women in the United States, who are predominantly from ethnic minority groups. However, culturally congruent, feasible interventions for HIV-positive women who have experienced past and/or current violence are not widely available. The Office on Women’s Health Gender Forum has made several recommendations for responding to the National HIV/AIDS Strategy Implementation Plan, including recommendations to incorporate gender-based violence prevention into a comprehensive, gender-responsive national strategy. This paper draws on an example of a community-based project for HIV-positive women, the Healing Our Women Project, to illustrate how violence prevention can be achieved within peer-led and community-based programming. Strong community partnerships, responsiveness to community needs and local cultural norms, a trained workforce, and culturally competent care are programmatic cornerstones of gender-responsive services. HIV-positive women with histories of gender-based violence and risk factors for current and future violence deserve the highest quality gender-responsive services to ensure that they can address their health needs within contexts of safety and respect. [Copyright &y& Elsevier]

The authors consider how the care experiences of African Americans and Latinx people living with HIV (PLWH) could inform culturally relevant, multilevel strategies for managing public health crises like COVID-19 in the context of structural racism and bolster care for PLWH facing new health threats. Topics include conditions of the COVID-19 pandemic, public health strategies for HIV to COVID-19, and continuity of care and digital inclusion.

Women with histories of child sexual abuse (CSA) are more likely than those without such experiences to report a variety of negative sexual outcomes. This study examines the explanatory power of a CSA summed composite versus dichotomous (presence/absence) measurement in predicting a comprehensive negative sexual behavior outcome. Study participants were obtained from a community based sample examining women's sexual decision-making. The continuous CSA measurement reflects cumulative histories of CSA through a composite score capturing abuse specific characteristics. Using a cross-validation approach, the sample (n =835) was randomly split and the explanatory power of each measure was examined through a series of multiple linear regressions comparing model fit indexes and performing a formal likelihood ratio test of one model against another. All CSA measures explained a similar percentage of variance but overall the CSA summed composite explained the data significantly better in terms predicting negative sexual experiences and revictimization than a binary measure as demonstrated with the likelihood ratio test. The results were replicated by cross-validating the predictive power of the CSA composite score between the split samples. Consistency of CSA regression estimates for the summed composite between training and validation samples were also confirmed. Given the superiority of the CSA summed composites over the binary variable, we recommend using this measure when examining associations between CSA histories and negative sexual experiences and revictimization. [Copyright &y& Elsevier]

Trauma-focused research highlights the reactions of seasoned professionals when engaging with vulnerable clients; however, less is known about the common reactions of novices engaged in trauma research, who may lack the skills to cope and interact with traumatized participants. The purpose of this study is to (a) describe common reactions experienced by novice trauma interviewers; (b) examine whether the issues they face are similar to those of seasoned helping professionals; and (c) discuss ways in which training and supervision can increase the well-being of interviewers in trauma research. A semi-structured assessment was administered to novice interviewers who had previously conducted psychosocial and trauma assessments with diverse community participants. Participation was voluntary. The assessment elicited responses concerning secondary traumatic stress, vicarious trauma, posttraumatic growth, and self-help and resources. Audio files were transcribed; responses were compiled to explore themes and identify illustrative quotes. Eight interviewers (two males, six females) participated. Six reported no prior experience working with populations with histories of trauma. Novice interviewers described experiences of secondary traumatic stress, vicarious trauma, compassion fatigue, posttraumatic growth, and resilience. Novice interviewers described symptoms consistent with those reported by seasoned helping professionals; positive and negative symptoms often coexisted. Interviewers who completed more assessments described reactions of sadness, anger, insomnia, and changes in worldview. Interviewers who shared similar traumatic histories or environments reported more examples of countertransference. All reported similar feelings of posttraumatic growth, such as hope and optimism, for their participants and an increased appreciation of their resilience. Implications for training and supervision are discussed. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study examined the hypothesis that the capacity for emotional expression is a critical moderator of the emotional support–health relationship. Methods: In a sample of 61 HIV-seropositive women without AIDS, coping interviews were conducted to assess HIV-specific emotional support and emotional expression and inhibition (percentage of positive/negative emotion words and inhibition words, respectively). Results: Hierarchical regression analyses revealed no relationship between availability of HIV-specific emotional support and concurrent CD4 levels and no moderation of emotional expression or inhibition. However, a higher percentage of inhibition words was associated with lower CD4 T-cell levels controlling for health behaviors, demographics, and treatment regimen (ΔR2=.08, P<.05). Conclusions: These findings are consistent with prior theory and research showing a relationship between psychological inhibition and deleterious health outcomes. [Copyright &y& Elsevier]

That racial/ethnic discrimination has adverse physical and psychological consequences, including stress, anxiety, depression, and their attendant health effects, is well documented. However, the particular dimensions within the broad construct of discrimination and their role in mental health are less well understood. This study investigates the dimensions of discrimination and explores their relation to depression and posttraumatic stress (PTS) symptoms. Using the Brief Perceived Ethnic/Racial Discrimination Questionnaire-Community Version, discrimination experiences were assessed among a community sample of African American and Latinx participants (N = 500). Factor analyses revealed 4 dimensions: Social Rejection, Stereotyping, Direct Threats/Attacks, and Police Mistreatment. In multivariate analyses, full regression models were significantly related to PTS and depression symptoms. Among the individual predictors, Social Rejection and ethnicity (Latinx) uniquely contributed to PTS symptoms in men, whereas Stereotyping and Direct Threat/Attack were associated with PTS symptoms for women. In regards to depressive symptoms, income, ethnicity (Latinx), and Social Rejection were significant predictors for men, while Social Rejection had an independent contribution for women. Thus, social rejection emerged as a significant unique predictor in 3 of the four models, suggesting that social ostracism may be a particularly harmful aspect of discrimination. Implications of these findings include the use of proactive and intervention strategies that emphasize a sense of belonging and mitigate the effects of exclusion and rejection. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Health inequities and disparities among various racial/ethnic minority, sexual minority, and rural populations are the focus of increasing national efforts. Three health problems disproportionately affecting these populations-HIV/AIDS, substance abuse, and trauma-deserve particular attention because of their harmful effects on health across the life span. To address these problems, our training program, the UCLA HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), mentors and trains early career behavioral health scientists to conduct research using scientifically sound, culturally collaborative, and population-centered approaches. HA-STTP has been highly successful in training a diverse, productive, nationwide group of scholars. The program provides 2 years of training and mentorship to 20 (5 per year over 4 years) scholars. It is unique in its attention to traumatic stress as a form of dysregulation, particularly as experienced by underserved populations. Furthermore, our training program embraces a uniquely comprehensive, culturally grounded understanding of traumatic stress and its implications for substance abuse and HIV. HA-STTP advances scholars' knowledge of the interconnections among substance abuse, HIV/AIDS, traumatic stress, and health disparities, particularly in underrepresented populations; provides intensive mentorship to support scholars' research interests and career trajectories; capitalizes on a multidisciplinary, multiracial/ethnic network of expert faculty; and evaluates the program's impact on scholars' knowledge and productivity. By fostering the growth of scholars committed to conducting research with underrepresented populations that are disproportionately affected by HIV/AIDS, substance abuse, and traumatic stress, this program enhances nationwide efforts to diminish the prevalence of these problems and improve health and quality of life. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Background: Organizational context plays a critical role in the implementation of evidence-based interventions. Implementation research to date has focused largely on internal, rather than external, context. This paper presents key features of external context and their impact on implementation of Eban II, an evidence-based HIV/AIDS prevention intervention currently being tested in community-based organizations (CBOs). We examine external context factors that have influenced implementation, highlighting the ways in which client needs, agency resources, and changing policies permeate the theorized boundary between internal and external context, affecting both organizational capacity for implementation research and implementation processes themselves. Methods: Staff (n = 91) across participating CBOs completed a baseline survey of organizational functioning; a subset of key stakeholders (n = 15) completed semi-structured interviews. Client participants (n = 84) completed a baseline survey. Process notes and organizational documents were also analyzed. Results: Organizational readiness for implementation was high across the organizations. However, despite apparent readiness, external contextual barriers to implementation were substantial. Three categories of barriers were identified: (1) client needs as a manifestation of social determinants of poverty, (2) community agency resources, and (3) local and national policy changes. Clients' psychosocial vulnerability affected their everyday lives and priorities, which thereby affected the regularity and intensity of their interface with CBOs, and hence their participation in our intervention. CBOs typically lacked staffing and space. Furthermore, changing federal and state policy priorities destabilized the CBOs, which had a ripple effect on our study. Drawing on community-engaged research principles, we made numerous adjustments to the intervention format and structure according to the preferences and contexts of the CBOs. Had we not adjusted to external contextual factors, the organizations would not have been able to maintain their involvement and provide the intervention to their clients, despite expressed, genuine commitment to shared goals. Conclusions: Community-based implementation studies need to address complex organizational and client needs, using community-engaged research principles. If these studies are community-based among vulnerable populations, they need to more thoroughly evaluate, monitor, and address the ways in which external contextual factors impinge upon implementation processes and outcomes, with a parallel need for more comprehensive measures of fiscal, political, and social determinants of implementation success. [ABSTRACT FROM AUTHOR]

We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women. [ABSTRACT FROM AUTHOR]

The article presents a study that deals with the process of adapting Healing Our Women, a group-level HIV risk-reduction intervention, for transgender women of color in New York City. Topics include U.S. Centers for Disease Control and Prevention guidance for the adaptation of efficacious interventions, the acceptability and fidelity of the adapted intervention, and culturally appropriate HIV preventive interventions for transgender persons.

Background The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of 'Eban II,' an evidencebased risk reduction intervention for African-American heterosexual, serodiscordant couples. Methods/design This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level, staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). Discussion This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. [ABSTRACT FROM AUTHOR]

Adult men of different ethnic backgrounds who experienced childhood sexual abuse (CSA) may vary in their reports of the psychological and behavioural impact of CSA on their lives. Empirical studies rarely examine the impact of race/ethnicity or cultural context on the psychological and behavioural struggles of adult male CSA survivors. This study utilised qualitative content analysis to examine the reported CSA-related psychological and behavioural challenges of 150 US men, with equal numbers of Blacks, Latinos and non-Latino Whites. Interview data revealed some ethnic differences: Black men more frequently denied having present day adverse effects than other groups. However, Black men who did report negative consequences of CSA discussed difficulties with substance use and hyper-sexualised behaviour more often than other ethnicities. Latino men reported anger, anxiety, hyper-vigilance, flashbacks and communication problems more often than the other two groups. Black and Latino men also discussed guilt/shame issues and sexual identity concerns more often than Whites did. In contrast, White men more frequently discussed issues related to low self-esteem, loneliness and isolation. These findings suggest that ethnically diverse men may respond differently to CSA experiences and that considerations need to be taken into account when providing healthcare to men with CSA histories. [ABSTRACT FROM AUTHOR]

Modest or even occasional nonadherence to combined antiretroviral therapy (cART) can result in adverse clinical outcomes. African Americans demonstrate lower rates of adherence than Caucasians or Latinos. Identifying factors that influence medication adherence among African Americans is a critical step toward reducing HIV/AIDS disease progression and mortality. In a sample of 181 African American ( n=144) and Caucasian ( n=37) HIV-positive drug-using individuals [age (M=42.31; SD=6.6) education (M=13.41; SD=2.1)], we examined the influence of baseline drug use, literacy, neurocognition, depression, treatment-specific social support, and patient satisfaction with health care provider on medication adherence averaged over the course of 6 months (study dates 2002-2006). Our findings suggest differential baseline predictors of medication adherence for African Americans and Caucasians, such that patient satisfaction with provider was the strongest predictor of follow-up medication adherence for African Americans whereas for Caucasians depressive symptoms and treatment-specific social support were predictive of medication adherence (after controlling for duration of drug use). [ABSTRACT FROM AUTHOR]

A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to estimate the relative contributions of trauma, chronic stress burden, depression, anxiety, social support, and social undermining in predicting alcohol and drug abuse, and whether ethnicity moderated these relationships. A multi-ethnic sample of 288 HIV-positive and HIV-negative women was recruited. Multiple group path analysis indicated that greater drug dependence was associated with being HIV+, more depression, and higher chronic burden. Trauma was related only to anxiety. Also, greater alcohol dependence was associated with more depression and more social undermining, and these effects were moderated by ethnicity. African American and Latina women evidenced different relationships between depression, social support and social undermining. Depression, social support and social undermining served as intervening variables in influencing the relationships between the other psychosocial variables and drug and alcohol dependence. The implications of these findings for alcohol and drug abuse research and services are discussed. [ABSTRACT FROM AUTHOR]

Discusses the role that child sexual abuse (CSA) plays in sexual development and later sexual functioning. Differences in the effects for females and males; Potentially powerful influence that abusive childhood experiences contribute to sexual health, performance and satisfaction; Effects of CSA, as well as gender and ethnic differences, on the sexual functioning of male and female survivors.