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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.

The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs. [ABSTRACT FROM AUTHOR]

Beliefs of people living with HIV about their own responsibility for preventing HIV transmission (personal responsibility) and their sex partners’ responsibility for protecting themselves (partner responsibility) are poorly understood. A sample of 1163 HIV-seropositive men who have sex with men (MSM; 55% men of color) completed an A-CASI assessment of sexual behavior and psychosocial measures. A two-dimensional model that represents four orientations toward responsibility was tested: (1) self—high personal and low partner responsibility, (2) other—low personal and high partner responsibility, (3) shared—high personal and high partner responsibility, and (4) diminished—low personal and low partner responsibility. As predicted, the self-responsibility group demonstrated the lowest risk of HIV transmission; the other responsibility group had the highest risk. Intermediate risk was observed in the shared and diminished responsibility groups. Implications for future research and HIV prevention efforts are discussed. [ABSTRACT FROM AUTHOR]

Public health agencies have recommended incorporating HIV prevention counseling into the medical care of persons living with HIV/AIDS. Injection drug users (IDUs) especially need HIV risk-reduction counseling because of their high risk for HIV transmission through both sexual and injection behaviors. The objective of this study was to assess the prevalence of, and patient factors associated with, the delivery of HIV prevention messages to HIV-seropositive IDUs in primary care settings. A majority of participants reported having an HIV prevention discussion with their provider during their most recent primary care visit. Factors significantly associated with report of such discussion were being Hispanic or non-Hispanic Black; high school education or less; and better perception of engagement with provider. Medical providers should provide prevention messages to all HIV-seropositive IDUs, regardless of demographic factors. Effective HIV prevention interventions in primary care settings, including interventions to improve patient-provider communication, are needed for HIV-seropositive IDUs. [ABSTRACT FROM AUTHOR]

The article reports on the study of stigma dividing gay community. It has been reported that stigma surrounding HIV/AIDS has been around since the start of the epidemic but little is known about the HIV/AIDS in gay community and how it has affected men who have sex with men (MSM) living with HIV. A study is conducted to have a better understanding of the effects of stigma on this population and to lessen its harmful effects. Two types of protocol are conducted. The SUMS I, the first phase of the study protocol was conducted between June and November 1997. 250 participated and completed a paper-and-pencil questionnaire and a semistructured interview and was paid $30 each. The second phase (SUMS II) was conducted between May and September 1998. 206 participated and completed the questionnaire. The study showed that distinguished HIV/AIDS stigma in the current sample was not related to sexual risk behavior. However, those who distinguished higher levels of HIV/AIDS stigma in the gay community were more possible to look for partners in settings that will ease anonymous sex, like private sex parties and sex clubs.

Analyzes HIV status disclosure in an ethnically diverse sample of HIV-seropositive injection drug users from New York City and San Francisco, California. Negative and positive consequences of disclosing serostatus to sexual patterns; Role of responsibility in impacting disclosure and nondisclosure; Interventions for HIV-positive injection drug users.

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self-labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV-seropositive men who have sex with men. The majority of participants (88%) identified as a "top," a "bottom," or "versatile." Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self-labels, sexual behaviors of self-label groups were greatly overlapping. Differences were found among self-label groups in gay self-identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self-labels in addition to asking about sexual behavior. [ABSTRACT FROM AUTHOR]

Understanding how acculturation and gender affect Hispanics' sexual behavior is needed to prevent infection with the human immunodeficiency virus. We examined differences in and correlates of condom use among 398 Hispanics and 540 non-Hispanic Whites in San Francisco who were part of a random probability sample of unmarried adults. Hispanic women reported fewer sexual partners than all other groups. Condom use was low in all groups, but Spanish-speaking Hispanic women reported lower condom use than White women. Hispanics, generally, had poorer attitudes toward condoms and were less likely than non-Hispanic Whites to believe they could avoid acquired immunodeficiency syndrome. Hispanics need targeted prevention interventions. [ABSTRACT FROM AUTHOR]

The article presents a study among HIV-positive injection drug users (IDUs) to measure self-perceived responsibility to limit HIV transmission during sex. In a multivariate analysis, HIV-positive IDUs who felt responsible were those with greater HIV knowledge, perceived social support, self-efficacy for safely injecting, and self-efficacy using condoms. It concludes that working with HIV-positive IDUs to increase or reinforce feelings of responsibility may reduce the sexual transmission of HIV.

The article shows the relationship of depression among HIV-positive women and men who are injection drug users (IDUs). Results showed that approximately one third of women and men met the criteria for being at high risk of depression, and that women reported significantly more depressive symptoms than men. It concludes that case finding and interventions for depressions are likely to be similar for male and female HIV-positive IDUs, due to the similarities in correlates of depression.