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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. (Contains 1 figure.)

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]

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]

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.

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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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).

This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health., ((c) 2015 APA, all rights reserved).)

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.

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).

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., (Published by Elsevier Inc.)

HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.

Background: Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy., Methods: To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each other's serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups., Results: Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P < .001). The adjusted mean number of (log)unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, -1.52; 95% CI, -2.07 to -0.98; P < .001). The cumulative STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison groups. The overall HIV seroconversion at the 12-month follow-up was 5 (2 in the intervention group, 3 in the comparison group) of 535 individuals, which translates to 935 per 100,000 population., Conclusion: To our knowledge, this is the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples., Trial Registration: clinicaltrials.gov Identifier: NCT00644163.

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.

HIV/AIDS continues to create a significant health crisis in African-American communities and health disparities within the United States. Understanding African-American sexuality within a culturally congruent and ethnocentric approach is critical to decreasing the HIV infection and transmission rates for African Americans. This brief discusses two major factors: 1) confusion about race-based stereotypes; and 2) historical health disparities and mistrust, which have influenced our understanding of African-American sexuality despite that fact that very little research has been conducted in this area. This paper discusses the limitations of what is known and makes recommendations for research surrounding sexuality and HIV/AIDS. Research trainings for new and established investigators and collaborations among health, community, religious, political organizations, and historically black colleges and universities are needed to disseminate relevant HIV prevention messages. Conducting research to better understand African-American sexuality will facilitate the development of behavioral interventions that address health, HIV and mental health risk reduction within the context of African-American life.

A constellation of factors contributes to Black women's health including stressors and traumatic experiences. Their psychological adjustment and substance use can further affect their health status. The purpose of this study was to examine patterns of substance abuse and barriers to health care among HIV-positive Black women with histories of childhood sexual abuse (CSA). Baseline data on a community sample of 75 Black HIV-positive women were analyzed to assess and identify drug use, alcohol use, participation in an alcohol or drug treatment program, and communication skills with providers, all of which may act as barriers to health care. Findings indicate that substance use is a significant health problem, with 83% of the participants having used at least one substance regularly and 28% having engaged in regular injection drug use. Barriers to health care included confidentiality issues, poor financial resources, difficulty getting an appointment, excessive waiting to see a health care provider and obligation to care for others. Contrary to past research, poor communication between the participants and the providers did not seem to be a barrier to health care utilization for these women. Early traumatic experiences, including CSA, regardless of whether incidents involved penetration, may exacerbate the problems faced by HIV-positive Black women. Implications for future research and culturally relevant prevention and intervention programs are discussed.

As we move into the 21st century, information about sex is widespread and more accessible to the general public than ever before. This interest in sex also increases the focus on symptoms and patterns associated with sexual problems. However, the etiology of sexual dysfunction is multifaceted and poorly understood. One factor that has received growing attention is the role that early sexual abuse plays in sexual development and later sexual functioning, and how these associations differ between males and females. Despite high prevalence rates of child sexual abuse (CSA), which occurs to approximately 1 in 3 females and 1 in 10 males under the age of 18, we do not completely understand the complexities of how and to what extent CSA affects sexual functioning. Nonetheless, the research highlights the need to recognize the potentially powerful influence that abusive childhood experiences contribute to sexual health, performance, and satisfaction. We review research on the relationship between CSA and adolescent and adult sexual functioning. We use a developmental framework to guide our understanding of the effects of CSA, as well as gender and ethnic differences, on the sexual functioning of male and female survivors.