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HIV/AIDS knowledge among Hispanics living in Nogales, Arizona
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HIV/AIDS KNOW LEDGE AMONG HISPANICS
LIVING IN NOGALES, ARIZONA
by
Ana Corina Rojas
A Dissertation Presented to the
FACULTY O F T H E GRADUATE SCHOOL
UNIVERSITY O F SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
D O CTO R OF PHILOSOPHY
(Public Administration)
August 2000
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UMI Number: 3018120
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90089
This dissertation, written by
under the direction of fc .fiB Dissertation
Committee, and approved by all its members,
has been presented to and accepted by The
Graduate School, in partial fulfillment of re
quirements for the degree of
Ana Corina Rojas
DOCTOR OF PHILOSOPHY
Dean
DIS 9ERTATlQ>r COMMITTEE
Chairperson
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Ana Corina Rojas
ABSTRACT
Dr. Robert Myrtle
HIV/AIDS KNOWLEDGE AMONG fflSPANICS
LIVING IN NOGALES, ARIZONA
Numerous public education efforts have been implemented over the years to
increase knowledge and awareness about HIV and AIDS. However, the literature reveals
substantial differences in knowledge about HIV and AIDS among ethnic groups, with
Hispanics having less knowledge about HTV and AIDS than their Anglo counterparts.
The purpose of this research study was to obtain a clearer understanding of the factors
that contribute to knowledge differences among Hispanics.
This exploratory study used secondary data from a cross-sectional study
conducted by David Hayes-Bautista, Ph.D. and consisted o f Hispanics living in Nogales,
Arizona (N = 334). The study looked at knowledge about condoms and transmission o f
HIV/AIDS. Univariate analyses o f the data were first performed to obtain distributions of
data in each dependent and independent variable. The hypotheses were then tested using
analysis of variance (ANOVA) procedures on each of the nine dependent variables and the
independent variable to determine if mean differences existed in knowledge between the
groups.
As a whole, the respondents generally had high knowledge o f HIV/AIDS
transmission. Respondents were substantially less knowledgeable regarding condoms.
1
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The most common sources for receiving HIV/AIDS information were television, radio,
family, and friends. Health-care sources were the least common source o f information
mentioned for providing AIDS information. With respect to the ANOVA findings, this
study identified three subgroups within the study population who were less knowledgeable
than their counterparts: monolingual Spanish speakers, Latino males, and individuals who
have more than one sexual partner. Implications for public health programs include (a)
identification of specific target populations within the Hispanic population requiring HIV
and AIDS education intervention programs, (b) obtaining a clear understanding the types
of messages that Latinos need to receive that will most likely lead to behavior changes and
risk reduction, (c) shifting messages to meet knowledge needs, and (d) identify vehicles
for public health messages that have implications for the success o f the programs.
2
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ACKNOWLEDGMENTS
I would like to sincerely thank my committee members, Dr. David
Lopez-Lee, Dr. Ramon Salcido, and especially my chair, Dr. Robert Myrtle for their
enduring commitment and guidance in the completion o f this dissertation.
I would also like to thank the many faculty at the School of Public
Administration, for their instruction and support throughout the Doctoral program
which prepared me to complete this dissertation.
I am very grateful to Dr. David Hayes-Bautista for generously providing the data
for this paper as well as his contributions in its development.
My two children, Linda and Chris, have been wonderful during this lengthy
process for which I am very thankful.
Last, I would like to thank my Aunt Delydee for her belief in me.
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TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS............................................................................................ ii
LIST OF TABLES ....................................................................................................... v
Chapter
1. INTRODUCTION .................................................................... 1
Purpose and Significance o f Study.................................................... 3
Organization o f Dissertation............................................................ 5
2. LITERATURE REVIEW........................................................................ 6
Problem .............................................................................................. 6
Public Education on HTV and AIDS ............................................... 9
Effectiveness of Programs................................................................. 15
Knowledge Differences..................................................................... 17
Hispanics and HIV/AIDS ................................................................. 20
Summary ............................................................................................ 30
Research Focus and H ypotheses...................................................... 34
3. M ETHODS............................................................................................... 38
Procedures ......................................................................................... 41
Sample Population Characteristics.................................................... 42
Exclusions............................................................................................ 45
Dependent Variables.......................................................................... 45
Independent Variables........................................................................ 48
Form o f the Analysis.......................................................................... 49
4. RESULTS................................................................................................. 52
Overall Knowledge............................................................................ 52
Sources o f HIV and AIDS Information........................................... 55
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Chapter Page
Results o f Hypotheses Testing........................................................... 58
5. CONCLUSIONS....................................................................................... 87
Overall K nowledge............................................................................. 87
Sources o f AIDS Information........................................................... 89
AIDS Education for Children........................................................... 91
Hypothesis Testing Findings............................................................. 92
Limitations.......................................................................................... 101
Public Health, Research, and Policy Implications............................ 102
BIBLIOGRAPHY.......................................................................................................... 109
APPENDICES .............................................................................................................. 118
A. QUESTIONNAIRE.................................................................................. 119
B. TABLE 21: CHARACTERISTICS SANTA CRUZ POPULATION . 131
iv
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LIST OF TABLES
Table Page
1. Hayes-Bautista Sample Strata................................................................ 39
2. Sub-Sample Characteristics..................................................................... 43
3. Dependent Variables: Knowledge Questions and Scores ................. 46
4. Independent Variables.............................................................................. 50
5. Dependent Variables: Frequency Table .............................................. 53
6. Sources of HTV/AIDS Information....................................................... 56
7. Summary o f Statistically Significant Findings ...................................... 59
8. Analysis o f Variance of Knowledge Variables by Annual Earnings .. 61
9. Analysis o f Variance of Knowledge Variables by Years o f Education 63
10. Analysis o f Variance of Knowledge Variables by Language Spoken . 65
11. Analysis o f Variance of Knowledge Variables by Language
Respondents Listen to the R a d io.................................................... 67
12. Analysis o f Variance of Knowledge Variables by Language
Respondents Read the Newspaper.................................................. 69
13. Analysis o f Variance of Knowledge Variables by Station on Which
Respondents Watch Television ...................................................... 71
14. Analysis o f Variance of Knowledge Variables by Station on Which
Respondents Listen to the R a d io .................................................... 73
v
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Table Page
15. Analysis o f Variance of Knowledge Variables by Country of
Publication Read by Respondents ................................................. 75
16. Analysis o f Variance of Knowledge Variables by Gender ................. 77
17. Analysis o f Variance of Knowledge Variables by A g e ........................ 79
18. Analysis o f Variance of Knowledge Variables by Male Risk Factor .. 81
19. Analysis of Variance of Knowledge Variables by Respondents
Who Have More Than One Partner............................................... 83
20. Analysis o f Variance of Knowledge Variables by Marital Status .... 85
21. Characteristics Santa Cruz Population................................................... 132
vi
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CHAPTER 1
INTRODUCTION
Since the mid-1980s, numerous national, state, and local intervention campaigns
have been launched to combat the incidence Q f human immunodeficiency virus (HTV)1
and acquired immunodeficiency syndrome (AIDS).2 For the most part, the campaigns
have been successful in reducing the rate o f growth o f AIDS in the total population.
The CDC (Centers for Disease Control, 1998b) documented the first-ever drop in AIDS
incidence rates from 1995 to 1996, with the pattern continuing from 1996 to 1997.
AIDS incidence rates for all groups (i.e., race/ethnicity, exposure category, region)
decreased in 1997 as compared to 1996. However, not all ethnic groups have experi
enced the same levels of success (CDC 1999b). Hispanics and African-Americans3 have
u‘The revised CDC classification system for HIV-infected adolescents and adults
categorizes persons of the basis o f clinical conditions associated with HIV infection and
CD4+ T-lymphocite counts” (CDC MMWRDec 18, 1992 (RR-17), p. 2. CDC HIV
surveillance statistics for HIV “includes only persons reported with the HIV infection
who have not developed AIDS” (CDC, 1998a, p. 5).
Effective January 1, 1993, “the CDC, in collaboration with CSTE [Council of
State and Territorial Epidemiologists, has expanded the AIDS surveillance case definition
to include all HIV-infected persons with CDC+ T-lymphocyte counts of less than 200
cells/uL, or a CDC+ percentage o f less than 14” (CDC MMWR, 1992 (RR-17), p. 4.
3 African-Americans and Hispanics are documented in the literature as the highest
risk minority group for HIV and AIDS in the U.S. Although Hispanics are the popula
tion for this research study, data for African-Americans are included so that the quotes
and other references remain in context.
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disproportionately higher rates of growth o f new cases o f AIDS and HIV as compared
to the Anglo population. “From 1992 through 1996, non-Hispanic Blacks, Hispanics,
and women accounted for increasing proportions o f persons reported with AIDS”
(CDC, 1997a, p. 167). Further, HIV surveillance data indicate a changing demographic
profile of the epidemic which disproportionately affects Hispanics (CDC, 1997b; CDC,
1998a).
Public education is one area in which the government has invested a substantial
amount of funding to increase knowledge and awareness about HIV and AIDS. In
1986, public education was determined the most effective method for reducing the
spread of the HIV virus (Institute of Medicine National Academy of Sciences, 1986).
Since that time, government programs have evolved to employ numerous behavioral
theories to ultimately elicit behavioral change (Fishbein and Guinan 1996; Valdiserri,
West, Moore, Darrow, & Hinman, 1992). However, the underpinning of behavior
change and ultimately reduced risk to acquiring the HIV virus lies in having correct
knowledge about HIV and AIDS. In other words, individuals must have correct
knowledge about HIV and AIDS, at a minimum, to consciously make and carry out
healthy decisions that will reduce their risk o f acquiring HTV and ADDS.
The literature reveals substantial differences in knowledge about HTV and AIDS
among ethnic groups, with Hispanics and African-Americans having substantially less
knowledge about HIV and AIDS than their Anglo counterparts (Aruffo, Coverdale, &
Vallbona, 1991; Hingson et al., 1989). The published research available on AIDS and
2
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HIV knowledge has generally categorized minority groups together and fails to
differentiate between them. Further, there is very little published research which
clarifies why some individuals of a specific ethnic group are more knowledgeable about
HTV and AIDS than other individuals o f the same ethnic group. Thus, factors leading to
knowledge differences among Hispanics, the topic of this paper, is still relatively
undocumented in research.
Purpose and Significance of Study
The purpose o f this research study is to obtain a clearer understanding o f the
factors that contribute to knowledge differences about HTV and AIDS among Hispan
ics. This exploratory analysis will use secondary data from a transitional Hispanic
population living in Nogales, Arizona, to explore factors that may lead to these differ
ences. This population and data were chosen with the following in mind:
First, Hispanics are the largest growing ethnic group in the U.S. today. The
Hispanic population was estimated to be 30,769 million, or 11.4% of the total U.S.
population, in 1998 (U.S. Bureau of the Census 1998b). The Hispanic population is
estimated to grow to 46,704 million, or 15.2% of the total U.S. population, by the year
2015 (U.S. Bureau, 1996). According to Hayes-Bautista, Schink, and Chapa (1988),
“Fueled by high fertility and immigration, the Latino population appears to be a major
component o f the population in the future” (p. 17).
The second reason for choosing this study population was that it represents, to
some degree, the foreign-born migrant population which makes up a very significant
3
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percentage of the population in the U.S. Each year, thousands o f documented and
undocumented individuals migrate back and forth between Mexico and the U.S. Of the
foreign bom in the U.S., 54% come from Mexico (U.S. Bureau, 1999). While many of
these individuals have entered the U.S. legally, there are a substantial number of
undocumented individuals also living in the U.S. An estimated 5.0 million undocu
mented individuals resided in the U.S. in 1996 and “is estimated to be growing by about
275,000 ...” (U.S. Immigration and Naturalization Service, 1999, p. 1). The dire
economic situation in Mexico and other countries, coupled with the demand for
undocumented workers in the U.S., only fuels immigration.
The third reason for studying the Hispanic population was age. The Hispanic
population is a relatively young group with the mean age being 26.6 (U.S. Bureau,
1998b). The majority of HTV cases are reported among younger populations. For
example, HTV cases among Hispanic men reported through June 1999 in the age groups
20 to 24, 25 to 29, and 30 to 34 were 11%, 22%, and 24% respectively (CDC, 1999a).
The same pattern was observed for Hispanic women with 14%, 21%, and 22% of all
cases falling in these respective age categories. This is also a group of child-bearing
age, thus increasing the likelihood for perinatal transmission o f HIV.
Thus, AIDS and HTV are a threat to one of the largest growing populations in
the U.S. We must ensure that prevention programs are effective in this population.
Also, we must understand the factors that increase knowledge and make sure these
programs are culturally relevant.
4
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The literature reveals that we know relatively little about factors which influence
knowledge among Hispanics as a subgroup. We have even less information about
knowledge among the migrant Hispanic population. Curbing the HTV and AIDS
epidemic in this very large segment of the U.S. is a necessary prerequisite to having a
healthy foundation from which Hispanics can contribute to society. This research study
will shed light on factors that contribute to knowledge differences. Findings o f this
research study will add to a base of knowledge with which policy can be developed to
better address the HTV and AIDS knowledge needs of Hispanics.
Organization o f Dissertation
Chapter 1 introduced the area of research, the purpose, significance, and the
organization of the dissertation. Chapter 2 provides a review o f the literature. Subsec
tions of the literature review include a description o f the problem, public education,
effectiveness of programs, knowledge differences, and Hispanics and HIV/AIDS. The
literature review ends with a subsection on the focus of the research and the hypotheses
to be tested. Chapter 3 consists of the methods section, which includes a description of
the methodology used by Dr. Hayes-Bautista to collect the original data as well as the
study design used for this research study. The results are described in chapter 4
followed with the conclusions in chapter 5.
5
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CHAPTER 2
LITERATURE REVIEW
Problem
Prior to 1980, the terms “HTV” and “AIDS” were virtually unknown in the U.S.
Today, HIV and AIDS and their linguistic translations are recognized in almost every
U.S. household. As o f June 1998, a total of “665,357 persons with AIDS have been
reported to the CDC” (CDC, 1998b, p. 3). In the U.S., AIDS is currently the leading
cause o f death among individuals ages 25 to 44 (CDC, 1997a).
As early as 1986, African-American and Hispanic populations were documented
to be disproportionately affected by AIDS (CDC, 1986; Marin, 1989). Selik, Castro,
and Pappaioanou (1988) identified the risk o f AIDS in African-American and Hispanic
men to be 2.8 and 2.7 times greater, respectively, than that in Anglo men. African-
American and Hispanic women were at 13.2 and 8.1 greater risks, respectively, than
Anglo women to become infected with the virus (Selik et ai., 1988). Throughout the
epidemic, the African-American and Hispanic populations continue to have a dispropor
tionate number o f AIDS and HIV cases. “During 1995, estimated AIDS opportunistic
illnesses4 (AIDS-OI) incidence rates per 100,000 population were approximately
4 The CDC (1998b) started reporting AIDS opportunistic illnesses (AIDS-OI)
incidence in 1994. “The procedure to estimate AIDS-OI was developed to take into
account the 1993 expansion o f the case definition which temporarily distorted the AIDS
6
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sevenfold higher among non-Hispanic Blacks (99) and threefold higher among Hispanics
(50) than among non-Hispanic Whites (15)” (CDC, 1997b, p. 167).
Minorities are also disproportionately represented in reported HIV cases, an
important surveillance tool for monitoring the AIDS epidemic.3 Improvements in
medical treatment of individuals infected with HIV have “altered the natural history of
HTV infection, and slowed progression to AIDS” (CDC, 1998b, p. 3). For this reason,
HIV as well as AIDS statistics are being used to determine characteristics o f the
epidemic (CDC, 1998a, p. 309).
According to a recent study on reported HTV data from 25 states, “provisional
data indicate that declines in AIDS incidence in these states were not accompanied by
comparable declines in the number of newly diagnosed HIV cases” (CDC, 1998a, p.
309). That study found that the “number of persons in whom HTV infection was the
initial diagnosis increased 10% among Hispanics . .. and decreased 3% among non-
Hispanic Blacks . . . and 2% among non-Hispanics Whites . . . .”(pp. 310-311).
Karon et al. (1996) estimated the prevalence of HIV using the Survey on
Childbearing Women (SCBW), AIDS case surveillance and the Third National Health
and Nutritional Examination Survey (NHANES HI) found similar patterns. The
incidence curve. By 1996, the temporary distortion had almost entirely waned and
AIDS-OI incidence was similar to AIDS incidence” (p 3).
^‘Through June 30, 1998, 28 states had laws or regulations requiring confidential
reporting by name of all persons with confirmed HIV infection, in addition to reporting
o f persons with AIDS. Two other states, Connecticut and Texas, required reporting by
name o f HIV infection only for children less than 13 years of age, and Oregon required
reporting for children less than 6 years o f age” (CDC, 1998b, p. 3).
7
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researchers estimated prevalence to be 10.6 to 14.2 per 1,000, 5.6 to 8.2 per 1,000, and
1.7 to 2.6 per 1,000 for African-American, Hispanic, and Anglos populations, respec
tively. The disproportionate number of HIV and AIDS cases in minorities is only
increasing as demonstrated by surveillance data (Sullivan, 1997).
The epidemic has not spared minority children. The risk o f children being
infected is also substantially higher among African-American and Hispanic children than
among Anglos children. The incidence of HTV infection among African-Americans and
Hispanics is 11.6 and 6.6 times that, respectively, of Anglo children (CDC, 1994). In
1993, racial and ethnic minorities accounted for 84% of cases reported for children less
than 13 years of age (CDC, 1994). Efforts to control the incidence of pediatric AIDS
by reducing perinatal HIV transmission has been very successful (CDC, 1999b).
Between 1992 and 1996, “the number of children with perinatally acquired cases
dropped 43% between 1992 and 1996. But despite declines in all racial/ethnic groups,
the majority o f perinatally acquired AIDS cases continue to occur among African-
American and Hispanic children” (CDC, 1999b, p. 12).
As the disease has evolved, the mode of transmission has also changed dramati
cally to create new patterns o f infections. Males who have sex with males (MSM)
continue to be the largest risk factor for HTV and AIDS. They accounted for 35% of
total adult and adolescent AIDS cases reported between July 1997 and June 1998 in the
U.S. (CDC, 1998b). However, modes of transmission are changing dramatically. The
largest proportionate increase in the U.S. between June 1995 and June 1996 has been
8
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through heterosexual contact (CDC, 1999b). This study which examined HTV diagnosis
in 25 states found that newly diagnosed cases were occurring disproportionately among
heterosexual individuals as well as African-Americans and Hispanics. That study found
that “Comparing HIV and AIDS diagnoses reported in these states provides a much
clearer picture of shifts in the epidemic, with a greater number of HTV cases diagnosed
among women and African-Americans” (p. 3). Using AIDS data, the same study found
that the incidence of AIDS among men decreased 8% from 1995 to 1996, but increased
1% for women.
Public Education on HTV and AIDS
Understanding factors that contribute to the spread o f HIV and determining
effective interventions has been a complex undertaking. The CDC has been the leading
agency to fund HTV and AIDS prevention programs in the U.S. CDC HIV prevention
programs have grown rapidly since the first five cases o f Pneumocystis carinii pneumo
nia were first reported in 1981 (Nobel, Parra, & Holman, 1991). The perception of the
magnitude o f the epidemic is reflected by the CDC’s 1981 HIV prevention budget of
only $200,000 (Nobel et al., 1991) in comparison to the 1998 budget for HIV and
ADDS activities of approximately $624 million (CDC, 1999c).
Early in the AIDS epidemic, public education was determined the most effective
method for reducing the spread o f the HIV virus (Institute, 1986). Therefore, many of
the early HTV and AIDS prevention campaigns were directed at informing individuals
9
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about the disease, including transmission, risk factors and prevention (Fishbein and
Guinan 1996).
The CDC’s first public-service campaign, entitled “American Responds to
AIDS” (ARTA), was launched in September 1987 and consisted o f four phases which
were described by Keiser (1991). Phase I was highly successful and consisted primarily
of media dissemination of information about AIDS via public service announcements
(PSAs) in the media, media interviews with public officials, and other coverage. The
news media were extremely responsive to airing the campaign materials. Phase II was
launched in October 1987 during which a national mailing of a brochure, “Understand
ing AIDS,” was distributed to American households while PSAs were aired. The
mailing also received extensive media coverage across the U.S., including African-
American and Hispanic media. Phase III targeted women at risk, sexually active adults,
reaching out to minority media, and used a national mailing campaign with media
coverage. This phase was launched in October 1988 but was the least successful o f all
phases in terms o f media coverage. The last phase, Phase IV, launched in May 1989,
targeted parents and youths and received a "positive media response"(Keiser, 1991, p.
626). Phase IV produced and distributed PSAs with a Spanish language translation and
news releases for radio directed at the general audience, African-American, and
Hispanic media. An information tool, “AIDS Prevention Guide” for parents to educate
their young about HTV and AIDS, was also produced and distributed.
10
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The ARTA campaign was successful with respect to raising the public’s aware
ness about HTV and AIDS. One way the success o f PSAs was measured was the “the
extent to which television and radio stations donate air time for them (Gentry &
Jorgensen, 1991, p. 652). Reports from the Broadcast Advertisers Reports (BAR)
provides a service which "monitors commercial advertising on television and radio
stations" were used to measure determined air time for PSAs (Gentry & Jorgensen
(1991, p. 652). The BAR data tape contains detailed information about PSAs (i.e.,
network, time of day) which the researchers then translated into dollar value. Gentry
and Jorgensen found that between 1987 and 1990, more than $65 million worth o f air
time was donated to the ARTA campaign of which $46 million was in television. A
substantial number of individuals increased their initial awareness of HIV and AIDS in
the last years of the 1980s. According to Hardy, Thomberry, and Dawson (1980), the
data from the National Health Interview Survey indicated that the PSAs were viewed by
the majority of U.S. adults. Eighty percent of adults responding to the survey reported
seeing an AIDS-related PSA on television during the last 3 months of 1989. Another
45% reported hearing a PSA about AIDS on the radio.
Other early CDC-fiinded programs and organizations focused on homosexual
and bisexual populations in urban areas (Bailey, 1991). The "the earliest prevention
resources were directed at individuals engaging in behaviors that placed them at risk of
infection such as men who have sex with men” (Noble et al., 1991, p. 604). According
to Bailey (1991), four of the eight early projects funded focused exclusively on
11
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homosexual and bisexual males, two on intravenous drug abusers (TVDA), one on the
issue of homophobia among physicians, and one to African-American and Hispanic
youth. In 1985, the CDC announced the availability of funds for community-based
demonstration projects and innovative projects (as cited in Bailey, 1991). According to
Bailey, the "CDC developed AIDS community demonstration projects and projects to
test innovative risk-reduction approaches" (p. 704). The new AIDS Community
Demonstration Projects (ACDP) protocol required each community site to implement
interventions that would reach individuals at risk who would not normally access HTV
and AIDS prevention services (Higgins et al., 1996). For example, instead o f providing
interventions which relied on individuals’ motivations to seek information and health
care on their own, new programs moved into community outreach which required
reaching those individuals. The ACDP, funded through the CDC, provided interven
tions which used people in at-risk populations who lived and worked in the community
to deliver HTV prevention messages during their daily activities. It allowed them to
reach those individuals “who might not otherwise receive HTV prevention messages”
(Guenther-Grey, Norvian, Fonseka, & Higgins, 1996).
HTV and AIDS prevention activities are as diverse as they are numerous. In
1991, Nobel et al. wrote that the program had evolved to an “extensive public informa
tion program, a comprehensive school health education effort, a major collaborative
partnership with national, state, and local organizations involved in primary prevention
efforts” (p. 604). Extramural HIV prevention programs funded by the CDC included
12
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such activities as epidemiological studies, surveillance, AIDS community demonstration
projects, cooperative activities with government agencies, cooperative agreements with
community based organizations (CBOs), cooperative agreements with minority
organizations, and others (Noble et al., 1991). More recently, the CDC has developed
an extensive Internet site which provides an array o f information both for the public and
health-care professionals.
HTV and AIDS prevention programs, prior to 1987, did not addressed Hispanics
specifically, and very few programs were available outside of the high incidence areas
(O’Reilly & Higgins, 1991). Shortly thereafter, funds were made available to Hispanic
and other ethnic populations for HTV and AIDS prevention programs through CDC
cooperative agreements with state and local health departments and through the U.S.
Conference o f Mayors (USCM) (Holman, Jenkins, Gayle, Duncan, & Lindsey, 1991).
In 1988, the CDC “initiated a five year grant program for HIV prevention efforts by
national racial and ethnic minority organizations and regional consortia o f racial and
ethnic minority organizations” (as cited in Holman et al., 1991, p. 687). Community-
based organizations were funded by the CDC to “assist HTV education and risk reduc
tion activities in the 27 metropolitan areas most affected by the acquired immunodefi
ciency syndrome (AIDS) epidemic” (Bailey, 1991, p. 702). This program was directed
towards organizations “that are working with members o f racial and ethnic minority
groups and others at highest risk for infection with . .. the HIV virus” (p. 702).
13
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In summary, HIV and AIDS prevention programs have received considerable
exposure to the public and specific subsets of the public. But how effective have these
programs been? The realization of this epidemic and its severe consequences was
sudden. Thus, programs were quickly implemented without the benefit o f knowing
what worked and what did not work. Choi and Coates (1994) found that “prevention
practice has occurred more rapidly than the evaluation and study o f those practices and
the development o f a science base to establish directions for practice” (p. 1386). Bailey
(1991) identified difficulties in evaluating HIV prevention programs. According to
Stryker et al. (1995), we still need to implement demonstration and research projects to
determine the “best policies, organizational structures, interventions, and ancillary
services for the variety o f populations at risk for HIV” (p. 1147). Most intervention
programs were rapidly implemented in the early years of the epidemic without theoreti
cal foundations or knowledge about the communities they were to address. It was not
until late 1980 that the CDC initiated the application of theory to most intervention
projects (as cited in Choi & Coates 1994).
In addition to the application of theory in programs, the need to have culturally
appropriate interventions was recognized as rate disparities and were found in different
ethnic groups (CDC, 1986; Flaskerud & Nyamathi, 1989; Hingson et al. 1989; Marin
1989). The CDC began to use formative research methods, for example, to plan AIDS
Community Demonstration Projects (Higgins et al., 1996) in order to “gain and apply
extensive knowledge and understanding of the communities as the foundation for the
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interventions” (p. 29). HIV and ADDS prevention programs of today apply complex
theoretical models that incorporate factors such as an individual’s self-efficacy, expected
outcomes, perception o f susceptibility to disease, perceived norms (Fishbein & Guinan,
1996; O’Reilly & Higgins, 1991) and the stages o f change theory (Valdiserri et al.,
1992).
However, there is considerable debate among scientists regarding the generaliza
tion of HTV and AIDS prevention theories. According to Amaro (1995, p. 64), theories
that have been applied in prevention programs are limited because the assumptions of
the theoretical models may not be useful in understanding sexual risk behaviors of
Hispanics.
Effectiveness of Programs
In spite of the latency in the application o f theory and the evaluation of pro
grams, intervention programs have been substantially effective in reducing the overall
incidence of HTV and AIDS. In one o f the most comprehensive reviews completed,
Choi and Coates (1994) “identified 20 studies (26% of the 77 studies reviewed) in
which long-term behavior change was assessed and demonstrated” (p. 1382). Holt-
grave et al. (1995) reviewed “previously published (or readily available) lists o f general
characteristics of successful,6 behaviorally based HIV prevention programs . .. .” (p.
^‘Successful is defined here as averting or reducing HTV-related risk behaviors or
favorably modifying their determinants . . . or both, and doing so at a minimal, cost-
effective or cost-beneficial level o f resource investment.. . .” (Holtgrave et. al, 1995, p.
135).
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135). These researchers found that “behaviorally based HTV prevention programs have
a favorable impact on behavioral outcomes in specific populations, especially when
delivered with sufficient resources, intensity, and cultural competency” (p. 142). While
the programs reviewed by Choi and Coates (1994) contained a variety o f services (i.e.,
HTV testing), education was frequently provided in HIV and AIDS prevention pro
grams.
Educational programs are found to increase an individual’s perception o f risk, an
integral component o f the Health Belief Model (Becker, 1974; Rosenstock, 1974) which
then may affect their behavior (O’Reilly & Higgins, 1991). Keeter and Bradford (1988)
found that 65% of sexuality active non-monogamous individuals reported changing their
behavior because o f concern about AIDS (52% o f those who changed reported having
fewer sexual partners; 51% were learning more about potential partners than before the
AIDS crisis; and 37% were using condoms to minimize risk). Hingson et al. (1989)
documented that respondents who were more concerned about acquiring AIDS were
more likely to have changed their behavior. HTV and AIDS intervention programs have
successfully changed the way many individuals think and behave.
Unfortunately, the success has not been equal among all ethnic groups. Hispan-
ics and African-Americans continue to be disproportionally represented in HTV and
AIDS rates (CDC, 1999b). The epidemic has “slowed considerably from the early
years” (p. 3), but new cases are increasing in African-American, women, Hispanics, and
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through heterosexual transmission. Further, cases of perinatally acquired AIDS
continue to predominately affect the Hispanic and African-American communities.
Knowledge Differences
Knowledge and awareness are the areas that may explain this discrepancy.
Having the correct information about HTV and AIDS is one o f the first steps an individ
ual must experience before making the behavior changes that will reduce their risk of
HTV and AIDS. While knowledge alone is usually not effective in changing behavior,
awareness of AIDS and HIV, in combination with other interventions, does contribute
to behavior change. However, research indicates that Hispanics (and other minority
groups) throughout the AIDS epidemic have sustained lower levels o f knowledge about
HTV and AIDS, compared to the Anglo population.
In 1987, Albrecht, Levy, Sugrue, Prohasta, and Ostrow (1989) conducted a
survey o f 1,540 subjects to determine the general public’s knowledge, attitudes, and
behavior toward AIDS. Results suggested that being Hispanic, or Asian, as well as
having lower educational levels predicted lack of education about AIDS. Another
survey by Hingson et al. (1989) on 1,323 Massachusetts residents found that Hispanics
were significantly less knowledgeable about HIV transmission than Anglos, African-
Americans, or other racial groups. Similar findings were reported by Aruffo et al.
(1991) in a convenience sample survey o f health centers which found race/ethnicity to
be a predictor of AIDS knowledge. Hispanics had the least amount o f knowledge when
compared to Anglos and African-Americans. DiClemente, Boyer, and Morales (1988)
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found that African-American and Latino adolescents were approximately twice as likely
as Anglo adolescents to have misconceptions about the casual transmission of HIV and
AIDS. These same researchers also found that African-American and Latino adolescents
were less likely than Anglo adolescents to be “aware that using condoms during sexual
intercourse would lower risk of disease transmission” (p. 55). Research indicates a
clear difference in knowledge levels about HTV and AIDS among ethnic groups.
Education and Knowledge
In addition to the Albrecht et al. (1989) study, education has been documented
to have an impact on HIV/AIDS knowledge in various other studies. In a pilot study of
African-American and Latina women, conducted to test variables such as knowledge of
symptoms, transmission, prevention, and community resources, attitude items regarding
sexuality, drug use, and fears, and practice items, such as current sexual and drug use
practices (Flaskerud & Nyamathi, 1989), knowledge was significantly and positively
related to years of education. A survey o f 409 unmarried individuals, ages 18 to 39,
also found education to be a strong predictor of knowledge about transmission (Aruffo
et al., 1991; Keeter & Bradford, 1988). Kennamer and Bradford (1996) conducted a
survey of 1,087 Anglos, 365 African-Americans, and 492 Hispanics in Virginia and
found a correlation between education, as well as income, to correct responses regard
ing HTV transmission, prevention, and responsibility for HIV prevention and treatment.
A study on data taken from the 1988 National Health Interview Survey (NHIS) of
AIDS knowledge and attitudes found that persons having less than a high school
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education, over 50 years of age and African-American or Hispanic, had lower knowl
edge and higher misperception scores (McCaig, Hardy, & Winn, 1991).
Acculturation
Acculturation also appears to affect knowledge about HIV and AIDS. Nya-
mathi, Bennett, Leake, Lewis, & Flaskerud (1993) conducted a study of 1,173 minority
women with high-risk characteristics to describe “AIDS-related knowledge, percep
tions, and behaviors o f impoverished African-Americans and high-and low acculturated
Latina women; delineate the relationships between knowledge of AIDS, personal
characteristics, perceived risk, and risky behaviors among these women” (p. 65).
African-American women and highly acculturated Latinas were more likely than low-
acculturated Latinas to know ways in which AIDS cannot be acquired (i.e., from being
sneezed on by a person with AIDS, or from toilet seats previously used by a person with
AIDS). Latina women were least likely to know o f places where one could get tested,
and to understand transmission via drug paraphernalia (i.e., cleaning paraphernalia is not
sufficient to kill the AIDS virus). In this study, low-acculturated Latina women
reported a significantly lower perceived risk of HTV/AIDS than either high-acculturated
Latina women or African-American women: 50% felt they had no chance of contract
ing HIV/AIDS, 21% felt there was some chance, 24% didn’t know, and 5% saw a high
chance o f contracting AIDS.
Language has been used as an indicator to determine acculturation levels in
bilingual individuals. English language fluency has been associated with knowledge
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about HTV. In a study o f 1087 Anglos, 365 African-Americans, and 492 Hispanics in
Virginia, Kennamer and Bradford (1996) found that speaking English correlated with
correct HTV responses.
Hispanics and HIV/AIDS
The literature, thus far, has provided some general guidance regarding knowl
edge about HTV and AIDS. The strongest factor affecting HTV and AIDS knowledge
documented in the literature, apart from ethnicity and acculturation, appears to be
education. However, the antecedents for acquiring and integrating knowledge is much
more complex than merely receiving education. Factors influencing knowledge are as
complex as the dynamics o f human behavior. In fact, the CDC has recognized the
complexities associated with knowledge and subsequent behavior change. This recogni
tion is reflected in changes in theoretical models for HTV and AIDS education pro
grams.
Early models applied to HTV and AIDS prevention programs based upon the
belief that knowledge alone leads to behavior change (Fishbein & Guinan, 1996) were
quickly challenged. In their paper, Fishbein and Guinan describe an early model used in
education programs that was based on cognitive decision-making theories of human
behavior. This model assumes that people react to information in a standard and
rational way, using that information to change their behavior and avoid HTV infection.
However, Fishbein & Guinan write, the model does not address cultural, social or
environment barriers that affect behavior. A more realistic model is complex and
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consistent with other behavioral theories that recognizes the influence of cultural and
peer group norms, socioeconomic circumstances, and environment on behavior change
(Fishbein & Guinan, 1996). HIV and AIDS prevention programs implemented in later
years incorporated the theory models which addressed social factors.
Because o f the importance o f social factors in the knowledge process and,
subsequently, the behavior change process, it is appropriate to discuss social factors
within the Hispanic population which have an impact on both. The next section will
explore some o f these factors. Further, because antecedents which affect knowledge,
knowledge acquisition itself behavior and behavior change are so interrelated, different
aspects of each will be touched on in the next section. However, the next section is
written with caution, as it is difficult, if not impossible, to generalize about the Hispanic
community.
While the Hispanic community has core cultural values such as familism (Marin,
1989), the culture is diverse and represents numerous countries. As o f November 1998,
the U.S. had an estimated 30,769,000 identified Hispanics living in the country (U.S.
Bureau, 1998b). Of these, approximately 61% are Mexican, 12% Puerto Rican, 5%
uban, 2.4% Dominican, 3% Salvadoran, 1% Guatemalan, and 2% Colombian.
Hondurans, Nicaraguans, Panamanians, Columbians, Ecuadorians, Peruvians, and other
Hispanics also reside in the U.S. in smaller numbers (National Latino Research Center,
1999).
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Each group has distinct cultural characteristics. Differences in education,
income, and ethnic subgroups make it important to determine the different risk levels in
various Hispanic subgroups (Estrada, 1995). Dentels (1995) wrote, “if effective
intervention activities are to be achieved, they may well need to be specific for the
different subgroups. This is not only because o f the cultural differences between these
subgroups, but also because they may engage in different risk activities .. . .” (p. 22).
Differences in modes o f transmission among Hispanics of different origins is also noted
by Dominguez (1995). For example, the use of clean needles for intravenous drug use
varies between Mexican-Americans and Puerto Ricans (Estrada, 1995, p. 94). Unfortu
nately, the lack o f available research addressing these differences is evident. Therefore,
the factors presented in the following paragraphs are presented with this caveat in mind.
Acceptance of HTV and AIDS
in the Hispanic Community
AIDS is associated with homosexuality, a behavior not generally accepted
among the Latino population. This is in spite of the fact that 36% of all diagnosed
AIDS cases through June 1998 in Hispanic men were attributed to men having sex with
men (CDC 1998b). Bisexuality, as well as homosexuality, is as much a part o f the
Latino culture as of any other.
Unfortunately, the attitudes toward homosexuality and bisexuality have had their
effect. The negative attitude toward homosexuality has contributed to a delay in
mobilization and prevention activities by the Hispanic community early in the epidemic
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(Friedman et al. 1987). They wrote, “The major Black and Hispanic institutions have
done little or nothing, and there has been no grass-roots flowering o f new ADDS related
organizations in minority communities” (p. 490). These researchers write about the
impasse as “deep fissures in minority populations and leadership about how to deal with
homosexuality and IV drug use aspects o f ADDS . . . thus, to many African-American
and Hispanic persons, raising the idea of helping people with AIDS seems to be giving
support to sexual behaviors they cannot accept” (p. 491). Hispanic communities thus
had to grapple with the presence of homosexuality as part of their lives before progress
could be made. This form o f denial, along with lack of resources has greatly reduced
the initiation o f timely interventions in Hispanic populations.
Even in more recent years, homosexuality and bisexuality are still difficult issues
to accept by many Hispanics. This negative attitude is reflected in the “Proceedings o f
the National Latino HIV/AIDS Research Conference” (Brooks, 1995) where “little
attention had been given to issues related to gay and bisexual men .... This lack of
attention to the issues concerning gay and bisexual men is not something new, but is a
reflection of the general attitude and uncomfortableness Latinos still have in dealing
with these groups” (Brooks, 1995, p. 3). Caudle (1992), in a study about how women
learn about AIDS, found an unusual silence regarding bisexuality and homosexuality.
The Latinas in the study failed to mention bisexuality or homosexuality. They also
failed to verbalize that their male partners could possibly have sex with other men.
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Gender Roles
Gender roles also play a significant factor in prevention efforts. “We now know
that knowledge, perceived susceptibility or even skills in using condoms do not suffi
ciently describe the contextual factors that impinge on women’s ability to engage in
safer sex” (Amaro, 1995, p. 63). Women’s ability to control their risk o f HIV and
AIDS is affected by various social factors, including their power relative to men’s in
their relationships (Ramos, 1995), culture or language barriers (CDC, 1994). Weeks,
Schensul, Williams, Singer, & Grier (1995) identified cultural forces as a factor greatly
influencing sexual practices. “Cultural force too, such as role expectations o f women as
mothers, care givers, and sexually subordinate partners, obstruct women’s ability to
gamer social supports to initiate and maintain sexual practices that will eliminate their
risk” (p. 262).
Caudle’s (1992) second antecedent, “relating to men,” addresses the way men
and women interact and the role each play in relationships. The researcher found that,
essentially, the rules are different for men and women. Caudle wrote, “these data
seemed to support literature that described Latino males as being encouraged to seek
sexual outlets early in life and to prove themselves as men” (p. 73). Further, “standards
that encourage men to have many sexual encounters increases the risks for exposure to
HTV/AIDS. At the same time, women are expected to be chaste and to refrain from
questioning their mate’s sexual past” (p. 74). These matters have much to do with a
woman’s ability to protect herself from HIV. As Gollub (1995) phrases it, “After all, a
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male condom may be 90% effective for consistent users, but for a woman with a partner
who says no, they are 0% effective” (p. 74).
Generally speaking, traditional Hispanic culture allows men to enjoy more sexual
freedom (Amaro 1995; Padilla & O’Grady 1987) and to seek extramarital affairs
(Caudle, 1992). A study by VanOss, Gomez, and Tschann (1993) found that of the 968
Hispanic men surveyed by telephone in nine states, 361 (37.8%) “reported at least one
secondary partner in the previous 12 months” (p. 746). Choi, Catania, and Dolcini
(1994), in an examination of the prevalence o f extramarital sex among Anglos, African-
American and Hispanic heterosexual respondents using the National AIDS Behavioral
Survey, found that extramarital sex or multiple partners poses special risk factors for
women. The study looked at a national sample, an urban sample, and a special Hispanic
urban sample o f 7,066 married individuals. Extramarital sex was considered more than
one partner during the year prior to the survey, and did not include multiple partners
before that period. This methodology more than likely underestimated the figures of
extramarital sex over the life o f a marriage. The prevalence o f reported extramarital sex
in the national sample was substantially higher among Hispanic men (10.9%) than
among Anglos (2.1%), African-American (4.0%) or other (7.2%) men. The urban
sample reflected less of a difference, with 6.7% o f Hispanic men reporting extramarital
sex compared with 3.0% Anglos, 6.6% African-American, and 2.1% of other men
reporting extramarital sex. The Hispanic sample reflected 7.5% of the men reporting
extramarital sex and 0.9% of the women.
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Caudle (1992) wrote that while extramarital affairs by men are not desirable by
women, they are often quietly accepted. Confronting a partner regarding his sexual past
or condom use may be considered confrontational and, therefore, uncomfortable and
unacceptable. Further, many respondents “did not want to jeopardize their relationship
with their husbands or mates by confronting them about extramarital affairs” (p. 97).
Another way o f coping with a husband’s or partner’s extramarital affairs and
“saving face” is by “pretending” that their husbands are monogamous (Caudle, 1992, p.
93). This was reinforced by respondents who stated they lacked education and
resources and depended on their mates for support and direction. Pretending, a type of
denial and a method used to help women cope with unacceptable situations, only
decreases her assessment of risk factors and increases her risk of acquiring AIDS.
Information about the transmission of the HIV virus from a man’s extramarital activities
may be shut out because a woman does not want to believe the situation affects her. In
other words, to accept herself at risk from her husband would also be to admit the
possibility of his infidelity, either with another woman or another man.
Condom Use
Another factor that affects how one deals with HTV and AIDS prevention is in
one’s comfort level with sexually related issues. In a study o f 986 Hispanic men,
VanOss et al. (1993) found that the “Hispanic culture may contribute to high risk sexual
activity” (p. 748). Their study, which covered nine states, found that “comfort with
sexuality was an important predictor of self-efficacy to use condoms . . . as well as
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predicting greater frequency o f condom carrying and a positive attitude toward con
doms” (p. 748). Other predictors of condom usage include self-efficacy to use con
doms, friends’ use of condoms, positive attitude towards condom use and knowing
someone with HIV or AIDS. “Low acculturation” was one predictor for carrying
condoms, although not for actually using them.
In the study described previously by Choi et al. (1994) o f 7,066 married couples,
condom use was extremely low among respondents. Of the 33 respondents who
reported extramarital sex in the national sample, 73% never used condoms during
vaginal intercourse with their main partner and 65% never used condoms with their
secondary partner. Of the 77 respondents reporting extramarital sex in the urban
sample, 65% “never used condoms with their main partners” and 60% “never used
condoms with their secondary partners” (p. 2005). The study did not differentiate
between ethnic groups and condom use. That research study grouped together all
ethnic groups in reporting condom use.
Once again, it is necessary to take into consideration that many available studies
regarding sexual attitudes and practices may not apply to the entire Hispanic population.
For example, Padilla and O’Grady’s 1987 study, which contradicts the literature thus
far, found Mexican Americans more conservative than Anglos concerning various
sexual practices. The results of the study showed that “Mexican Americans, in compari
son with Anglos, had experienced intercourse less frequently . . . had fewer intercourse
partners . . . and had used condoms more frequently” (p. 7). Padilla and O’Grady did
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find differences between men and women. Men, “in comparison to women, had had
intercourse more frequently. .. had engaged in sex involving the exchange of money
more frequently . . . had more intercourse partners .. .. ” (p. 7). These findings reflect,
to some extent, gender sexual patterns. However, Padilla and O’Grady’s population
represented a smaller subset o f the Hispanic population— college age, undergraduate
students, and English speakers. In reality, very few Hispanics go to college. In 1997,
only 61.8% of U.S. Hispanics age 25 to 29 completed high school. Furthermore, only
53.9% of that group completed 1 or more years o f college, and only 35% of high school
graduates completed 4 years of college (U.S. Bureau, 2000). These figures suggest that
the study population used in Padilla and O’Grady’s study do not represent Hispanics in
the U.S.
Therefore, with the exception of Padilla and O’Grady’s study and perhaps Choi,
Catania, and Dolcini (1994), published research most likely reflects an over-representa
tion of low-income populations. However, the literature does strongly suggest that
these sexual attitudes and practices are real and do place Hispanics at risk for HTV and
AIDS. Therefore, while the literature on sexual attitudes and practices may not repre
sent the majority of Hispanics, it does reflect those at highest risk o f acquiring HTV and
AIDS. For this reason, these attitudes and practices (i.e., extramarital sex) will be
considered as risk factors for Hispanics as well as factors that affect knowledge.
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Socioeconomic Status
One factor that particularly affects minority populations’ risk of acquiring HTV
and AIDS is socioeconomic status. Individuals living in poverty are more likely to have
AIDS than those who do not. “HIV thrives in a medium o f poverty, joblessness,
homelessness, discrimination, and despair. The spread of HIV disease is fostered and its
impact multiplied by related illness, such as other sexually transmitted diseases, tubercu
losis, and addictions” (Stryker et al., 1995, p. 1146). Bracha (1998) demonstrated a
clear correlation between individuals diagnosed with AIDS and living in a high poverty,
geographical area. AIDS has a disease pattern very similar to other diseases which
affect socioeconomically disadvantaged populations. A survey o f 3,617 individuals
found that socioeconomic status was directly related to the age at which individuals
acquired chronic diseases (House et al., 1990). The lower the socioeconomic strata, the
younger the individuals stricken with chronic disease.
Hispanics and other minorities are often at the lower levels of the socioeconomic
ladder. Hispanics made up 27.1% o f the 35,574 million people living below poverty in
the U.S. in 1997, although the total Hispanic population made up only 11.4% o f the
U.S. population (U.S. Bureau. 2000). According to the CDC (1993), ethnic and racial
minorities are disproportionately affected by “other social and economic factors, such as
poverty, underemployment, and poor access to the health care system” (p. 1). Latinos
have substantially lower levels of high school and college level graduates (Latino
Futures Research Group, 1993, p 53) and have the lowest median income o f all other
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major ethnic groups in the U.S.7 Living in high poverty areas exposes individuals to
higher risk behaviors such as intravenous drug use, which accounted for 29% of adult
male and 28% of adult female reported AIDS cases between July 1997 and June 1998
(CDC, 1998b).
Health Access
The number o f Hispanic individuals without health insurance has reached critical
numbers in the U.S. with approximately 34% of Hispanics living without such protec
tion (U.S. Bureau, 1998a). This factor directly limits access to HIV screening, informa
tion, prevention, and/or treatment for HTV and AIDS. Differences in AIDS opportunis
tic rates among ethnic groups may be due to socioeconomic disadvantages, cultural
factors, decreased access to health-care (CDC, 1994).
Summary
HIV and AIDS are a serious problem in the Hispanic community. To combat
the disease, many prevention programs have been implemented. However, one of the
major issues in HTV and AIDS education programs is a lack o f solid outcome data to
identify effective interventions. While many programs have been implemented, rela
tively few have reported outcome data (Stryker et al., 1995). Today, we have approxi
mately 10 years of research on HIV intervention programs but are still grappling with
7 The medium income for Hispanics in 1996 was $24,906 compared to $35,492
for Anglos (U.S. Bureau, 1996). However, the median income reported for Hispanics is
most likely understated due to non-reporting of undocumented residents.
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understanding which interventions are most effective. Methodologies to determine the
effectiveness o f prevention measures are slowly evolving (Leviton & O’Reilly, 1996).
Leviton and O’Reilly wrote that there are issues o f internal validity (establishing causal
relationships between interventions and behavior change) and external validity (the
degree to which findings can be generalized). According to Stryker et al. (1995) “The
first priority is a series o f demonstration and research projects to determine the best
policies, organizational structures, interventions, and ancillary services for the variety of
populations at risk for IV [intravenous drug] users” (p. 1147).
Furthermore, research devoted specifically to the Latino population regarding
HTV and AIDS knowledge is extremely limited. There is “insufficient or non-existent
research data on Latino/Latina populations that is needed to develop education and
prevention efforts” (Brooks, 1995, p. 8).
The literature that we do have suggests that knowledge about AIDS leads to
behavior changes that contribute to the reduction of risk behaviors. It also documents
Hispanics and other minorities as having less knowledge about HTV and AIDS when
compared to the Anglo population. While the literature is relatively clear with respect
to knowledge levels among minority groups, it is unclear as to the reasons for these
differences. Apart from years o f education, very few other factors have been substanti
ated to account for knowledge differences. Acculturation, age, and income have been
suggested, but have not been solidly verified. In the case of acculturation, it appears
low acculturation correlates with lower knowledge.
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Overall, there is very little published research which explains why some Hispan
ics are more knowledgeable about HIV and AIDS than others. Also, published research
on AIDS and HTV knowledge has generally categorized minority groups together and
fails to differentiate between them. The literature is limited to the comparison of racial
and ethnic groups. Thus, factors that lead to knowledge differences among Hispanics,
the topic o f this paper, is still relatively undocumented in research.
We do know that a number of culturally related factors are linked to knowledge.
For example, cultural factors are related to how knowledge is perceived and received.
Social norms, gender roles, and silence about sexually related issues all play important
roles in how information is filtered and subsequently applied to prevent HTV and AIDS.
The uniqueness of the Hispanic culture creates opportunities as well as chal
lenges. It creates opportunities by giving program planners the use of traditional
Hispanic values to enhance the effectiveness of their programs. Weeks et al. (1995)
concluded that while cultural forces could obstruct a woman’s ability to eliminate risk,
“race and culture can also provide the key to effective intervention for these women to
reduce their risk .... Key cultural values, beliefs, and practices are identifiable that
reinforce efforts to protect women against infection in order to enhance their ability to
perform the socially sanctioned roles they wish to carry out in accordance with their
personal goals” (p. 262). On the other hand, without consideration of cultural influ
ence, programs will, at best, be sub-optimal and, at worst, dismal failures. Published
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literature on HIV and AIDS has repeatedly documented the need for culturally relevant
interventions.
In summary, research is just now beginning to unravel the complexities associ
ated with knowledge, factors that affect knowledge and behavior change. Some of
these issues can be addressed by examining factors that may contribute to knowledge
differences about HIV and AIDS among Hispanics.
This study uses secondary data from a cross-sectional study conducted by David
Hayes-Bautista, PhD (UCLA, 1995). The details of that study are described in the
methods chapter. Due to the timeliness and resources available at the time, the resulting
preliminary report only provided a “rough overview of Latino border populations” and
defined “some areas for further research” (UCLA, 1995, p. 2). The treatment of the
data was “largely descriptive” and the report called for a “more rigorous analysis . . . to
be conducted in order to better pinpoint the characteristics of the High Knowledge
group and the Low Knowledge group” (p. 2). This investigation follows that finding
and seeks to carry out the data analysis to a higher level to better understand factors
that may contribute to knowledge differences among Hispanics.
Furthermore, this investigation studies knowledge differences within a subset of
the entire sample of the Hayes-Bautista study. The descriptive analysis conducted by
Hayes-Bautista reported on 486 subjects which consisted of Nogales, Arizona, as well
as Sonora residents, some o f which were non-Hispanics. The study under investigation
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focuses on a subset of the sample consisting o f only Nogales, Arizona, Hispanic
respondents.
Research Focus and Hypotheses
This investigation brings forth the following hypotheses:
Hypothesis la
Hispanic respondents with higher income levels have more
HIV/AIDS knowledge than those with lower income levels.
Rationale. Earlier studies have found educational levels to be associated with
knowledge. Educational level, along with income leveL, have often been used as
indicators for socioeconomic status. This study uses income as a socioeconomic
indicator to explore this relationship.
Hypothesis lb
Hispanic respondents with greater years of education have more
HIV/AIDS knowledge than those with lower years of education.
Rationale. This investigation seeks to confirm finding from earlier studies which
suggest that years of education are associated with HIV/AIDS knowledge.
Hypothesis II
Bilingual (English/Spanish) speakers have more HTV/ADDS knowl
edge than monolingual Spanish speakers.
Rationale. Language has been used as an indicator to determine acculturation
levels of Hispanics and will be used as such in this research study (Angel & Cleary,
34
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1984; Guamaccia, Angel, & Worobey, 1989). Further, language barriers have been
documented as barriers to accessing information, health care, or utilizing HTV and AIDS
information effectively (Aruffo et al., 1991; Hu, Keller, & Fleming, 1989). This
investigation seeks to explore the relationship between language and knowledge about
HTV and AIDS as an indirect measure o f acculturation to explore language differences
and as a barrier to HIV and AIDS knowledge.
Hypothesis HI
Hispanic respondents who use English language media have more
HIV/AIDS knowledge than those who use Spanish language media.
Rationale. Similar to the Hypothesis n, this hypothesis further explores the
relationship between language and AIDS knowledge by using media language as the
independent variable. Media are the major sources of AIDS information. Television
(Aruffo et al., 1991; Caudle, 1992; Hingson et al., 1989), in addition to radio (Hu et al.,
1989), was mentioned as a primary source of information about AIDS for Hispanics.
Newspapers, pamphlets (Hu et al., 1989) and magazines and brochures (Aruffo et al.,
1991; Hingson et al., 1989) were also mentioned as sources o f information, but were
secondary sources to television and radio. Hingson et al. (1989) also looked at who
was most likely to have received information from television, radio, magazines, and
newspapers in the week prior to the survey. They found that Hispanics were least
likely, when compared to other ethnic groups, to have received information.
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Hypothesis IV
Hispanic respondents who use media from the U.S. have more
HIV/AIDS knowledge those who use media from Mexico.
Rationale. This hypothesis seeks to explore knowledge differences between
those who use media from the U.S., from Mexico, and from both countries to explore
specific knowledge differences. It is expected that due to the intensive AIDS media
campaigns in the U.S., those using U.S. media will be more knowledgeable.
Hypothesis V
Female Hispanic respondents have more HIV/AIDS knowledge
than males.
Rationale. Although differences in knowledge between genders has not been
documented in the literature, females may be more exposed to HTV and AIDS preven
tion strategies than their male counterparts. Females seek medical services more often
than men, are more likely to be seen by an obstetrician/gynecologist, and seek family-
planning services which include AIDS counseling. Also AIDS and HIV prevention
programs are often part o f government funded programs from which women receive
services.
Hypothesis VI
Younger Hispanic respondents (i.e., under 25 years of age) have
more HIV/AIDS knowledge than older Hispanic respondents (i.e., 25 to
44; 45 and over years o f age).
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Rationale. AIDS is a relatively new phenomenon. Younger populations tend to
be more affected than older populations both in terms o f incidence rates and higher risk
behaviors. It is hypothesized that this younger population is more receptive to messages
about HIV and AIDS because they may be at higher risk. They are more likely to be
single, have multiple sexual partners, and have a more active sexual life.
Hypothesis Vila
Hispanic respondents who do not practice high-risk behaviors have
more HIV/AIDS knowledge than those who practice high risk behaviors.
Rationale. Knowledge alone does not lead to behavior change. However, the
literature demonstrates that HIV prevention programs have led to behavior change and,
subsequently, a reduction in HIV infections. This hypothesis explores the relationship
between two types o f high-risk behaviors and knowledge.
Hypothesis VTIb
Single Hispanic respondents have more HTV/AIDS knowledge than
married Hispanic respondents.
Rationale. The rationale for this hypothesis follows the same rationale as the
age group hypothesis. Single individuals at higher risk for HTV may be more receptive
to HTV prevention efforts than are those at lower risk (i.e., married individuals) for
HIV.
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CHAPTER 3
METHODS
The data analyzed in this dissertation were originally gathered by David Hayes-
Bautista, Ph.D. in late 1994, while at the Center for the Study of Latino Health, UCLA
School of Medicine. His study was an exploratory cross-sectional survey o f 486
persons and was a result o f a CDC request for proposals. Under Dr. Hayes-Bautista’s
direction, the Center for the Study of Latino Health worked with the Santa Cruz Family
Guidance Center, a state funded mental health center, to cany out the data collection.
The strata for the original data and the type of survey conducted are listed in Table 1.
The data analyzed for the current research study used a subset of Dr. David Hayes-
Bautista’s sample.
The questionnaire used in the Hayes-Bautista study was developed in coordina
tion with other researchers by “drawing upon earlier questionnaires about HIV/AIDS
and previous work done by Latino HIV/AIDS researchers, as well as instruments about
health beliefs, such as the Hispanic NHANES and the Epidemiological Catchment Area
Survey” (UCLA, 1995). The first draft of the questionnaire was developed in English
and Spanish and was field tested on 11 respondents by telephone.
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Table 1
Haves-Bautista Sample Strata
Strata Type of Survey
Youth 18 to 25 Telephone
Women 18 and over Telephone
Monolingual Spanish Speaking Telephone
High-Risk Males (previously homosexual Primarily telephone, with face to face sur
males) vey conducted if chosen by subject
Commuter Immigrants Face to face
Note. From An assessment of Latino-focused A IDS/HIV education and prevention
efforts in Nogales. Arizona, by UCLA Center for the Study of Latino Health, 1995,
unpublished preliminary report. Adapted with permission.
The pretesting of the survey tool revealed a resistance by male subjects to
answer questions specifically related to sexual orientation over the telephone. The
questionnaire was revised based on these findings and a new high-risk question was
created. Instead o f directly inquiring about sexual orientation, the new high-risk
question inquired if the male respondents had relations with a drug addict, a prostitute,
or a male. This was an indirect way to identify male subjects with high-risk behaviors.
Further, a decision was made to offer face-to-face interviews to high-risk males. Other
modifications resulted from the feedback on the original tested questionnaire including
the elimination o f seven questions.
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The final questionnaire used in the Hayes-Bautista (UCLA, 1995) study con
sisted of 50 questions (see Appendix A). However, several questions consisted of two
or more parts. Thus, the actual number of questions asked could be as high as 92,
depending on the individual responses. The majority of questions were answered using
multiple choice answers with the exception of age, years of education, hours respon
dents listen to the radio, hours respondents watch television, and number o f times
HIV/AIDS8 information was received from television and radio. The categories of the
questions are as follows:
1. General demographic information
2. Risk factors for HTV/AIDS
3. Socioeconomic information
4. Perceived knowledge about HTV/AIDS
5. Perceptions of where knowledge about HIV/AIDS should be obtained
6. Exposure to media sources
7. Perceptions of media sources effectiveness regarding HTV/AIDS informa
tion
8. HTV/AIDS education for children
9. Exposure to HTV/AIDS information via media sources, churches, schools,
workplace, medical facilities, family, spouse, friends
8 The term “HTV/AIDS” was used in the survey questionnaire with no
differentiation between the two terms. Therefore, to maintain consistency, the same term
is used in the methods, reporting and conclusion sections as appropriate.
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10. Accessibility to HTV/AIDS information
11. Likelihood o f seeking HTV/AIDS information different sources
12. Knowledge about condoms
13. Knowledge about transmission
14. Perceived risk o f acquiring HTV/AIDS
15. Likelihood o f seeking HTV/AIDS test from various sources
16. Confidentiality about HTV/AIDS testing.
Procedures
Sampling Design
The- Hayes-Bautista (UCLA, 1995) data set is comprised o f two samples, a tele
phone survey and a convenience sample. This dissertation is a sub-sample of this datum
set and consists o f respondents living in Nogales Arizona (n = 334). The commuter
immigrant data set (n = 97) were omitted from the sub-sample. For the telephone data
set, every fifth household from the telephone directory was selected as a study candidate
for the telephone surveys. Four attempts were made at each household before that
household was eliminated from the sample. If the household was successfully reached,
the survey was explained to the candidates. Subjects who agreed to participate in the
study were screened for eligibility and categorized in a stratum. Candidates who were
identified as high-risk males were given the choice to be interviewed either over the
telephone or in face-to-face interviews in the clinic. Oral informed consents were given
by all candidates prior to the initiation of the surveys. Subjects were interviewed either
41
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in Spanish or English, depending on their preference, with 76% interviewed in English
and 24% interviewed in Spanish. All interviews were conducted between October 24,
1993 and January 23, 1994. Data were entered directly into a computer as questions
were answered by subjects (1995 report from UCLA Center).
Sample Population Characteristics
The sample for this research study consists of 334 Hispanics o f which 62% are
female and 37%9 are male (see Table 2). Twenty-three percent o f the subjects were in
the 18-to 24-year-old age category, 41% between 25 to 44 years o f age, and 34% were
in the over 44-year-old age category.1 0
The majority of the subjects (69%) were bom in Mexico, 30% were bom in the
U.S. All respondents reported living in Nogales, Arizona. Subjects spoke English only
(1%), Spanish only (45%), English and Spanish (54%). However, the preferred
language for the interview was Spanish (76%). The majority o f subjects received their
education in Mexico (54%). Others were educated in the U.S. (45%) and Central
America (1%). Marital status of subjects included single (30%), married (58%),
divorced (4%), widowed (4%), and separated (2%).
Seventy-eight percent reported sexual relations within the last 3 months prior to
the interview. Eighteen percent reported having more than one partner in the past 3
months. Forty-three percent o f the male and 3% of the female respondents reported
figures are rounded off and may not total 100%.
I 0 Total may not add up to 100% due to missing data.
42
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Table 2
Sub-Sample Characteristics
Characteristics f % a Characteristics f %a
Birthplace Marital Status
U.S. 101 30 Single 101 30
Mexico 232 69 Married 195 58
Other 1 0 Divorced 14 4
Widowed 15 4
Separated 8 2
Missing 1 0
Laneuaee Spoken Sexual Relations Within the
Last 3 Months
English 4 1 No 73 22
Spanish 151 45 Yes 261 78
Bilingual 179 54
Laneuaee Preferred for Have More Than One Partner
Interview No
English 81 24 Yes 273 82
Spanish 253 76 61 18
Gender More Than One Partner/ Mar
ital Status
Female 208 62 Single 31 51
Male 125 37 Married 22 36
Missing 1 0 Divorced 4 7
Widowed 1 2
Separated 2 3
Missing 1 1
Annual Earnings Relations with Drue Addict.
Prostitute or Manb
Under $15K 162 49 No 106 85
$15Kto $29,999 66 20 Yes 19 15
$30K to $44,999 23 7
$45K and Over 8 2
Refused to Answer 63 19
Missing 12 4
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Table 2 fcontinued)
Characteristics f % “ Characteristics f % *
Religion Where Received Education
Catholic 288 86 U.S. 150 45
Protestant 12 4 Mexico 181 54
None 16 5 Central America 2 1
Other 18 5
Age Years o f Education
18-24 78 23 0-8 80 24
25-44 137 41 9-12 174 52
Over 44 113 34 13-16 67 20
Missing 6 2 Over 16 11 3
Missing 1 0
“ Rounded off. ‘ Male respondents only.
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having more than one partner in the past 3 months. Fifty-one percent of the single
population, 36% of the married population, 7% of the married, 2% o f the widowed, and
3% of the separated reported having more than one partner. Catholicism was the
prominent religion reported (86%). The remaining subjects reported their religion as
Protestantism (4%), or other/none (10%) of subjects. Forty-nine percent of subjects
reported annual incomes under $15,000, 29% over $15,000, and 22% refused to
answer.
Exclusions
This exploratory study used the data from this cross-sectional survey with the
following exclusions:
1. Non-Hispanics were excluded from the sample for all data analyses.
2. Other data were excluded for specific analyses and are detailed in the subse
quent sections.
Dependent Variables
For the purposes o f this study, knowledge is defined as “knowledge about
condoms and transmission o f HIV/AIDS.” This research study examines very specific
HTV/AIDS knowledge by using nine knowledge questions to test the hypotheses (see
Table 3). Four questions are directly related to transmission, four to condoms and one
to partner history. Other knowledge questions from the original data base were not
used in testing the hypotheses because they either did not have a clear correct answer,
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Table 3
Dependent Variables: Knowledge Questions and Scores
Questions Score
Related to Condom Knowledge
“In your opinion, how effective is the use of condoms to prevent 1 - Not effective
getting HTV/AIDS through sexual intercourse.” (How effective is use 2 — Somewhat Effective
of condoms to prevent HTV/AIDS) 3 - Very Effective
“The material with which condoms are made, latex or natural mem 1 - False
brane, may affect its effectiveness in preventing transmission of 2 — True
HTV/AIDS.” (Condom material may affect effectiveness)
If participant answered true, the following question was asked “Can 1 — Membrane
you tell me which, latex or membrane is better.” (Which condom 2 — Latex
better, latex or membrane
“Oil-based lubricants, such as Vaseline, can cause latex condoms to 1 - False
break.” (Oil based lubricants can cause latex condoms to break) 2 — True
Related to Transmission Knowledge and Partner
Sex and sharing needles have been demonstrated to be the most common way of spreading
HTV/AIDS. What is the risk of getting HIV/AIDS from each of the following?:
“Having sex with many different partners” (Risk of HTV/AIDS: Sex 1 - No Risk
with many different partners) 2 - Some Risk
3 - High Risk
“Men having sex with other men” (Risk of HIV/AIDS: Men having I - No Risk
sex with other men) 2 - Some Risk
3 - High Risk
“Women having sex with men that also have sex with men” (Risk of 1 - No Risk
HTV/AIDS: Women having sex with men who also have sex with 2 - Some Risk
men) 3 - High Risk
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Table 3. (continued)
Questions Score
“Having sex with an injecting drug user” (Risk of HIV/AIDS: Sex
with an injecting drug user)
1 - No Risk
2 - Some Risk
3 - High Risk
“How important do you feel it is for you to know about your part
ner’s sexual past” (How important to know partner's sexual past)
1 - Not Important
2 — Somewhat Important
3 - Very Important
Note. Dependent Variables have been shortened for the purposes of this paper as specified in the
parenthesis. From An assessment of Latino-focused AIDS/HTV education and prevention efforts in
Nogales. Arizona, by UCLA Center for the Study of Latino Health, 1995, unpublished preliminary
report Adapted with permission.
47
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or there was not enough variability o f the answers to carry out hypothesis testing.
Values o f “don’t know” for the dependent variables were excluded in statistical tests.
Independent Variables
Several adjustments and exclusions made to the data for the specific statistical
tests are listed below:
1. Earnings (annual). The categories for “annual earnings” in the three highest
categories, “$15,000 to $29,999,” “$30,000 to $44,999,” and “$45,000 and over,”
were collapsed into two categories (i.e., “under $15,000” and “$15,000 and over”) due
to the small number o f cases in each o f these categories. Respondents who answered
“refused to answer” were excluded from the analysis.
2. Years o f education. “Years o f education,” originally continuous variable
values, were condensed into two categories (i.e., “0 to 12”, and “over 12”) due to the
small number of respondents with higher years of education.
3. Language spoken. English-only speakers were not included in the analysis
due to the small number of English speakers in the sample.
4. Language in which respondent watches television. Respondents who
reportedly did not watch television were excluded from specific analysis.
5. Language in which respondent listens to the radio. Respondents who report
edly did not listen to the radio were excluded from specific analyses.
6. Language in which respondent reads newspapers. Respondents who report
edly did not read newspapers were excluded from the analysis.
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7. Station on which respondent watches television (U.S. or Mexico). Respon
dents who did not watch television were excluded from the analysis.
8. Station on which respondent listens to the radio (U.S. or Mexico). Respon
dents who did not listen to the radio were excluded from the analysis.
9. Country o f publication of newspapers read (U.S. or Mexican). Respondents
who did not read newspapers were excluded from the analysis.
10. Male risk factors (relations with drug addict, prostitute or male. Females
were excluded from this analysis.
11. Marital status. The values for “Marital Status” (divorced, separated, and
widowed), were excluded from this analysis due to the small number of cases in these
categories.
12. Age. “Age,” originally a continuous variable, was condensed into a categori
cal variable consisting o f three groups: “18 to 24,” “25 to 44,” and “over 44.”
13. The independent variables and their values used in the analyses for this
research study are listed in Table 4.
Form of the Analysis
Univariate analysis of the data was first performed to obtain distributions o f data
in each dependent and independent variable. The hypotheses were then tested using
analysis o f variance (ANOVA) procedures on each o f the nine dependent variables and
the independent variables to determine if mean differences exist in knowledge between
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Table 4
Independent Variables
Variable Value Variable Value
Years of education com
pleted
1 — 0-12 years
2 — Over 12 years
Station on which
respondent watches tele
vision (U.S. or Mexican)
1 — U.S.
2 — Mexican
3 — Both U.S. & Mexi
can
Where received most of
schooling
1 — U.S.
2 — Mexico
3 — Central America
4 — Other
Station on which respon
dent listens to the radio
(U.S. or Mexican)
1 — U.S.
2 — Mexican
3 — Both U.S. & Mexi
can
Earnings (annual) 1 — Under $15,000
2 — $15,000 and over
Country of publication of
newspapers read
1 — U.S.
2 — Mexican
3 — Both U.S.& Mexi
can
Language(s) spoken 1 — Spanish
2 — Bilingual
Gender 0 — Female
2 — Male
Language in which
respondent watches
television
1 — English
2 — Spanish
3 — Both English and
Spanish
Male risk factors (rela
tions with drug addict,
prostitute, or other man)
0 — No
1 — Yes
Language in which
respondent listens to the
radio
1 — English
2 — Spanish
3 — Both English and
Spanish
Marital status 1 — Single
2 — Married
Respondent reads the
newspaper
1 — No
2 — Yes
More than one partner
within the past 3 months
0 — No
1— Yes
Language in which
respondent reads the
newspapers
1 — English
2 — Spanish
3 — Both English and
Spanish
Age 1 — 18 to 24 yrs. of age
2 — 25 to 44 yrs. of age
3 — Over 44 yrs. of age
the groups. A procedure suggested by Winer (1962) was used to perform ANOVA
tests on the dependent categorical variables. Winer’s example designates numerical
values of 0 and 1 for dichotomies, which are then used in ANOVA tests. Following
Winer’s technique, numerical values were designated to both dichotomous as well as
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tricotomous dependent variable categories (0, 1, and 2) in this investigation. Results
were reported significant at the .05 level o f significance, but were also judged sugges
tive of differences between the .05 and .10 levels o f significant. Post-hoc tests were
conducted to determine which groups differed significantly if the independent variable
consisted of more than two categories.
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CHAPTER 4
RESULTS
The results are presented in three parts. The first part is a descriptive analysis of
the nine knowledge questions that constitute the dependent variables and measure
knowledge. The second presents sources of HIV/AIDS information as reported by
survey participants. The last section provides the results o f the ANOVA analyses and is
organized by hypothesis. In this last section, the statistically significant results for
transmission knowledge, represented by four dependent variables; results for condom
knowledge, represented by four other dependent variables, is presented; and results for
the ninth dependent variable, relating to the need to know a sexual partner’s history, are
presented.
Overall Knowledge
As a whole, the respondents generally had high knowledge o f HTV/AIDS
transmission (see Table 5). Approximately 90% of respondents correctly answered
each o f the four transmission questions (i.e. risk of getting HTV/AIDS from having sex
with many different partners, men having sex with other men, women having sex with
men who also have sex with men, and having sex with an injecting drug user).
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Table 5
Dependent Variables: Frequency Table
Questions f %
Related to Condom Knowledge
In your opinion, how effective is the use of condoms to pre Not effective 25 7.5
vent getting HIV/AIDS trough sexual intercourse? Somewhat effective 186 55.7
Very effective 57 17.1
Don’t know 63 18.9
Missing 3 0.8
The material with which condoms are made, latex or natural False 68 20.4
membrane, may affect its effectiveness in preventing trans True 171 51.2
mission of HTV/AIDS? Don’t know 94 28.1
Missing 1 0.3
If participant answered true, the following question was Membrane 16 9.4
asked: Can you tell me which, latex or membrane is better? Latex 94 55.0
Don’t know 59 34.5
Missing 1 0.3
Oil-based lubricants, such as Vaseline, can cause latex con False 56 16.8
doms to break? True 114 34.1
Don’t know 163 48.8
Missing 1 0.3
Related to Transmission Knowledge and partner History
Sex and sharing needles have been demonstrated to be the most common way of spreading
HTV/AIDS. What is the risk of getting HIV/AIDS from each of the following:
Having sex with many different partners?
Men having sex with other men?
No risk 1 0.3
Some risk 19 5.7
High risk 301 90.1
Don’t know 12 3.6
Missing 1 0.3
No risk 0 0.0
Some risk 9 2.7
High risk 302 90.4
Don’t know 22 6.6
Missing 1 0.3
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Table 5 (Continued)
Questions f %
Women having sex with men who also have sex with men? No risk 2 0.6
Some risk 16 4.8
High risk 299 89.5
Don’t know 17 5.1
Having sex with an injecting drug user? No risk 1 0.3
Some risk 14 4.2
High risk 302 90.4
Don’t know 17 5.1
How important do you feel it is for you to know about your No risk 11 3.3
partner’s sexual past? Some risk 32 9.6
High risk 267 79.9
Don’t know 23 6.9
Missing 1 0.3
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Respondents were substantially less knowledgeable regarding condom-related
questions. Only 17.1% responded that condoms are very effective in preventing
HIV/AIDS. Fifty-one percent stated that condom material affects the effectiveness of
condoms. O f those who answered this question correctly, only 55% knew that latex
condoms are better than membrane condoms in preventing HIV/AIDS and 34.1% (n =
334) knew that oil-based lubricants, such as Vaseline can cause condoms to break. The
majority of respondents (80.7%) responded that it is very important to know a partner’s
sexual past.
Sources of HIV and AIDS Information
Subjects were asked two questions regarding the number of times they received
HTV/AIDS information from 11 sources. The most common sources for receiving
HTV/AIDS information (between 1 and 10 times as well as more than 10 times in 6
months previous to the interview) were television, radio, family, and friends (see Table
6). The least common sources for receiving HTV/AIDS information were churches,
workplace, doctors, schools, clinics, and health department.
In response to the question, “Who should provide you with HTV/AIDS informa
tion?” the overwhelming percentage o f respondents felt that the health department
(98%), clinics (97%), medical doctors (97%), schools (96%), television (94%), and
family (93%) should provide them with information.
While most subjects felt that HIV/AIDS education should be available in school,
most subjects also felt that the best choice to teach children about HIV/ATDS were
55
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Table 6
Sources o f HIV/ATDS Information
Source Number
Received 1-10 Messages in Last 6 Months
TV 177
Families 143
Radio 142
Friends 134
Newspapers 105
Health Departments 99
Clinics 91
Schools 87
MDs 80
Workplaces 62
Churches 60
Received Over 10 Messages in Last 6 Months
TV 122
Radio 66
Families 59
Newspapers 38
Friends 29
Churches 17
Schools 17
Clinics 17
Workplaces 15
Health Departments 14
MDs 12
56
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Table 6 (Continued)
Source Number
Received No Information in Last 6 Months
Churches 257
Workplaces 257
MDs 242
Schools 230
Clinics 226
Health Departments 221
Newspapers 191
Friends 171
Families 132
Radio 126
TV 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
parents (50%). Another 26% chose teachers, 17% chose nurses, 3% chose other young
people, and 5% chose other as the best choice to teach young children about
HIV/AIDS. When asked the grade to teach young regarding HIV/AIDS, 68% stated
children should be taught about HTV/AIDS between first and sixth grades, 21%
between 7* and 9t h , and 4% between 10t h and 12t h grade.
Results of Hypotheses Testing
The results below are presented by order o f the hypotheses. Table 7 reflects the
overall significant findings of the analyses. The following section will present these
results in detail.
Hypothesis la
Hispanic respondents with higher income levels have more HTV/AIDS
knowledge than those with lower income levels.
The results for these analyses are listed in Tables 7 and 8. Two of the seven
variables were found to be associated with income. The higher income group (i.e.,
greater than $15,000 per year) scored higher than the lower income group (i.e., less
than $15,000) regarding the importance of knowing a partner’s sexual past, F(l, 245) =
8.679, p < .05.
While not statistically significant, results are suggestive that the higher income
group were more knowledgeable regarding the risk o f getting HIV/AIDS from having
sex with many different partners, F(l, 249) = 2.818, p < .10. The other five dependent
variables (i.e., risk o f getting HIV/AIDS for women having sex with men who also have
58
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Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Table 7
Summary of Statistically Significant Findings
Independent Variables Dependent Variables
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Table 8
Analysis of Variance of Knowledge Variables bv Annual Earnings
Annual Earnings
Q
M §D SS i f
M S E
Sig.
Dependent Variable: How Important is it to Know Partner’s Sexual Past
Under $15,000
$15,000 and Over
Total
151
96
247
2.75 0.53 Income (between groups) 1,88 1
2.93 0.33 Error 52.93 245
2.82 0.47 Total 54.80 246
Deoendent Variable: Risk of HIV/AIDS: Havine Sex With Manv Different Partners
1.88
0,22
8.68 0.004
Under $15,000
$15,000 and Over
Total
156
95
251
2.91 0.31 Income (between groups) 0,20 1
2.97 0.18 Error 17.65 249
2.93 0.27 Total 17.85 250
0.20
7.09
2.82 0,094
sex with men; risk o f getting HTV/AIDS for men having sex with other men; risk of
getting HIV/AIDS having sex with an injecting drug user; condom materials affect its
effectiveness; which condom is better (latex or membrane); oil-based lubricants can
cause latex condoms to break; how effective are condoms in preventing HTV/AIDS)
were tested, but no statistically significant differences were found. The means o f the
scores of the non-significant findings did not reflect any patterns (i.e., neither of the
groups scored consistently higher than the other on most or all of the questions).
Hypothesis lb
Hispanic respondents with greater years o f education have more
HTV/AIDS knowledge than those with lower years of education.
The results for these analyses are listed in Tables 7 and 9. Two o f the variables
were found to be associated with education. The higher educated group (i.e., 12 years
and over of education) were found to be more knowledgeable about the risk of getting
HTV/AIDS for women having sex with men who also have sex with men, F(l, 313) =
5.761, p < .05 than the lower educated group (i.e., less than 12 years of education).
While not statistically significant, results are suggestive that the higher educated
group has more knowledge regarding the risk of getting HTV/AIDS for men who have
sex with other men, F(l, 307) = 3.034, p < .10. No statistically significant differences
were found in knowledge among the two educational groups with respect to other
knowledge variables (i.e., risk of getting HIV/AIDS from having sex with many
62
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Table 9
Analysis of Variance of Knowledge Variables by Years of Education
Education n
M SD SS df MS F Sig.
Deoendent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
0 through 12
Greater than 12
Total
238
77
315
2.92 0.31 Education (between groups)
3.00 0.00 Error
2.94 0.27 Total
0.41
22.32
22.73
1 0.41
313 7.13
314
5.76 0.017
Deoendent Variable: Risk of HIV/AIDS: Men Having Sex With Other Men
0 through 12
Greater than 12
Total
233
76
309
2.96 0.19 Education (between groups)
3 0 Error
2.97 0.17 Total
8.55
8,65
8.74
1 8.55
307 2.82
308
3.03 0.0083
different partners; risk o f getting HTV/AIDS having sex with an injecting drug user;
condom materials affect its effectiveness; which condom is better; oil-based lubricants
can cause latex condoms to break; how effective are condoms in preventing HTV/AIDS;
and the importance of knowing a partner’s sexual past). However, the mean knowledge
scores for higher educated respondents were fund to be higher than for the lower
educated with respect to risk knowledge, but not condom knowledge.
Hypothesis II
Bilingual (English/Spanish) speakers have more HTV/AIDS knowl
edge than monolingual Spanish speakers.
The results for these analyses are listed in Tables 7 and 10. Three of the
variables were found to be associated with language. Overall, bilingual speakers scored
higher than monolingual Spanish speakers. Bilingual speakers were more knowledge
able about the risk of getting HTV/AIDS from having sex with many different partners,
F(l, 315) = 5.512, p < .05, and about the risk of getting HTV/AIDS having sex with an
injecting drug user, F(l, 311) = 5.459, p < .05. The bilingual speakers were also more
knowledgeable about which condom is better in preventing HTV/AIDS, F(l, 121) =
5.705,p < .05. No statistically significant differences were found in knowledge among
the two language groups with respect to the other variables (i.e., risk o f getting
HIV/AIDS for women having sex with men who also have sex with men; risk o f getting
preventing HTV/AIDS; and the importance of knowing a partner’s sexual past). How
ever, the mean knowledge scores did vary in the hypothesized direction.
64
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Table 10
Analysis of Variance of Knowledge Variables by Language Spoken
Language n
M
SD SS df MS F Sig.
Denendent Variable: Risk of HIV/AIDS: Having Sex With Manv Different Partners
Spanish
Bilingual
Total
147
170
317
2.9
2.97
2.94
0.32
0.17
0.25
Language (between groups)
Error
Total
0.34 1 0,34
19.52 315 6.20
19.86 316
5.51 0.019
Dependent Variable: Risk of HIV/AIDS: Having Sex With an Iniectine Drue User
Spanish
Bilingual
Total
141
172
313
2.91
2.98
2.95
0.28
0.19
0.23
Language (between groups)
Error
Total
0.30 1 0.30
16.89 311 5.43
17.18 312
5.46 0,020
Dependent Variable: Which Condom Is Better (" L atex or M em brane"!
Spanish
Bilingual
Total
39
84
123
1.74
1.90
1.85
0.44
0.3
0.35
Language (between groups)
Error
Total
0.69 1 0.69
14.67 121 0.12
15.37 122
5.71 0.018
Hypothesis HI
Hispanic respondents who use English language media have more
HIV/AIDS knowledge than those who use Spanish language media.
This hypothesis was tested with three independent variables. The results are
listed in Tables 7, 11, and 12 and are presented by order o f independent variable.
1. Language in which respondents watch television. None o f the variables were
found to be associated with the language in which respondents watch television.
2. Language in which respondent listens to the radio. The hypothesis was not
supported by the analyses. However, the groups differed statistically on one question
and contrary to the hypothesis. Statistically significant differences in knowledge were
found with respect to knowledge about oil-based lubricants causing latex condoms to
break, F(2, 160) = 5.586, p < .05 (see Table 11). A Dunnet T3 revealed that respon
dents who listened to the radio in both languages were more knowledgeable than the
English language listeners. Those who listened in Spanish were also more knowledge
able than those who iistened in English. No statistically significant differences were
found between the groups with respect to the other variables (i.e., risk o f getting
HIV/AIDS for women having sex with men who also have sex with men; risk of getting
HIV/AIDS from having sex with many different partners; risk o f getting HIV/AIDS for
men having sex with other men; risk of getting HTV/AIDS having sex with an injecting
drug user; condom materials affect its effectiveness; which condom is better; how
effective are condoms in preventing HTV/AIDS; and the importance o f knowing a
partner’s sexual past). The mean scores for the non-significant questions showed a
66
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Table 1 1
Analysis of Variance of Knowledge Variables bv Language Respondents Listen to the Radio
Radio n M SD SS df MS F Sig.
Dependent Variable: Oil-Based Lubricants Can Cause Latex Condoms to Break
English 23 1.39 0.5 Radio (between groups) 33.10 2 1.16 5.59 0.005
Spanish 83 1.71 0.46 Error 35.41 160 0.21
Both 57 1.75 0.43 Total 162
Total 163 1.68 0.47
O N
trend for the transmission questions in the hypothesized direction, but not for condom-
related questions.
3. Language in which respondents read the newspapers. Two o f the variables
were found to be associated with the language in which respondents read newspapers.
Statistically significant differences in knowledge were found with respect to knowledge
about the risk o f getting HTV/AIDS for women having sex with men who also have sex
with men; HTV/AIDS, F(2, 164) = 4.471, p < .05 (see Table 12). A Dunnet T3 revealed
that the respondents who read newspapers in English were more knowledgeable than
respondents who read newspapers in both languages. No statistically significant differ
ences were found between those who read English only newspaper and those who read
Spanish only newspapers.
While not statistically significant, results are suggestive of knowledge differences
regarding the risk o f getting HIV/AIDS for men having sex with other men, F(2, 160) =
2.53, p < .10 (see Table 12). A Dunnet T3 did not reveal specific differences within the
groups. The other dependent variables (i.e., risk of getting HTV/AIDS from having sex
with many different partners; risk o f getting HTV/AIDS having sex with an injecting
drug user; condom materials affect its effectiveness; which condom is better, oil-based
lubricants can cause latex condoms to break; how effective are condoms in preventing
HTV/AIDS; and the importance of knowing a partner’s sexual past) were tested, but no
significant differences were found. The mean scores for the non-significant questions
68
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Table 12
Analysis of Variance of Knowledge Variables bv Language Respondents Read the Newspaper
Language n M SD SS df MS F Sig.
Dependent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
English 75 2.99 0.12 Language read newspaper (between groups)
Spanish 45 2.93 0.25 Error 0.53 2 0.27 4.47 0.013
Both 47 2.85 0.36 Total 9.74 164 5.94
Total 167 2.93 0,25 10.28 166
Dependent Variable: Risk of HIV/AIDS: Men Having Sex With Other Men
English 74 3.00 0.00 Language read newspaper (between groups)
Spanish 42 3.00 0.00 Error 6.06 2 3.03 2.53 0.083
Both 47 2.96 .02 Total 1.92 160 1.20
Total 163 2.99 0.11 1.98 162
showed a trend for the transmission questions in the hypothesized direction, but not for
remaining condom-related questions.
Hypothesis IV
Hispanic respondents who use media from the U.S. have more
HTV/AIDS knowledge those who use media from Mexico.
This hypothesis was tested with three independent variables for a total of 21
statistical tests. The results are listed in Tables 7, 13, 14, and 15 and are presented in the
following paragraphs by order o f independent variable.
1. Station on which respondents watch television (U.S. or Mexican). Three vari
ables were found to be associated with the television station watched. Statistically
significant differences in knowledge were found with respect to the risk of getting
HTV/AIDS having sex with an injecting drug user; F(2, 307) = 4.283, p < .05 (see Table
13). A Dunnet T3 was performed, but did not differentiate statistical differences between
the groups. Although the group that watched television on U.S. stations had a higher
mean score than the other two groups.
While not statistically significant, results are suggest that respondents who watch
television on U.S. stations were more knowledgeable than the other two groups regarding
which condom is better for preventing HIV/AIDS, F(2, 121) = 2.343, p < .10, as well as
the effectiveness o f condoms in preventing HTV/AIDS F(2, 260) = 2.775, p < .10 (see
Table 13). No statistically significant differences were noted between respondents who
watch television on both U.S. and Mexican stations, those who watch on Mexican
70
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Table 13
Analysis of Variance of Knowledge Variables bv Station on Which Respondents Watch Television
TV Station n M SD SS df MS F Sig.
Deoendent Variable: RiskofHIV/AIDS: Having Sex With an Injecting Drue User
U.S. 104 2.98 0.14 TV Station (between groups) 0.47 2 0.23 4.28 0.015
Mexico 64 2.88 0,38 Error 16.71 307 5.44
Both 142 2.96 0.20 Total 17.17 309
Total 310 2.95 0.24
Dependent Variable: Which Condom is Better fLaxtex or Membrane)
U.S. 49 1.94 0.24 TV Station (between groups) 0.57 2 0.289 2.34 0.100
Mexico 19 1.79 0.42 Error 14.81 121 0.12
Both 56 1.80 0.4 Total 15.39 123
Total 124 1.85 0.35
Deoendent Variable: How Effective are Condoms in Preventing HIV/AIDS
U.S. 92 2.22 0.53 TV Station (between groups) 1.59 2 0.80 2.78 0.064
Mexico 53 2.13 0.59 Error 74.52 260 0.29
Both 118 2.04 0.51 Total 76.11 262
Total 263 2.12 0.54
stations only, or U.S. stations only. The other dependent variables (i.e., risk of getting
HIV/AIDS for women having sex with men who also have sex with men; risk o f getting
HIV/AIDS from having sex with many different partners; risk o f getting HIV/AIDS for
men having sex with other men; condom materials affect its effectiveness; oil-based
lubricants can cause latex condoms to break; and the importance of knowing a partner’s
sexual past) were tested, but no significant differences were found. The mean scores for
the non- significant findings showed a trend for the transmission questions in the
hypothesized direction, but not for remaining condom-related questions.
2. Station on which respondents listen to the radio (U.S. or Mexican). Two
variables were found to be associated with the radio station listened to, but did not
support the hypothesis . Statistically significant differences in knowledge were found
with respect to the risk o f getting HTV/AIDS for women having sex with men who also
have sex with men, F(2, 290) = 3.806, p < .05 (see Table 14). A Dunnet T3 revealed
that respondents who listened to Mexican based radio stations were more knowledge
able than respondents who listened to stations from both countries.
While not statistically significant, the results are suggestive of differences in
knowledge about the effectiveness of condoms in preventing HTV/AIDS, F(2, 246) =
2.578, j > < .10 (see Table 14). However, a Dunnet T3 did not differentiate group
differences. The other dependent variables (i.e., risk o f getting HTV/AIDS from having
sex with many different partners; risk of getting HTV/AIDS for men having sex with
other men; risk o f getting HIV/AIDS having sex with an injecting drug user; condom
72
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Table 14
Analysis of Variance of Knowledge Variables by Station on Which Respondents Listen to the Radio
Radio Station n M SD SS df M S F Sig.
Dependent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
U.S. 44 2.98 0.15 Radio Station (between groups) 0.44 2 0.22 3.81 0.023
Mexico 131 2.98 0.15 Error 16.69 290 5.76
Both 118 2.9 0.33 Total 17.13 292
Total 293 2.95 0.24
Dependent Variable: How Effective are condoms in Preventing HIV/AIDS
U.S. 37 2.3 0.52 Radio Station (between groups) 1.41 2 0.70 2,58 0.078
Mexico 111 2.14 0.53 Error 67.22 246 0.27
Both 101 2.07 0.51 Total 68.63 248
Total 249 2.13 0.53
- ~ 4
u >
materials affect its effectiveness; which condom is better; oil-based lubricants can cause
latex condoms to break; and the importance of knowing a partner’s sexual past) were
tested, but no significant differences were found. The mean scores for these groups
were mixed in result and no trends were noted.
3. Country o f publication o f newspapers read. Two of the variables were found
to be associated with country of publication of newspapers read. Statistically significant
differences in knowledge were found with respect to the risk of getting HTV/AIDS for
women having sex with men who also have sex with men, F(2, 162) = 4.006, p < .005
(see Table 15). A Dunnet T3 was conducted, but did not reveal statistical differences
between groups. However, the mean for the groups was in the hypothesized direction.
While not statistically significant, results are suggestive o f knowledge differences
between groups regarding the risk o f getting HTV/AIDS for men having sex with other
men, F(2, 158) = 3.02, p < ,10(see Table 15). A Dunnet T3 did not reveal group differ
ences. However, the mean scores were not in the hypothesized direction. The other
dependent variables (i.e., risk of getting HTV/AIDS from having sex with many different
partners; risk o f getting HTV/AIDS having sex with an injecting drug user; condom
materials affect its effectiveness; which condom is better; oil-based lubricants can cause
latex condoms to break how effective are condoms in preventing HTV/AIDS; and the
importance o f knowing a partner’s sexual past), were tested, but no significant differ
ences were found. The mean scores for the non-significant findings showed a trend for
74
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Table 15
Analysis of Variance of Knowledge Variables by Country of Publication Read bv Respondents
Publ. Country n M SD SS df MS F Sig.
Dependent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
U.S. 82 2.99 0.11 Publ. Co. (between groups) 0.48 2 0.24 4.01 0.020
Mexico 42 2.88 0.33 Error 9.78 162 6.02
Both 41 2.88 0.33 Total 10.27 164
Total 165 2.93 0.25
Dependent Variable: Risk of HIV/AIDS: Men Having Sex With Other Men
U.S. 80 3.00 0.00 Publ. Co. (between groups) 7.27 2 3.64 3.02 0.052
Mexico 40 3,00 0.00 Error 1.90 158 1.20
Both 41 2.95 0.22 Total 1.98 160
Total 161 2.99 0,11
i/i
the transmission questions in the hypothesized direction, but not for remaining condom
questions.
Hypothesis V
Female Hispanic respondents have more HIV/AIDS knowledge than
male respondents.
The results for these analyses are listed in Tables 7 and 16. Three o f the
variables were found to be associated with gender. Female respondents were more
knowledgeable than male respondents regarding the risk o f getting HTV/AIDS for
women having sex with men who also have sex with men, F (l,3 14 ) = 18.59, £ < .001;
risk o f getting HTV/AIDS from having sex with many different partners, F ( l,318)=
21.84, j) < .001; and the importance o f knowing a partner’s sexual past, F (l, 307) =
5.422, £ < .05 (see Table 16). The other dependent variables (i.e., risk o f getting
HTV/AIDS for men having sex with other men; risk o f getting HTV/AIDS having sex
with an injecting drug user; condom materials affect its effectiveness; which condom is
better; oil-based lubricants can cause latex condoms to break; how effective are
condoms in preventing HTV/AIDS) were tested, but no statistically significant differ
ences were found. However, the mean knowledge scores for females on these depend
ent variables were generally higher for females and were in the hypothesized direction.
76
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Table 16
Analysis of Variance of Knowledge Variables by Gender
Gender n
M SD SS i f MS F Sig.
Deoendent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
Female 200 2.99 0.12 Gender (between groups) 1,27 1 1.27 18.5 0.00
Male 116 2.85 0.4 Error 21.46 314 6.84 9
Total 316 2.94 0.27 Total 22.73 315
Deoendent Variable: Risk of HIV/AIDS: Having Sex With Manv Different Partners
Female 201 2.99 0.12 Gender (between groups) 1.39 1 1.39 21.8 0.00
Male 119 2.85 0.38 Error 20.23 318 6.36 4
Total 320 2.93 0.26 Total 21.62 319
Deoendent Variable: How ImDortant is it to Know Partner’s Sexual Past
Female 193 2.88 0.39 Gender (between groups) 1.14 1 1.14 5.42 0.021
Male 116 2.75 0.56 Error 64.77 307 0.21
Total 309 2.83 0.46 Total 65.91 308
Hypothesis VI
Younger Hispanic respondents (i.e., under 25 years o f age) have more
HTV/AIDS knowledge than older Hispanic respondents (i.e., 25 to 44; 45
and over years o f age).
The results for these analyses are listed in Tables 7 and 17. Two o f the variables
were found to be associated with age, one in the hypothesized direction and one
contrary to the hypothesized direction. Group differences were observed regarding oil-
based lubricants causing latex condoms to break, F(2, 163) = 6.56, p < .05 (see Table
17). A Dunnet T3 Post-Hoc analysis revealed the younger age group (i.e., “18 to 24”)
to be more knowledgeable than the middle age group (i.e., “25 to 44”) and the oldest
age group (i.e., “over 44”). Group differences were also observed regarding the risk o f
getting HTV/AIDS for women having sex with men who also have sex with men, F(2,
308) = 5.678, p < = .05. Contrary to the hypothesis, the older age group (i.e., over 44
years o f age) were found to be more knowledgeable than the youngest age group (i.e.,
18 to 24 years o f age) regarding the risk o f HIV/AIDS for women in this risk category.
The other dependent variables (i.e., risk o f getting HTV/AIDS from having sex with
many different partners; risk o f getting HTV/AIDS for men having sex with other men;
risk o f getting HTV/AIDS having sex with an injecting drug user; condom materials
affect its effectiveness; which condom is better; how effective are condoms in prevent
ing HTV/AIDS; and the importance o f knowing a partner’s sexual past) were tested, but
no significant differences were found. No trends were observed in the mean scores for
groups.
78
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Table 17
Analysis of Variance of Knowledge Variables by Age
Age n M SD SS df MS F Sig.
Dependent Variable: Oil-Based Lubricants Can Cause Latex Condoms to Break
18-24 42 1.88 0.33 Age (between groups) 2.71 2 1.36 6.56 0.002
2 5-44 81 1.64 0.48 Error 33.72 163 0.21
Over 44 43 1.53 0.50 Total 36.43 165
Total 166 1.67 0.47
Dependent Variable: Risk of HIV/AIDS: Women Having Sex With Men Who Also Have Sex With Men
18-24 75 2.85 0.43 Age (between groups) 0.81 2 0,40 5.68 0.004
2 5 -4 4 136 2.94 0.24 Error 21.91 308 7.11
Over 44 100 2.99 1.00 Total 22.71 310
Total 311 2.94 0.27
V O
Hypothesis V ila
Hispanic respondents who do not practice high risk behaviors have
more HIV/AIDS knowledge than those who practice high risk behaviors.
This hypothesis was tested using two independent variables. The results for
these analyses are listed in Tables 7, 18 and 19 and are presented in the following
paragraphs.
1. “High risk male.” Two o f the variables were found to be associated with male
high risk behavior. Males who answered “no” to the question, “Have you had sexual
relations with a prostitute, injecting drug user, or male,” scored statistically higher on
two knowledge questions. Lower risk males were more knowledgeable about the risk
o f getting HIV/AIDS having sex with an injecting drug user, F (l, 114) = 5.155, p < .05
(see Table 18); and the importance o f knowing a partner’s sexual past, F (l,l 14) =
5.184, p < .05 (see Table 18). The other dependent variables (i.e., risk o f getting
HIV/AIDS for women having sex with men who also have sex with men; risk o f getting
HTV/AIDS from having sex with many different partners; risk o f getting HTV/AIDS for
men having sex with other men; condom materials affect its effectiveness; which
condom is better; oil-based lubricants can cause latex condoms to break; how effective
are condoms in preventing HTV/AIDS) were tested, but no significant differences were
found. Generally, the mean scores for the groups were in the hypothesized direction for
all knowledge questions.
2. “More than one partner.” Five o f the variables were found to be associated
with have more than one partner. Respondents who reported they did not have more
80
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Table 18
Analysis of Variance of Knowledge Variables by Male Risk Factor (Had Sex With Prostitute. IV Drug User, or Prostitute)
Male Risk Factor n M SD SS df MS F Sig,
Dependent Variable: Risk: Having Sex With an Injecting Drug User
No (low risk male 98 2.95 0.26 Male risk factor (between groups) 0.45 1 0.45 5.16 0.025
Yes (high risk male 18 2.78 0.43 Error 9.86 114 8.65
Total 116 2.92 0.30 Total 10.30 115
Dependent Variable: How Important is it to Know Partner’s Sexual Past
No (low risk male 99 2.8 0.49 Male risk factor (between groups) 1.56 1 1.56 5.18 0,025
Yes (high risk male 17 2.47 0.80 Error 34.20 114 0.30
Total 116 2.75 0.56 Total 35.75 115
0 0
than one partner consistently scored higher on the five questions. These respondents
were more knowledgeable about the risk o f getting HIV/AIDS from having sex with
many different partners, F (l, 319) = 11.98, p = .001; risk o f getting HIV/AIDS for
women having sex with men who also have sex with men, F (l, 315) = 5.853, p < .05;
risk o f getting HTV/AIDS having sex with an injecting drug user; F (l, 315) = 6.806, p <
.05; condom materials affect its effectiveness, F (l, 7.648), p < .05; and the importance
o f knowing a partner’s sexual past, F (l, 308) = 18.76, p < .001 (see Table 19). The
other dependent variables (i.e., risk o f getting HTV/AIDS for men having sex with other
men, which condom is better; oil-based lubricants can cause latex condoms to break;
how effective are condoms in preventing HTV/AIDS) were tested, but no significant
differences were found. However, the mean scores o f these questions were generally in
the hypothesized direction.
Hypothesis V T Ib
Single Hispanic respondents have more HTV/AIDS knowledge than
married Hispanic respondents.
The results for these analyses are listed in Tables 7 and 20. This hypothesis was
not supported by the analyses. In fact, contrary to expectation, married respondents
were more knowledgeable about the risk of getting HIV/AIDS for women having sex
with men who also have sex with men, F (l, 282) = 9.812, p < .05 (see Table 20).
While not statistically significant, results are suggestive that married individuals
are more knowledgeable about the risk o f getting HIV/AIDS having sex with an
82
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Table 19
Analysis of Variance of Knowledge Variables bv Respondents Who Have More Than One Partner
# of Partners n M SD SS df MS
Deoendent Variable: Risk of HTV/AIDS: Havine Sex With Manv Different Partners
Not Had More Than 1 in More Than 1 Partner (between groups) 0.78 1 0,78
Past 3 Months 262 2.% 0.20 Error 20.84 319 6.53
Had More Than 1 in Past Total 21.63 320
3 Months 59 2.83 0.42
Total 321 2.93 0.26
Deoendent Variable: Risk of HIV/AIDS: Women Havine Sex With Men Who Also Have Sex With Men
Not Had More Than 1 in More Than 1 Partner (between groups) 0.42 1 0.42
Past 3 Months 260 2.95 0,23 Error 22.32 315 7.09
Had More Than 1 in Past Total 22.74 316
3 Months 57 2.86 0.40
Total 317 2.94 0.27
E Sig.
11.98 0,001
5.85 0.016
Not Had More Than 1 in
Past 3 Months
Had More Than 1 in Past
3 Months
Total
Dependent Variable: Risk: Having Sex With an Injecting Drug User
260 2.97 0.18 More Than 1 Partner (between groups) 0.36 1 0.36 6.81 0.010
Error 16.83 315 5.34
57 2.88 0.38 Total 17.19 316
317 2.95 0.23
00
w
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Table 19 (Continued!
§ of Partners M SB ss df MS F Sig,
Dependent Variable: Condom Material Affects Its Effectiveness
Not Had More Than 1 in More Than 1 Partner (between groups) 1.52 1
Past 3 Months 186 1.76 0.43 Error 47.13 237
Had More Than 1 in Past Total 48.65 238
3 Months 53 1.57 0.50
Total 239 1.72 0.45
Dependent Variable: How Important is it to Know Partner’s Sexual Past
Not Had More Than 1 in More Than 1 Partner (between groups)
3.82 1
Past 3 Months 254 2.88 0,39 Error
” 5 A Q
Had More Titan 1 in Past Total
oz. / / J v O
3 Months 56 2.59 0,65 66.59 309
Total 310 2.83 0.46
1.52
0.20
3.82
0.20
7.65 0.006
18.76 0.000
0 0
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Table 20
Analysis of Variance of Knowledge Variables bv Marital Status
Marital Status n
M
SD SS df MS F Sig.
Deoendent Variable: Risk of HIV/AIDS: Women Havine Sex With Men Who Also Have Sex With Men
Single 99 2.87 0.40 Marital Status (between groups) 0.70 1 0.70 9.81 0.002
Married 185 2.97 0.16 Error 20.16 282 7.15
Total 284 2.94 0.27 Total 20.86 283
Dependent Variable: Having Sex With an Injecting Drug User
Single 96 2.91 0.33 Marital Status (between groups) 0.20 1 0.20 3.35 0.068
Married 187 2.96 0.19 Error 16.89 281 6.01
Total 283 2.94 0.25 Total 17.10 282
0 0
injecting drug user, F (l, 281) = 3.346, p < .10. The other dependent variables (i.e., risk
o f getting HIV/AIDS from having sex with many different partners; risk o f getting
HIV/AIDS for men having sex with other men; condom materials affect its effective
ness; which condom is better; oil-based lubricants can cause latex condoms to break;
how effective are condoms in preventing HTV/AIDS; and the importance o f knowing a
partner’s sexual past) were tested, but no significant differences were found. No trends
were observed for the non-significant means.
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CHAPTER 5
CONCLUSION
This section will begin with a discussion o f the descriptive analysis and continue
with a discussion o f the ANOVA test results.
Overall Knowledge
Respondents were found to be generally knowledgeable about how AIDS is
transmitted. The majority o f respondents were familiar with AIDS and four different
modes o f transmission which included the risk o f transmission from sex (a) between
males, (b) with an injecting drug user, (c) for females having sex with men who also
have sex with men, and (d) with multiple sexual partners.
However, respondents were considerably less knowledgeable about condoms.
Approximately 17% answered correctly that condoms are very effective in preventing
AIDS. Approximately half o f the respondents knew that condom materials affect the
effectiveness o f condoms. O f those who answered correctly, a little over half knew that
latex condoms were better than membrane condoms for preventing AIDS. These
findings are o f concern because the use o f condoms is virtually the most effective
preventive measure available for individuals at risk for acquiring HIV.1 1 Unfortunately,
“The female condom is also effective in preventing HTV infection, but is not used
or widely known.
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low condom use has been documented in the literature among EGspanics as well as other
ethnic groups. Also, low condom knowledge, along with other risk factors within the
Hispanic community (i.e., multiple sexual partners and denial about bisexuality and
homosexuality), places this population at greater risk for HTV and AIDS.
In looking at the descriptive data, it is important to emphasize that knowledge
about ADDS is not one unit o f analysis. Differences exist in the specific types of
HIV/AIDS knowledge individuals have and do not have. For example, this study
population is generally knowledgeable about the high risk o f AIDS for males who have
sex with males. However, the study population is not generally knowledgeable about
the effectiveness o f condoms in preventing HIV. Study results suggest that an evalua
tion o f specific knowledge needs is appropriate at this time to identify and plan for very
specific knowledge deficits. Once this is accomplished, refinement o f types o f educa
tional messages used within the Hispanic community is needed to ensure that educa
tional programs address specific knowledge deficits. One example o f this may be the
need to develop a message to educate individuals on the effectiveness o f condoms in the
prevention of HTV.
Also worthy o f mention is the large percentage o f individuals who answered
“don’t know” to many o f the condom-related questions.1 2 There appears to be a pattern
in the literature o f Hispanics not responding or answering “don’t know” to questions.
Flaskerud and Nyamathi (1989) found that Latina woman had higher non-response rates
1 2 Non responses were categorized as “don’t know” in this research study.
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on knowledge and practice items than did African American women. Non-response
among Latinas in their study was related to less education, being married, and being
bom outside o f the U .S. Non-responses and “don’t know” answers may also come
from a reluctance to discuss sensitive issues, intimidation with the study interview
process, or truly from not having enough information on the subject to make an
educated guess. To truly address the knowledge, education, and prevention needs o f
Hispanics, more exploratory research would be required to understand this population,
identify knowledge deficits, and apply interventions to address these deficits.
Sources o f AIDS Information
Also consistent with the literature is the finding that most individuals obtain their
AIDS information from television and radio. A third source, family, was the third most
common source for information. Health-care sources were the least common source o f
information mentioned for providing AIDS information. The AIDS literature has
pointed out that health-care providers are not a frequent source o f AIDS information.
According to Hingson et al. (1989) “only 5% had ever discussed AIDS with a doctor”
(p. 809) They reported that even “among persons previously diagnosed with an STD,
and among persons who reported having used IV drugs [one o f the highest risk factors
for HIV/AIDS infection], less than one in five had discussed HIV/AIDS with a physi
cian” (p. 809). Aruffo et al. (1991) found that only 2 % o f Hispanics in his sample, who
visited a health center more than once, talked to anyone about AIDS, compared to 5%
o f Anglos and 7% African-Americans.
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However, when respondents o f this study were asked, “Who should provide
AIDS information,” medical sources were ranked the highest. This finding is also
consistent with AIDS literature. Marin and Marin (1990) interviewed 460 Hispanic
adults via telephone regarding credibility o f sources o f HIV and AIDS. They reported
that individuals such as position, counselors, and those in close contact with the disease
were perceived as the most credible sources o f information.
In spite o f the individual preference for education through health-care resources,
public education through the media can be supported with compelling arguments
(Woods, Davis, & Westover, 1991). One perspective about educating the public is that
it creates momentum for change by changing population norms. Kroger (1991) argues
that the general public, or “total population is an important target for HIV prevention
efforts” (p. 7). Kroger wrote that educating the general public is important because
low-risk individuals can play a role in shaping social norms and influence local and
national political decisions, among other things.
Public-information campaigns have been used successfully to create social norms
or social environments to get desired behavior change (Warner, 1987). Mass media
efforts (i.e,. PSAs) also have been used effectively in altering awareness, knowledge,
and attitudes toward smoking (Flay, 1987). Roper (1991) wrote that the most success
ful methods in countering the HIV epidemic “may be those that parallel methods used to
help reduce cigarette smoking. We have used various strategies to come this far in
achieving this feat ‘(not smoking is the accepted norm)’, although it has taken nearly 40
years to achieve that objective” (p. 601). Although mass media campaigns may have
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taken some time to change behavior, they have worked extremely well at altering social
norms and perceptions regarding smoking.
While using the mass media may be a very effective method for public education,
refinement, and reinforcement o f these messages through health-care providers is also
important. Individual risk factors can be assessed during one-on-one sessions, appropri
ate interventions planned based on risk factors, and the information provided by a
credible source. Findings in this study are consistent with other studies, which reveal
that health-care providers are not giving HIV and AIDS education to their patients.
Additional research is needed to determine the reasons why this occurs.
ATDS Education for Children
Most respondents felt that while parents are the best choice to teach children
about AIDS, respondents also felt that AIDS education should be taught at school. The
majority o f respondents felt that AIDS education should be taught between the 1st and
the 6t h year. This finding is relevant for at least two reasons. First, this research study
suggests that most respondents are supportive o f AIDS education in school. Second,
while many respondents feel parents should discuss AIDS with their children, parents
may be reluctant to do so. Silence about sexually related issues among groups of
Hispanics poses barriers to communication about AIDS. Teaching children about AIDS
in schools assists parents in carrying out what may be a very delicate task for them.
Public education for children also may be a key to early prevention efforts by the school
system. Therefore, understanding Hispanics’ desire for AIDS education in the schools
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may assist public educators in implementation o f programs supported by and collabo
rated with parents.
Hypothesis Testing Findings
Table 7 presents an overall summary o f significant findings o f the hypotheses
tested. The factors that are most associated with higher AIDS knowledge included: (a)
having more than one partner, (b) gender, and (c) language. Earnings, years o f educa
tion, language in which respondents listen to the radio, language in which respondents
read newspapers, country o f origin o f media used, marital status, and risk factors for
males also were associated with at least one knowledge measure.
Gender and Risk Factors
for HIV and AIDS
Female respondents scored higher on three o f the nine knowledge questions than
did male respondents. This pattern persisted in all statistically non-significant findings
as well. These findings have several implications for public health education models.
The first has to do with why this gender difference exists. One possible explana
tion is that women are more exposed to health-care services than are men. First,
women generally seek more health-care services than do men. Women, in general, are
more likely to seek preventive services for obstetrical and gynecological services, while
men may seek services only when ill. Second, lower income women may be more
exposed to government funded programs (i.e., family planning programs) that have
extensive educational components such as AIDS prevention and are directed specifically
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at women. Many o f these programs do not have residency or other “immigration”
related requirements for them to be utilized. Many of these programs are community
based and are considered a safe haven for undocumented as well as documented
women.
The second issue is the implication o f unequal knowledge between genders and
whether this influences behavior. For example, “gender roles and cultural values and
norms influence, if not define, the behavior o f men and women and the interpersonal
relationships in which sexual behavior occurs. For women, this often means that sexual
behavior occurs in the context o f unequal power and in a context that socializes women
to be passive sexually and in other ways” (Amaro, 1995, p. 64). While this situation
may not reflect all male-female dynamics, it does reflect some. Thus, the situation we
have is that although women may have more knowledge about HIV/AIDS prevention,
they may not have the ability to carry out healthy behaviors due to power differences.
These findings are important with reference to documented high-risk behaviors in
the Hispanic community. One finding in this study was that males were more likely to
have more than one partner than females. Further, respondents who stated they had
more than one sexual partner were consistently less knowledgeable than those who
reported not having more than one sexual partner. This finding suggests that those at
greater risk for infection are not as knowledgeable about AIDS than are those at lower
risk (for this particular risk factor). However, it would be difficult to conclude that
higher knowledge alone leads to lower risk behavior because o f the many cultural
factors involved with this high-risk behavior.
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Another behavior that is tied into the high-risk category is male specific high-risk
behavior. For the purposes o f this study, male high-risk behavior is defined as having
sexual relations with a prostitute, drug addict, or another male. This study found that
male respondents who did not report high-risk behavior had higher scores on two
knowledge questions. Generally, this lower risk group also had more knowledge on
other knowledge questions.
The need to ensure that Hispanic males are knowledgeable about HTV and AIDS
and how to prevent transmission is an important goal in preventing o f the spread o f HIV
and AIDS. This research study brings forth the need for more research to understand
and confirm if knowledge differences do exist between men and women, and to under
stand why these differences exist so that prevention programs can be implemented to
address needs.
Language
This study found that bilingual respondents were more knowledgeable than
monolingual respondents on three o f the nine knowledge. Bilingual respondents were
more knowledgeable about condoms (i.e., which condom is better for preventing AIDS
[latex or membrane], the effectiveness o f condoms in preventing AIDS), and transmis
sion (i.e., risk o f transmission from sex with multiple partners and risk o f transmission
from sex with an injecting drug user).
There may be a number o f reasons for these findings. The first may be simply an
inadequacy o f prevention programs that address the Hispanic population. Several
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researchers have suggested that prevention programs have not adequately addressed the
specific needs o f Hispanics. Early HIV/AIDS prevention programs prior to 1987 did
not address Hispanics specifically, and very few were available outside o f the high
incidence areas (O’Reilly & Higgins 1991). According to Weeks et al. (1995),
Prevention programs have been predominantly male oriented and
have neglected issues o f racial, cultural, class, and gender differ
ences. Hispanics, in general, were late to address sensitive risk
factors in their community. Only recently, have efforts begun to
comprehensively address the critical gaps in prevention programs
for women o f color who are at risk. (p. 252)
Additionally, AIDS messages need to be not only in Spanish, but also presented
in a manner understood by the audience with culture and language appropriate transla
tions. “To be successful with Hispanics, an information campaign needs to consider the
culturally appropriate way o f presenting information about behaviors that are considered
to be private (sexual), or which are disapproved of (IV drug use), avoiding the simple
translation o f messages already being used with non-Hispanic groups” (Marin, 1989, p.
414). We may look to Holtgrave et al. (1995) who included the following characteris
tics o f a successful program:
1. “HTV prevention programs must address the real and expressed HTV preven
tion needs o f the community being served.”
2. Regarding cultural competency within programs, the authors wrote, “Mes
sages, at the very least must be (a) sensitive to the particular culture o f the audience..
.” (b) appropriate to the developmental status o f the audience . . . and, (c) linguistically
specific, which goes beyond using the same language as the audience.”
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3. Programs must have “clearly defined audiences, objectives and interventions.”
4. Programs have a “basis in behavioral and social science theory and research”
5. Programs must have a process for monitoring quality and adhering to the
program plan.
6. Programs must use evaluation findings for “mid-course corrections.”
7. Programs must also have sufficient resources to achieve “their goals and
objectives.”
The monolingual population may also face other, very specific, barriers to AIDS
prevention efforts. This population is more likely to be undocumented, may fear using
the health-care system because o f immigration issues and are less likely to seek AIDS
information from public sources. The undocumented Hispanics represent a relatively
large segment of the uninsured population in the U.S. These individuals are less likely
to receive preventive services and are more likely to delay seeking health care services
or emergency care.
These findings strongly suggest that a large and growing segment o f the popula
tion is not receiving HIV and AIDS messages. This population may not have the
adequate knowledge to make and carry out healthy decisions about AIDS. Language
differences may be a significant factor contributing to the knowledge disparities between
ethnic groups. However, the literature regarding language as a factor affecting knowl
edge is very limited. Further research is needed to confirm what types o f knowledge
deficits exist in the Hispanic community with an emphasis on the monolingual Spanish
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speakers. Further research is needed to identify and address barriers to these messages
as well as identify appropriate interventions to meet knowledge needs.
Media Language
This study did not find any statistically significant differences between those who
watched television in Spanish, English, or in both languages. However, this study found
statistically significant knowledge differences between bilingual and Spanish radio
listeners regarding condom knowledge.
With respect to language in which newspapers are published, readers o f English-
language newspapers were more knowledgeable than those who read both English and
Spanish language newspapers. This trend was observed for both statistically significant
and non-significant findings.
Generally, these findings suggest that the language used to communicate
information may have an influence on knowledge. It may be that because o f the
limitations of the sample (i.e., similar socioeconomic status among respondents), the
variation within this group may not be enough to identify strong statistically significant
findings for media language variables.
Country o f Origin o f Media
With reference to the significant findings, respondents who used media from the
U.S. were generally more knowledgeable than respondents who used media originating
in Mexico. These findings have certain implications. First, we find that there are some
differences between individuals who watch television on U.S. verses Mexican stations.
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One o f the reasons for these differences may be the intervention strategies used by each
country. While Mexico has implemented various HIV and AIDS prevention programs
(Bronfman et al., 1993), differences most likely exist in the media messages between the
two countries (i.e., type o f message or intensity o f the programs).
In general, individuals using media from the U .S. appear to be more knowledge
able about the effectiveness o f condoms. This finding is important because condoms are
one o f the most effective methods for preventing HTV and AIDS. If this message is not
reaching all at-risk populations, there is cause for concern. The reason for these differ
ences may be as simple as less public education on Mexican media stations compared to
U.S. stations. On the other hand, there may be a more complex rationale. More
research is required to understand reasons for these differences and implement programs
that address knowledge needs.
In spite o f differences between some o f the knowledge questions, it is also
important to note that differences did not exist for many others. Therefore, it appears
that the differences between respondents who use Mexican and U.S. media are very
specific to the knowledge question being tested. In other words, knowledge differences
exist, but only on specific types o f HTV and AIDS knowledge.
The overall findings thus far suggest that it is time to refine the messages that are
sent as well as the populations to whom they are sent. For example, it is important to
identify new HIV and AIDS messages appropriate to Hispanic knowledge deficits.
Future research and education efforts should be considered that are directed specifically
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at condom knowledge deficits to ensure that the appropriate messages get to those at
risk for HIV and AIDS.
Years of Education and Earnings
These two variables will be discussed together as they are often used as measures
for socioeconomic factors. Years o f education had an impact on two o f the nine knowl
edge questions. A pattern was observed which showed that the highest educated group
(over 12 years o f education) generally scored higher than the lower educated group
(less than 12 years o f education).
The literature suggests that years of education is a primary determinant of
knowledge about AIDS. This research study supports the literature in two o f the nine
dependent variables. However, there are at least two considerations that may make this
research study different from those in the literature. First, the number o f “higher”
educated respondents was very low in this study. A college-graduated category was not
possible because o f the range restrictions in the sample. Therefore, the comparison
made in this study was o f those with less than a 12l h -grade education to those with more
than 12 years o f education. A second factor to be considered is the definition of
knowledge as a dependent variable. The term “knowledge” about AIDS is defined
differently in different studies. It may be that this study measured a different variation
o f knowledge that may give rise to different results.
Income had an impact on one knowledge question (how important is it to know
a partner’s sexual past). The non-significant findings, however, did not reflect a trend
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o f more knowledge for the highest income group. However, the analyses conducted for
the income variable have similar problems found in the education variable— the low
number o f respondents in the high-income group restricted the range o f income. The
original data included four categories o f income. However, the number o f respondents
falling into the two highest categories were too small for analyses and the three highest
categories had to be collapsed into one group.
The results o f the analyses for education and earnings suggest that both factors
have a limited effect on knowledge. The tests generally suggest, in both the significant
and non-significant findings, that earnings and education do play a role in knowledge.
The tests for education also partially confirm other research studies showing higher
educated individuals having more knowledge than those with less education.
Age
Results suggest that age is a factor associated with very specific HIV/AIDS
knowledge. For example, this study found that the younger age group was more
knowledgeable about oil-based lubricants causing condoms to break, but found that the
oldest age group was more knowledgeable regarding the risk o f HIV/AIDS for women
having sex with bisexual men. More research is needed to understand how age factors
affect knowledge.
Marital Status
Married respondents were found to be more knowledgeable than unmarried
respondents on two knowledge questions. This finding is contrary to the hypothesis. It
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was expected that single respondents are at greater risk for HTV and AIDS and would
be more receptive to prevention messages. This finding, as well as the finding for age
groups is indicative that we may need to look at the need for interventions directed at
higher risk groups. More research is indicated to explore these differences and identify
appropriate interventions.
Risk o f Transmission for a Female Having
Sex with a Gay or Bisexual Male
A last pattern observed in the significant findings relates to knowledge about the
risk o f transmission for a female having sex with a gay or bisexual male. Overall knowl
edge was fairly high on this question. However, the findings suggest that specific sub
groups have less knowledge than others do. For example, respondents with less years
o f education, males, and those with more than one partner, were found to have less
knowledge about this specific risk factor. This finding suggests that although knowl
edge is fairly high about this mode o f transmission, there is room for improvement. The
growing trend in heterosexual transmission makes education about this risk factor a
priority. More research is needed to identify if knowledge regarding this mode of
transmission is truly low and, if so, how to provide the necessary interventions to
increase knowledge.
Limitations
This research study had several limitations. One o f the limitations was the re
stricted age group for the sample. Eighteen years o f age is the youngest respondent in
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the sample. Unfortunately, this restriction leaves out a young population that may be at
risk for HIV and AIDS.
Further, the type o f survey conducted— telephone, may elicit different responses
than face to face interviews. The pretest o f the instrument indicated that some males
were hesitant to respond to questions regarding homosexual experiences. These males
were offered the opportunity to come to the clinic for interviews. There are at least a
couple limitations here. First, is that if respondents were hesitant to respond to anony
mous questions over the telephone, they would probably be less likely to make a clinic
visit to report the same. Second, the original questions were changed to categorize all
high-risk behaviors in one, thus making it difficult to know which high risk behaviors are
most prevalent in this study population.
The process used for selecting the sample also poses limitations. First o f all, the
study design eliminated certain individuals (i.e., those with unlisted telephone numbers
and those without a telephone) by virtue o f being a telephone survey. A comparison o f
demographics from Santa Cruz County, which contains Nogales, Arizona, from the
1990 U.S. Census was used to compare the two populations which revealed a few
differences (see Table 21 in the Appendix. Overall, the sample population used in this
study was more likely to have been bom outside the U.S., had a larger female popula
tion, and had lower earnings. Based on these findings, the populations are somewhat
different. However, it is difficult to determine the accuracy o f the comparison because
the same populations are not truly being compared. Further, an area o f contention
regarding the U.S. Census data used in this comparison relates to the accurate counting
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o f undocumented individuals. These factors reveal uncertainty about the how well the
sample represents the population o f Nogales, Arizona.
A last limitation o f this study is that the sample may represent a low socioeco
nomic group. Years o f education as well as earnings (two variables often used to
measure socioeconomic status) were low for both variables. The highest categories in
each variable were collapsed because o f the small numbers. Therefore, a true “highly
educated group” and a true “high earnings group” were not possible for the analyses.
Further, this study did not take into account family size, which also affects income as
family size grows.
Public health. Research, and Policy Implications
HIV and AIDS are serious and growing problems among the Latino population.
Having knowledge about HIV and AIDS is one factor that helps prevent the spread o f
HTV. The findings o f this research study have several public health, research, and policy
implications related to increasing knowledge about HTV and AIDS within the Latino
population.
Public Health Implications
The first public health implication has to do with defining subgroups within the
Hispanic population which have knowledge deficits regarding HTV and AIDS. This
study identified three such subgroups within the study population (monolingual Spanish
speakers, Latino males, and individuals who have more than one sexual partner). More
than likely, there are other unidentified subgroups with knowledge deficits. It is critical
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that public health programs identify low knowledge populations and address these
knowledge needs within a public health context. Up until recently, programs have
targeted high-risk individuals (homosexual males and intravenous drug users).
Identification o f low knowledge groups is especially crucial today when changing modes
o f transmission have created new populations at risk for HIV and AIDS.
The second public health-implication relates to the types o f messages being
presented. This research study found a clear difference between the study population’s
knowledge about transmission o f HIV/AIDS and their knowledge about condoms. In
other words, the study population was aware o f how HTV is transmitted, but not about
the effectiveness o f condoms— the most practical and effective method to prevent the
spread o f HIV for sexually active individuals.
Based on the results o f this study, one can only speculate on the lack o f informa
tion Hispanics have about other practical condom knowledge (i.e., where to obtain
affordable condoms and how to use condoms). For prevention interventions to be
effective, individuals must have fairly accurate information. Prevention efforts also need
to include specific issues that will enhance efficacy o f prevention interventions (i.e.,
dealing with a dominant non-monogamous partner who refuses to use condoms).
Therefore, it is imperative to obtain a clear understanding o f the types o f messages that
Latinos need to receive that will most likely lead to behavior changes and risk reduction.
Based on the findings o f this research study, the general message needs to shift from
transmission of HTV to other “practical” information on preventing this life threatening
disease.
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Next, public health messages need to be delivered in a culturally and language
relevant manner. This study identified monolingual Spanish speakers as a sub-group
having less knowledge than bilingual speakers. It also touched on several of the cultural
characteristics that affect knowledge and/or may contribute to high-risk behavior.
Prominent researchers have called for cultural and linguistic competency in HIV and
AIDS prevention programs. Substantial research has identified cultural and linguistic
competence as core components o f HIV and AIDS prevention programs. Future
programs must incorporate cultural and linguistic appropriate interventions, factors
documented to be an important element in prevention programs.
The vehicles for public health messages have implications for the success of the
programs as well. This study, like other studies, found that television and radio are
common sources o f HTV and AIDS information. Mass media campaigns in the 1980s
were fairly successful in making individuals aware of the AIDS epidemic. It is critical at
this time to implement mass media campaigns for Latinos with the same intensity that
was applied to the earlier prevention programs that targeted the bisexual, homosexual,
and intravenous drug user population. These campaigns must include the elements
described previously (i.e., specific target groups, specific messages, and culturally and
linguistically appropriate delivery).
However, we cannot ignore other extremely relevant vehicles o f information
within the Latino community. Word of mouth, education through family and friends,
and personal communications are extremely effective modes of education in the Latino
communities. Further, education through medical providers is viewed as a highly
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credible source o f information, although few Latinos actually receive information from
medical providers. Another vehicle for AIDS information supported by respondents is
the school system. This study found that most respondents were supportive o f children
receiving HIV and AIDS information from schools. There is no one sure vehicle for
delivering public health messages. Programs must be comprehensive in identifying
specific elements about intervention and prevention and must incorporate a variety of
vehicles to deliver messages.
Research Implications
Current research needs and questions in the area o f HTV and AIDS knowledge
includes:
1. Knowledge deficits among the Latino populations:
a. What are the Latino sub-populations at greatest risk for knowledge
deficits?
b. Do individuals who under the “non-response” category have difference
knowledge needs than other groups?
2. Public health messages:
a. What specific knowledge information do Latinos, in general need? For
example, this study found that knowledge about the effectiveness of condoms is
low among the study population. Is this also a knowledge deficit among Latinos
in general?
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b. What specific public health messages need to be sent out to address
knowledge deficits?
3. Interventions:
a. What other specific public health interventions work best to address
knowledge deficits within the general population as well as specific sub-popula
tions?
4. Cultural and linguistic issues:
a. Are current public health programs adequately addressing cultural and
linguistic needs?
b. How can we best incorporate cultural and linguistic competency in public
health programs?
3. What interventions can we implement to address gender power differ
ences?
5. Vehicles for delivering messages:
a. How can we best use television and radio in public health programs to
increase knowledge?
b. How can we best involve family and friends in public health programs to
increase knowledge?
c. How can we best involve health-care providers in public health programs
to increase knowledge?
d. How can parents and schools collaborate in public health programs to
increase knowledge among children?
107
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While we cannot afford to wait until we have adequate data to implement new
public health programs, we must concurrently carry out research and evaluation efforts
to support ongoing programs and plan future ones.
Policy Implications
It is clear that we need increased data and public health programs to curb the
HTV and AIDS epidemic in the Latino communities. However, this need cannot be met
without the policy to provide the adequate resources to do so. It is imperative that
appropriate funding be allocated to support research, planning, and public health
education with the appropriate intensity needed. Policy is also necessary to shape how
research and public health programs take place. For example, cultural and linguistic
policy requirements currently being developed for other health programs also need to be
applied to HIV and AIDS programs. Lastly, policy development needs to be a dynamic
process. As we learn more about HIV and AIDS through research and practical
experience, policy changes need to evolve to meet new challenges.
1 0 8
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BIBLIOGRAPHY
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BIBLIOGRAPHY
Albrecht, G. L., Levy, J. A., Sugrue, N. M., Prohasta, T. R _, & Ostrow, D. G.
(1989). Who hasn’t heard about AIDS? AIDS Education and Prevention. 1. 261-267.
Amaro, H. (1995). Gender and sexual risk reduction: Issues to consider.
Prepared by R. A. Brooks, B. Solis, & D. E. Hayes (Eds.), Defining the Path for Future
Research Proceedings o f the National Latino HIV/AIDS Research Conference (pp. 61-
76). Los Angeles: UCLA School o f Medicine.
Angel, R., & Cleary, P. D. (1984). The effects of social structure and culture on
reported health. Social Science Quarterly. 65. 814-828.
Arufifo, J. F., Coverdale, J. H.,& Vallbona, C. (1991). AIDS knowledge in low-
income and minority populations. Public Health Reports. 106. 115-119.
Bailey, M. E. (1991). Community-based organizations and CDC as partners in
HTV education and prevention. Public Health Reports. 106. 703-707.
Becker, M. H. (1974). The health belief model and personal health behavior.
Health Education Monographs. 2. 324-508.
Bracha, A. (May, 1998). Presentation at the Latino Coalition Health Care
Conference. Los Angeles.
Bronfman, M., Gonzalez, M., Palma, R., Rico, D., & del Rio, C. (1993). The
increasing risk of HTV infection in Mexican migrants going to the U.S.: A TV soap-
opera based on research data. International Conference on AIDS. 9(11.
Brooks, R. A. (1995). Conference process note: Confronting internalized
homophobia. Prepared by R. A. Brooks, B. Solis, & D. E. Hayes-Bautista (Eds.),
Defining the Path for Future Research Proceedings o f the National Latino HTV/AIDS
Research Conference (p. 3). Los Angeles: UCLA School of Medicine.
Caudle, P. W. (1992). How Latinas come to know about A TPS and AIDS
prevention. Unpublished doctoral dissertation, University o f San Diego.
110
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Centers for Disease Control and Prevention (CDC). (1986). Current trends
update: Acquired immunodeficiency syndrom-United States. Morbidity and Mortality
Weekly Report. 35. 17-21.
Centers for Disease Control and Prevention (CDC). (1992). 1993 revised
classification system for HIV infection and expanded surveillance case definition for
AIDS among adolescents and adults. Morbidity and Mortality Weekly Report. 41 (no.
RR-17).
Centers for Disease Control and Prevention (CDC). (November, 1993). Facts
about HIV/AIDS and race/ethnicity [On-line]. Available: www.cdc.gov
Centers for Disease Control and Prevention (CDC). (1994). AIDS among
racial/ethnic minorities— United States, 1993. Morbidity and Mortality Weekly Report.
43. 643-655.
Centers for Disease Control and Prevention (CDC). (1997a). Update: trends in
AIDS incidence, deaths, and prevalence— United States, 1996. Morbidity and Mortality
Weekly Report. 46. 165-173.
Centers for Disease Control and Prevention (CDC). (1997b). Update: trends in
AIDS incidence— United States, 1996. Morbidity and Mortality Weekly Report. 46.
861-867.
Centers for Disease Control and Prevention (CDC). (1998a). Diagnosis and
reporting of HIV and AIDS in states with integrated HIV and AIDS surveillance— U. S.
January, 1994-June, 1997. Morbidity and Mortality Weekly Report. 47. 309-314.
Centers for Disease Control and Prevention (CDC). (1998b). HIV/AIDS
surveillance report. Atlanta: Division o f HTV/AIDS Prevention-Surveillance and
Epidemiology, National Center for HTV, STD, and TB Prevention.
Centers for Disease Control and Prevention (CDC). (March, 1999a).
HTV/AIDS surveillance report (Midyear edition). Atlanta: Division of HTV/AIDS
Prevention-Surveillance and Epidemiology, National Center for HTV, STD, and TB
Prevention.
Centers for Disease Control and Prevention (CDC). (March, 1999b). Trends in
the HTV and ATDS epidemic— 1998 rOn-linel. Available:
www.CDC.gov/nchstp/od/Trends.htm
Centers for Disease Control and Prevention (CDC). (October, 1999c). Budget.
United States [On-line]. Available: www.cdc.gov
111
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Choi, K, & Coates, T. (1994). Prevention o f HIV infection. ATDS. 8. 1371-
1389.
Choi, K., Catania, J. A., & Dolcini, M. (1994). Extramarital sex and HTV risk
behavior among US adults: Results from the National AIDS Behavioral Survey.
American Journal of Public Health. 84. 2003-2007.
Dan, B. B. (1987). The national AIDS information campaign. JAMA 258.
1942.
DiClemente, R. J., & Peterson, J. L. (Eds.). (1994). Preventinp ATDS- Theories
and methods o f behavioral interventions. New York: Plenum Press.
DiClemente, R. J., Zoran, J., & Temoshok, L. (1986). Adolescents and AIDS:
A survey of knowledge, attitudes and beliefs about AIDS in San Francisco. American
Journal of Public Health. 76. 1443-1445.
DiClemente, R _ J., Boyer, C. B., & Morales, E. S. (1988). Minorities and
AIDS: Knowledge, attitudes, and misconceptions among Black and Latino adolescents.
American Journal of Public Health. 78. 55-57.
Dominguez, K. L. (1995). Comparing apples and oranges? Research issues in
the surveillance of HIV/AIDS in Latinos residing in the U.S. Prepared by R. A Brooks,
B. Solis, & D. E. Hayes-Bautista (Eds.L Defining the path for future research proceed
ings of the National Latino HTV/AIDS Research Conference (pp. 15-16). Los Angeles:
UCLA School of Medicine.
Erickson, P. (1991). Hewlett Foundation Annual Report. Los Angeles: Univer
sity of Southern California + Los Angeles County Medical Center, Teen Pregnancy
Prevention Program.
Estrada, A L. (1995). Deriving culturally competent HTV prevention models
for Mexican American injection drug users. Prepared by R. A. Brooks, B. Solis, :&: D.
E. Hayes-Bautista (Eds.), Defining the path for foture research proceedings of the
National Latino HIV/AIDS Research Conference (pp.93-108). Los Angeles: UCLA
School of Medicine.
Fishbein, M., & Guinan, M. (1996). Behavioral science and public health: A
necessary partnership for HTV prevention. Public Health Reports. 3 (Supplement), 5-9.
Flaskerud, J. H., & Nyamathi, A M. (1989). Black and Latina womens’ [sic]
AIDS related knowledge, attitudes, and practices. Research in Nursing & Health. 12.
339-346.
112
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Flaskerud, J. H., & Nyamathi, A. M. (1990). Effects of an AIDS education
program on the knowledge, attitudes, and practices. Journal of Community Health. 15.
343-355.
Flaskerud, J. H., Uman, G., & Lara, R. (1996). Sexual practices, attitudes and
knowledge related to HIV transmission in low income Los Angeles Hispanic women.
The Journal of Sex Research. 33. 1126-1130.
Flay, B. R. (1987). Mass media and smoking cessation: A critical review.
American Journal o f Public Health. 77. 153-160.
Friedman, S., Sotheran, J., Abdul-Quader, A., Primm, B., DesJarlais, D.,
Kleinman, P., Mauge, C., Goldsmith, D., El-Sadr, W., & Maslansky, R. (1987). The
AIDS epidemic among Blacks and Hispanics. The Milbank Quarterly. 65. 455-499.
Gentry, E. M., & Jorgensen, C. M. (1991). Monitoring the exposure o f
America “Responds to AIDS.” Public Health Reports. 106. 651-655.
Gollub, E. L. (1995). Women-centered prevention techniques and technologies.
In A. O’Leary & L. S. Jemmott (Eds.), Women at risk: Issues in the primary prevention
o f ATDS (pp. 43-82). New York: Plenum Press.
Guamaccia, P. J., Angel, R., Worobey, J. L. (1989). The factor structure o f the
CES-D in the Hispanic health and nutrition examination survey: The influences of
ethnicity, gender, and language. Social Science Medicine. 29. 85-94.
Guenther-Grey, C., Norvian, D., Fonseka, J., & Higgins, D. (1996). Develop
ing community networks to deliver HTV prevention interventions: The AIDS commun
ity demonstration projects. Public Health Reports. 11 l fSuppl. 1), 41-49.
Hardy, A , Thomberry, O. T., & Dawson, D. (June 20-23, 1990). AIDS knowl
edge among Hispanic American subgroups. International Conference on AIDS. 6(31.
249 (Abstract No. S.C. 640).
Hayes-Bautista, D. E., Schink, W. O., & Chapa J. (1998). The burden o f
support: Young Latinos in an aging society. Stanford: Stanford University Press.
Higgins, D. L., O’Reilly, K., Tashima, N., Crain, C., Beeker, C., Goldbaum, G.,
Elifson, C. S., Galavotti, C., & Guenther-Grey, C. (1996). Using formative research to
lay the foundation for community level HTV prevention efforts: An example from the
AIDS community demonstration projects. Public Health Reports. 3 (Suppl.), 28-35.
113
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Hingson, R., Strunin, L., Craven, D., Mofenson, L., Mangione, T., Berlin, B.,
Amaro, H., & Lamb, G. (1989). Survey of AIDS knowledge and behavior changes
among Massachusetts adults. Preventive Medicine. 18. 806-816.
Holman, P. B., Jenkins, W. C., Gayle, J. A., Duncan, C., & Lindsey, B. K.
(1991). Increasing the involvement o f national and regional racial and ethnic minority
organizations in HIV information and education. Public Health Reports. 106. 687-694.
Holtgrave, D. R., Qualls, N. L., Curran, J. W., Valdiserri, R. O., Guinan, M. E.,
& Parra, W. C. (1995). An overview of the effectiveness and efficiency of HTV
prevention programs. Public Health Reports. 110(21. 134-146.
House, J. S., Kessler, R. C., Herzog A., Regula, M., Richard P., Kinney, A. M.,
& Breslow, M. J. (1990). Age, socioeconomic status, and health. The Milbank
Quarterly. 68. 383 - 411.
Hu, D., Keller, R., & Fleming, D. (1989). Communicating AIDS information to
Hispanics: The importance o f language and media preference. American Journal o f
Preventive Medicine. 5. 196-199.
Institute of Medicine National Academy o f Sciences. (1986). Confronting
AIDS: Directions for public health care, health care and research. Washington, D.C:
Author.
Karon, J. M., Rosenberg, P. S., McQuillan, G., Khare, M., Gwinn, M., &
Petersen, L. R. (1996). Prevalence of HTV infection in the United States, 1984-1992,
JAMA. 276. 126-131.
Keeter, S., & Bradford, J. B. (1988). Knowledge of AIDS and related behavior
change among unmarried adults in a low-prevalence city. American Journal o f Preven
tive Medicine. 3. 146-152.
Keiser, N. H. (1991). Strategies of media maarketing for “America responds to
AIDS” and applying lessons learned. Public Health Reports. 106. 623-628.
Kennamer, J. D., & Bradford, J. B. (1996). Whites, African-Americans, and
Hispanics in Virginia: A comparison of beliefs about HTV transmission, prevention, and
responsibility. International Conference on AIDS 11 (Abstract No Mo.D. 1907).
Kroger, F. (1991). Preventing HIV infection: Educating the general public.
Journal o f Primary Prevention. 12(11. 7-16.
114
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Latino Futures Research Group (1993). Latinos and the future o f Los Angeles:
A guide to the twenty-first century. Unpublished report, Los Angeles.
Leviton, L C., O’Reilly, K. (1996). Adaptation o f behavioral theory to CDCs
HTV prevention research: Experience at the Centers for Disease Control and Preven
tion. Public Health Reports. 5(Suppl. 1), 11-17.
Marin, G. (1989). AIDS prevention among Hispanics: Needs, risk behaviors,
and cultural values. Public Health Reports. 104. 411-415.
Marin, G., & Marin, B. V. (1990). Perceived credibility of channels and sources
of AIDS information among Hispanics. AIDS Education and Prevention. 292. 154-161.
McCaig, L., F., Hardy, A. M., & Winn, D. M. (1991). Knowledge about AIDS
and HIV in the U.S. adult population: Influence of the local o f AIDS. American
Journal of Public Health. 81. 1591-1595.
National Latino Research Center. (1999). NLRC demographics [On-line].
Available: www.csusm.edu/hlrc/xusa.html
Noble, G. R., Parra, W. C., & Holman, P. B. (1991). Organizational structure
and resources o f CDC’s HTV-AIDS prevention program. Public Health Reports 106.
604-608.
Nyamathi, A., Bennett, C, Leake, B., Lewis, C., & Flaskerud, J. (1993). AIDS-
related knowledge, perceptions, and behaviors among impoverished minority women.
American Journal of Public Health. 83. 65-71.
Nyamathi, A. M., Flaskerud, J., Bennett, C., & Lewis, C. (1994). Evaluation of
two AIDS education programs for impoverished Latina women. AIDS Education and
Prevention. 6. 296-309.
O’Reilly, K. R., & Higgins, D. L. (1991). AIDS community demonstration
projects for HTV prevention among hard-to-reach groups. Public Health Reports. 106.
714-720.
Padilla E. R., & O’Grady, K. E. (1987). Sexuality among Mexican Americans:
A case o f sexual stereotyping. Journal of Perspective of Social Psychology. 52. 5-10.
Ramos, D. (1995). A second wage. The New Republic. 212. 29.
Roper, W. L. (1991). A comprehensive HIV prevention program. Public
Health Reports. 106. 601-603.
115
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Rosenstock, I. M. (1974). The health belief model and prevention behavior.
Health Education Monographs. 2. 354-386.
Selik, R. M., Castro, K. G., & Pappaioanou, M. (1988). Racial/ethnic differ
ences in the risk o f AIDS in the United States. American Journal o f Public Health. 78.
1539-1545.
Stryker, J., Coates, T. J., DeCarlo, P., Haynes-Sanstad, K., Shriver, M.,
Makadon, H. J. (1995). Prevention of HIV infection: Looking back, looking ahead.
JAMA. 273. 1143-1148.
Sullivan, P. S., Chu, S. Y„ Fleming, P. L. & Ward, J. W. (1997). Changes in
AIDS incidence for men who have sex with men, United States 1990-1995. ATDS. 11.
1641-1646.
UCLA Center for the Study of Latino Health. (1995). An assessment o f Latino-
focused AIDS/HTV education and prevention efforts in Nogales. Arizona. Unpublished
preliminary report.
United States Bureau o f the Census. (March, 1996). Resident population of the
United States: Middle series projections. 2015-2030. by sex, race, and Hispanic origin,
with median age [On-line]. Available:
www.census.gov/population/projections/nation/nsrh/nprhl530.txt
United States Bureau o f the Census. (September, 1997). March current popula
tion summary [On-line]. Available: www.census.gov
United States Bureau o f the Census. (1998a). Health insurance coverage: 1997
[On-line]. Available: www.census.gov/ftp.pub/hhes/hlthins/hlthin97/hi97t2.html
United States Bureau o f the Census. (1998b). Resident population o f the
United States: Estimates bv sex, race, and Hispanic origin with median age [On-line].
Available: www.census.gov/population/estimates/nation/intfile3-l .txt
United States Bureau o f the Census. (April, 1999). US Immigration and
Naturalization Service, illegal alien resident population TOn-linel. Available:
www.ins.usdoj.gov/stats/illegalallien/index.html
United States Bureau o f the Census. (April, 2000). 1990 U.S. census data [On
line]. Available: www.census.gov
116
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Valdiserri, R. O., West, G. R., Moore, M., Darrow, W. W., & Hinman, A. R.
(1992). Structuring HIV prevention service delivery systems on the basis of social
theory. Journal of Community Health. 17. 259-268.
VanOss, B., Gomez, C. A., & Tschann, J. M. (1993). Condom use among
Hispanic men with secondary female sexual partners. Public Health Reports. 108. 742-
750.
Warner, K. (1987). Television and health education: Stayed tuned. American
Journal of Public Health. 77. 140-142.
Weeks, M. R., Schensul, J. J., Williams, S. S., Singer, M., & Grier, M. (1995).
AIDS prevention for African-American and Latina women: Building culturally and
gender-appropriate intervention. AIDS Education and Prevention.. 7. 251-263.
Winer, B. J. (1962). Statistical principals in experimental design. New York:
McGraw-Hill.
Woods, D. R., Davis, D., & Westover, B. J.. (1991). “America responds to
AIDS”: Its content, development process, and outcome. Public Health Reports. 106.
616-623.
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APPENDIXES
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APPENDIX A
QUESTIONNAIRE-LATINO-FOCUSED HIV/AIDS EDUCATION
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QUESTIONNAIRE
Assessment o f Latino-Focused HIV/AIDS Education Efforts
1 * Language Spoken?
□ English (1) □ Spanish (2) Q Both (3)
2. Which language would you prefer this interview to
be given?
□ English (1) □ Spanish (2)
The first set of questions asks information about you and your background.
These are needed fo r statistical purposes only.
3. Do you Uvein. the d ty of Nogales, AZ? 3_____
□ NO (0} □ YES (1)
4. Are you living in the city of Nogales, Son. Mexico? 4_____
□ NO (0) □ YES (1)
5. Are you: 5_____
□ Female (0) □ M ale(l)
6. What is your age? _________ (#)_______________________$______
7. Have you had sexual relations within the past three
(3) months?
□ NO (0) □ YES (1)
8. In that time, have you had more than one (1) partner? 8 _
□ NO (0) Q YES (1)
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9. In that time, did you have any reason to believe that you
might have had relations with a drug addict a prostitute
or a man?
□ NO (0) Q YES (1)
10. Where were you bom?
Q US. (0) Q Mexico (1)
O Central America (2) □ Other (3)
11. What is your ethnic background?
O Hispanic (1) Q Native American (2)
□ Other__________(3)
12. What is your race?
□ White (1) □ Black (2)
O Native American (3) Q Other________ (4)
13. What is your religious preference?
□ Catholic (1) □ Protestant (2)
O No Preference (3) Q Other_________ (4)
14. How many years of school have you completed?
________Years (#)
15. Where did you receive most of your schooling?
Q US. (0) □ Mexico (1)
O Central America (2) O Other_________ (3)
16. Approximately how much did your family earn last
year? (DO NOT READ RANGES)
Q Less than $15,000 (1) ' O $15,000 - $29,999 (2)
□ $30,000 -$44,999(3) □ $45,000 and over (4) .
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17. What is your marital status?
□ Single (1) □ Married (2)
□ Divorced (3) Q Widowed (4)
□ Separated (5}
17a. If NOT married.. Are you In a steady relationship or
living w ith someone? ' 17a
□ No(0) □ Yes(l)
18. How much do you think you know about AIDS? 18
O A lo t(l) O Some (2) □ Very little (3)
The next questions ask about different sources of information
available in your community.
19. In your opinion, who should provide you with HTV/
AIDS information ?
a. Radio
NO (0)
□
YES (11
□ 19a.
b. Television Q Q
c. Newspapers □ Q
d. Churches □ □ 19b.
e. Schools □ □
f. Workplace □ a
g. Health Department
h. Clinics
□ □ 19c.
□ Q
i. Doctor □ Q
j. Family
k. Spouse
□ a 19d.
□ □
I. Friends □ Q
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20. On average how many hours per week do you listen to
the radio?______________(#> 20._________
20a. When you listen to the radio, is it usually in English, in
Spanish or about the same? 20a._____ —
□ English(l)
Q Spanish (2)
□ About die same (3)
20b. When you listen to the radio, do you usually listen to a
U.S. station, a Mexican station or about the same? 20b.________
□ U.S. Station (1)
□ Mexican Station (2)
□ About the same (3)
21. On the average, how many hours per week do you watch
television?_______________(#) 21_________
21a. When you watch television, is it usually in English, in
Spanish or about the same? 21a._______
□ English (1)
□ Spanish (2)
O About the same (3)
21b. When you watch television, is it usually a U.S. station, a
Mexican station, or about the same? 2 1 b .________
□ U.S. Station (1)
□ Miexican station (2)
□ About the same (3)
22. Throughout the year the various media provide educational and
informational articles and programs. In the past six (6) months,
how effective do you think the following sources have been in
providing you with HIV/AIDS information?
a. Radio (Spanish/U.S.) 22a._______
□ Very effective (1) □ Somewhat effective (2)
Q Somewhat ineffective (3) G Very ineffective (4)
□ Don't know (•)
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b. Radio (Spanish/Mex.)
□ Very effective (1)
□ Somewhat ineffective (3)
□ Don't know (•)
c- Radio (English)
Q Very effective (1)
□ Somewhat ineffective (3)
□ Don't know (•)
d. Television (Spanish/US.)
□ Very effective (1)
□ Somewhat ineffective (3)
□ Don't know (•)
e. Television (Spanish/Mex.)
□ Very effective (1)
□ Somewhat ineffective (3)
□ Don't know (*)
f. Television (English)
□ Very effective (1)
□ Somewhat ineffective (3)
□ Don't know (•)
g. Newspapers (Spanish/U.S.)
□ Very effective (1)
□ Somewhat ineffective (3) -
□ Don't know (•)
2 2 b . ____________
□ Somewhat effective (2)
□ Very ineffective (4)
22c------------
Q Somewhat effective (2)
□ Very ineffective (4)
22d.________
□ Somewhat effective (2)
□ Very ineffective (4)
22e.________
□ Somewhat effective (2)
□ Very ineffective (4)
22f.________
□ Somewhat effective (2)
□ Very ineffective (4)
22g.------------
□ Somewhat effective (2)
□ Very ineffective (4)
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h- Newspapers (Spanish/Mex.)
□ Very effective (1) Q
□ Somewhat ineffective (3) □
□ Don't know(*)
i- Newgpfrpjera (English)
□ Very effective (1) □
□ Somewhat ineffective (3) □
□ Don't know (•)
The next series of questions ask your opinion about AIDS education.
23. Do you have children under the age of 18 living 23________ _
at home?
□ NO(0) □ YES (1)
23a. Have you discussed HIV/AIDS with them? 23a________
□ NO (0) O YES (1)
23b. Have your children been given Information 23b_______
on HIV/AIDS in school?
O NO (0) ’ □ YES (1) O Don't know (•)
23c. Have your children been given information 23c_______
on HTV/AIDS in church.
□ NO (0) O YES (1) O Don't know (•)
24. In your opinion, have the churches in your community
influenced decisions regarding HIV/AIDS education? 24________
O NO (0) □ YES (1) □ Don't know (•)
25. In your opinion who would be the best choice, in your
community, to teach young people about HIV/AIDS ? 25________
O Parents (1) O Teacher (2) O Nurse (3)
Q Other young people (4) ' O Other_______ (5) _________
125
22h..
Somewhat effective (2)
Very ineffective (4)
22i._
Somewhat effective (2)
Very ineffective (4)
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26.
27.
28.
29.
30.
In your opinion w h e r e would be the beat place for
young people to learn about HTV/AIDS 7
□ Home (1) □ Church (2) □ School (3) □ Other (4)
Should schools teach about HIV/AIDS 7
Q NO (0) Q YES (1)
27a. If yes, at what grade level should this
instruction begin 7_____ ___________ (#))
27b. Should this be done only with parental
consent?
□ NO (0) □ YES (1)
How much HIV/AIDS information are young people
presently getting 7
O Not enough (0) O Enough (1) O Too much (2)
In your opinion, how easily accessible is HIV/AIDS
inhumation in your community ?
O Not accessible (0)
O Somewhat accessible (1)
Q Very accessible (2)
In the past six (6) months how many times have you
received HIV/AIDS information from the following?
26
27_
27a.
27b.
28.
29.
a. Television
b. Radio
c Newspapers
d. Churches
e. Schools
f. Workplace
g. Health Dept,
h- Clinic
i. Doctor
j. Family
k. Spouse
1 . Friends
-(#)
30a.
-(#)
30b.
-(#)
30c
-(#)
30d.
30e_
3G f_
-(#)
30g.
_(#)
30K
-(#)
30i_
_(#)
30j
-(#)
30k.
-(#)
301
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31. If you needed spedflc Information about HTWAIDS,
how likely w ould you be lo g o to each of the follow ing
for that information ?
a. Library
31a
□ likely (1) Q Somewhat likely (2) O Not likely (3)
b. Doctor
31b_
□ Likely (1) □ Somewhat likely (2) Q Not likely (3)
c. Pastor/Priest 31c_
□ likely (1) □ Somewhat likely (2) □ Not likely (3)
d. Friend 31cL
□ Like!y(l) □ Somewhat likely (2) Q Not likely (3)
e. Health Center 31 e_
Q likely (1) □ Somewhat likely (2) Q Not likely (3)
f. Other 31 f_
O Likely (1) O Somewhat likely (2) O Not likely (3)
Please tell me whether you believe the following statements to be true or false.
32. A person with HIV/AIDS can feel and look healthy.
□ False(O) □ True(l) □ Don't know (•) 32_______
33. The material with which condoms are made, latex or
natural membrane, may affect its effectiveness in
preventing transmission of HTVZAIDS.
□ False (0) □ True (1) Q Don't know (•)____________ 33_______
If TRUE then ask. _
33a. Can you tell me which, latex or natural
membrane is better?
□ . Latex condoms (1) □ Natural membrane condom (2) 33a_______
• k j . c t i r ) f
127
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
54. Oil-based lubricants, such, as Vaseline, can cause latex
condoms to break.
Q False (0) □ True (1) □ Don't know (•) 34_
35. There is a vaccine available to the public that protects
a person from getting HIV/AIDS. 35.
Q False (0) Q True (1) □ Don't know (•)
How likely is a person to become infected with HIV/AIDS from each of the
following?:
36. Sharing plates, forks or glasses with someone who has
HIV/AIDS.___________________________________________ 36____
□ Very likely (1) □ Somewhat likely (2)
a Somewhat unlikely (3) Q Unlikely (4)
□ Don't know (•)
37. Being cared for by a doctor, nurse, dentist or other health
worker who has HIV/AIDS. 37_
□ Very likely (1) □ Somewhat likely (2)
□ Somewhat unlikely (3) □ Unlikely (4)
□ Don't know (•)
38. Being coughed or sneezed on by someone who has
HIV/AIDS. 38___
□ Very likely (1) □ Somewhat likely (2)
□ Somewhat unlikely (3) □ Unlikely (4)
□ Don't know (•)
Sex and sharing needles have been demonstrated to be the m ost common
w ay of spreading HIV/AIDS. What is the risk of getting HTVfAIDS from
each of the following.
39. Having sex with many different partners. 39___
□ High risk (1) O Some risk (2)
□ No risk (3) □ Don't know (•)
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
40. Having sex where there is mouth to penis contact 40_______
O High risk (1) □ Some risk (2)
□ No risk (3) □ Don't know (•)
41. Having sex where the penis is inserted into the anus/rectum.
□ High risk (1) □ Some risk (2) - 41_______
Q No risk (3) □ Don't know (•)
42. Men having sex with other men.
□ High risk (1) Q Some risk (2) 42________
□ No risk (3) □ Don't know (•)
43. Women having sex with men that also have sex with in ext.
□ High risk (1) □ Some risk (2) 43________
Q No risk (3) Q Don't know (•)
44 Havi ng sex wi th an inj ecting drug user.
□ High risk (1) □ Some risk (2) 44________
□ No risk (3) □ Don't know (•)
45. In your opinion, how effective is the use of condoms to
prevent getting HIV/AIDs through sexual intercourse.
□ Very effective (1) □ Somewhat effective (2) 45._______
□ Not effective (3) □ Don't know (*)
46. Do you know or have you known someone with HIV/AIDS?
□ NO (0) □ YES (1) 46________
129
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46a. If yes, was this person a...
Q Spouse (I) □ Family member (2) 46a------------
□ Significant other (3) □ Friend (4)
□ Co-worker (5) □ Employee (6)
□ Employer (7) □ Other (8)-----------------------------------
47. At what risk do you think your are of becoming Infected
with HIV/AIDS.
□ High risk (1) □ Some risk (2) 47________
□ No risk (3) □ Don't know (♦)
48. If you. needed to be tested for HIV/AIDS/ how likely would you
be to go to each of the following for testing?
a. Your family doctor 48a________
□ Most likely (1) □ Somewhat likely (2) □ Not likely (3)
b. A doctor, in town, who does not know you. 48b________
□ Most likely (1) □ Somewhat likely (2) □ Not likely (3)
c. Community Health Center 48c________
□ Most likely (1) □ Somewhat likely (2) □ Not likely (3)
d. A doctor out of town 48d_______ _
□ Most likely (1) Q Somewhat likely (2) □ Not likely (3)
49. How confident are you that your HTV/AIDS test will remain
confidential?
□ Very confident (1) □ Somewhat confident (2) 49________
□ Not confident (3)
50. How important do you feel it is for you to know about your
partner's sexual past?
□ Very important (1) □ Somewhat important (2) 50________ _
□ Not important (3) □ Don't know (•)
130
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
APPENDIX B
TABLE 21: CHARACTERISTICS SANTA CRUZ POPULATION
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
T able 21
Characteristics Santa Cruz Population
f %
Birthplace
U.S. 17585 59
Outside the U.S. 12271 41
Language Spoken at Home
English Only 6163 23
Spanish 20392 76
O ther 243 1
Gender
Female 14131 48
M ale 15545 52
Annual Earnings
U nder $15K 3650 41
S15K to S29,999 1935 22
S30K to $44,999 1694 19
S45K and Over 1594 18
M arital Status — >15 yrs o f age
N ever Married 5684 28
M arried, except separated 12260 61
Separated 464 2
Widowed 1290 6
Divorced 548 3
Age
18-24 2814 16
25-44 6543 37
Over 44 8314 47
Year o f Education (persons over 18)
0 through 12
G reater than 12 13424 69
6048 31
Note. From United States Bureau of the Census, A pril, 2000, 1990 U.S. census data [On-line]. Available:
www.census.gov
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Asset Metadata
Creator
Rojas, Ana Corina
(author)
Core Title
HIV/AIDS knowledge among Hispanics living in Nogales, Arizona
School
Graduate School
Degree
Doctor of Philosophy
Degree Program
Public Administration
Publisher
University of Southern California
(original),
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(digital)
Tag
health sciences, public health,OAI-PMH Harvest
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Myrtle, Robert (
committee chair
), Lopez-Lee, David (
committee member
), Salcido, Ramon (
committee member
)
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