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Amy M. Hernandez, William A. Zule, Rhonda S. Karg, Felicia A. Browne, Wendee M. Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women.
Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner Wm looking for hispanic girl. Hispanics are the fastest growing minority group in the United States and in the state of North Carolina [ 1 — 3 ]. While Hispanic women are disproportionately affected by HIV and sexually transmitted infections in the USA, paradoxically they tend to report lower levels of HIV risk behaviours than African-American and non-Hispanic white women [ 56 ].
This raises questions regarding why these rates are higher. One possible factor might be related to Hispanic cultural norms surrounding gender roles. While there are positive aspects to machismo, other elements of it such as the belief in male dominance and an emphasis on male sexual prowess are used by some men to justify sexual encounters outside of their primary relationship [ 910 ].
Newly immigrated women may be the least acculturated and hold less power in a relationship [ 11 ]. Another factor may be that recently immigrated Hispanic males in North Carolina, who often leave their families behind when they come to the USA, have been reported to engage in sex with commercial sex workers at relatively high rates [ 1213 ]. Another study developed an intervention for male Hispanic immigrants in rural North Carolina using a community-based participatory research approach with a local soccer league whose teams were composed almost entirely of Hispanic immigrants [ 14 ].
The intervention employed a peer navigator approach and resulted in reductions in risk behaviour [ 15 ]. research suggests that interventions deed to reduce HIV risk among Hispanic immigrants must be sensitive to Hispanic cultural norms to be effective [ 71617 ]. However, a qualitative study that conducted 13 focus groups with researchers, service providers, and heterosexual male and female Hispanics in Puerto Rico, the Dominican Republic, and Mexico concluded that for interventions to be effective they would need to include both males and females [ 16 Wm looking for hispanic girl.
The same study identified important barriers that must be overcome to conduct successful couples-based interventions with Hispanics. Therefore, it is still unclear how to best reach Hispanics, and more formative research is required. A recent qualitative study examined the intervention needs regarding sexual health of immigrated Hispanic women in North Carolina [ 19 ]. This study concluded that a culturally appropriate intervention should be deed for just these women. The intervention should utilize skill building and include simple sexual health knowledge. The study also recommended the intervention incorporate condom negotiation skills that recognize gender roles and power.
This paper incorporates findings from a two-phase formative inquiry involving Hispanic female immigrants and community-based providers who serve Hispanic women in Durham, Wake, and Orange counties in North Carolina. While some interventions have been based on empowering women [ 2324 ] or specifically working with Hispanics [ 25 — 27 ] or Hispanic youth [ 2829 ], few if any have been developed for adult Hispanic females that include a personal plan to evaluate and address risky behaviors, including substance use, in a culturally appropriate manner.
It combines an individualized appraisal of several types of risky behavior, including partner risk with intervention sessions to improve communication skills. However, at the core of each adaptation is a process of working with targeted community members and their social supports to best determine the adaptation process. Family medical providers can now play an important role with rapid testing in addressing HIV prevention with Hispanics and have the potential to offer linkages to other care or offer STI treatment [ 3031 ]. Since Hispanics are more likely than other groups to delay the onset of medical treatment once diagnosed with HIV [ 3233 ], early testing, treatment, and prevention interventions for Hispanics must be provided by family physicians to reduce HIV transmissions, assist those with the virus, and improve health outcomes.
Though the field of family medicine has demonstrated HIV prevention and care programs can be incorporated into clinical practices [ 34 — 36 ], there is little knowledge regarding culturally competent clinical strategies geared towards Hispanics or Hispanic female immigrants [ 37 ]. The study was conducted in two phases by two investigators over several years and included focus groups with immigrated Hispanic women and community-based health care providers who served them.
The first phase of the adaptation process was conducted by one investigator in September and October and entailed six focus groups with 40 at-risk Hispanic women and providers who delivered health services to newly immigrated Hispanics in Durham and Chapel Hill, NC, USA. The second Wm looking for hispanic girl of the adaptation took place from January to March and involved another investigator who conducted three focus groups in June with 26 service providers who worked directly with Hispanic women and represented several community-based agencies.
Organisations in Durham, Wake, and Orange counties were first contacted to ensure the support of influential and established community organisations and to serve as venues for both phases of this study. A community-based agency in Durham County and another in Orange County hosted the phase-one focus groups.
For phase two, one organisation from each of the major counties agreed to host a focus group.
For phase one, participants were recruited through both street outreach and announcements at community organisations for Hispanics. Staff conducting the street outreach screened volunteers to determine if they were eligible to participate in the focus groups. Because the target population for an HIV prevention intervention would be Hispanic women who were at risk for HIV, eligibility criteria included having two or more dating or sexual experiences with men in the past 12 months. Therefore, other eligibility criteria included being a female Hispanic immigrant, being at least 18 years old, speaking Spanish as their primary language, and having had two or more dating or sexual experiences with men in the past 12 months.
Of the 63 women who were screened for the study, 51 were eligible and invited to participate in the focus groups. Reasons for ineligibility included: an unwillingness to answer questions on the screening questionnaire and being less than 18 years old. Of the 51 Hispanic women who were scheduled for the focus groups, 11 did not attend the groups for unknown reasons. Of the 28 who were eligible and agreed to participate, 26 attended the focus groups.
The focus group discussions for phase one and phase two were held at three local organisations in the evening and lasted approximately two hours. Most of the focus groups were held at nonprofit organisations for Hispanics in Durham, Wake, and Orange County, Wm looking for hispanic girl one was held at a county health department. Participants from both phases of the project were first asked to describe the Hispanic women in the area, the available services or programs offered to them, and the issues Hispanic women face.
Third, participants were asked their opinions about how best to conduct an HIV prevention intervention with local Hispanic women. In order to gain knowledge about their understanding of the Hispanic population they served, their perspectives as members of their respective organisations were sought.
All the questions asked were related directly to their work as staff members from community-based organisations who work with Hispanic females. Participants were instructed to talk about their experiences, in some cases as immigrant Hispanic women and as service providers, but not talk personally about their own behaviour or experiences outside of their service provider perspective.
The phase-one focus groups were led by two Hispanic women indigenous to the Hispanic community who were fluent in English and Spanish and had experience conducting community-based health research and interventions with Hispanic women. The phase-two focus groups were led by the investigator of the second phase, who is fluent in English and Spanish, with assistance and note taking from a research assistant, who is also fluent in both languages. While focus groups were primarily conducted in English, participants were encouraged to speak in the language they felt most comfortable.
As a result, some of these discussions were conducted in Spanish. To supplement note taking, all discussions were audio-taped. After the group discussions, the note taker transcribed the audio tapes verbatim. A of steps were taken to ensure quality of the data. After each focus group in phase one, the discussion leader, note taker, and investigator compared their notes to verify completeness and to correct any commissions or omissions.
These notes were then consolidated onto one set of transcripts for each focus group and were reviewed again for accuracy by the team. Next the team met to determine themes that emerged from the six focus groups. The focus group discussions were not audio recorded due to concerns that doing so could interfere with participation. Therefore, verbatim transcripts for this phase of the study were not used for the analyses. Focus group discussions from phase two were recorded, allowing the note taker and the investigator to compare the audio files to the transcriptions for completeness and accuracy.
A set of qualitative descriptive code definitions and coding procedures were drafted by two coders and refined through an iterative process. Code definitions were based on the focus group topics and major themes of the study. Coders then independently coded all data during the formal coding phase. Coders met to discuss ambiguous text and reconcile discrepancies before the coding was considered complete.
The first author conducted the data analyses for the findings reported in this publication which entailed the query and extraction of relevant passages that have been synthesized and summarized below. For phase one, the age range of the 40 Hispanic female focus Wm looking for hispanic girl participants was 18 to 41 years, with an average age of All of the women were first-generation immigrants, living in the United States for two to seven years average 5.
The female participants from phase one stated they migrated from MexicoHondurasand Guatemala. Nearly half of the sample had completed six to nine years of education, another third had at least some high school education, and one woman had earned an advanced degree. All had been primarily educated in their native country, but approximately one-third had also received some education in the United States.
Most of the women worked outside the home, mainly in unskilled labour positions. Although women were not asked whether they were documented or undocumented immigrants because they were fearful to share this information during the screening process, many made comments during the group discussions that suggested they were undocumented. For phase two, the 26 service provider focus group participants ranged in age from 25 to 61, with 22 women and 4 men.
Participants had been at their current positions from six months to 15 years. According to several service provider participants in both phases, the vast majority Wm looking for hispanic girl their Hispanic clients were from Mexico. The majority of participants stated almost all of their Hispanic clients were poor and had low incomes.
According to many service providers in phase two, most of their clients had very little formal education. Although some of their clients were able to read and write at a third-grade level, many of them were functionally illiterate. In all of the phase-two focus groups, the majority of respondents stated their Hispanic female clients were in relationships with Hispanic men.
The partners of the Hispanic female clients, according to most service providers, were most often Hispanic males. Community-based service providers who participated in phase-one and phase-two focus groups provided a range of services to their Hispanic clients who resided in Durham, Wake, or Orange County in North Carolina. The organisations that they worked for included Hispanic community centres that offered education, youth, and health promotion programs, county health departments, and local community health centres. Other organisations provided behavioural health and substance use counselling.
Participants also delivered mental health services for Hispanics experiencing trauma, violence, crime, domestic violence, and rape or sexual assault. According to service provider participants from phase one and phase two, their Hispanic clients hold misconceptions and believe in a variety of myths regarding STIs, such as contracting HIV by simply looking or touching a person with the virus and others listed below, see Table 1. Providers also reported that many of their Hispanic clients did not understand the difference between HIV and AIDS as reflected in the statement below from a service provider.
We think about AIDS. Oh he has AIDS.
She has AIDS. In half of the phase-one groups, few Hispanic women were knowledgeable about the proper application of a male condom. Participants in two-thirds of the focus groups were also unfamiliar with female condoms and their usage. Several providers and Hispanic females from both phases described how Hispanics were not familiar with the symptoms, the routes of transmission, or their personal risk factors for STIs and HIV.
When discussing the symptoms of HIV, a group respondent who provided HIV-related services articulated a common misunderstanding of the symptoms and fear among some Hispanic clients:. And so people come in because they have a rash and they think they have HIV… And so when people ask about symptoms we were told to say that they were very much like the symptoms of a cold or flu. During phase two, when a service provider Wm looking for hispanic girl Hispanic women how to handle the diagnosis of HIV, the women often explained false information about their own risks in relation to the ways in which HIV can be transmitted to their spouses.
What happens if you know you have HIV? My husband takes a shower every day. Hispanic women and service providers often described Hispanic women mostly in terms of traditional gender roles. The majority of service providers and Hispanic females stated their male partners were Hispanic men. In both phases of the study, they were depicted as often being dependent upon and subservient to their Hispanic male partners.
The primary roles of Hispanic men were often defined as being the decision makers and monetary contributors of their families. They [Hispanic men] can have their lady all day busy and at home. This is why we have the Latinas here with the big families in the United States. They disclosed that this was partially because their families could not intervene from a distance on their behalf. According to many participants in the Hispanic women and provider groups, Hispanic women tended to be submissive about sexual behaviour.
Because discussing sexuality was culturally prohibited or forbidden, Hispanic women were often reported to have experienced uneasiness and trepidation when discussing the topic, as this quote from a Hispanic female provider illustrates. Personally, you talking here about relationships, I think communication is key. To me, Latinas have come from a different background. We tend to be more, we were taught to be more submissive, more private, not to talk about this openly with our partners, about sexuality or that [safe sex]. So really, you have to incorporate some of our cultural taboos, fears, there is a lot of fear, to be able to talk about these things.
Using the word sexuality will bring a lot of taboo, especially, depending on the age range. How do I talk about sex? In two-thirds of the phase-one groups, the participants discussed how initiating a discussion related to sex would be considered culturally improper. According to several respondents, Hispanic women allowed their decisions about condom use to be made by their male sexual partners who were said to most likely be Hispanic themselves. Some participants in both provider and Hispanic female focus groups stated that Hispanic men disliked condoms and did not use them.
Some providers Wm looking for hispanic girl their organisations provided safe sex workshops for Hispanic women.Wm looking for hispanic girl
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