This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. PHASE I:
SPECIFIC AIMS 1. Translate and adapt existing instruments in order to develop and to validate a culturally appropriate measure on HIV-related felt stigma for Puerto Rican people at Risk and PLWHA. 2. Translate, adapt and validate a culturally appropriate instrument that addresses lifetime abuse and neglect for Puerto Rican people at Risk and PLWHA. PHASE II SPECIFC AIMS 1. To characterize HIV-related felt stigma in a cohort of Puerto Ricans living with HIV/AIDS (LWHA). 2. To characterize the lifetime abuse, HIV-related risk behaviors, and adherence to treatment in a cohort of Puerto Rican PLWHA. 3. To explore the relationship between HIV-related felt stigma, lifetime abuse, treatment adherence, and clinical outcomes. 4. To develop and evaluate the effect of an intervention model to reduce the impact of HIV-related felt stigma in a group of Puerto Ricans living with HIV/AIDS. 5. To assess the impact of the intervention model on risk behaviors, treatment adherence and clinical outcomes in a group of Puerto Ricans living with HIV/AIDS. II Significance of the Study This study fills a research gap regarding the impact of HIV related felt stigma and a history of abuse on HAART treatment adherence. Furthermore, it will explore the association between HIV related felt stigma and the experience of having been abused and how these may represent a risk factor to become infected with HIV. The development of culturally sensitive and valid instruments to assess HIV related felt stigma and experiences of abuse is a much needed scientific contribution. It will help to identify Puerto Ricans LWHA who perceive themselves as stigmatized because of their serostatus. This study will serve as groundwork for the development of intervention strategies to reduce and/or prevent the impact of HIV felt related stigma and abuse in the lives of PLWHA in Puerto Rico. Design: A cross sectional survey using the HIV felt stigma and experiences of Abuse self- administered questionnaires adapted for Puerto Rico. Recruitment of PLWHA: Sixty seven PLWHA have participated in PHASE II of the study. Recruitment was accomplished with the help of case managers from community based programs funded by the Ryan White Title 1 Ponce EMA. Research assistants Juan Carlos Ramos and Eida Castro were responsible to invite PLWHA from the Ryan White Agencies (Ponce and Juana D az) to participate in the study at their convenience. Potential participants were screened through the use of the Spanish version of the Brief Psychiatric Rating Scale (BPRS). Two People who presented psychotic symptoms and/or severe cognitive impairments were not included in the study. The investigators completed an incident report each time a potential participant was found not eligible. Individuals excluded from the study were referred to community services as needed. Analysis of results: The collected data was sent to the CCHD Data Core Center at the Universidad Central del Caribe (UCC) for statistical analyses. Original documents such as signed consents, completed instruments and socio-demographic questionnaires are secured in a locked cabinet. Procedures: Instruments -CCHD Sociodemographic Questionnaire -HIV Felt Stigma Scale Adapted Spanish Version (Jim nez, and Puig et al., 2005) A 48 item self report 4- point Likert Scale; ranges from never (0) to always (3) Total Inter Item Cronbach s Alpha of .959 Dimensions of HIV Felt Stigma Scale a. Personalized stigma: one s own experiences or fear of rejection due to having HIV. b. Disclosure concerns: desire to keep one s HIV status secret or worry of other s disseminating his/her diagnosis. c. Negative self-image: refers to feelings of personal devaluation, guilt, shame, or being a bad or unclean person for having HIV. d. Concern with public attitudes about people with HIV: perception of what others think and how they act toward a person with HIV - History of Abuse Experiences Questionnaire Adapted Spanish version (Jim nez and Puig et. al.,2005) ? A 40 item self- report questionnaire ? Dichotomous scale: Yes/No ? Includes five types of abuse: neglect, emotional and physical abuse, domestic violence, and sexual abuse ? Inter Item Cronbach s Alpha of .855 ? Sub-scales a. Sexual abuse includes contact or non-contact sexual acts either developmentally inappropriate or forced. b. Emotional abuse is when a caregiver fails to provide nurturance or stimulus to foster feelings of competence. c. Neglect is a caregiver s inability to provide basic needs. d. Domestic violence refers to physical, sexual, and psychological abuse by a person with whom the victim has an intimate relationship Analyses Non-parametric tests Spearman (Rho) was used to evaluate the correlation between HIV-related stigma and History of Experiences of Abuse Wilcoxon-Mann-Whitney was used to assess if there were differences among groups Test/ re-test content validity analysis The developed instruments to assess HIV related felt stigma and lifetime abuse were presented to a group of 8 PLWHA in order to ensure the items comprehensibility. Minor modifications were made after the instruments were piloted. The 67recruited participants were asked to read and sign an informed consent form and proceeded to complete the instruments (Sociodemographic, Abuse, and HIV Felt Stigma). Appointments were established as subjects agreed to return between two and four weeks later to complete the re-test.
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