1. Analysis of Sexual Risk Reduction (HIV/AIDS)
Chiao-Chin Lin
BACH 5300
11/23/2013
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2. School of Public Health
Academic Integrity
Honor Statement
I did not receive, nor did I give any unauthorized assistance on this assignment.
I have adhered to the Academic Integrity Agreement of the School of Public Health at the
University of NorthTexas Health Science Center, in which I promised to conduct myself in a professional and
ethical manner during all of my academic pursuits.
_Chiao-Chin Lin_____________ __November 23, 2013___________________ _Chiaochin
Lin____________
Name (print) Signature Date
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3. Introduction
According to CDC factual data, AIDS is the fourth leading cause of death among married
women. More than half of the AIDS cases are reported among African American women. AIDS cases
attributable to heterosexual transmission are rapid upsurge. In the past decades, AIDS cases
attributed to heterosexual contact in women increased more than double of the percentage.
Around two decades ago, Ralph DiClemente hosted an intervention program focusing on the
sexual behaviors of young African-American women. The program was meant to enhance condom
usage as comprehensible means to prevent human immunodeficiency virus (HIV). Overall
effectiveness of the program was estimated to reduce HIV incidence by 80%. Therefore, condom
usage was selected as a good means of suppressing -the transmission of HIV since its efficacy has
been proven. The community-based skills prevention program evaluated factors implicated in the
transmission of HIV and power imbalance was mentioned. Power imbalance in sexual interaction can
make people engage in unsafe sex and this may contribute to the spread of HIV.
Actually, gender power imbalance considerably affects female capability to ask their partners to
use condom. The report indicated that women with older male partners more than a decade, suffering
from abuse, and those have disadvantaged income comparing to their partners are relatively
unwilling to ask for condom usage. It also affects men’s tendency to reject condom use. If they are
husbands and wives, and there is no communication about HIV/AIDS between them. The most
stunning part is that men with more than one partners tend to reject condom usage.
Across through upper and lower social levels, it is necessary to observe social prototypes to alter
relationships between women and men. From unequal sociality with dominance presenting
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4. imbalance of rights in patriarchal societies to the social structure with equality and respect, both of
them have delivered bipolar cognitive value to the sociality between them. Moreover, there are also
physical and psychological factors that involve behavioral and social variables mediate the linkage
between social economic status (SES) and three types of stress hormones: cortisol, adrenaline and
norepinephrine. Lower SES was associated with a grading patterns of higher basal levels of cortisol
and catecholamine. The above associations occurred alone with race, such as African-American.
Through it is minority, the dataset keeps consistent in harmony of health practices and social factors.
With development of SES, defined as education, occupational, and employment growth are
associated with higher morning cortisol levels in middle-aged Germen. Therefore, it is proven that
education and income were correlated
Applied Theories
The program choose a randomized controlled trial (RCT) as its study design. Randomized
controlled trials are the gold standard to distribute the sample to particular group and engage the
clinical trials on each group. As a result, RCTs can collect information which may play critical roles on
relevant effects. For examples, there are several factors can be found through the RCT study design,
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5. such as HIV knowledge and abstinence. Furthermore, there are two theories which had been applied
into the research process. They are social cognitive theory (SCT) and the theory of power and
gender (TGP) respectively.
First of all, social cognitive theory requires participants to learn social skills, norms, and suitable
knowledge on the purpose of avoiding risky sexual behaviors. As African American women with
assorted factors follow the social norms and skills, the sessions in the HIV intervention program
specifically addressed issues relevant to social cognitive theory. In the initial session, it provided
ample information regarding HIV risk reduction, such as associated risk behaviors and preventative
strategies. This session intended to provide participants with appropriate information. Later, they can
gain more supportive knowledge to enter into the next session.
In the fourth session, it successfully sets up and stresses on proper socially positive norms
towards the primary outcome, consistent condom usage.
On the other hand, the theory of gender and power (TGP) in conjunction with social cognitive
theory (SCT) were both used to create bonds between the cultural and gender among African-
American women. In 1987, Robert Connell developed on the theories of sexual inequality and gender
and power imbalances. According to the theory of gender and power, there are three primary social
structures that peculiarize the affiliations among sexes. With the gradual alteration of societies, these
structures remain unscathed among societal levels in long terms.
Target Population
As a matter of fact, African American women represent 13% of the U.S. female population and
67% of the AIDS cases among women. Hence, participants in Ralph DiClemente’s study include 128
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6. women recruited the Bayview-Hunter’s Point community of San Francisco. Actually, African-American
contributes 84% population in the community; one out of four people in the neighborhood were
regarded as poor. It was best to use this population because they have a low socioeconomic status
and they are mostly unemployed. The author further narrowed the demographic factors to African
-American women between 18 to 29 years old and with heterosexual desires. The researchers also
required all of the participants to be sexually active. The author found that twenty-five percent of them
consistently used condom more than 3 months.
Analysis of HIV Sexual Risk-reduction Intervention
The author applied logistic regression analyses due to its bifid characters from diversified
variables. All of the variables were considered. There was another three-month-follow-up survey to
evaluate the effectiveness of the treatment conditions. Furthermore, potential confounders were
controlled by using analysis of variance (ANOVA). However, the P value was below 0.1 which
indicates that there is no association between these factors and the treatment
The adjusted odds ratio (OR) was applied to count for consequences of HIV intervention. African
American women who join the HIV sexual risk-reduction intervention had 2.1 times higher odds on
consistent condom usage than those who are with limited time to acquire HIV education.
Furthermore, those who were in the HIV sexual risk-reduction intervention had 4.1 times higher odds
on sexual communications comparing to women with delayed HIV education conditions. It showed
that the intervention program had proven every population had its own demographic features, and
controlling the gender and cultural factors as variables can compose to a clear comparison among
variables.
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7. Results
The result of the study showed that Outcome measures can be categorized into several parts.
First, interpersonal skills intervention has positive effects on persistent condom usage. (Adjusted
Odds Ratio=4.15) Second, perceived partner norm also performs positive effects on the progress of
intervention. (Adjusted Odds Ratio=2.1) Third, sexual self-control in women who had the intervention
program was increased 1.9 times higher than in women who didn’t participat. Fourth, the sexual
communication play crucial role on the intervention program and the odds present 4.1 times higher
than the control group. Besides, there is 1.8 times higher odds on the intervention group about sexual
assertiveness. Eventually, partners’ adoption of condom usage has 2.1 time higher odds.
In sum, through the community orientated HIV risk-reduction intervention, it seems that the
demographic information and cultural features can both be applied to be effective ways to improve
social interpersonal skills among the risk-exposed population. Consequently, the persistent condom
usage is the ultimate goal to lower the HIV infection risks.
Strength and Weakness
The straight patterns of designs save plenty of time to discover proper variables on behaviors.
Moreover, the fusion basis of the diversified knowledge on behavior science broaden the horizons of
the HIV intervention. While the author host the survey on African American women as target
population, he can definitely match the relevant behavioral theories patterns in his mind and create
more thoughtful ways. For examples, the appliance of theory of power and gender (TGP) transmits
distinctness between genders and causes the issues of uneven distribution of power. This theory
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8. fitted in the target population who were not merely women but also African Americans, the relatively
low SES groups.
On the contrary, social cognition theory has limited capability to interpret the emotional
triggers to the risky behavior. Moreover, the intervention program lacks in suitable measurements
to evaluate the consistency of condom usage in the long run. Another shortage on the
intervention program can be the statistical outcome. According to the study, the outcome of p-
value is only below 0.1. If p-value is bigger than 0.05, we cannot reject the null hypnosis to
support our view. Hence, it seems like that there is no significantly association between
treatment conditions and potential confounders. In addition, selection bias can also be produced
while choosing the samples. It is still possible that young African American women who obtain
distinguished education but prefer to live in the forgotten edge of San Francisco. After all, as
researchers, we had better not to constrain our conditions on people before we discover the
truth.
Future Prospective
Owing to the inspiration from the experience of DiClemente, we are witnesses to see the
effective outcome from the intervention among communities. It shows that community intervention is
a more valuable way to address the risky behavior rather than providing clinical treatments to fight
against HIV viruses.
On the other hand, it is beneficial to stratify the target population by diversified
gender and cultural factors. In this way, researchers can save lots of time on irrelevant samples.
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9. There are upcoming studies that can be found in the thesis database. Another one is mainly focus on
the risk exposure with the appliance of the theory of gender and authority. Basically, it seems to be
ideal on the HIV risk-reduction intervention program. With appropriate study design, since the
variables remains multiple causes, the RCT keep its steady positions on analysis of the HIV risk
consideration. The future studies are expected to conclude more psychical and emotional factors
rather than ignorance.
Reference
Weller Sc, Davis-Beaty K. (2007). Condom effectiveness in reducing heterosexual HIV transmission
http://apps.who.int/rhl/reviews/langs/CD003255.pdf
Ralph J. DiClemente. Efficacy of an HIV Prevention Intervention for African American Adolescent Girls.
JAMA. 2004;292(2):171-179
http://jama.jamanetwork.com/article.aspx?articleid=199083
A Joint Report by UNAIDS/UNFPA/UNIFEM: Using Education to Prevent HIV.
Website: http://www.unfpa.org/hiv/women/report/chapter5.html
Hobfoll SE, Jackson AP, Lavin J, Britton PJ, Shepherd JB. Safer sex knowledge, behavior, and attitudes
of inner-city women. Health Psychol. 1993 Nov; 12(6):482-8
http://www.ncbi.nlm.nih.gov/pubmed/8293732
The council of State Government. (2011) HIV and STD Prevention Policies: Focus on Rural Areas. 2011
April http://knowledgecenter.csg.org/kc/system/files/HIV_and_STD_Prevention_Policies_Rural.pdf
Gina M. Wingood, Ralph J. DiClemente. Application of the Theory of Gender and Power to Examine HIV-
Related Exposures, Risk Factors, and Effective Interventions for Women. Health Education Behavior
October 2000 vol. 27 no.5 539-565. http://heb.sagepub.com/content/27/5/539.abstract
Margrit Eichler. Power, dependency, love and the sexual division of labour: A critique of the decision-
making approach to family power and an alternative approach with an appendix: On washing my dirty
linen in public. Women’s Studies International Quarterly vol. 4, Issue 2 (1981) 201-219.
http://www.sciencedirect.com/science/article/pii/S0148068581932425
Langen TT. Gender power imbalance on women’s capacity to negotiate self-protection against HIV/AIDS
in Botswana and South Africa. African Health Science (2005) September; 5(3):188-97.
http://www.ncbi.nlm.nih.gov/pubmed/16245988
Gina M. Wingood and Ralph J. DiClemente. Partner Influences and Gender-Related Factors Associated
with Non-condom Use Among Young Adult African American Women. American Journal of Community
Psychology February 1998, Volume 26, Issue 1, pp 29-51
http://link.springer.com/article/10.1023/A:1021830023545
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10. SHELDON COHEN, PHD, WILLIAM J. DOYLE, PHD, AND ANDREW BAUM, PHD. Socioeconomic
Status Is Associated With Stress Hormones. Psychosomatic Medicine (2006) 68:414 – 420
http://www.psy.cmu.edu/~scohen/ses_and_stress_hormones.pdf
DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk-reduction intervention
for young African-American women. Journal of the American Medical Association. 274 (1995): 1271-1276.
http://www.ncbi.nlm.nih.gov/pubmed/7563531
http://jama.jamanetwork.com/article.aspx?articleid=389870
Cynthia Prather, Taleria R. Fuller, Winifred King, Mari Brown, Marilyn Moering, Stacey Little, and Keydra
Phillips. Diffusing an HIV Prevention Intervention for African American Women:
Integrating Afrocentric Components Into the SISTA Diffusion Strategy. AIDS Education and Prevention.
(2006) vol. 18 149-160.
http://www.ncbi.nlm.nih.gov/pubmed/16987096
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