10/16/2009

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Women’s Knowledge, Attitudes, Women’s Knowledge, Attitudes, Beliefs and Decisions about Beliefs and Decisions about

HIV/AIDS:HIV/AIDS:A Cross National ComparisonA Cross National Comparison

Research Team

Johns Hopkins University School of Nursing Phyllis Sharps, PhD, RN ,FAAN, CNE, PI

◦ Professor, Chair, Department of Community Public Health Veronica Njie-Carr, PhD, APRN,BC, Co-PI

◦ Post-Doctoral FellowUnited States Virgin Islands Doris Campbell, PhD, RN, FAAN, Co-I

o Professor Emeritus, University of South Florida Ophelia Torres, MSN, RN Edris Evans, BSN Funding

◦ Caribbean Export Research Center, Gloria Callwood, PhD, RN, PI, University of the Virgin Islands (P20 Center, 5 R24 MD 001123-02, Office of Minority Health Research/NIH)

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Background

Globally, pregnant and parenting women of African heritage suffer the greatest burdens of HIV/AIDS

64% of the 126,964 women living with HIV/AIDS in the US are AA (www.cdc.gov)

Rates in US Virgin Islands are the second only to Washington, DC

The rates of new HIV infections and the consequences of AIDS is increasing most rapidly among women of African heritage

HIV/AIDS contributes significantly to infant and maternal morality among women of African heritage

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Background

AA women in the US are the highest risk group for acquiring new HIV infections

Recent findings suggest that Caribbean young women are 2.5 times more likely to be infected than young men (http://womenandaids.unaids.org/ Retrieved 2/16/06)

Few studies have simultaneously compared the women of African heritage from different National or International settings

Cross national comparison among women with similar heritage are critical to examine differences and similarities important in risks or aspects of living with HIV/AIDS that may contribute to effective and sustainable evidenced based care

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Purpose

The purposes of this multisite pilot study comparing pregnant and parenting women of African heritage in Baltimore and USVI at risk or living with HIV/AIDS were:

1.Describe and examine the relationships among knowledge,

attitudes, beliefs, depression, self-esteem, and abuse.

2.Compare HIV/AIDS status, abuse, knowledge, attitudes, and beliefs among women in Baltimore and USVI.

3.Describe how knowledge, attitudes, beliefs, feelings, and abuse may influence decisions about participating in voluntary testing and counseling, disclosing disease status to family and friends, and decisions related to parenting.

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Methods

Conceptual Model Nola Pender’s (2006) Health Promotion

Model (HPM)Design

Mixed methods – Quantitative/Qualitative – Descriptive Correlational – Descriptive phenomenological method

Setting USA: Baltimore, Maryland US Virgin Islands: St. Thomas, St. John

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Methods

Sample AA pregnant (medically diagnosed) and

parenting women (infants up to 6-months) Afro Caribbean pregnant or parenting women USA Sample sites:

HIV Perinatal Services Transitional Housing

US Virgin Islands Public health clinic Prenatal/Postpartum public clinics

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Methods

Data Collection Methods In-Depth Interview (qualitative) Questionnaires (quantitative)

Abuse Assessment Screen (AAS) Rosenberg Self Esteem Scale (RSE) CES-D10 Depression Scale (CES-D10) HIV/AIDS Knowledge, Attitudes, Beliefs Patient Questionnaire (HAKABPQ)

Medical Records Review

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Results

Total of 49 women 30 AA; 26 Afro Caribbean women

Age ranged from 18 to 40 yearsGestational age ranged from 15 to 39

weeksIn Baltimore there were a higher

number of participants with HIV/AIDS diagnosis than in USVI

There were significant differences between HIV status and research sites

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Reproductive History

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N = 56

Table 2: Comparison of Demographic Characteristics

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USVIHIV negN = 22

USVIHIV/AIDS

N = 4

BaltimoreHIV negN = 13

BaltimoreHIV/AIDS

N = 17

Age (M; SD) (Median)

27.95 (5.84) 27.5

25 (6.27) 23.5

28.85 (7.02)27

26.65 (6.13) 26

Gravida 2 (Median) 1 3 3

Education (Median)

12.45 (3.17 12.5

11.5 (2.52) 12

12.42 (2.25) 12

12.40 (2.47) 12

Unemployed Employed

12 (54.5%)10 (45.5%)

1 (25%)3 (75%)

5 (38.5%)8 (61.5%)

11 (67.7%) 5 (29.4%)

Marital status Single Married Other

12 (54.5%)4(18.2%)4 (18.2%)

3 (75%)1 (25%) ___

7 (53.8%)2 (15.4)4 (30.8%)

10 (58.8%)5 (29.4)2 (11.8%)

Figure 1: HIV Status by Research Site

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Table 3: Results of Internal Consistency using Cronbach’s alpha

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USVI

N = 22 N = 4HIV- HIV+

Baltimore

N = 13 N = 17HIV- HIV+

Instrument summary

CES-D (10 items) .67 .23 .69 .84 Short version of the 20 item scale. Score of 10 and greater suggests that respondent is depressed.

RSE (10 items) .81 .88 .81 .83 The higher the score, the higher the self-esteem.

HAKABPQ (72 items) Knowledge (17) Attitudes (14) Spiritual Beliefs (12) Social Beliefs (14)

Cultural Beliefs (15)

.67

.75

.78

.56

.64

-.30

.75

.98

.87

.66

.65

.85

.67

.73

.78

.78

.82

.96

.83

.78

The higher the scores in the subscales, the stronger the beliefs.

Table 4: Scores, Means and Standard Deviations

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USVIHIV negN = 22

USVIHIV/AIDS

N = 4

BaltimoreHIV negN = 13

BaltimoreHIV/AIDS

N = 17

RSE0 - 30

25.32 (4.05) 21.5 (5.26) 23 (4.86) 23.71 (4.85)

CES – D0 - 30

8.5 (4.52) 12.5 (3.32) 11.10(5.16) 10.18 (6.81

Knowledge1 - 68

57.55 (5.38) 57 (1.42) 53.30 (5.76) 58.88 (6.54)

Attitudes1 - 56

44.09 (5.19) 49.25 (9.54) 44.56 (7.02) 46.82 (6.45)

Spiritual Beliefs1 - 48

42.05 (4.65) 42.25 (9.54 45 (3.37) 44.11 (5.42)

Social beliefs1 – 56

39.14 (6.07) 40.25 (10.53) 39.77 (6.15) 41.47 (8.38)

Cultural beliefs1 - 60

48.86 (4.68) 50.25 (5.74) 48.54 (6.16) 47.41 (10.38)

Statistical Analysis

Purpose # 1: Describe and examine the relationships among

knowledge, attitudes, beliefs, depression, self-esteem, and abuse

Analysis Zero-order Pearson Moment correlations were

computed

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Zero-Order Correlations

Analysis Zero-order correlations were computed to determine

relationships among self-esteem, depression, knowledge, attitudes and beliefs

Adjusting for multiple variables using Bonferroni procedure Correlations must be < .005 to be considered significant

Results No significant associations were found between demographic

characteristics and the variables No significant correlations were found for USVI women

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Table 5: Comparison of Zero Order Correlations of Variables

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Baltimore: HIV negativeN = 13

RSE CES-D Knowledge Cultural Beliefs

RSE ____ - .897* - .141 - .234

CES-D _____ .153 .174

Knowledge _____ .768*

Cultural Beliefs _____

*p < .005

Table 6: Comparison of Zero Order Correlations of Variables

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Baltimore: HIV/AIDSN = 17

Knowledge Attitudes SoB CuB

Knowledge ___ .656* .675*

.838*

Attitudes ___ .838*

.651*

Social Beliefs ___ .721*

Cultural Beliefs ___

*p < .005

Statistical Analysis

Purpose #2:

Compare HIV/AIDS status, abuse, knowledge, attitudes, and beliefs among women in Baltimore and USVI

Analysis

Fisher’s exact test was computed

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Results

Abuse Over 12% reported physical and sexual abuse since

they were pregnant

39.3% reported lifetime (ever abused & yr before pregnancy) physical and sexual abuse

Using Fisher’s exact test, no significant differences were found between women abused since pregnancy and lifetime abuse; and HIV status at the research sites

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Table 7: Abuse Items

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USVI- HIV NegN = 22

Yes No Fisher’s

Baltimore - HIV Neg

N = 13

Yes No Fisher’s

Physical & sexual abuse since pregnancy (3 & 5)

Physical & sexual lifetime abuse (1, 2, & 4)

2 20

7 15

p = .132

2 11

7 6 p = .09

Table 8: Abuse Items categorized

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USVI – HIV PosN =4

Yes No Fisher’s

Baltimore – HIV Pos

N = 17

Yes No Fisher’s

Physical & sexual abuse since pregnancy (3 & 5)

Physical & sexual lifetime abuse (1, 2, & 4)

0 4

1 3

2 20

7 15 p = .132