Advertisement

AIDS and Behavior

, Volume 6, Issue 4, pp 339–350 | Cite as

Pathways of Risk: Race, Social Class, Stress, and Coping as Factors Predicting Heterosexual Risk Behaviors for HIV Among Women

  • Jeannette R. Ickovics
  • Susan E. Beren
  • Elena L. Grigorenko
  • Allison C. Morrill
  • Jennifer A. Druley
  • Judith Rodin
Article

Abstract

African-American women and Latinas as well as women of lower socioeconomic status are disproportionately represented among women with AIDS; therefore, understanding the factors associated with HIV risk behavior for these women is of particular concern. With a diverse sample of women, the current study examined the validity of a theoretical model that proposed that stress and coping mediated the relationships of race/ethnicity and social class to sexual risk behaviors. Structural equation modeling indicated that although social class demonstrated direct and indirect associations with HIV risk behavior, race did not. Women with lower income had higher levels of stress and riskier sexual partners. However, women with higher income were more likely to engage in unprotected intercourse, often within a committed relationship. Coping style did not mediate the relationship of race, social class, and/or stress with risky sexual behaviors. These findings indicate that social class may be a more important factor than race in predicting individual HIV risk behaviors and that assumptions about race and social class must be empirically tested to understand these complex associations. Pathways to risk and prevention are discussed.

HIV/AIDS behavior risk social class race stress coping 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Aldwin, V. M. (1994). Stress, coping, and development: An integrative perspective. New York: Guilford Press.Google Scholar
  2. Alexander, B. K., and Hadaway, P. F. (1982). Opiate addiction: The case for an adaptive orientation. Psychological Bulletin, 92, 367–381.Google Scholar
  3. Amaro, H. (1995). Love, sex and power: Considering women's realities in HIV prevention. American Psychologist, 50, 437–447.Google Scholar
  4. Aral, S. E., and Wasserheit, J. N. (1995). Interactions among HIV, other sexually transmitted diseases, socioeconomic status, and poverty in women. In A. O'Leary and L. S. Jemmott (Eds.), Women at risk: Issues in the primary prevention of AIDS (pp. 13-41). New York: Plenum Press.Google Scholar
  5. Baquet, C., Horm, J., Gibbs, T., and Greenwald, P. (1991). Socioeconomic factors and cancer incidence among Blacks and Whites. Journal of the National Cancer Institute, 83, {pp551-557}.Google Scholar
  6. Becker, E., Rankin, E., and Rickel, A. U. (Eds.). (1998). High-risk sexual behavior: Interventions with vulnerable populations. New York: Plenum Press.Google Scholar
  7. Bollen, K. A., and Long, J. S. (Eds.). (1993). Testing structural equation models. Newbury Park: Sage.Google Scholar
  8. Centers for Disease Control and Prevention (2001). HIV/AIDS Surveillance Report, vn12, Atlanta, GA: Author.Google Scholar
  9. Cornelius, L. J., Okundaye, J. N., and Manning, M. C. (2000). Human immunodeficiency virus-related behavior among African-American females. Journal of the National Medical Association, 92, 183–195.Google Scholar
  10. de Bruyn, M. (1992). Women and AIDS in developing countries. Social Science and Medicine, 34, 249–262.Google Scholar
  11. De La Cancela, V. (1989). Minority AIDS prevention: Moving beyond cultural perspectives towards sociopolitical empowerment. AIDS Education and Prevention, 1, {pp141-153}.Google Scholar
  12. Dohrenwend, B. P. (Ed.). (1998). Adversity, stress and psychopathology. New York: Oxford University Press.Google Scholar
  13. Faryna, E. L., and Morales, E. (2000). Self-efficacy and HIV-related risk behaviors among multiethnic adolescents. Cultural Diversity and Ethnic Minority Psychology, 6, 42–56.Google Scholar
  14. Fee, E., and Krieger, N. (1993). Understanding AIDS: Historical interpretations and the limits of biomedical individualism. American Journal of Public Health, 83, 1477–1486.Google Scholar
  15. Fernandez, I. (1995). Latinas AIDS: Challenges to prevention efforts. In A. O'Leary and L. Jemmott (Eds.),Women and AIDS: Primary prevention (pp. 159-174). New York: Plenum Press.Google Scholar
  16. Finn, P. R., Martin, J., and Pihl, R. O. (1987). Alexithymia in males at high genetic risk for alcoholism. Psychotherapy and Psychosomatics, 47, 18–21.Google Scholar
  17. Folkman, S., Chesney, M. A., Pollack, L., and Phillips, C. (1992). Stress, coping, and high-risk sexual behavior. Health Psychology, 11, 218–222.Google Scholar
  18. Folkman, S., and Lazarus, R. S. (1986). The dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992–1003.Google Scholar
  19. Greenberg, M., and Schneider, D. (1994). Violence in American cities: Young Blacks is the answer, but what was the question? Social Science and Medicine, 39, 179–187.Google Scholar
  20. Gupta, G., and Weiss, E. (1993). Women's lives and sex: Implications for AIDS prevention. Culture, Medicine and Psychiatry, 17, 399–412.Google Scholar
  21. Haan, M., Kaplan, G., and Camacho, S. L. (1989). Socioeconomic status and health: Old observations and new thoughts. In J. Bunker, D. Gomby, and B.Kehrer (Eds.), Pathways to health: The role of social factors (pp. 76-135). Menlo Park, CA: Henry J. Kaiser Family Foundation.Google Scholar
  22. Hobfoll, S. E., Dunahoo, C. L., Ben-Parath, Y., and Monnier, J. (1994). Gender and coping: The dual axis model of coping. American Journal of Community Psychology, 22, {pp49-81}.Google Scholar
  23. Ickovics J. R., Druley, J., Grigorenko, E., Morrill, A., Beren, S., and Rodin, J. (1998). Long-term effects of HIV counseling and testing for women. Health Psychology, 17, 395–402.Google Scholar
  24. Ickovics, J. R., Morrill, A. C., Beren, S. E., Walsh, U., and Rodin, J. (1994). Limited effects of HIV counseling and testing for women. Journal of the American Medical Association, 272, 443–448.Google Scholar
  25. Ickovics, J. R., and Rodin, J. (1992). Women and AIDS in the United States: Epidemiology, natural history, and mediating mechanisms. Health Psychology, 11, 1–16.Google Scholar
  26. Ickovics, J. R., Thayaparan, B., and Ethier, K. (2000). Women and AIDS: A contextual analysis. In A. Baum, T. Revenson, and J. Singer (Eds.), Handbook of Health Psychology (pp. 821-839). Hillsdale, NJ: Erlbaum.Google Scholar
  27. Ickovics, J. R., Viscoli, C. M., and Horwitz, R. I. (1997). Recovery following myocardial infarction: The importance of social class. Annals of Internal Medicine, 217, 518–525.Google Scholar
  28. Jemmott, L. S., Catan, V., Nyamathi, A., and Anastasia, J. (1995). African American women and HIV-risk reduction issues. In A. O'Leary and L. S. Jemmott (Eds.), Women at risk: Issues in the primary prevention of AIDS (pp. 131-157). New York: Plenum Press.Google Scholar
  29. Joreskog, K. G., and Sorbom, D. (1993). LISREL VIII: User's reference guide. Mooresville, IN: Scientific Software.Google Scholar
  30. Jung, J., and Khalsa, H. K. (1989). The relationship of daily hassles, social support, and coping to depression in Black and White students. Journal of General Psychology, 116, 407–417.Google Scholar
  31. Kerwin, M. S., Howard, G. S., Maxwell, S. E., and Borkowski, J. G. (1987). Implications of covariance structure analysis (LISREL) versus regression models for counseling research. Counseling Psychologist, 15, 287–310.Google Scholar
  32. Kessler, R. C., and Neighbors, H. W. (1986). A new perspective on the relationships among race, social class, and psychological distress. Journal of Health and Social Behavior, 27, 107–115.Google Scholar
  33. Klevens, R. M., Diaz, T., Fleming, P. L., Mays, M. A., and Frey, R. (1999). Trends in AIDS among Hispanics in the United States, 1991-1996. American Journal of Public Health, 89, 1104–1106.Google Scholar
  34. Kline, T. J. B., and Klammer, J. D. (2001). Path model analyzed with ordinary least squares multiple regression versus LISREL. Journal of Psychology, 135, 213–225.Google Scholar
  35. Lauby, J. L., Smith, P. J., Stark, M., Person, B., and Adams, J. (2000). A community-level HIV prevention intervention for inner-city women: Results of the women and infants demonstration projects. American Journal of Public Health, 90, 216–222.Google Scholar
  36. Lazarus, R., and Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  37. Lefcourt, H. M., Martin, R. A., and Selah, W. E. (1984). Locus of control and social support: Interactive moderators of stress. Journal of Personality and Social Psychology, 47, 378–389.Google Scholar
  38. Lillie-Blanton, M., Anthony, J. C., and Schuster, C. R. (1993). Probing the meaning of racial or ethnic group comparisons in crack cocaine smoking. Journal of the American Medical Association, 269, 993–997.Google Scholar
  39. Mays, V. M., and Cochran, S. D. (1988). Issues in the perception of AIDS risk and risk reduction activities by Black and Hispanic/Latina women. American Psychologist, 43, 949–957.Google Scholar
  40. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171–179.Google Scholar
  41. McKusick, L. M., Hortsman, W., and Coates, T. J. (1985). AIDS and sexual behavior reported by gay men in San Francisco. Journal of Public Health, 75, 493–496.Google Scholar
  42. Morrill, A. C., Ickovics, J. R., Golubchikov, V., Beren, S., and Rodin, J. (1996). Safer sex: Social and psychological predictors of behavioral maintenance and change among heterosexual women. Journal of Clinical and Consulting Psychology, 64, 819–828.Google Scholar
  43. Navarro, V. (1990). Race or class versus race and class: Mortality differentials in the United States. Lancet, 336, 1238–1240.Google Scholar
  44. Nyamathi, A. M. (1992). Comparative study of factors relating to HIV risk level of Black homeless women. Journal of Acquired Immune Deficiency Syndromes, 5, 222–228.Google Scholar
  45. Nyamathi, A. M., and Flaskerud, J. (1992). A community-based Inventory of current concerns of impoverished homeless and drug-addicted minority women. Research in Nursing and Health, 15, 121–129.Google Scholar
  46. Pearlin, L. I., and Aneshensel, C. S. (1986). Coping and social supports: Their functions and applications. In L. Aiken and D. Mechanic (Eds.), Applications of social science to clinical medicine and health policy (pp. 417-437). New Brunswick, NJ: Rutgers University Press.Google Scholar
  47. Pohorecky, L. A. (1981). The interaction of alcohol and stress: A review. Neuroscience and Bio-behavioral Review, 5, 209–229.Google Scholar
  48. Rodin, J., and Ickovics, J. R. (1990). Women's health: Review and research agenda as we approach the 21st century. American Psychologist, 45, 1018–1034.Google Scholar
  49. Rosario, M., Rotheram-Borus, M. J., and Reid, H. (1996). Gay related stress and its correlates among gay and bisexual male adolescents of predominantly Black and Hispanic background. Journal of Community Psychology, 24, 136–159.Google Scholar
  50. Rotheram-Borus, M. J., Coopman, C., and Ehrhardt, A. A. (1991). Homeless youths and HIV infection. American Psychologist, 46, 1188–1197.Google Scholar
  51. Russell, L. D., Alexander, M. K., and Corbo, K. F. (2000). Developing culture-specific interventions for Latinas to reduce HIV high-risk behaviors. Journal of the Association of Nurses in AIDS Care, 11, 70–76.Google Scholar
  52. Ryan, D. (1997). New Haven on-line [Database]. New Haven, CT: Yale University, Institution for Social and Policy Studies [producer and distributor].Google Scholar
  53. Saldana, D. H. (1994). Acculturative stress: Minority status and distress. Hispanic Journal of Behavioral Sciences, 16, 116–128.Google Scholar
  54. Sandler, I. N., and Lakey, B. (1982). Locus of control as a stress moderator: The role of perceptions and social support. American Journal of Community Psychology, 10, 65–80.Google Scholar
  55. Schilling, R. F., El-Bassel, N., Schinke, S. P., and Nichols, S. (1991). Sexual behavior, attitudes toward safer sex, and gender among a cohort of 244 recovering drug users. International Journal of the Additions, 26, 859–877.Google Scholar
  56. Shain, R. N., Piper, J. M., Newton, E. R., Perdue, S. T., Ramos, R., Champion, J. D., and Guerra, F. A. (1999). A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. New England Journal of Medicine, 340, 93–100.Google Scholar
  57. Sher, K. J. (1987). Stress response dampening. In H. T. Blane and K. E. Leonard (Eds.), Psychological theories of drinking and alcoholism, New York: Guilford Press.Google Scholar
  58. Sikkema, K. J., Kelly, J. A., Winett, R. A., Solomon, L. J., Cargill, V. A., Roffman, R. A., McAuliffe, T. L., Heckman, T. G., Anderson, E. A., Wagstaff, D. A., Norman, A. D., Perry, M. J., Crumble, D. A., and Mercer, M. B. (2000). Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. American Journal of Public Health, 90, 57–63.Google Scholar
  59. Soler, H., Quadagno, D., Sly, D. F., Riehman, K. S., Eberstein, I. W., and Harrison, D. F. (2000). Relationship dynamics, ethnicity and condom use among low-income women. Family Planning Perspectives, 32, 82–88.Google Scholar
  60. Stein, J. A., and Nyamathi, A. (1999). Gender differences in relationships among stress, coping and health risk behaviors in improverished, minority populations. Personality and Individual Differences, 26, 141–157.Google Scholar
  61. Stiffman, A. R., Dore, P., Cummingham, R. M., and Earls, F. (1995). Person and environment inHIVrisk behavior change between adolescence and young adulthood. Health Education Quarterly, 22, 211–226.Google Scholar
  62. Stone, A. A., Lennox, S., and Neale, J. M. (1985). Daily coping and alcohol use in a sample of community adults. In S. Shiffman and T. A.Wills (Eds.), Coping and substance use (pp. 199-220). New York: Academic Press.Google Scholar
  63. Suls, J., and Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.Google Scholar
  64. Tesh, S. (1988). Hidden arguments, political ideology and disease prevention policy. New Brunswick, NJ: Rutgers University Press.Google Scholar
  65. Torres, J. B. (1998). Masculinity and gender roles among Puerto Rican men: Machismo on the US mainland. American Journal of Orthopsychiatry, 78, 16–26.Google Scholar
  66. U.S. Census Bureau. (2000). Poverty 1998. Washington, DC: Author.Google Scholar
  67. Vincke, J., Bolton, R., Mak, R., and Blank, S. (1993). Coming out and AIDS-related high-risk sexual behavior. Archives of Sexual Behavior, 22, 559–586.Google Scholar
  68. Walter, H. J., Vaughn, R. D., and Cohal, A. T. (1991). Psychosocial influences on acquired immunodeficiency syndrome-risk behaviors among high school students. Pediatrics, 88, 846–852.Google Scholar
  69. Williams, D. R., and Collins, C. (1995). US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.Google Scholar
  70. Wills, T. A., Sandy, J. M., Yaeger, A. M., Cleary, S. D., and Shintar, O. (2001). Coping dimensions, life stress, and adolescent substance use: A latent growth analysis. Journal of Abnormal Psychology, 110, 309–323.Google Scholar
  71. Winkleby, M. A., Fortmann, S. P., and Barrett, D. C. (1990). Social class disparities in risk factors for disease: Eight-year prevealence patterns by level of education. Preventive Medicine, 19, 1–12.Google Scholar
  72. Winkleby, M. A., Jatulis, D. E., Frank, E., and Fortmann, S. P. (1992). Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. American Journal of Public Health, 82, 816–820.Google Scholar
  73. Wohl, A. R., Lu, S., Odem, S., Sorvillo, F., Pegues, C. F., and Kerndt, P. R. (1998). Sociodemographic and behavioral characteristics of African-American women with HIV and AIDS in Los Angeles County, 1990-1997. Journal of Acquired Immunodeficiency Syndrome, 19, 413–420.Google Scholar
  74. Worth, D. (1990). Minority women and AIDS: Culture, race and gender. In D. A. Feldman (Ed.), Culture and AIDS (pp. 111-135). New York: Praeger.Google Scholar
  75. Wyatt, G. E. (1994). The sociocultural relevance of sex research: Challenges for the 1990's and beyond. American Psychologist, 49, 748–754.Google Scholar
  76. Zierler, S., and Krieger, N. (1997). Reframing women's risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436.Google Scholar
  77. Zierler, S., Krieger, N., Tang, Y., Coady, W., Siegfried, E., DeMaria, A., and Auerbach, J. (2000). Economic deprivation and AIDS incidence in Massachusetts. American Journal of Public Health, 90, 1064–1073.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Jeannette R. Ickovics
    • 1
  • Susan E. Beren
    • 2
  • Elena L. Grigorenko
    • 2
  • Allison C. Morrill
    • 2
  • Jennifer A. Druley
    • 2
  • Judith Rodin
    • 2
  1. 1.Department of Epidemiology and Public HealthYale University, and Center for Interdisciplinary Research on AIDS, New Haven, Connecticut. Department of Psychology, Yale UniversityNew Haven
  2. 2.Department of PsychologyYale UniversityNew Haven

Personalised recommendations