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HIV-Related Stigma and HIV Disclosure Among Latinos on the US-Mexico Border

Abstract

Latinos in the USA have lower levels of disclosure and higher levels of HIV-related stigma when compared to non-Hispanic whites. However, the nature of the stigma-disclosure relation has not been fully explored. We hypothesize that the path between HIV-related stigma and disclosure may be through a mediating attitude toward disclosure. As a secondary hypothesis, we predicted differences in the strength of association that cognitive attitudes and affective attitudes share with disclosure. We interviewed 241 HIV-positive individuals on HAART at an outpatient clinic in El Paso, Texas, a large city that borders Mexico. The significant association between HIV-related stigma and HIV disclosure was fully mediated by attitudes toward disclosure. In addition, the differences between correlations (i.e., both affective and cognitive attitudes with disclosure behaviors) were statistically significant for family members and casual sex partners (Steiger’s Z-test, Z = 5.15 and 2.54, ps < .01). Our model of disclosure-related attitudes suggests that as stigma becomes more salient, negative evaluations about disclosing may become more important during the disclosure decision-making process. Also, despite evidence from the literature that disclosure to certain targets (e.g., intimate partners) may occur for emotional reasons related to catharsis or emotional relief, our data suggest that cognitive appraisals (e.g., responsibility to educate) are more strongly related to disclosure rates to family members and casual sex partners.

Keywords

  • Attitude Object
  • Main Partner
  • Affective Attitude
  • Cognitive Attitude
  • Disclosure Level

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Fig. 11.1

References

  • Ajzen, A. (1991). The theory of planned behavior. Organizational Behavioral and Human Decision Processes, 50, 179–211.

    CrossRef  Google Scholar 

  • Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behavior: A meta-analytic review. British Journal of Social Psychology, 40, 471–499.

    CrossRef  Google Scholar 

  • Bairan, A., Jones Taylor, G. A., Blake, B. J., Akers, T., Sowell, R., & Mendiola, R. (2007). A model of HIV disclosure: Disclosure and types of social relationships. Journal of the American Academy of Nurse Practitioners, 19, 242–250.

    CrossRef  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    CrossRef  Google Scholar 

  • Bogart, L. M., Cowgill, B. O., Kennedy, D., Ryan, G., Murphy, D. A., Elijah, J., & Schuster, M. A. (2008). HIV-related stigma among people with HIV and their families: A qualitative analysis. AIDS and Behavior, 12, 244–254.

    CrossRef  Google Scholar 

  • Brouwer, K. C., Strathdee, S. A., Magis-Rodríguez, C., Bravo-García, E., Gayet, C., Patterson, T. L., Bertozzi, S. M., & Hogg, R. S. (2006). Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 83, 299–307.

    CrossRef  Google Scholar 

  • Brown, L., Macintyre, K., & Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15, 49–69.

    CrossRef  Google Scholar 

  • Centers for Disease Control. (2008). Subpopulation estimates from the HIV incidence survelliance system – United States, 2006. Morbidity and Mortality Weekly Report, 57(36), 985–989. Retrieved November 1, 2010, from http://www.cdc.gov/mmwr/preview.mmwrhtml.mm5736a1.htm

  • Centers for Disease Control and Prevention. (2008a, March). HIV/AIDS policy fact sheet: Latinos and HIV/AIDS. Retrieved December 12, 2010, from http://www.cdc.gove/hiv/stats.htm

  • Centers for Disease Control and Prevention. (2008b, April). HIV/AIDS among Hispanics/Latinos: CDC HIV/AIDS facts. Retrieved December 12, 2010, from http://www.cdc.gove/hiv/stats.htm

  • Centers for Disease Control and Prevention. (2010). HIV survelliance report (Vol. 22). http://www.cdc.gov/hiv/topics/survelliance/resources/reports/

  • Cooke, R., & French, D. P. (2008). How well do the theory of reasoned action and theory of planned behavior predict intentions and attendance at screening programmes? A meta-analysis. Psychology & Health, 23, 745–765.

    CrossRef  Google Scholar 

  • Crandall, C. S., & Coleman, R. (1992). AIDS-related stigmatization and the disruption of social relationships. Journal of Social and Personal Relationships, 9, 163–177.

    CrossRef  Google Scholar 

  • Crepaz, N., & Marks, G. (2003). Serostatus disclosure, sexual communication and safer sex in HIV-positive men. AIDS Care, 13, 379–387.

    CrossRef  Google Scholar 

  • Crites, S. L., Fabrigar, L. R., & Petty, R. E. (1994). Measuring the affective and cognitive properties of attitudes: Conceptual and methodological issues. Personality and Social Psychology Bulletin, 6, 619–634.

    CrossRef  Google Scholar 

  • Darrow, W. W., Montanea, J. E., & Gladwin, H. (2009). AIDS-related stigma among Black and Hispanic young adults. AIDS and Behavior, 13, 1178–1188.

    CrossRef  Google Scholar 

  • del Rio, C., & Sepúlveda, J. (2002). AIDS in Mexico: Lessons learned and implications for developing countries. AIDS, 16, 1445–1457.

    CrossRef  Google Scholar 

  • Derlega, V. J., Winstead, B. A., Greene, K., Serovich, J., & Elwood, W. N. (2002). Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis. Journal of Health Psychology, 7, 415–432.

    CrossRef  Google Scholar 

  • Derlega, V. J., Winstead, B. A., Greene, K., Serovich, J., & Elwood, W. N. (2004). Reasons for HIV disclosure/non-disclosure in close relationships: Testing a model of HIV-disclosure decision making. Journal of Social and Clinical Psychology, 23, 747–767.

    CrossRef  Google Scholar 

  • Duran, R. (1998). Differential consequences of serostatus disclosure in men and women. Paper presented at the annual meeting of the American Psychological Association, San Francisco.

    Google Scholar 

  • Eagly, A. H., & Chaiken, S. (2007). The advantages of an inclusive definition of attitudes. Social Cognition, 25, 582–602.

    CrossRef  Google Scholar 

  • Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1170.

    CrossRef  Google Scholar 

  • Fazio, R. H. (2007). Attitudes as object-evaluation associations of varying strength. Social Cognition, 25, 603–637.

    CrossRef  Google Scholar 

  • Galanti, G. A. (2003). The Hispanic family and male-female relationships: An overview. Journal of Transcultural Nursing, 14, 180–185.

    CrossRef  Google Scholar 

  • Glasman, L. R., & Albarracin, D. (2006). Forming attitudes that predict future behavior: A meta-analysis of the attitude-behavior relation. Psychological Bulletin, 5, 778–822.

    CrossRef  Google Scholar 

  • Gonzales, J. S., Hendriksen, E. S., Collins, E. M., Duran, R. E., & Safren, S. A. (2009). Latinos and HIV/AIDS: Examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS and Behavior, 13, 582–602.

    CrossRef  Google Scholar 

  • Instituto Nacional de Estadística. (2003). Censo Nacional de Población 2000. San José: INEGI.

    Google Scholar 

  • Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., & DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26, 315–332.

    CrossRef  Google Scholar 

  • Kalichmen, S. C., & Nachimson, D. (1999). Self-efficacy and disclosure of HIV-positive serostatus to sex partners. Health Psychology, 18, 281–287.

    CrossRef  Google Scholar 

  • Lawton, R., Conner, M., & McEachan, R. (2009). Desire or reason: Predicting health behaviors from affective and cognitive attitudes. Health Psychology, 28, 56–65.

    CrossRef  Google Scholar 

  • Lee, S. R., Kochman, A., & Sikkema, K. J. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 4, 309–319.

    CrossRef  Google Scholar 

  • Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., Cali, J., Folds, J. D., & Evans, D. L. (1999). Progression to AIDS: The effects of stress, depressive symptoms and social support. Psychosomatic Medicine, 61, 397–406.

    Google Scholar 

  • Leserman, J., Petitto, J. M., Golden, R., Gaynes, B., Gu, H., Perkins, D. O., Silva, S. G., Folds, J. D., & Evans, D. L. (2000). Impact of stressful life events, depression, social support, coping and cortisol on progression to AIDS. The American Journal of Psychiatry, 157, 1221–1228.

    CrossRef  Google Scholar 

  • MacKinnon, D. P., & Luecken, L. J. (2008). How and for whom? Mediation and moderation in health psychology. Health Psychology, 2(Suppl), S99–S100.

    CrossRef  Google Scholar 

  • Mason, H. R. C., Marks, G., Simoni, J. M., Ruiz, M. S., & Richardson, J. L. (1995). Culturally sanctioned secrets? Latino men’s nondisclosure of HIV infection to family, friends, and lovers. Health Psychology, 14, 6–12.

    CrossRef  Google Scholar 

  • Miller, M. G., & Tesser, A. (1986). Effects of affective and cognitive focus on the attitude-behavior relation. Journal of Personality and Social Psychology, 51, 270–276.

    CrossRef  Google Scholar 

  • Moskowitz, D. A., & Roloff, M. E. (2008). Vengeance, HIV disclosure, and perceived HIV transmission to others. AIDS and Behavior, 5, 721–728.

    CrossRef  Google Scholar 

  • Mutchler, M. G., Bogart, L. M., Elliott, M. N., McKay, T., Suttorp, M. J., & Schuster, M. A. (2008). Psychosocial correlates of unprotected sex without disclosure of HIV-positivity among African-American, Latino, and White men who have sex with men and women. Archives of Sexual Behavior, 37, 736–747.

    CrossRef  Google Scholar 

  • O’Cleirigh, C., & Safren, S. A. (2008). Optimizing the effects of stress management interventions in HIV. Health Psychology, 3, 297–301.

    CrossRef  Google Scholar 

  • Olson, M. A., & Fazio, R. H. (2009). Implicit and explicit measures of attitudes: The perspective of the MODE model. In R. E. Petty, R. H. Fazio, & P. Briñol (Eds.), Attitudes: Insights from the new implicit measures (pp. 20–64). New York: Psychology Press.

    Google Scholar 

  • Özer, G., & Yilmaz, E. (2011). Comparison of the theory of reasoned action and the theory of planned behavior: An application on accountants’ information technology usage. African Journal of Business Management, 5, 50–58.

    Google Scholar 

  • Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science & Medicine, 57(1), 13–24. doi:10.1016/S0277-9536(02)00304-0.

    CrossRef  Google Scholar 

  • Paxton, S. (2002). The paradox of public HIV disclosure. AIDS Care, 4, 559–567.

    CrossRef  Google Scholar 

  • Perez, D., Sribney, W. M., & Rodríguez, M. A. (2007). Perceived discrimination and self-reported quality of care among Latinos in the United States. Journal of General Internal Medicine, 3(Suppl), 548–554.

    Google Scholar 

  • Poindexter, C. C., & Shippy, R. A. (2010). HIV diagnosis disclosure: Stigma management and stigma resistance. Journal of Gerontological Social Work, 53, 366–381.

    CrossRef  Google Scholar 

  • Pulerwitz, J., Michaelis, A. P., Lippman, S. A., Chinaglia, M., & Diaz, J. (2008). HIV-related stigma, service utilization, and status disclosure among truck drivers crossing the southern borders in Brazil. AIDS Care, 7, 764–770.

    CrossRef  Google Scholar 

  • Rajabiun, S., Rumptz, M. H., Felizzola, J., Frye, A., Relf, M., Yu, G., & Cunningham, W. E. (2008). The impact of acculturation on Latinos’ perceived barriers to HIV primary care. Ethnicity & Disease, 4, 403–408.

    Google Scholar 

  • Rosser, B. R. S., Horvath, K. J., Hatfield, L. A., Peterson, J. L., Jacoby, S., & Stately, A. (2008). Predictors of HIV disclosure to secondary partners and sexual risk behavior among a high-risk sample of HIV-positive MSM: Results from six epicenters in the US. AIDS Care, 8, 925–930.

    CrossRef  Google Scholar 

  • Sanchez, M. A., Lemp, G. F., Magis-Rodríguez, C., Bravo-García, E., Carters, S., & Ruiz, J. D. (2004). The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 4), S204–S214.

    CrossRef  Google Scholar 

  • Santo, G., Puga, A. M., & Medina, C. (2004). HAART, adherence and cultural issues in the US Latino community. The AIDS Reader, 10(Suppl), S26–S29.

    Google Scholar 

  • Sayles, J. N., Hays, R. D., Sarkisian, C. A., Mahajan, A. P., Spritzer, K. L., & Cunningham, W. E. (2008). Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS and Behavior, 12, 748–758.

    CrossRef  Google Scholar 

  • Serovich, J. M. (2001). A test of two HIV disclosure theories. AIDS Education and Prevention, 13, 355–364.

    CrossRef  Google Scholar 

  • Serovich, J. M., Esbensen, A. J., & Mason, T. L. (2005). HIV disclosure by men who have sex with men to immediate family over time. AIDS Patient Care and STDs, 19, 506–517.

    CrossRef  Google Scholar 

  • Serovich, J. M., Mason, T. L., Bautista, D., & Toviessi, P. (2006). Gay men’s report of regret of HIV disclosure to family, friends, and sex partners. AIDS Education and Prevention, 18, 132–138.

    CrossRef  Google Scholar 

  • Serovich, J. M., Reed, S., Grafsky, E. L., & Andrist, D. (2009). An intervention to assist men who have sex with men disclose their serostatus to casual sex partners: Results from a pilot study. AIDS Education and Prevention, 3, 207–219.

    CrossRef  Google Scholar 

  • Shedlin, M. G., & Shulman, L. (2004). Qualitative needs assessment of HIV services among Dominican, Mexican and Central American immigrant populations living in the New York City area. AIDS Care, 4, 434–445.

    CrossRef  Google Scholar 

  • Simoni, J. M., Huang, B., Goodry, E. J., & Montoya, H. D. (2005). Social support and depressive symptomatology among HIV-positive women: The mediating role of self-esteem and mastery. Women & Health, 4, 1–15.

    Google Scholar 

  • Sowell, R. L., & Phillips, K. D. (2010). Understanding and responding to HIV/AIDS stigma and disclosure: An international challenge for mental health nurses. Issues in Mental Health Nursing, 31, 394–402.

    CrossRef  Google Scholar 

  • Steiger, J. H. (1980). Test for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251.

    CrossRef  Google Scholar 

  • Stirratt, M. J., Remien, R. H., Smith, A., Copelan, Q. O., Dolezal, C., & Krieger, D. (2006). The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS and Behavior, 10, 483–493.

    CrossRef  Google Scholar 

  • Strachan, E. D., Bennett, W. R. M., Russo, J., & Roy-Byrne, P. P. (2007). Disclosure of HIV status and sexual orientation independently predicts increased absolute CD4 cell counts over time for psychiatric patients. Psychosomatic Medicine, 69, 74–80.

    CrossRef  Google Scholar 

  • Sutton, S. (1998). Predicting and explaining intentions and behavior: How well are we doing? Journal of Applied Social Psychology, 28, 1317–1338.

    CrossRef  Google Scholar 

  • Texas Department of State Health Services. (2009). Texas STD/HIV surveillance report. Retrieved January 5, 2011, from www.dshs.state.tx.us

  • U.S. Census Bureau. (2002). Texas 2000: Summary population and housing characteristics. Retrieved July 15, 2007, from www.census.gov

  • VanOss Marín, B., Tschann, J. M., Gomez, C. A., & Gregorich, S. (1998). Self-efficacy to use condoms in unmarried Latino adults. American Journal of Community Psychology, 1, 53–71.

    CrossRef  Google Scholar 

  • Volkow, P., Villasis, A., Cornejo, P., & Sierra-Madero, J. (2007). Rapid scaling-up of access to antiretroviral therapy in Mexico: Is it better not to treat? AIDS, 21, 261–262.

    CrossRef  Google Scholar 

  • Weinrich, J. D., & Klein, F. (2002). Bi-gay, Bi-straight, and Bi-Bi: Three bisexual subgroups identified using cluster analysis of the Klein sexual orientation grid. Journal of Bisexuality, 4, 109–139.

    CrossRef  Google Scholar 

  • Zea, M. C., Reisen, C. A., & Poppen, P. J. (1999). Psychological well-being among Latino lesbians and gay men. Cultural Diversity and Ethnic Minority Psychology, 5, 371–379.

    CrossRef  Google Scholar 

  • Zea, M. C., Reisen, C. A., Poppen, P. J., Echeverry, J. J., & Bianchi, F. T. (2004). Disclosure of HIV-positive status to Latino gay men’s social networks. American Journal of Community Psychology, 33, 107–116.

    CrossRef  Google Scholar 

  • Zea, M. C., Reisen, C. A., Poppen, P. J., Bianchi, F. T., & Echeverry, J. J. (2005). Disclosure of HIV status and psychological well-being among Latino gay and bisexual men. AIDS and Behavior, 9, 15–26.

    CrossRef  Google Scholar 

  • Zea, M. C., Reisen, C. A., Poppen, P. J., Bianchi, F. T., & Echeverry, J. J. (2007). Predictors of disclosure of human immunovirus-positive serostatus among Latino gay men. Cultural Diversity and Ethnic Minority Psychology, 13, 304–312.

    CrossRef  Google Scholar 

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Acknowledgments

This research was based on data collected for the M.A. thesis of the first author. It was supported by grant 1R34 MH08674 and MH084674-S from the National Institute of Mental Health. We are grateful to the patients and staff of Centro de Salud Familiar La Fe CARE Center, Inc., for their participation and facilitation of this study. Jessica Armendariz, Teresa Frias, Carolina Lara, Chrisie Lemon, Virginia Longoria, Elsa Martin, Antonio Martinez, Miriam Pando, Tatiana Rodriguez, Giselle Sanchez, and Cesar Villareal Ramos assisted with data collection, entry, and analysis.

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Sauceda, J.A., Wiebe, J.S., Rao, D., Pearson, C.R., Simoni, J.M. (2013). HIV-Related Stigma and HIV Disclosure Among Latinos on the US-Mexico Border. In: Liamputtong, P. (eds) Stigma, Discrimination and Living with HIV/AIDS. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6324-1_11

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