Hispanicvs Non-Hispanic White - NCBI

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References 1. Chu SY, Peterman TA, Doll LS, et al. AIDS in bisexual men in the United States: epidemiology and transmission to women. Am JPublic Health. 1992;82:220-224. 2. Centers for Disease Control. U.S. AIDS cases reported through June, 1992. HIVI AIDS SwveilL July 1992:8(Table 3). 3. Doll L, Petersen L, White CR, Johnson ES, Ward JW, The HIV Blood Donor Study Group. Homosexually and nonhomosexually identified men who have sex with men: a behavioral comparison. Sex Res. 1992;29:1-14. 4. Earl WL. Married men and same-sex activity: a field study on HIV risk among men who do not identify as gay or bisexual. J Sex Marital Ther. 1990;16:251-257.

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5. Ames LJ, Beeker C, Rose DT. Continuing riskbehavior amongbisexually active men. Presented at the 118th Annual Meeting of the American Public Health Association; October 1990; New York, NY. 6. Beeker C, Rose DT, Ames LJ. Marginal men, mainstream risk. Poster presented at the Sixth International AIDS Conference; June 1990; San Francisco, Calif. 7. Handsfield HH, Wardell M, Goldstein L, Shriver K Screening and diagnostic performance of enzyme inmunoassay for antibody to lymphadenopathy-associated virus. J Clin MirobioL 1987;25:879-884. 8. Taylor RN, Hearn TC, Schalla WO, Valdiserri RO. Indirect immunofluorescence test performance and questionnaire results from the Centers for Disease Control

Model Performance Evaluation Program for human immunodeficiency virus, type 1 testing. J Clin MicrobioL 1990;28:17991807. 9. Centers for Disease Control. Interpretation and use of the Western blot assay for serodiagnosis of human immunodeficiency virus, type 1 infections. MMWR 1989; 38(suppl 7):S-7. 10. Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5: A Word processing database, and statisfics program for on mcrocomputers. Stone epidemil Mountain, Ga: USD Inc; 1990. 11. Lifson AR. Men who have sex with men: continued challenges for preventing HIV infection and AIDS. Am J Public Healt 1992;82:166-167.

Acculturation and Gender Differences in Sexual Attitudes and Behaviors: Hispanic vs Non-Hispanic White Unmarried Adults Babara VanOss Maruz, PhD, Jeanne M. Tschann, PhD, Cynia A G6mez PhD, and Susan M. Kegeles, PhD

Intodudion In the United States, acquired immunodeficiency syndrome (AIDS), the human immunodeficiency virus (HIV), and sexually transmitted diseases are disproportionately found in Hispanic populations.1- 4Thus, models for understanding sexual risk behaviors among these populations are urgently needed. Culturally appropriate programs must be based on a clear understanding of the antecedents of risk behaviors.5'6 Among Hispanics, acculturation-a process of adaptation in which immigrants alter their attitudes and behaviors to more closely resemble those of the host society-is an important predictor of many health-related behaviors, including cigarette smoking, alcohol use, and early sexual initiation.7-9 For certain behaviors, such as smoking and drinldng, acculturation affects each gender differently, making women more likely to adopt risky behaviors but not men.8,9 Given the traditional atfitudes toward gender roles reported among less acculturated Hispanics,10 gender and acculturation should be important factors in understanding sexual behavior among Hispanics.

The present study sought to identifY ethnic, acculturative, and gender differences both in the number of sexual partners and in condom attitudes and behaviors among a random sample of young unmarried Hispanic and non-Hispanic White adults in San Francisco.

Metods Respondents In total, 1770 respondents were interviewed from 1988 to 1989 for a research project, the AIDS in Multiethnic NeighBarbara VanOss Mainn and Cynthia A. Gomez are with the Department of Epidemiology and Biostatistics and the Center for AIDS Prevention Studies, Institute of Health Policy Studies; Jeanne M. Tschann is with the Department of Psychiatry; and Susan M. Kegeles is with the Department of Medicine and the Center for AIDS Prevention Studies, Institute of Health Policy Studies, at the University of Califormia in San Francisco. Requests for reprints should be sent to Barbara VanOss Manrn, PhD, Center for AIDS Prevention Studies, University of Califomia, 74 New Montgomery St, Suite 600, San Francisco, CA 94105. This paper was accepted April 9, 1993.

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Public Health Briefs sessment of sexual behavior in the previous 12 months, a variety of attitudinal measures, and demographic items. Acculturation was not measured directly, but the language spoken in the interview was used as a reasonable proxy.1213 The instrument was translated into Spanish using a back-translation procedure.14

Stafisfical Analytsis A series of 3x2 analyses of covariance were conducted, with ethnicity/ language and gender as independent variables, and age, education, and income as covariates. The first analysis included all respondents and used partner tpe (not sexually active; monogamous, long term; monogamous, less than 1 year; and multiple partnered) as the dependent variable. Additional analyses of covariance were based on sexually active respondents only and used condom use (always, sometimes, or never with all partners), condom attitude, or beliefs about avoiding ADDS as the dependent variable.

Result Ethnic/Language and Gender Differences in Seawl Behavior Partner type. Overall, 18% (n = 165) of respondents were not sexually active in the pastyear, 35% (n = 324)were monogamous with no new partner, 10% (n = 90) were monogamous with a new partner, and 38% (n = 359) had multiple partners. Ethnicity/language (F [2, 915] = 16.37, P < .001), gender (F [1, 915] = 30.45, P < .001), and their interaction (F [2, 915] = 7.33, P < .001) are all signifcant predictors of partner type (see Table 2).

Condom use. Condom use was low:

among the 773 sexually active respon-

dents, 58% (n = 452) reported neverusing condoms, 33% (n = 255) reported sometimes using condoms, and 9% (n = 66) reported always using condoms. Only the interaction between ethnicity/language and genderis significant (F[2, 755] = 3.12, P < .05) (see Table 3).

borhoods Study. This paper reports on 938 respondents who reported no homosexual or bisexual behavior in the 12 months prior to the interview and who self-identified as eitherHispanic(n = 398) or White (n = 540). Table 1 reports the demographics of this sample.

Procedure A complete description of the rationale for target population selection, sam-

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pling methods, and participation rates for the research appears elsewhere.11 Briefly, the target population consisted of currently unmarried men and women, aged 20 to 44, who lived in 16 census tracts of San Francisco. Each household had the same probability of being selected (1 in 6.2). All eligible respondents in the household were interviewed. The response rate was 64%. The interview included a detailed as-

Ethnic/Language and Gender Differences in Psychological Variables

Con,dom attide. Women had more positive attitudes about condom use than men (F [1, 764] = 35.80, P < .0001), and non-Hispanic Whites had more positive

attitudes than Spanish-speaking Hispanics (F [2, 764] = 4.43, P < .02). The in-

teraction between ethnicity/language and gender is not significant (see Table 4). December 1993, Vol. 83, No. 12

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Belifs about avoidingAlDS. Spanish-speaking Hispanics had the lowest belief that they could do something to avoid AIDS (F [2, 764] = 68.54, P < .0001). Women had higher scores than men (F [1, 764] = 11.02, P < .001). The interaction between ethnicity/language and gender is not sigificant (see Table 4).

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Unmarried Hispanic women reported fewer partners than unmarried Hispanic men or unmarried - non-Hispanic White men and women. On the other hand, more than one third of the Spanishspeaking Hispanic men and almost half of the English-speaking Hispanic men in this study reported having multiple partners. In traditional Hispanic culture, such "macho" behavior is expected of a man.10,15,16 Accordingly, it is often erroneous for a Hispanic woman with only one partner to consider herself at low risk. Moreover, among sexually active respondents, Spanish-speaking Hispanic women had the lowest rates of condom use. Thus, Hispanic women can be seen as both more protected and more at risk; although they reported lower sexual activity, those who were sexually active had lower rates of condom use while their male counterparts reported high rates of multiple partners. These findings form part of a larger context in which Spanish-speaking women are less knowledgeable about HIV in general than non-Hispanic White women,17 canfy condoms less often,18 and see condoms as unpleasureable. In this study, men were more likely than women to view condoms as interfering with their sexual pleasure. Respondents were fairly negative about condoms, with men, and particularly Spanish-speaking men, being most negative. Both Spanish-speaking men and women believed there was little they could do to avoid AIDS. This suggests the need for special campaigns in Spanish to address these beliefs. This random sample of unmarried adults drawn from 16 census tracts in San Francisco may be representative particularly of Hispanic and non-Hispanic Whites who are young, unmarried, and living in urban areas. However, generalization to Hispanic subgroups other than Mexicans and Central Americans should be done with caution. AIDS-related attitudes and behav-

December 1993, Vol. 83, No. 12

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iors are strongly associated with gender, ethnic group, and level of acculturation. Traditional Hispanic culture may pose particular challenges to AIDS prevention educators, especially to those attempting to reach and influence less acculturated Hispanic women. L

Ackmowledgments This research was funded by center grant MH42459 from the National Institute of Mental Health and the National Institute on Drug Abuse, and grants MH46777 and MH46789 from the National Institute of Mental Health. The authors wish to acknowledge Drs Mindy Thompson Fulhlove, Stephen B. Hulley, and Joseph Catania, who initiated and directed the AIDS in Multiethnic Neighborhoods Study, as well as the staff at the Survey Research Center, who collected the interview data. Drs Olga Grinstead and Thomas Coates provided particularly helpful comments on an earlier draft of this paper. A more detailed version of this paper is available from Barbara VanOss Main.

References 1. Centers for Disease Control. HIV/AIDS

surveillance. HIV/AIDS Surveillance. 1991;June:1-18. 2. Selik RM, Castro KG, Pappaioanou M. Centers for Disease Control Surveillance Summaries. MMWR 1988;37:1-10. 3. CentersforDisease Control. Continuingincrease in infectious syphilis-United States. MMWR 1988;37:35-38. 4. Centers for Disease Control. Syphilis and congenital syphilis-United States, 19851988. MMWRR 1988;37:486-489. 5. Coates T, Greenblatt R. Behavioral change using community level interventions. In: Holmes K, ed. Sexually Transmitted Diseases. New York, NY: McGraw-Hill; 1989:1075-1080. 6. Coates T. Strategies for modifying sexual behavior for primary and secondary prevention of HIV disease.J ConsultCltnPsYchoL 1990;58:57-69.

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7. Anashensel CS, Becerra RM, Fielder EP, Weiss NS. Onset of fertlity-related events during adolescence: a prospective comparison of Mexican American and non-Hispanic White females. Am JPublic Health. 1990;80:959-964. 8. Marin G, Perez-Stable EJ, Marin BV. Cigarette smoking among San Francisco Hispanics: the role of acculturation and gender.Am JPublic Health. 1989;79:196-199. 9. Caetano R. Patterns and problemsof drinking among US Hispanics. In: Reporl ofthe Secretary's Task Force on Black and Minority Health. Washington, DC: US Dept of Health and Human Services; 1986;7: 142-186. 10. Pavich EG. A Chicano perspective on Mexican culture and sexuality.JSoc Work Hum Sexuaity. 1986;4:47-65. 11. Fuiiilove MT, Wiley J, Fullilove RE, et al. Risk for AIDS in multiethnic neighborhoods of San Francisco: the populationbased AMEN study. West J Med 1992; 157:32-40. 12. Marin G, Sabogal F, Marin B, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hispanic JBehav ScL 1987;9:183-205. 13. Rogler LH, Cortes DE, Malgady RG. Acculturation and mental health status among Hispanics. Am PsychoL 1991;46:585-597. 14. Marin G, Marin B. Research with Hispanic Populations. Newbury Park, Calif: Sage Publications; 1991. 15. Burgos NM, Diaz Perez YI. An exploration of human sexuality and the Puerto Rican culture. J Soc Work Hum Sexuality.

1986;4:135-150. 16. Comas-Diaz L. Mainland Puerto Rican women: a sociocultural approach. J Com-

munity PsychoL 1988;16:21-31. 17. Dawson D. AIDS Knowledge and Attitudes of Hispanic Americans: Povisional Data from the National Health Interview Survey. Washington, DC: National Center for Health Statistics; 1989. 18. Marin BV, Marin G. Predictors of condom accessibility among Hispanics in San Francisco. Am J Public Heath. 1992;82:592595.

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