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.
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REFERENCES
Aldwin, V. M. (1994). Stress, coping, and development: An integrative perspective. New York: Guilford Press.
Alexander, B. K., and Hadaway, P. F. (1982). Opiate addiction: The case for an adaptive orientation. Psychological Bulletin, 92, 367–381.
Amaro, H. (1995). Love, sex and power: Considering women's realities in HIV prevention. American Psychologist, 50, 437–447.
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.
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}.
Becker, E., Rankin, E., and Rickel, A. U. (Eds.). (1998). High-risk sexual behavior: Interventions with vulnerable populations. New York: Plenum Press.
Bollen, K. A., and Long, J. S. (Eds.). (1993). Testing structural equation models. Newbury Park: Sage.
Centers for Disease Control and Prevention (2001). HIV/AIDS Surveillance Report, vn12, Atlanta, GA: Author.
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.
de Bruyn, M. (1992). Women and AIDS in developing countries. Social Science and Medicine, 34, 249–262.
De La Cancela, V. (1989). Minority AIDS prevention: Moving beyond cultural perspectives towards sociopolitical empowerment. AIDS Education and Prevention, 1, {pp141-153}.
Dohrenwend, B. P. (Ed.). (1998). Adversity, stress and psychopathology. New York: Oxford University Press.
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.
Fee, E., and Krieger, N. (1993). Understanding AIDS: Historical interpretations and the limits of biomedical individualism. American Journal of Public Health, 83, 1477–1486.
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.
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.
Folkman, S., Chesney, M. A., Pollack, L., and Phillips, C. (1992). Stress, coping, and high-risk sexual behavior. Health Psychology, 11, 218–222.
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.
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.
Gupta, G., and Weiss, E. (1993). Women's lives and sex: Implications for AIDS prevention. Culture, Medicine and Psychiatry, 17, 399–412.
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.
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}.
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.
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.
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.
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.
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.
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.
Joreskog, K. G., and Sorbom, D. (1993). LISREL VIII: User's reference guide. Mooresville, IN: Scientific Software.
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.
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.
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.
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.
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.
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.
Lazarus, R., and Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
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.
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.
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.
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171–179.
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.
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.
Navarro, V. (1990). Race or class versus race and class: Mortality differentials in the United States. Lancet, 336, 1238–1240.
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.
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.
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.
Pohorecky, L. A. (1981). The interaction of alcohol and stress: A review. Neuroscience and Bio-behavioral Review, 5, 209–229.
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.
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.
Rotheram-Borus, M. J., Coopman, C., and Ehrhardt, A. A. (1991). Homeless youths and HIV infection. American Psychologist, 46, 1188–1197.
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.
Ryan, D. (1997). New Haven on-line [Database]. New Haven, CT: Yale University, Institution for Social and Policy Studies [producer and distributor].
Saldana, D. H. (1994). Acculturative stress: Minority status and distress. Hispanic Journal of Behavioral Sciences, 16, 116–128.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Suls, J., and Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.
Tesh, S. (1988). Hidden arguments, political ideology and disease prevention policy. New Brunswick, NJ: Rutgers University Press.
Torres, J. B. (1998). Masculinity and gender roles among Puerto Rican men: Machismo on the US mainland. American Journal of Orthopsychiatry, 78, 16–26.
U.S. Census Bureau. (2000). Poverty 1998. Washington, DC: Author.
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.
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.
Williams, D. R., and Collins, C. (1995). US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.
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.
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.
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.
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.
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.
Wyatt, G. E. (1994). The sociocultural relevance of sex research: Challenges for the 1990's and beyond. American Psychologist, 49, 748–754.
Zierler, S., and Krieger, N. (1997). Reframing women's risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436.
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.
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Ickovics, J.R., Beren, S.E., Grigorenko, E.L. et al. Pathways of Risk: Race, Social Class, Stress, and Coping as Factors Predicting Heterosexual Risk Behaviors for HIV Among Women. AIDS Behav 6, 339–350 (2002). https://doi.org/10.1023/A:1021100829704
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DOI: https://doi.org/10.1023/A:1021100829704