Women’s Knowledge, Attitudes, Beliefs and Decisions about HIV/AIDS: A Cross National Comparison

1. Women’s Knowledge, Attitudes, Beliefs and Decisions about HIV/AIDS:A Cross National Comparison

2. 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 Fellow United States Virgin Islands • Doris Campbell, PhD, RN, FAAN, Co-I • 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)

3. 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

4. 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

5. 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: • Describe and examine the relationships among knowledge, attitudes, beliefs, depression, self-esteem, and abuse. • Compare HIV/AIDS status, abuse, knowledge, attitudes, and beliefs among women in Baltimore and USVI. • 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.

6. 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

7. 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

8. 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

9. Results • Total of 49 women • 30 AA; 26 Afro Caribbean women • Age ranged from 18 to 40 years • Gestational age ranged from 15 to 39 weeks • In 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

10. Reproductive History N = 56

11. Table 2: Comparison of Demographic Characteristics

12. Figure 1: HIV Status by Research Site

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

14. Table 4: Scores, Means and Standard Deviations

15. 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

16. 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

17. Table 5: Comparison of Zero Order Correlations of Variables

18. Table 6: Comparison of Zero Order Correlations of Variables

19. 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

20. 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

21. Table 7: Abuse Items

22. Table 8: Abuse Items categorized