1. 10/16/2009 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 o 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) 8/30/2015 2

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)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 8/30/2015 3

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)http://womenandaids.unaids.org/ 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 8/30/2015 4

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: 1. Describe and examine the relationships among knowledge, attitudes, beliefs, depression, self-esteem, and abuse. 2. Compare HIV/AIDS status, abuse, knowledge, attitudes, and beliefs among women in Baltimore and USVI. 3. 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. 8/30/2015 5

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 8/30/2015 6

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 8/30/2015 7

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 8/30/2015 8

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 8/30/2015 9

10. Reproductive History 8/30/2015 10 N = 56

11. Table 2: Comparison of Demographic Characteristics 8/30/2015 11 USVI HIV neg N = 22 USVI HIV/AIDS N = 4 Baltimore HIV neg N = 13 Baltimore HIV/AIDS N = 17 Age (M; SD) (Median) 27.95 (5.84) 27.5 25(6.27) 23.5 28.85 (7.02) 27 26.65 (6.13) 26 Gravida 2 (Median) 13 3 Education (Median) 12.45 (3.17 12.5 11.5 (2.52) 12 12.42 (2.25) 12 12.40 (2.47) 12 Unemployed Employed 12(54.5%) 10 (45.5%) 1 (25%) 3 (75%) 5 (38.5%) 8 (61.5%) 11 (67.7%) 5 (29.4%) Marital status Single Married Other 12 (54.5%) 4(18.2%) 3 (75%) 1 (25%) ___ 7 (53.8%) 2 (15.4) 4 (30.8%) 10 (58.8%) 5 (29.4) 2 (11.8%)

12. Figure 1: HIV Status by Research Site 8/30/2015 12

13. Table 3: Results of Internal Consistency using Cronbach’s alpha 8/30/2015 13 USVI N = 22 N = 4 HIV- HIV+ Baltimore N = 13 N = 17 HIV- HIV+ Instrument summary CES-D (10 items).67.23.69.84Short version of the 20 item scale. Score of 10 and greater suggests that respondent is depressed. RSE (10 items).81.88.81.83The higher the score, the higher the self- esteem. HAKABPQ (72 items) Knowledge (17) Attitudes (14) Spiritual Beliefs (12) Social Beliefs (14) Cultural Beliefs (15).67.75.78.56.64 -.30.75.98.87.66.65.85.67.73.78.82.96.83.78 The higher the scores in the subscales, the stronger the beliefs.

14. Table 4: Scores, Means and Standard Deviations 8/30/2015 14 USVI HIV neg N = 22 USVI HIV/AIDS N = 4 Baltimore HIV neg N = 13 Baltimore HIV/AIDS N = 17 RSE 0 - 30 25.32 (4.05)21.5 (5.26)23 (4.86)23.71 (4.85) CES – D 0 - 30 8.5 (4.52)12.5 (3.32)11.10(5.16)10.18 (6.81 Knowledge 1 - 68 57.55 (5.38)57 (1.42)53.30 (5.76)58.88 (6.54) Attitudes 1 - 56 44.09 (5.19)49.25 (9.54)44.56 (7.02)46.82 (6.45) Spiritual Beliefs 1 - 48 42.05 (4.65)42.25 (9.5445 (3.37)44.11 (5.42) Social beliefs 1 – 56 39.14 (6.07)40.25 (10.53)39.77 (6.15)41.47 (8.38) Cultural beliefs 1 - 60 48.86 (4.68)50.25 (5.74)48.54 (6.16)47.41 (10.38)

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 8/30/2015 15

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 8/30/2015 16

17. Table 5: Comparison of Zero Order Correlations of Variables 8/30/2015 17 Baltimore: HIV negative N = 13 RSE CES-D Knowledge Cultural Beliefs RSE ____ -.897 * -.141 -.234 CES-D _____.153.174 Knowledge _____.768* Cultural Beliefs _____ * p <.005

18. Table 6: Comparison of Zero Order Correlations of Variables 8/30/2015 18 Baltimore: HIV/AIDS N = 17 Knowledge Attitudes SoB CuB Knowledge ___.656 *.675 *.838 * Attitudes ___.838 *.651 * Social Beliefs ___.721 * Cultural Beliefs ___ *p <.005

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 8/30/2015 19

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 8/30/2015 20

21. Table 7: Abuse Items 8/30/2015 21 USVI- HIV Neg N = 22 Yes No Fisher’s Baltimore - HIV Neg N = 13 Yes No Fisher’s Physical & sexual abuse since pregnancy (3 & 5) Physical & sexual lifetime abuse (1, 2, & 4) 2 20 7 15 p =.132 2 11 7 6 p =.09

22. Table 8: Abuse Items categorized 8/30/2015 22 USVI – HIV Pos N =4 Yes No Fisher’s Baltimore – HIV Pos N = 17 Yes No Fisher’s Physical & sexual abuse since pregnancy (3 & 5) Physical & sexual lifetime abuse (1, 2, & 4) 0 4 1 3 2 20 7 15 p =.132