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AIDS EDUCATION FOR MIGRANT WORKERS: AN
EXPERIMENTAL EVALUATION OF CHANGES IN KNOWLEDGE,
ATI'ITUDES AND BH-IAVIORS

by

Milagritos Gonzalez Rivera

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements

for the degree of

DOCI'OR OF PHILOSOPHY

Department of Psychology

1992

c/~//— 5/4: 7

ABSTRACT

AIDS EDUCATION FOR MIGRANT WORKERS: AN
EXPERIMENTAL EVALUATION OF CHANGES IN KNOWLEDGE, ATTITUDES
AND BEHAVIORS

By

Milagritos Gonzalez Rivera

This research designed, implemented and evaluated two HIV/AIDS educational
interventions for the Hispanic migrant community in Michigan. The main objectives of
the educational effort were : (a) to increase knowledge about AIDS in Hispanic migrant
communities, (b) to promote the subjects exploration of their attitudes towards people
with AIDS (PWAs), (c) to motivate more openness to receive information about AIDS,
and (d) to increase awareness of the importance of AIDS education for the Hispanic
community. A participatory learning meeting was chosen as the preferred educational
strategy for the migrant families. A ﬁeld experiment was conducted comparing this
approach to didactic learning meetings and control condition meetings. Family units on
six migrant camps were randomly assigned to one of these three conditions. Two non-
equivalent control camps were studied. Quantitative data on knowledge about AIDS
and attitudes toward PWAs, homosexuals, and injection drug users was gathered with a
post-test survey. Qualitative observations were recorded about elements of the culture
and social conditions, and receptiveness and understanding of the HIV/AIDS prevention
messages. There was a follow-up on behaviors related to openness and awareness.
The study found (a) high scores on general knowledge about AIDS across all groups,
(b) signiﬁcantly higher scores on knowledge about prevention in the participatory
learning group than the didactic or control groups, (c) signiﬁcant positive correlations

between attitudes towards homosexuals, drug users and PWAs and the scores on
general knowledge about AIDS, ((1) positive correlations between attitudes toward
homosexuals and drug users, and attitudes towards PWAs. There were no signiﬁcant
differences between groups in the variables openness and awareness. Still, the
encouragement of openness to information about AIDS and the display of awareness of
the nwd to learn about the topic were captured in qualitative observations. Qualitative
observations are discussed about interaction between the cultural beliefs and the
implementation of the educational program.

Copyright by
MILAGRITOS GONZALEZ RIVERA
1992

ACKNOWLEDGEMENTS

First I want to express my gratitude to the sponsors of this research, Cristo Rey
Community Center, the Mid-Michigan Chapter of the American Red Cross, the
HIV/AIDS Prevention and Intervention Section (MDPH) and the Department of
Psychology at Michigan State University, because of their faith in this project and their
interest in the Hispanic community.

Next I need to thank my advisor, Dr. William Davidson and committee members,
Dr. Anne Millard, Dr. Galen Bodenhausen, and Dr. Marilyn Rothert for their advice,
support, and patience during this fast pace process and for their willingness to teach me
what I needed, and to learn with me from this research.

I need to mention the "victims” of this project, my family and friends: my friend,
boss and companion during the visits to the camps, Robert Patiﬁo, and his family who
all participated in this project in ways they never expected to be involved; my parents
Orlando and Vivian, and my sisters, Chaqui and Lourdes who did their best to support
me and to ”panic" with me when there were problems; and my friends Olga Hernandez
and Waded Cruzado who have always been there for me and never lost their faith in
this project. Having this team of people supporting and pressuring me to achieve, is
probably one of God's ways to more directly say when He wants me to do
something.

But more than to anyone else I owed this project to the migrant families who let me
interrupt their lives and routines visiting them, setting up a tent in their yards and
inviting them to come to help me learn if I could be of help. What I am reporting in this
dissertation belongs to them and it was their decision to let me see it and record it. I
will show my appreciation of what they did for me communicating what they teach me
to people that can work and provide services to Hispanic migrant families.

TABLE OF CONTENTS

CHAPTER I: INTRODUCTION
CHAPTER II: AIDS AND THE GENERAL PUBLIC
AIDS: Origin and Development
The HIV/AIDS Epidemics
Knowledge and Attitudes about AIDS
CHAPTER III: AIDS AND THE HISPANIC COMMUNITY
Knowledge, Attitudes and Behaviors of Hispanics about AIDS
Special Issues on AIDS Education for the Hispanic Population
Attitudes Toward Homosexuals
Cultural Values
HIV/AIDS Prevention
HIV/AIDS Prevention Programs
Theories of Prevention
Summary and the Need for Further Research
An HIV/AIDS Prevention Program for Hispanic Migrant Families
CHAPTER IV: METHOD
Setting
Research Participants
Sample
Research Design
Procedure
Participatory taming group
Didactic Learning Group

iv

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20
20
27
28
31
38
38
43
53

7O
7O
72
75
78
79
82
87

Control Group 87

Measures 88
The Questionnaire 88
The Qualitative Observations 95

CHAPTER V: RESULTS 97

Quantitative Findings . 97
Knowledge about AIDS 97
Attitudes Towards People with AIDS 102
Knowledge about AIDS and Attitudes Towards People with AIDS 103
Attitudes towards People with AIDS and Behaviors Related to 103

Openness and Awareness

Attitudes Towards Homosexuals and Drug Users 105
Openness to Information about AIDS, and Awareness of the 108

Relevance of Educating the Community

Summary of Quantitative Findings 109

Exploratory Analysis 109

Age, Education, and Knowledge about AIDS 110

Age, Education, and Attitudes 110

Number of Previous Sources of Information about AIDS 11 1

Relationship Between Responses about Behaviors and the 11 1
Actual Behaviors

Relationship Between the Behavioral Cards and the Actual Behaviors 112

Regression of Independent Variables into Knowledge about AIDS 113
Summary of Exploratory Analysis 114
Qualitative Observations 116
Satisfaction with the Educational experience 116

Sex Roles 119

Women's Reactions and Behaviors
Men's Reactions and Behaviors
Young Couples (17 to 25 years old)
Older Couples (26 years old or more)
Cultural Beliefs

General Health Values

Frequently Asked Questions
Summary of Qualitative Observations

CHAPTER VI: DISCUSSION

Research Questions

Summary of Findings

Limitations of the Study

Issues for Further Research

Conclusions and Recommendations
Bibliography
Appendix A: Format and Content of the Invitation
Appendix B: Key Messages Provided in the Presentations
Appendix C: Summary of Content of Public Service Advertisements
Appendix D: Consent Forms
Appendix B: English and Spanish Versions of the Questionnaire
Appendix F: Examples of the Color Coded Cards
Appendix G: Tables

120
122
123
124
124
126
127
128

131

131
143
149
150
152
157
162
163
164
165
167
175
178

LIST OF TABLES AND FIGURES

Figure 1: Elements of the Health Beliefs Model affected by
social inﬂuences and information about HIV/AIDS.
Figure 2: Elements of the Theory of Reasoned Action affected
by social inﬂuences and information about HIV /AIDS.
Figure 3: A model of health behavior through the promotion of
openness and awareness.
Figme 4: Model for the prevention program implemented.
Figure 5: Research Design.
Figure 6: Relationship Between Variables.
Table 1: Number of Migrants Invited, and Attendance by Gender
and Condition.
Table 2: Mean Age and Education by Conditions.
Table 3: Distribution of Responses on Demographic Characteristics
by Condition.
Table 4: Purpose of the Visits to the Camps.
Table 5: Variables and Sections of the Questionnaire.
Table 6: Item-total Correlation for Scores on Knowledge about Prevention.
Table 7: Item-total Correlation for Score on Attitudes Towards People
with AIDS.
Table 8: Item-total Correlation for Score on Attitudes Towards Homosexuals.
Table 9: Item-total Correlation for score on Attitudes Towards Drug Users.
Table 10: Average Score on Knowledge about AIDS on each group.
Table l 1: ANOVA of knowledge about Prevention by Condition.
Table 12: ANOVA of score on Attitudes Towards People with AIDS.

55

56

58

65
78
146
75

76
76

80
89
9O

92

93

100
102

13bit
Tabb

Tabi
Tab!
Tab

Tab

Table 13:
Table 14:

Table 15:
Table 16:
Table 17:
Table 18:

Frequencies on openness and awareness.

Mean Group Score on Attitudes Towards Homosexuals and
Drug Users.

Relationship Between Age and Education, and Attitudes.
Regression on General Knowledge about AIDS.
Regression on Knowledge about Prevention.

Sex Role Behavior During the Presentations.

104
105

110
114
114
129

CHAPTER I
INTRODUCTION

De la Cancela (1989), Singer, Flores, Davison, Burke, Castillo, Scanlon and
Rivera (1990), and Marin and VanOss Marin, (1991) advocate for research on the
social issues faced by Hispanics living in the United States. Marin and VanOss Marin,
(1991) identify "Prejudice, discrimination, institutional racism, low academic
achievement, health problems, lack of access to public services, poor housing,
underemployment and unemployment" (p.2) among the unresolved topics that the
limited number of social researchers focusing in the Hispanic community have to study.
Recently, an even more critical and frightening concem—related to all the other social
issues-~has been added to the list. It is the high rate of Human Immunodeﬁciency Virus
(HIV) in the Hispanic population in the United States; twice as high as among whites
non-Hispanics (Centers for Disease Control, 1989). Singer and his colleagues (1990)
reported that in 1988, even thought Hispanics constituted about 8% of the U.S.
population, they accounted for 15% of Acquired Immunodeﬁciency Syndrome (AIDS)
eases reported to the Centers for Disease Control. Moreover, Selik, Castro and
Pappaioanou (1988) found out that the risk of AIDS is higha in African Amerieans and
Hispanics than in whites. The Center From Disease Control reports that 108,788 of the
cases of HIV infection reported were whites, 58,791 were Black and 33,204 Hispanics
(Michigan Department of Public Health, J an. 1992). In Michigan the cumulative rates of
HIV (cases per 100,000 of the population in that group) are 16.5, 105.9 and 39.4 in
whites, blacks and Hispanics respectively (Michigan Department of Public Health,
Jan.1992). Even though the data shows that people of color (speciﬁcally blacks and
Hispanics) have been disproportionately affected by the epidemic, there is neither

enough research on the reasons for these high rates of infection , nor enough

information regarding the preventive interventions that will work best in Hispanic or
non-Hispanic communities.

The characteristics of the HIV (Human Immunodeﬁciency Virus) and AIDS
(Acquired Immunodeﬁciency Syndrome) epidemic are so different from those of any
other venereal disease (e.g., syphilis) that the research community has not identiﬁed the
most effective psychological, educational, social or medical intervention to control the
spread of the HIV infection. Some of these characteristics of the HIV epidemic are: (3)
AIDS is a fatal disease which could induce great fear among those who correctly or
incorrectly perceived themselves to be at risk; (b) the long latency period from initial
infection to development of symptoms—sometimes more than ﬁve years—(Des Jarlais, &
Stepherson, 1991) which makes it impossible for the general public to identify who is
infected; (c) HIV is transmitted through behaviors such as unprotected receptive anal
intercourse, sharing of needles between drug users, or unprotected vaginal intercourse
(Morin, 1988) which produce pleasurable and have been part of most society's sexual
practices ; (d) the need for immediate prevention initiatives (and services) appears to
outweigh the need for research on effectiveness, and consequartly, many different
programs are taking place, but there is little evaluation research being conducted (on
lack of funding for experimental research on the educational methods to change risk
behaviors see,Watkins, 1988) ; and (c) all the HIV prevention messages are
controversial, making it difﬁcult to obtain government and public support for the
implementation of HIV/AIDS prevention programs.

Otha' obstacles limiting the effectiveness of prevention strategies are: (a) lack of
knowledge about the attitudes and behaviors of speciﬁc populations, which makes it
difﬁcult to design programs for them (Bakeman, McCray, Lumb, Jackson, & Whitley,
1987; Stall, Coates, & Hoff, 1988; Singer, Flores, Davison, Burke, Castillo, Scanlon,
& Rivera, 1990;Marin & VanOss Marin, 1991); (b) the ethical dilemmas faced by the

government and health educators because of the potential conﬂict of some programs
with commonly accepted principles of biomedical ethics--beneﬁcence, justice and respect
for autonomy (Walters, 1988)-,the explicit presentation of information about AIDS risk
behaviors, and with mandatory HIV testing (Eisenberg, 1989); and, (d) the stigmas
attached to AIDS because of its evocation of death and illness-the "fundamental anxiety"
we repress, according to Schutz (cited in Herek and Glunt, 1988)-and especially when
linked with the groups that have been identiﬁed at highest risk of developing AIDS:
homosexuals, drug users, blacks and Hispanics (Herek & Glunt, 1988; Sabatier,
1988).

The moderate success of preventive efforts due to the barriers listed above,
supports the logic of Batchelor' s (1988) statement about the causes of the spread of the
disease, "AIDS is caused by a virus, but clearly it is indirectly being spread by fear,
denial, and prejudice” (p. 853). It is expected that fear, denial and prejudice could be in
some ways diminished by educational efforts which are the main strategies in prevention
of illness like AIDS. Some of these reactions are probably relawd to the confusing
information about what AIDS is, its origin and its ways of transmission.

Unfortrmately, the lack of information about AIDS is more common among blacks
(Hardy, 1990) and particularly Hispanics (Dawson and Hardy, 1989), whom also
show higher cumulative incidence of AIDS than the White non-Hispanic adults
(Bakeman, McCray, Lumb, Jackson, & Whitley, 1987; Torres, R. E., 1990).

Given the characteristics of the HIV epidemic, and the barriers to prevention
programs many researchers suggests that, in the absence of a vaccine to prevent the
HIV, the only way to control the epidemic will be educating the population about the
risk factors (Fisher, 1988; Eisenberg, 1989; Sabatier, 1988; Baum & Nesselhof, 1988;
Crawford, Jason, & Salina, 1990; Peterson, & Marin, 1988; Ostrow, 1989).

Thee is a large Hispanic community in Michigan (mostly migrant workers). In a
recent report, providers of services to this community identiﬁed health as the second
most important problem of Hispanic migrant workers (Rochin, R.I., Santiago, A.M.,
& Dickey, K.S., 1989). Reports about health of Hispanics in the Midwest also show
that the cumulative incidence of AIDS is much higher than the cumulative incidence for
white non-Hispanics in Michigan: 20.3 vs. 9.9 per 100,000 (Torres, R., 1990a, 1990b)
and 39.4 vs. 16.5 per 100,000 (Michigan Department of Public Health, January, 1992).
Lafferty (1991) interviewed a convenience sample of 411 eastern stream migrant farm
workers and found that : (a) 36.8% of the men had two or more sexual partners during
the previous year, (b) 25% reported having multiple partners without the use of a
condom, (c) anal intercourse was present at insigniﬁcant levels, (d) 18% reported having
intercourse with women who sell sex, (e) 2.9% said they used illegal drugs, and (f)
20.3% reported self-injecting antibiotics and vitaminsufrom which 3.5% reported
having injected those with a shared needle. Also, Selik (1989) reported that the risk of
AIDS for Hispanics in the Midwest was three times higher than the risk for non-
Hispanic Whites. If education is a key to AIDS prevention, it is critical to note thata
survey about knowledge, attitudes and behaviors of Hispanics served by the Cristo Rey
Community Center in Lansing (Special Ofﬁce on AIDS prevention and Cristo Rey
Community Center, 1990), showed high percentages of people answering incorrectly to
questions about AIDS and about ways to prevent it.

Intaestingly, different studies have found that the Hispanics get their information
about AIDS mainly from the television and that a large proportion of the samples
reported having heard about AIDS (Dawson, D.A., & Hardy, A.M., 1989). Why is
theresuchadifference intheknowledgeandattitudesaboutAIDSintheI-Iispanic
community when compared to other groups? Stipp and Kerr (1989) suggested that
negative attitudes toward homosexuals constrain the ability of the media to communicate

is It
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the

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information about AIDS to the general public. More speciﬁc to the Hispanic
community, it has been hypothesized that the culture and beliefs of this group have not
been taken into consideration in the design of educational efforts and therefore, it is
difﬁcult for Hispanics to relate with the information and/or to follow the advice (Mays,
V.M. & Cochran, SD, 1988). Some elements of the Hispanic culture and beliefs that
have been suggested for consideration in the design of programs are: religiosity,
sexuality, "familismo', "simpatia" script, "respeto"--also discussed as ”power
distance” by Marin and VanOss Marin, 1991", ”machismo", and "marianismo". Also,
it has been suggested that AIDS education efforts should not be limited to passive
dissemination of information techniques, and that participatory approaches could be
more effective (Crawford, Jason, & Salina, 1990).

The lack of information on the sexual behaviors of Hispanics and other people of
color as well as a lack of information regarding their attitudes toward prevention
behaviors makes the design of prevention programs for these communities very
uncertain. Howeve, the high and fast rate of HIV contagion among people of color
does not allow researchers to conduct the studies on attitudes, cultural values,
socioeconomic inﬂuences, and other social conditions while waiting to, proceed to
design and implement prevertion programs. The research presented in this dissertation
is the result of an exploratory ﬁeld comparison of two HIV/AIDS education methods
implemented with Hispanic (Mexican) migrant communities in Michigan during the
Summe' of 1991. Quantitative data on knowledge about AIDS and attitudes toward
people with AIDS (PW A), homosexuals, and injection drug users was gathered to test
the effectiveness of educational interventions. Further, qualitative observations wee
recorded to study possible relationships between elemerts of the culture and social
conditions, and receptiveness and understanding of the HIV/AIDS prevention
messages. Chapter 11 (AIDS and the general public) will discuss: the origin and

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development of AIDS and knowledge, attitudes and behaviors about AIDS in the
gereral population. Chapter III (AIDS in the Hispanic population) will discuss (a)
knowledge, attitudes and behavior of Hispanics concerning AIDS, (b) special issues on
AIDS education for the Hispanic population, (c) HIV/AIDS prevention, and (d) the
rationale for an HIV/AIDS prevention program for Hispanic migrant families in
Michigan. Chapter IV describes the method used in the implementation of a ﬁeld
comparison of two education programs about AIDS. Chapter V describes the results of
the comparison and chapter VI discusses the results and proposes questions for further
remix. The literature review covers the peiod since 1971 until 1991. The sources
reviewed during the literature search were mainly, the PsyInf compute database, the
”Index to Health Information: A Guide to Statistical and Congressional Publications on
Public Health”, a computer search of the "Index Medicus" (last 10 years), a computer
search on "Health" (last ﬁve years), and the ”Social Sciences Index".

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CHAPTER II
AIDS AND THE GENERAL PUBLIC

This chapte provides background information on the AIDS epidemic and knowledge,
attitudes and behaviors of the general public about AIDS. The following sections of this
chapter discuss: (a) the origin and developmert of the HIV/AIDS epidemics, and; (b)
knowledge and attitudes of the general public about AIDS.

AIDS: Origin and Development

Sabatier (1988) provided a deﬁnition of AIDS, "AIDS is not really a disease, but a
syndrome of opportunistic infections which strike when immune functioning has been
impaired by HIV" (p. 35). Batchelor (1988) provided a very simple explanation of
what the AIDS virus does to the organism. He explained that HIV does not destroy the
immune system, but rather damages it by infecting and killing the T4 "helper/induce”
white blood cells, which are supposed to notify the B-cells (the ones in charge of
attacking viruses) when they should attack a virus present in the body and wher they can
cease the attack Theefore, the body becomes susceptible to infections and canoes;
these infections are the so called ”opportunistic infections,” because they develop in a
body contaminated with HIV.

In addition to the physical symptoms that each of the infections associated with the
syndrome would cause in the person with AIDS (PWA), a neurological syndrome
called AIDS—dementia has been identiﬁed. Price, Brew, Sidtis, Rosenbaum, Scheck and
Clearly (1988) described the characteistics of AIDS-dementia as including
abnormalities in cognition, motor performance and behavior. This syndrome is thought
tobetheoutcomeofthedirecteffectoftheviruson thebrain. Also, sincePWAs face
many sources of stress, AIDS has beer found to affects psychosocial variables such as

vocational and social functioning, self-esteem, mood states, physical abilities, family
and other relationships, and sexual function (Narnir, Wolcott, Faozy & Alumhaugh,
1987). Howeve, it is also known that people infected by the HIV could be entirely
asymptomatic, only a fraction have the more serious syndrome of AIDS, and it is a
virus very difﬁcult to contract (Watkins, 1988). This observation is true since AIDS is
only transnritted through direct contact with contaminated blood, vaginal cervical
secretions or semen (Osborn, 1986). Research is currently being conducted identifying
possible co—factors or variables that could precipitate the development of AIDS in
subjectsinfected with theHIVorofvariablesthat will makea subject morevulnerable
to develop HIV infection. Among the factors already identiﬁed are othe' non-HIV
infections that will increase the likelihood of infection following exposure, or increase
HIV virulency among those people who are already HIV infected (Koop, 1986). Also,
environrrrental factors such as malnutrition, are also being hypothesized as potential co-
factors (Bakeman, McCray, Lumb, Jackson, & Whitley, 1987).

In spite of the great inteest and effort of the research community, there has not
been success in the identiﬁcation of the origin of the HIV. In his book, Sabatier
(1988) described three theories about the possible origin of the virus. First, that it may
develop from an old human disease previously found only in an isolated group having
immunity; when the virus was transmitted to someone from another ethnic group, it
became a disease of deathly consequences. The second theory is that the virus
developed from a virus in monkeys. The third theory is that it was developed purposely
or accidentally in a laboratory. Sabatier explained that there is some evidence for the
ﬁrst theory, since thee are still some very isolated groups-«especially in Central Africa.
Sabatie thwghtthatthesewndtheoryisnottooprobableanymorebecausethe
scientists who identiﬁed a virus similar to the HIV in monkeys, reported in 1988 that
theyhadmadea mistake. Thethirdtheoryisdifﬁculttoconﬁrmordiscorrﬁrmusing

scientiﬁc methods. Even though the origin of the syndrome has not been identiﬁed, the
efforts to ﬁnd it has lead to the discovey ofpossible AIDS cases in patients as early as
1959 (Sabatie, 1988). Part of the early history of the disease lead to the unfortunate
stigmatimtion of Aﬁican blacks and Haitians, as potential original disseminates of the
HIV virus.

I] III]! IEIESE 'l .

Cases of AIDS began to be noticed in the late 1970's and early 1980's in different
locations, such as, Belgium, France, Haiti, the U.S., Zaire and Zambia (Sabatier,
1988). Seveal articles (Morin, 1988; Eisenberg, 1989) identiﬁed the onset of AIDS
according to the Center for Disease Control's report of the ﬁrst case in June, 1981. It
has been also argued that press coveage for AIDS was inadequate until heterosexual
membes of the society started to suffer the syndrome (Herek & Glunt, 1988).
Researches have presented eviderce that this pheromenon could be attributed to
prejudice against homosexuals (Herek & Glunt, 1988).

Mann (1988) explained that AIDS evolved in three distinctly separated epidenrics:
an epidenic of HIV infection beginning in the mid-1970's, the epidemic involving the
case surveillance deﬁnition of AIDS, and a third one involving the social, cultural,
economic and political reactions to AIDS—the latte being studied recently.

Three diffeert pattens of HIV infection have beer identiﬁed according to
geographic locations, as described by Eiserberg (1989):

1. The pattern of transmission in North Ameica, Western Europe, Australia, New

Zealand, and urban areas of Latin America, which is basically transmission among

homosexual and bisexual men, and through blood among injection drug users (IDUs).
2. The pattern of transmission of HIV found in Sub-Saharan Africa and the Caribbean
which consists mainly of heterosexual transmission through blood transfusions.

10

3. The patten of transmission found in North Aﬁica, the Middle East, Easten Europe,
Asia and the Paciﬁc, which is characteized by low rates of infection and primarily
through exposure to imported blood products, or through sexual contact with
travelles from areas with patterns I and 11.

Crawford, Jason and Salina (1990) reported estimates of more than 1.5 million
people in the United States infected with the HIV virus (seopositive) who are probably
asymptomatic, but capable of transmitting the virus to others. It has been suggested that
people of color (blacks and Hispanics) have a higher rate of AIDS than the whites, but
still have the same rate of HIV infections. It is further suggested that environmental
conditions make them more vulnerable to develop the syndrome. Nevertheless,
Bakeman, McCray, Lumb, Jackson & Whitley (1987) reported that higher rates of HIV
have been found among blacks and Hispanics than among whites.

In terns of patients idertiﬁed suffeing the development of AIDS, Eiserberg
(1989) reported that in July 1988, 100,000 cases of AIDS had been reported to the
World Health Organimtion, which at that time estimated the actual cumulative total as
probably of about 250,000 cases. In the United States, homosexuals were the ﬁrst
group identiﬁed as suffering of AIDS-especially in New York, Los Angeles and San
Francisco (Batchelor, 1988). After 1982, othe concerns regarding AIDS started to
emerge because heteosexual contact and shared needle use were also identiﬁed as
sources of transmission (Morin, 1988). On the other hand, the discovery of high rates
of AIDS among Haitian imnrigrants to the United States was intepreted by some
researchers and policy makers as an increased potential for spreading AIDS among the
heterosexual community (Batchelor, 1988).

Bakeman, McCray, Lumb, Jackson, and Whitley (1987) analyzed a data set ﬁom
the Center of Disease Control (CDC) on 33,720 cases of AIDS (as of 1986). They
foundthatwhitemenaccountedfor64% oftheadultmalecasesofAIDS reportedto

11

CDC and black , Hispanic, and other racial/ethnic groups, accounted for 21%, 14% and
1% of AIDS cases, respectively. In 1988, Siegel reported that, as of 1987, 70% of the
AIDS cases in heterosexual males wee accounted for by blacks and Hispanics. In the
United States 108,788 cases of AIDS in whites, 58,791 in blacks and 33,204 in
Hispanics, have been reported to the Certer for Disease Control (Michigan departmert
of Public Health, January 1992). In 1987, Bakeman and his colleagues reported the
transmission groups for males and females of three diffeent racial/ethnic groups. The
largest transmission group for whites, blacks and Hispanics was that of homosexual or
bisexual men (83% of white men with AIDS, 50% of black men, and 53% of Hispanic
men). The second largest transmission group for black (34%) and Hispanic (34%)
males includes the heterosexual men who used injection drugs (IDs). The white males
contaminated through IDs constitute a 4% of the adult, white male population with
AIDS. Also, 8.5%, 8.7% and 7.6% of white, black and Hispanic males with AIDS
were identiﬁed as both, IDUs and homosexuals or bisexuals. More recertly, Singer and
his colleagues (1990) reported that the percentages of cases of HIV infection among
Hispanics were almost the same in the IDU category as in the homosexual/bisexual
contact category. They also reported that the pecentages of cases of exposure through
heteosexual contact are similar for Hispanics and whites and far below the percentages
for blacks, and that fewe' Hispanics have been exposed to HIV through blood
transfusions.

Researchers (Bakeman et.al., 1987) identiﬁed a strong correlation between the
numbe of male heterosexual IDUs with AIDS and the number of AIDS cases among
women in the three racial/ethnic groups (the correlation was .95). Moreove, when they
computed the correlation betweer female and male cases of AIDS, in geneal, the
correlation was just .389. The study found that black, white and Hispanic women
accounted for 49%, 30%, and 21%-of the female—cases ofAIDS reported to CDC.

12

The major source of transmission for all three racial/ethnic groups of womer was ID
use (61% blacks, 41% whites and 55% Hispanics) and, the second one, heterosexual
contact with IDUs.

Wher Bakeman, McCray, Lumb, Jackson & Whitley (1987) compared the
cumulative incidence of the disease in whites, blacks and Hispanics-the cumulative
index is the number of cases reported to CDC since 1981 per million relevant
population— they found that AIDS has affected blacks and Hispanics
disproportionately. The CI index for black and Hispanic men were 2.6 and 2.5 times
higher than the rate for white men, and the C1s for black and Hispanic women were,
respectively, 12.2 and 8.5 times higher than the CI for White females. Interestingly,
Selik, Castro, Papaioanou and Buchler (1989) found variations in the HIV risk factors
betweer different Hispanic groups in the United States--deperding on the country of
origin. In each region of the United States, the cumulative index of AIDS in
heterosexual intravenous drug users/abuses in Puerto Rican born persons was higher
than in any other Hispanic group. Also Puerto Rican-born pesons were the only
Hispanic group in whom most of the cases of AIDS were reported from heterosexual
intraverous drug uses/abuses as opposed to the highe percentages of infection in the
Cuban community who are classiﬁed in the homosexual/bisexual category of exposure.
Bakeman, McCray, Lumb, Jackson & Whitley (1987) analyzed variables that have been
hypothesized as related to the higher rates of inciderce in the black and Hispanic
population compared to the whites; the argumerts are listed and their criticisms of each
one are summarized:

1. More IV drug users among blacks and Hispanics: This argument was
not supported by their analysis because when they discounted the IV drug users and
computed the C13 for the three groups, the incidence of AIDS was still 1.7 times higher
for black and Hispanic men than for white men. Nevertheless, needle sharing is a

13

major factor for the high incidence of AIDS in people of color (43% and 42% of AIDS
cases in black and Hispanic men, respectively, resulted from nwdle sharing).

2. Undercounting of people of color in the census: This argument was
not supported by their analysis and, even if it were true, for the black CI to equal the
white C1 the number of black rrren in the population would have risen to 21.7 million
instead of the actual 8.3 million: an unlikely miscalculation.

3. Undercounting of AIDS cases in whites: Again, the argument was not
supported by the data because, if the AIDS cases in whites were undecounted, there
would have to be 50,359 cases of AIDS in this group—instead of the identiﬁed 19, 483--
in order to have the CI of AIDS cases that blacks have, another unlikely error of
undercourrting.

4. AIDS is more prevalent in large cities and people of color are
more likely to live in large cities: Researchers compared the CIs of whites and
peopleofcolorseparately forurbanandotherareasandratesofAIDS werehigher for
the people of color in both situations. Theefore, the argument that the highe' rate of
AIDS cases-Wher compared to the rates for whites-was due to the fact that people of
color tend to live in cities wee the conditions promote the spread of the disease, was not
supported.

5. Sexual behavior: The number of homosexual or bisexual cases of AIDS in
black and Hispanic men was 1.7 times higher than for white men. In this regard, the
authors discussed that little is known about the sexual behavior of blacks and Hispanics,
and that it is possible that members of these groups engage in unprotected sexual
behaviors, and/or that some men who engage in homosexual behavior fail to think of
themselves as homosexual (theefcre at risk, according to the media), if they have the

active role during inte'course.

14

6. Environmental factors that increase stress are more prevalent
among people of color: The authors suggest that it could be that differences in
nutritional pattens and coping skills make the people of color more likely to develop
HIV infections or AIDS, if the subject has beer exposed to HIV. This happens because
anything that weakers the immunological system (co-factors) makes the individual more
prone to progress from the HIV infection to AIDS, and nutritional patterns, as well as
stress, alcohol, and other infections are consideed co-factors (Bakeman, McCray,
Lumb, Jackson, & Whitley, 1987).

Knowledge and Attitudes About AIDS

If Bakeman, McCray, Lumb, Jackson & Whitley ( 1987) would have posited in
their article the expected trend for the incidence of AIDS in the next years, they
probably would have mentioned that it is expected that the diffeence in rates of AIDS
cases between racial/ethnic groups and whites is likely to increase. One of the
hypothesized reasons for such an increase in the already large difference, is that maybe
the educational efforts with whites are been more effective than the ones targeted at
people of color. This appears to be because there is more knowledge about whites'
attitudes, knowledge and behaviors,which facilitates the design of programs. Moreover,
the cultural beliefs of Hispanics and blacks are not well undestcod by policy makers in
the United States and have not been considered in the design of some public campaigns
for AIDS prevention (Mays, & Cochran, 1988; Singer, et.al., 1990).

Studies of attitudes, knowledge and behaviors about AIDS in the general
population and in Hispanics provide information on elements that should be considered
while educating Hispanics about AIDS. It is also apparent that some segmerts of the
population have been receiving more education about AIDS than others.

15

In 1987, Singer, Rogers and Corcoran reported that since the ﬁrst poll about
AIDS (1983) until 1986 there wee 23 surveys—almost all of them nationwide. The
summary of these 23 polls is organized according to six dimensions: (a) awareness of
the disease; (b) concen about AIDS, both as a medical problem in gereral and as a
problem for one's own health; (0) perceptions about the likelihood of its spread; (d)
beliefs about methods of transmission; (e) attitudes toward measures for protecting the
public; and, (t) reported changes in ones' own behavior to avoid exposure. The authors
identiﬁed that between 1983 and 1986 the numbe' of people who said that they had
heard about AIDS increased from 77% to 99%. Thee was just a slight difference in the
percentages of awareness about AIDS as a function of education. Even though those
with least amormt of education wee found to be least likely to be informed about AIDS,
the diffeences were not large.

It was found that those at greater risk are most likely to express concern about
AIDS. Some of the groups that showed greater than average concen about AIDS were:
young people, those under 30 years old, single people, people living in urban areas, and
blacks (who wee also most likely to have changed their behavior).

The polls revealed that people could accurately identify the extreme modes of
transmission of HIV (semen, blood and vaginal cervical secretions), but were confused
about intermediate behaviors (tears, saliva). The confusion was especially evidert
arrrong people of color (in this case the researcher reported data on all non-white groups
combined), since a large number of them thought that AIDS could be transmitted
through kissing, sharing a drink glass, and/or eating food prepared by someone who has
AIDS. Unfortunately, an increase in accuracy overtime is not reﬂected in the data from
the polls analyzed.

When the attitudes about government regulation regarding AIDS and attitudes
toward people with AIDS wee evaluated the following wee found, 1) a decrease in the

mm

m

.w

16

percertages of people indicating that they will ﬁght to have a child with AIDS removed
from the school, and 2) increases in the number of people reporting that school
employees with AIDS should be taken off the job. later, this issue will be revisited
because it could be related to attitudes toward homosexuals and drug uses and the
possible relation of these attitudes with attitudes towards people with AIDS.

Only a slight increase in the number of people reporting changes in their behavior
as a result of AIDS was captured in the data from polls between 1983 and 1986.
Another main ﬁnding reported by Singer, Roger and Corcoran (1987) was a small but
steady increase in the percent in the people saying that they avoided homosexuals,
stayed away from places where homosexuals might be present, and refused elective
surgery that would require blood transfusions.

Anothe major source of information on knowledge and attitudes about AIDS in
the general population is the report by Hardy (1990), based on a set of questions
included in the National Health Interview Survey (NHIS) of the National Certer for
Health Statistics. Hardy's report is based on data of the period from October 1989 until
December 1989. The information about AIDS gathered in the NHIS is classiﬁed in six
areas: (a) sources of AIDS information; (b) self-assessed levels of AIDS knowledge; (c)
basic facts about the AIDS virus and how it is transmitted; (d) blood donation and testing
expeierce; (e) awareness of and experience of the blood test for HIV; (t) personal
acquaintancewitlrpersons with AIDSorHIV; and, (g) willingnessto takepartina
proposed national seoprevalence survey.

Clearly, the most common source of information about AIDS is television: 80%
of the sample reported that they saw public service advertisements (PSA's) about AIDS
on television during the month before the survey, as opposed to 45% who reported
having heard information on the radio. Also, the proportion of people who had seen or
heard the information about AIDS, increased with years of education. In terms of other

Clem

havi

duri

AII

adu

bl

17

demographic characteristics, black adults were more likely than white adults to report
having heard radio PSA's (51% compared to 44%) and read brochures (29% vs. 19%)
during the last month. For all groups, the proportion who reported over having read
AIDS brochures was very similar and low. In addition, females wee identiﬁed as more
likely than males to have read the AIDS brochures. Sixty-three percert (63%) of the
parents said their children received information about AIDS in school, and 61% of the
adults said that they had eve discussed AIDS with a friend or relative.

Changes in the levels of self-assessed knowledge about AIDS were not found in
the data from 1989 (68% claimed to know at least something about AIDS). The
proportion of white and black adults that reported that they knew a lot about AIDS was
similar (25 and 23%, respectively), but the proportion of black adults which reported
that they knew little or nothing about AIDS was higher than in white adults (41% vs.
30%). Education and age of the subjects also had an effect in the levels of self-assessed
knowledge, with people with less than 12 years of education and people 50 years of age
or more claiming little or no knowledge about AIDS.

The assessment of knowledge showed that accurate information about the three
major modes of transmission was high in all demographic groups. In gereral, AIDS
knowledge increased with education, and was higher for people less than 50 years old
than for those 50 years or over. Hardy also reported a small differerce in the frequercy
of correct responses about AIDS between black and white adults.

The proportion ofpeople who had heard about the blood test for the AIDS virus
was high and remained unchanged throughout 1989 (74%). Once again, the proportion
of people who have more information about AIDS—in this case, those who had heard
about blood testing--was highe' for: white than for black adults; among people with 12
or more years of education; and, among adults younge' than 50 years old. In regard to
blood testing for AIDS, only 21% reported that they had beer tested for AIDS; the

18

majority of them as part of blood donation (67%) and only 19% sought the testing
voluntarily.

Using condoms and keeping monogamous relationships were consideed effective
prevention methods by all subgroups (71% or greater, and 74% or greater respectively).
The proportion who identiﬁed monogamy as an effective prevention method, was
greate among black adults (from 70% to 79%). The researchers did not report if this
difference is statistieally signiﬁeant.

The proportions of people reporting that they felt that they had no chance of having
HIV infection (83%) and of people reporting that they felt that they had no chance of
getting AIDS (77%), did not show too much change over the data collection period
(Octobe 1989 to Decembr 1989). Females wee more likely than males to report no
chances of having or getting AIDS, anduprobably related to less knowledge about
AIDS--peop1e 50 years or over and those with 12 or fewer years of education wee also
more likely to report no chance of infection than younger and more educated persons.

As it can be expected during epidemics, the number of adults which reported
knowing someone with AIDS was found to increase steadily since the NHIS started to
ask the question in 1987 until 1989, but Hardy (1990) does not report the numbers.

Summarizing what have been learned about the knowledge and attitudes of the
gereral public regarding AIDS, researches have found: (a) a steady increase in the
number of people who say they have heard about AIDS; (b) accuracy in idertiﬁcation of
the three major modes of transmission of HIV and confusion regarding intermediate
behaviors; (c) increases in the numbe' of people agreeing with more regulation and
isolation of adults infected with HIV; (d) that television seems to be the most common
source of information about AIDS; (e) small percentages of people saying that they
know a lot about AIDS; (f) a small number of people requesting the HIV blood test
volrmtarily; (g) large percentages of people identifying the use of condoms as effective

19

prevertion methods; and, (h) small percentages of people feeling at risk of having or
getting HIV. Both studies reviewed above (Singer, Rogers, & Corcoran, 1987; Hardy,
1990) found repeatedly that educational levels and age of the subjects were related to
most of the variables about AIDS, with the more educated and younger membes of the
sample having more information about the disease. None of the studies reported
information on Hispanics. Some data on black adults and people of color (non-whites)
was mentioned in the articles, and it showed that eithe' black or people of color in
gereral or olde' adults were in disadvantage in some aspect regarding AIDS (such as

knowledge, misconceptions, andlor preventive behaviors).

1h.

CHAPTER III
AIDS AND THE HISPANIC COMMUNITY

This chapter will discuss: (a) the knowledge, attitudes, and behaviors of Hispanics
about AIDS; (b) special issues on AIDS education for the Hispanic population, including
attitudes towards homosexuals, and cultural values; (c) HIV/AIDS prevention, including
theories of prevention, and HIV/AIDS prevertion programs, and (d) the rationale for the
design of the program and the research in the section titled ”AN HIV/AIDS prevention
program for Hispanic migrant families in Michigan.”

Knowledge Attitudes and Behaviors of Hispanics about AIDS

Dawson and Hardy (1989) published a special report on Hispanics' knowledge
and attitudes about AIDS, gathered during the National Health Interview Survey from
May to October, 1988. The authors speciﬁed that the sample of Hispanics was very
small and full of sampling erors, and therefore, only large differences were considered
statistically signiﬁcant. However, they did not provide information about the types of
sampling erors. The analysis of these data on Hispanics showed:

1. Similar changes in knowledge between Hispanic and non-Hispanic adults and
similar patterns of knowledge and attitudes about AIDS and HIV within the Hispanic
population, as for the U.S. population as a whole (during the period from May to
chbe 1988). Still, when compared to the group of non-Hispanic, those of Hispanic
origin wee found to be less lmowledgeable about many aspects of AIDS and HIV. The
relationship between education and age with more knowledge about AIDS discuswd in
the previous section was also identiﬁed in Hispanics in Dawson and Hardy's (1989)

sample.

20

21

2. A large percentage of Hispanics (84%) watched PSA's about AIDS on
television the month before the survey and 56% of them had heard ads on the radio. It is
important to note that the proportion of Hispanic adults who received the information
from television was also related to age and education: 87% on those 18-29 years, 78%
of those 50 years or older; and 73% of those with less than 12 years of education and
53% of those with 12 or more years of education and over, received the information
from television. Hispanic men heard the radio advertisement in a higher proportion
than Hispanic women (61% vs. 51%). This proportion of people getting the
information from the radio was also higher for people with more education than for
those with less than 12 years of education. Fifty-one percent (51%) of the Hispanic
people reported ever having read brochures or parrrphlets about AIDS (36% reported
having done so during the previous month). Only 45% of people with Mexiean ancestry
reported ever having read brochures or pamphlets about AIDS, compared with 57% of
other Hispanics. Once again, age and education were related to the proportions of
people who had ever read mate'ials on AIDS: 59% of those age 18-29 years , 32% of
those 50 years of age and over, 34% of those with less than 12 years of education , and
63% ofthose with 12 or more years of education.

3. The experiences of the Hispanic families in sharing information about AIDS--
especially communicating information to the children about AIDS-was studied. Fifty
peeent (50%) of Hispanic adults reported having discussed AIDS with their children
age 10 to 17 years and 60% stated that their children received information about AIDS at
their schools. It was also identiﬁed that Hispanic met (39%) were less likely than
Hispanic women (56%) to have discussed AIDS with their children. Subjects of
Mexiean ancestry wee less likely than other Hispanics to have talked about AIDS with
their children (42% vs. 57%, respectively).

22

4. Only a small number of Hispanic adults reported that they brew a lot about
AIDS (21%), and 36% said that they brew some information, 31% that they knew a
little, and 13% that they brew nothing about AIDS. Subjects of Mexican ancestry were
more likely than othe Hispanic adults to feel that they didn't know anything about AIDS
(16% vs. 9%, respectively) and less likely to report that they brew a lot than other
Hispanics (44% vs. 33%). The proportion of Hispanic adults who claimed to brow a
lot about AIDS was highe among those having 12 years of school or more than in those
with less education, those 50 years of age or over were less likely to report that they
brew a lot about AIDS than younger members of the sample (14% vs. 22%,
respectively).

5. The misconceptions about AIDS in Hispanics decrease with edueation. Still,
Mexieans reported nrisconceptions in a highe proportion than othe Hispanics.

6. Regarding HIV blood tests, Hispanics wee less likely than non-Hispanics to
have heard about the HIV blood test when they had less than 12 years of education, and
equally likely to have heard about the test wher they had 12 years or more of education.

7. With respect to the proportions of Hispanics that thought that using condoms
and/or keeping monogamous relationships with people not infected with HIV wee
effective methods of protection against getting infected with HIV: 28% said that
condoms were very effective (compared to 83% of non-Hispanic adults), and 77%
thought that monogamy was very effective.

8. Only one percent ofthe Hispanic adults reported that thee was a high chance
that they wee already infected with HIV. Severty-six pecent (76%) of the Hispanic
adults felt thee was no chance of them beconring infected, and 13% said that their
chance of becoming infected was low. Variations on peceived risk wee found to be
related to age (perception of risk decreased), but the variables of sex and education did
not seem to be related to that peception.

3162
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23

9. The proportion of Hispanics that trusted information about AIDS provided by
the govenment, and the proportion that said they trusted advice from the governmert on
how to avoid AIDS were 69% and 77% , respectively. Howeve, it was found that trust
in govenment information and advice decreased with age and increased with education.
Mexicans wee more skeptieal than the non-Hispanics or othe Hispanics.

Dawson and Hardy (1989) did not report the signiﬁcance of the diffeences
between Hispanics and non-Hispanics in many areas, but the proportions and values for
Hispanics were always lower—especially for Mexicans. A rrrain concern with their
report is the statemert that the data collection on Hispanics was full of sampling errors.
However, neither these erors nor information about income and other demographic
characteistics of the Hispanics surveyed—except age, sex, education, and whethe the
subject is Mexican American or ”Othe-I-Iisparric"-appear listed in the report. This
makes it difﬁcult to hypothesize what areas ofthe data could not be descriptive ofthe
majority of the Hispanic population. A survey of browledge, attitudes and behaviors
about AIDS conducted with the Hispanic clients of Cristo Rey Community Certer in
lensing, Michigan, provides information about poor and underprivileged Hispanics--
Mexiean or with Mexican ancestry. Some main diffeences betweer the data from Cristo
Rey and that of Dawson and Hardy will be highlighted.

The survey at Cristo Rey was conducted in the peiod of May-June 1989 as a
randomized survey assessing browledge, attitudes, beliefs, and behaviors of Hispanic
clients at Cristo Rey. It was administered to 145 clients by the Special Ofﬁce on AIDS
Prevention (as of Decembe, 1991 ealled HIV [AIDS Prevention and Intervention
Section) and Cristo Rey Community Center. Inteestingly, in most of the variables thee
were major differences between the Hispanics who answered the instrument in Spanish
andthosewhopreferedtodoitin English:

.Mw

mum rm.- %

24

1. In regard to browledge about AIDS: (a) seventy-three percent (73%) of those
who preferred to answe in Spanish answered incorrectly or did not brow the answer
to the item regarding if condoms and jelly are effective against HIV infection (compared
to 17% of those who answered in English); (b) only 5% of those answering in Spanish
reportedthattheybrewagreatdealaboutAIDS (asopposedto25% ofthosewho
answeed in English); and, (c) 68% of the Spanish speaking and 27% of those who
answeed in English reported that they brew very little about AIDS.

The only knowledge-related area where the Spanish speaking subjects seem to
have a slight advantage was in terms of the proportion of those who have heard about
AIDS (30% of Spanish speaking vs. 14% of English speakers). Howeve, this could be
a mistake in the report or in the subjects' interpretation of the question, beeause it is not
clear if it is possible to reconcile the fact that Spanish speaking subjects brew much less
about AIDS than English speaking subjects with the fact tint they have heard about it
more often than the English speaking subjects. If there are no mistakes in the report or
in the data, it suggests that, even though the Spanish speaking subjects received
information more often, they do not understand it as well as the English speaking
subjects. Also, Marin and VanOss Marin, 1989) found a strong positive correlation
between acculturation and browledge about HIV transmission, and acculturation in the
ease of the Hispanics in the United States, usually includes browledge of the English
language. Keith Bletzer, (1991) also found in a sample of migrant workers in Michigan
that from the respondents who answeed eight or nrore of ten questions about HIV/AIDS
correctly, 55% answered in English and 44% answered in Spanish.

The age of the subjects was related to knowledge about AIDS, since those under
40 years ofage or those with more education or both (under 40 years old and with more
education) were more likely to identify correctly the potential routes of transmission of
HIV, than older subjects-especially those 50 years of age or more. Also, age was

25

positively correlated with misconceptions about HIV/AIDS. The education level of the
respondents was positively correlated to a ”Summary Knowledge Index” and negatively
correlated to the number of misconceptions about AIDS.

2. When the subjects were asked if AIDS patierts should be forced to live away,
many of them (53% of the Spanish speaking and 13% of the English speaking), reported
that they didn't brow.

3. Thee was a large diffeence in the proportions of Hispanics reporting correctly
that women can get AIDS, in Spanish and English speaking subjects (50% vs. 80%,
respectively).

4. It was identiﬁed that single respondents were less likely to respond correctly to
questions on browledge, attitudes and beliefs: (a) 80% of single respondents didn't
believe AIDS was a problem, (b) 38% didn't think it was dangerous, (c) 50% didn't
brow that AIDS was transmitted in sexual intecourse, (d) 41% brew very little about
AIDS or had never heard of it.

5. The information about the sources of information about AIDS reﬂected the
ﬁndings of previous studies cited above. Television continued to be the main source of
information about AIDS (52% of the subjects).

6. Three items included in the survey dealt with the subjects' interest in the
education about AIDS for their family: (a) 55% wanted their family to get information
about AIDS, (b) 96% wanted their children to get information about AIDS, and (c) 39%
answered that a Community Center was the place to go for information.

7. The study included the computation of an ”Effective Prevention Summary
Index” and the variables: education, "Knowledge Index", and perception of oneself as
at risk of developing AIDS, showed to be positively correlated to the prevention index.

Othe studies of AIDS knowledge, attitudes and behaviors among Hispanics
found: (a) replication of the ﬁnding of highe misconceptions about AIDS in Hispanic

26

and black communities than in white communities (De la Cancela, 1989); (b) that
browledge about AIDS is negatively associated with perceived risk of infection , and
peeeived risk is positively correlated with prevalence of misconceptions (Di Clemerte,
et.al.,l988); (c) that only 15% of Hispanic respondents answeed correctly to the item,
"AIDS is common among Hispanics" (Marin & VanOss Marin, 1989); (d) that
approximately one-third of the Hispanics in the sample were unaware that there is no
cure for AIDS (AIDS Community Research Group, 1989); (d) that 36% of Hispanic
respondents compared to 80% of black and non-Hispanic white respondents were
aware that using a condom is an effective way to prevent HIV transmission; and (e) that
Hispanics are more likely to fear that they or someone they brow will get AIDS, than
blacks and non-Hispanic whites (AIDS Community Research Group, 1988).
Currently, there is no conclussive information about Hispanics' browledge,
attitudes and behaviors about AIDS ( a large scale randomized survey has not been
conducted), but some main points have been presented in the data described above: (a)
those of Hispanic origin are less browledgeable about AIDS than the group of non-
Hispanics; (b) the main source of infornration about AIDS for the Hispanics seems to be
the television; (c) moderately high percentages of Hispanics reported eve having read
AIDS brochures or pamphlets about AIDS; (d) Hispanic men are less likely than the
women to have discussed information about AIDS with their children; (e) a small
number of Hispanic adults identiﬁed condoms as an effective prevention method and a
high number of then thought that monogamy was an effective prevention method; (f)
perception of risk of HIV infection is not found frequently among the Hispanics and
when it is found it is negatively correlated with browledge about AIDS and positively
correlated with misconceptions about AIDS. ; (g) knowledge of Hispanics about
prevention nrethods is very limited; (h) single subjects wee less likely to answer
correctly to questions about AIDS, to believe that AIDS is a problem, and/or to have

27

heard about AIDS; (i) that a small number of Hispanics identiﬁed AIDS as problem in
the Hispanic community and brew that there is no cure for AIDS; and (i) that Hispanics
weremorelikelytobelievethattheyorsomeonethey browcouldgetAIDS thantlre
non-Hispanic whites and blacks. Also, another main ﬁnding was that when Mexican-
Arrrericans or Mexicans were compared to a group of ”other Hispanics", the Mexicans or
those with Mexican ancestry showed to be in disadvantage regarding many variables,
such as: (a) browledge about AIDS and prevention behaviors; (b) talking to the children
about AIDS; (c) number of misconceptions about AIDS; and, (d) skepticism regarding
govenment advice about AIDS.

Special Issues on HIV [AIDS Education for the Hispanic Population
Several reasons havebeen suggestedtoaccount forthe failureofthe mediain
communicating information about AIDS to the gereal public and speciﬁcally to the
Hispanic community (stigma towards homosexuals and cultural beliefs).

B.V. Marin, (1990) stated that there is data showing that mass-media-based
changes in attitudes and behaviors could be obtained, but that saturation is necessary for
an effect. It could be that the public sevice advetisemerts about AIDS-developed with
the Hispanic community in mind—- are not presented frequently erough. Also, Siegel
(1988) has stated that sometimes the media advetisemerts about AIDS have used
ambiguous language—such as "multiple partners", and ”sexually active"-and that the
focus should be on communicating only one or two clear messages consistently. This is
recommended becausethe subjectwillchoosetlrebehaviorthatiseasieforhim/herto
follow. For example, men who have sex with other men could reduce the numbe' of
sexual partrres totwoduringa montlrorayearand considerthat heispreventing his
infection with AIDS, while in fact, this behavior alone is not going to have a strong
effect in reducing the individual's risk of getting infected. Another alternative is that

28

presented by Stipp and Ker in 1989. Suggests that negative attitudes toward
homosexuals stand between media information and public browledge and public
opinion, limiting the potential effectiveness of the media. Stipp and Kerr's (1989)
study will be discuswd in more detailed because thee is evidence of progressive and
conservative attitudes toward homosexual rights among the Hispanic community
(Singe, et.al., 1990) and it is important to explore if that is in some way related to
browledge about AIDS.

Animdesl‘matdﬂnmnmalt

It has been found that Hispanics are more likely to support government funding for
AIDS research and government restrictions of homosexual behavior (Friedman et.al.,
1987) and that two thirds of the respondents in a Chicago sample opposed the quarantine
of people with AIDS (PWAs). Yet, 75% of that sample also believed that contact with
homosexual individuals should be avoided.

For the purpose of their research, Stipp and Kerr (1989) combined six items about
beliefs regarding the transmission of AIDS into a scale of attitudes toward contact with
people with AIDS (Alpha: .85). The highe the score on the scale, the greater the
willingness to have contact with people with AIDS (the index ranged from 0 to 6, with a
mean of 1.9 and SD. of 2.1). The researchers evaluated how much of the values on the
scale could be predicted by educational attainment, media exposure, age and attitudes
toward homosexual rights. Even though education was found to be a signiﬁcant
predictor of browledge about AIDS transmission, it accounted for considerably less
variance in the index than attitudes toward homosexual rights.

Stipp and Kerr (1989) discussed three alternative explanations for their ﬁndings.
First, they said that maybe the scale that they developed was one of perception of risks,
and that this perception was the one affecting the subjects' attitudes toward homosexual

29

rights (instead of the other way around). However, they suggest that if this explanation
wee adequate, the attitudes toward homosexual rights should have become more
negative since the discovey of AIDS. Instead, the public opinion is slightly more pro-
homosexual rights (according to Stipp and Ker). Another altenative explanation was
that the relationship between attitudes toward homosexual rights and peceived risks
stem from the variable of educational attainmert. The authors expected that since bette
educated people are more likely to be tolerant toward homosexual rights and to be
exposed to, and interpret correctly the information about AIDS transnrission, the
association between the attitudes toward homosexual rights and peceived risks was
going to attenuate when education was controlled. However, that was not the case.
The third alternative explanation that Skipp and Ker evaluated used education as an
indicator of media exposure, and hypothesized that media exposure would be less
strongly related to perceived risks among people with negative attitudes toward
homosexual rights than among those with positive attitudes. It was found that among
those with positive attitudes toward homosexual rights, each additional year of education
adds an average of .12 to the index but it makes less difference among those who hold
negative attitudes toward homosexual rights (each additional year of education adds

.03). This indicated that people with anti-gay attitudes are less responsive to information
about AIDS, which is a critical ﬁnding for the design of education campaigns about the
disease. Stipp and Kerr suggested that future studies should look at awareness, beliefs
about transmission, media exposure, and opinions about HIV testing and treatment,
addressing relevant attitudinal factors regarding homosexuals, drugs users and people of
color. They also suggested that a ﬁeld study should be conducted where people with
differert prior atu'tudes toward homosexual rights are exposed to AIDS information

campaigns.

su;
at
of .
(PE

30

Another interesting study about the relationship of the stigma toward homosexuals
and AIDS was the one conducted by Lawrence, Husfeldt, Kelly, Hood, and Smith
(1990). These researches compared the attitudes of the public toward people with
leukemia and people with AIDS (with descriptions of patients of both illness that varied
in that sometimes the person with AIDS was portrayed as an homosexual) and found
that people with AIDS wee viewed as: (a) more deseving and responsible for their
disease, (b) more deserving to die, (c) more dangerous and deseving to be quarantined,
(d) less entitled to work, and (e) of less intrinsic worth. Also, the subjects in the study
indicated less willingness to interact with a peson with AIDS in casual eveyday
contexts. These attitudes were very similar to the attitudes toward ill people wher the
only information provided to the subjects described the individual as homosexual. The
authors suggested that the stigma toward homosexuals could be responsible of some of
the irrational fears and avoidance behaviors in the communities with regard to AIDS. In
othe words, that PWAs might experience negative attitudes towards them in the
community because they are labeled as homosexuals and thee are negative attitudes
towards homosexuals.

Following Stipp and Kerr' and Lawrence et.al.'s ﬁndings and hypothesis it is
possible to believe that negative attitudes toward homosexuality might be a We to
AIDS education in the Hispanic community. The lack of browledge about AIDS among
Hispanics and the early label of homosexuals as one of the groups at risk (by the media)
might have effected already negative attitudes toward homosexuals, with the
consequence of Hispanics neglecting the information about AIDS. One example which
suggests that stigma toward homosexuality could be related to the Hispanics' fear and
avoidancebehaviorsaboutAIDS istlratpostesinforming Donrinican nrenabouttheuse
of condoms wee ineffective because mer were reluctant to be seen reading them

(Peterson & Marin 1988, refering to a personal communication with A. Moya in 1987).

M:

Sim

Sim

Ma

“11h

31

Also, regarding Hispanics' attitudes toward homosexuals, Marin, B.V. (1990) stated,
”...Hispanic culture includes a very powerful homophobic component" (p. 38). Still,
thee is not enough data and information on Hispanics' beliefs and behaviors regarding
homosexuality and no information about the relationship of these beliefs and behaviors
to receptiveness of information about AIDS. Howeve, a negative impact of attitudes
towards homosexuals on receptiveness of information about AIDS could be expected.

Crrltrualxalues

In talking about othe issues found in educating Hispanics about AIDS, or in the
conduction of research with Hispanics, Marin (1990), Peterson and Marin ( 1988),
Mays and Cochran (1988), Marin and VanOss Marin (1991) analyzed cultrual elements
that should be taken into consideration in planning educational inteventions for this
population. Even though it is well brown that there are many diffeences between
Hispanics depending on their countries of origin, Marin and VanOss Marin (1991)
speciﬁedthattherearevalues shared by mostHispanicsandthattherearemore
similarities than differerces between the Latino groups. The following paragraphs
summarize the shared cultural elements among Hispanic groups and their possible
relation with AIDS education efforts.

1. ”Familismo": The familismo refers to the Hispanics' emphasis on the
family as the main source of support, to their need to consult their family menbes
before making important decisions, and to help family membes economically and
emotionally (Peterson & Marin, 1988; Marin, 1990). Marin, B.V. ( 1988) also
explained how the relevance of the family- and especially the children-- for the Hispanic
women could make her continue with a pregnancy, after being identiﬁed as infected
with AIDS. Moreove, Mays and Cochran (1988) speciﬁed how the suggestion of
abortion and use ofbirth control nrethods are not accepted by some Hispanic women

illne
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if sh

“Rd:

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32

because of beliefs about family and religion. Howeve, all three articles suggested that
family beliefs should be used in education campaigns by presenting the AIDS issue as an
illness from which the individual has to protect his/her family, instead of as
individualistic self-protection behaviors and concens.

2. ”Simpatia": Triandis, Marin, Lisansky, and Betancourt (1984)
described the ”simpatia" as a cultural scriptm-pattern of social interacﬁon--of Hispanics.
The authors conducted a study and found that Hispanics were more likely to expect
high frequencies of positive social behaviors and low frequercies of negative social
behaviors. The ”simpatia" script also refes to certain levels of conformity and the strive
for harmony in intepersonal relations--which implies that direct confrontation and/or
interpersonal conﬂicts are avoided (Triandis, Marin, Lisansky, & Betancourt, 1984).
B.V. Marin, (1990) idertiﬁed three implications of this script for AIDS education: (a)
that AIDS prevertion activities that could promote confrontation regarding condom use
or for partners to share information about previous sexual behavior, could be seen as
inappropriate; (b) that the Hispanic listere may appear to agree with the message, even
if she/he has no intention of following the advice or did not understand it, and; (e) that
taboo topics will be avoided in the conversation, making inteventiorrs that require
discussion of sexual behavior and/or drug abuse, more difﬁcult. It is suggested that
polite ways to discuss topics such as condoms and previous sexual behavior need to be
taught to the subjects, and that questions or other ways to assure that the subjects
understood the inforrrration should be used during educational interventions (Marin,
1990).

The "simpatia" script could also be related to AIDS in terms of the behavior of
sharing needles among Hispanic drug uses. Peterson and Marin (1988) mentioned that
sometimes immigrants reuse needles for vitamin and medication sharing this equipmert
with their neighbors. Between injection drug uses the act of sharing a 'wash"-a

33

recently used syringe ﬁlled with water (Mays, & Cochran, l988)«or just the equipmert,
with a ”running partne" (the individual who shares the drugs in a syringe) is an act of
friendship and social bonding. Theefore, we could expect that in both cases, for drug
uses that have been sharing needles and for families who share needles with their
neighbors, changing these behaviors could mean that they are not going to be
"simpatico' to others, and/or it will mean that they will not trust others. As a
consequence, different ways to still show concen for othe's—in the case of the families-
-and ways to still show trust in other drug users will have to be explained as part of the
educational efforts.

3. "Respeto": The ”respeto" refers to Hispanics' attitude towards others in
their social group who are considered authority ﬁgures (such as, older people, parents,
or those with more money, more education, or who are mirristes or priests). In all of
these cases, the subject will try to be respected by the authority ﬁgures, and at the same
time may not question the authority ﬁgure, even if they do not understand him/her
(Marin, 1990). The implications of the ”respeto" are that treatments for drug abuse, as
well as suggestions on AIDS prevention behaviors, will be rejected if the individual does
not feel respected, and also, that the subjects could have a very good relationship with
the educators, even if they are not understanding what is been said (Marin, B.V., 1990).

4. Sexuality: In the Hispanic community, sexual matters sometimes are not
even discussed between sexual partners. There are cultural pressures on Hispanic
women toward female naiveté, and sex only within the context of marriage. Theefore,
it would seem inappropriate for a womer to suggest to a man the use of condoms or to
inquire about previous sexual behavior (Mays & Cochran, 1988). Even further, Mays
and Cochran reported that a small proportion of black and Hispanic women had
reported experiercing physical and/or ve'bal abuse from their partrres in response to a
request to use a condom. Form (1987) reported an estimate of 25% of Hispanic

husbands as being against any form of birth control. In terms of homosexual behavior,
it is suspected that many Hispanic men having sex with othe men will not consider
themselves as homosexuals if they are the active partner during intercourse (Marin,
1990). Peterson and Marin (1988) suggested that ethnic/racial minority homosexuals
(not speciﬁcally Hispanics) may not consider thenselves at risk of getting infected with
HIV, if they are the active partne and/or if they are not having sexual relationships with
white homosexuals. Theefore, the messages targeted to homosexuals will need to be
targeted at speciﬁc risk behaviors instead of risk groups, but it also needs to be clariﬁed
that the risk behavior takes place within the context of heterosexual and homosexual
relationships.

5. Religiosity: Rochin, Santiago and Dickey (1989) mentioned that one
of the most effective and frequently used source of health education and services for the
migrant workes in the Midwest are the community organizations—especially those
related to the church—because the Hispanic migrant workers terd to go ﬁrst to the
church when they need help. This situation presents the problem that, when the church
is the channel for AIDS education, the subjects may not get erough information about
condoms (Mays, and Cochran, 1988). However, the United States Catholic
Conference (1987) declared that in church based AIDS prevention messages, condoms
can be mentioned, but in a limited way. The rationale for a limited mention of condoms
in education intevertions sponsored by the chru'ch is that they appear to be a necessity
(Marin B.V., 1987, mentioned that Hispanic men felt that not having sex would be
nmrly impossible and unhealthy for them), that individuals will also receive information
about condoms from other sources in the community, and that the Church prefered
prevertion methods are abstinerce or morrogarnic relationships.

Another implication of the religiosity of subjects for the receptiveness of AIDS
education campaigns is that messages like ”play it safe” may not get enough attention,

35

because for many religious groups sexual intercourse is only licit for procreation and
should not be seen as a game (Mays & Cochran, 1988). More attention should be given
to show respect for the religious beliefs of individuals, and still communicate the
information about preventive behaviors.

A major controvesy that would probably continue to be discussed in the next
years is the situation whee even though most religions reject homosexuality, pastoral
ministries and values ercourage the religious groups to be involved with helping PWAs.
Some examples of problems that diffeent churches have faced with AIDS and
homosexuals included: (a) Mays and Cochran (1988) reported that a pesonal
communication from G. Gallup said that thee is data showing that evangelicals are more
likely to believe that AIDS is trarrsrrritted casually—and it has been reported that many
protestant leaders refer to AIDS as a ”punishment from God” (Nugent & Granrick,
1989); (b) Pope John Paul H's reaction to the AIDS epidemic, in one of his messages
to the United States, was that the church was concened with the moral background of
AIDS and with offering care and hope for the suffeing and those caring for them
(Nugent & Grarnick, 1989). Even though the religious position toward homosexuality
could make it difﬁcult to deal with the stigma toward this group and toward PWAs,
appeals to the religious principles of compassion, forgiveness and love for human kind,
could be of help when presenting information about AIDS.

6. "Machismo": Medina (1987) summarized the ”machismo" as a combination of
behaviors through which mer, by virtue of their gender exercise authority over women.
Some of the behaviors of men traditionally attributed to the ”machismo" are extramarital
sexual activity, heavy drinking, endurance of pain, to be the only provider of economic
supportforthefamilyandtoberesponsiblefortlrewellbeenofthe family. Thereisno
current data on the prevalelce of this trait in the Hispanic community. However, some
researches (Singe' et.al., 1990) suggest that the high numbe of Hispanic families

36

whee women and men provide income to the house could have modiﬁed the
characteistics of the "machismo." It is possible that mer who adhee to the traditional
role prescribed by the ”machismo" might ﬁnd it harde to limit extramarital sexual
activity, and that also the consumption of alcohol can become a risk of HIV because of
its effect on the immunologic system and because the individual might not take adequate
precautions during sexual behavior. Still, Singer and his colleagues (1990) provided
examples of cases were appeals to the sense of responsibility for the well been of the
family wee effective in getting mm inteested in learning about HIV/AIDS prevention.
Other examples of cases that Singe et.al., (1990) described showed mer getting into
risk behaviors because of frustration with themselves in the fulﬁllment of their role
expectations. For instance, they described a young Hispanic man who lost his job and
joined the army -as a way to have an income to send to his family—where he started to
have psychological problems being away from his family and began to use drugs and
share syringes. The researchers probably did not intend to show that Hispanics have
good reasons to incur in the high risk behaviors, but that socioeconomic pressures
might affect the social life of individuals in such a way that makes them more vulnerable
to high risk behaviors. It is possible to believe-and it will be necessary to study--that
economic conditions of the Hispanics could have a higher impact on HIV IAIDS
prevertion than the trait of ”machismo".

7. "Marianismo" . The "marianismo" prescribes a role to Hispanic women in which
she is supposed to be morally supeior to the mer-rernain virgin until marriage—and to
endure any type of pain or suffering with stoicism (Singer et.al., 1990). This role is
related to HIV/AIDS through its impact on women sexuality (as explained earlier)
because women might not be able to communicate openly about sexual topics with their
partnes. On the othe side, Singer and his colleagues (1990) discuss that Hispanic
women usuallytakecareof theirmalepartneswhen they ﬁnd outthattheyareinfected.

37

A role for Hispanic women that is sometimes regarded as opposite to the
”marianismo" is the ”hembrismo"or 'femaleness". This role implies that the women
should be obedient, make sacriﬁces for the family and work hard--just like the
”marianismo"-but that she is supposed to strive and achieve despite any cultural and
sociopolitical barries (Singe et.al.,1990). Researches comment that it must be
difficult for women to have to submit themselves to the men but to also be assertive and
successful. Singe et.aL (1990) provided examples of the way Pueto Rican women in
the United States balance both roles. For example, a woman might stay with a man that
is using drugs expecting him to quit, or might stay with a man who abuses her,
believing that he will change. But usually these womer also decide wher they are going
to abandon the rrran or ask him to leave. According to the authors, it could happen when
the man begins to steal from the family or if the individual abuses the children. Singer
and his colleagues found out that Pueto Rican women will sacriﬁce themselves but not
their children. Also, the researchers reported cases wee women were successful
negotiating with men and promoting behavioral change. For instance some wonren
specify to the men that they have to quit having extramarital affairs and/or quit using
drugs before they can come back to stay in the house. This dual role of Hispanic
women could be vey useful to consider in the design of HIV/AIDS prevertion
programs. Women should be targeted almost as ifthey were going to be the educators
of their families. Also, once again it is found that the economic and sociopolitical
conditions could have highe impact on AIDS prevertion than the gender role, because
the expression of behaviors and attitudes attributed to the ”marianismo" or "hernbrismo"
seem to vary deperding on the particular economic and sociopolitical situation at a
particular time.

HIV/AIDS Preveltion

The HIV/AIDS prevention programs can be classiﬁed as primary or secondary
prevention programs. Primary prevention programs are directed to the gereal
population and secondary prevention programs are directed to populations at highest risk
of infection. The most common primary prevention method is education (e.g., public
service advertisements, brochures, group discussions, lectures or one—on-one
education). The most frequently irnplemerted secondary prevertion programs for
HIV/AIDS, are: (a) needle exchange or distribution (Magma, Grossman, Lipton,
Siddigi, Shapiro, Marion & Amann, 1989; Guydish, Clark, Garcia, Downing, Cass, &
Sorensen, 1991), (b) HIV screening and testing (Cates, 1988; Fehrs, Hill, Kerndt,
Rose, & Henneman, 1991), and (c) condom use promotion (Solomon & Dejong, 1989;
Schechter, Craib, Willoughby, Douglas, McLead, Maynard, Constance, &
O'Shaughnessy, 1989). It is important to keep in mind that all the HIV/AIDS
secondary prevertion programs include educational componerts.

Unfortunately, evaluations of HIV/AIDS prevention programs are scarce. Also,
these programs are not implemelted expeimertally testing a theory or explicit model of
health behavior. The next two subsections on HIV Prevention discuss the most
common examples of HIV/AIDS prevention programs evaluated in the literature, and
theories related to prevention reviewed for the design of the program of HIV/AIDS

education for migrant workes.

W
The most frequeltly implemerted prevention programs for HIV/AIDS, are: (a)
needle exchange (Magura et.al., 1989; Guydish et.al., 1991), (b) HIV screening and
testing (Cates, 1988; Fehrs, Hill, Kerndt, Rose, & Helneman, 1991), and (c) condom
use promotion (Solomon, & Dejong, 1989; Schechter et.al., 1989).

38

 

Magma and his colleagues (1989) gathered data from a sample of injection drug
users (IDUs) in methadone treatments to study the determinants of needle sharing. The
data showed that sharing needles was directly related to peer group behavior, attitudes
conducive to sharing, economic motivation to share, not owning injection equipment and
fatalism about developing AIDS or perceived utility of risk avoidance. The following
variables were not found to be related to needle sharing: browledge of AIDS risks,
blowing people with AIDS/ARC, gende, age, ethnicity, marital status, and time in
methadone treatmert. The ﬁnding of peceived utility of risk avoidance as one of the
deterninants suggested that educational intervertions based on the health beliefs model
should be successful if the programs also Uy to develop skills and work with the
attitudes of the drug users.

One of the most controvesial programs to prevent the spread of HIV infection
among IDUs is the needle exchange program. Opponents to these programs argue that
exchange or distribution of needles increases intravenous illegal drug use. Guydish
etal. (1991) used capture-recapture methods to evaluate needle exchange. They marked
needles distributed by the exchange at two time periods. Half of the marked needles
(2,068l4239) returned within two weeks, and 61% (2,593/4,239) returned during the
study period. The rate of return for stationary exchange sites (63%) was greater than
that for roving/mobile sites (51%, X2 = 28.6, p<.001). Since a large number of needles
came back to the exchange sites, the researchers argumelt that needle exchange
programs did not increase the use of drugs. This type of intervention is based on the
effect that changes in public policy could have on health behavior. Nevetheless,
Guydish et.al.'s (1991) did not evaluate if the needle exchange program actually slowed
the spread of HIV or reduced needle sharing behavior. There was no data showing that

39

the individuals who used the needle exchange would have use intravenous drugs at the
same rate without the exchanged needles.

Another type of program which included needles distribution but was mainly an
educational intevention was that of Stephens, Feucht, and Roman (1991). They
implemented a one-on-one education program with four modules and reported that high
risk behaviors were signiﬁcantly reduced—compared to a pro-intervention assessment.
The pecentage of people who reported using injection drugs decreased from 92.2 to
70.5, and the percentage of people who reported sharing syringes decreased from 67.4
to 24.3. There was also an increase in the number of people who reported cleaning
works with bleach. Some of the limitations of the study included the use of a non—
equivalent control group, a group of individuals interviewed for the pre-test at the time
that the experimental subjects were interviewed for the post-test, and the use of self-

reportdata.

IE I S . l I .
Willard Cates (1988) review if counseling and testing fe' HIV antibodies to
promote prevertive behaviors. He explained that public health authorities suggested
voluntary HIV antibody test as a preventive intervention based on previous experience
with sexually transnritted diseases. This approach argues that seropositive persons
aware of their infections, wee going to be more likely to modify their behavior. Cates
(1988) reported mixed ﬁndings regarding behavioral changes after testing. He
discussed two major studies. The Vancouve study included gay men refered by geneal
practitioners. This study found that those who wee seopositive decreased the mean
numbe of sexual partnes similarly to those who were seonegative. Signiﬁcantly more
seopositive individuals changed to less risky sexual practices than the serorregatives
who in turn changed more than those who wee not tested. The Boston study of gay

41

mer did not ﬁnd a reduction in the numbe of sexual partners. It did report a positive
impact on risk behaviors such as unprotected insertive anal intecourse among infected
men.

Cates ( 1988) described the limitations of most of the evaluations of testing and
counseling programs. They included the fact that studies are conducted in samples of
homosexual men who were aware of their high-risk status, rely on self-reported
behavioral change, equate the decision to learn one's results with the decision to
undego testing and counseling, and the fact that the methodology itself could have
inflrrenced the impact of prevention messages.

One example of HIV testing in a population othe than the homosexual is a blinded
HIV seoprevalence study at a public prenatal and family planning certer seving mostly
Hispanic women. The blood drawn from the women coming to the cente for tests other
than the HIV test was tested for HIV. HIV testing was selectively offeed to women
who reported risk factors for HIV infection and 14% of clielts offeed testing chose to
do it. Only 28% of clients classiﬁed as being at highest risk of infection agreed to be
tested and none of the four women who tested positive by blinded HIV testing chose
testing. Theefore, the targeted screening program did not prove to be effective in
persuading women.

More information on the effect of counseling and testing on behavior change is
reported from a study in which 615 seropositive and 694 seonegative clients returned
to a testing site for their test results and received post-test counseling. Unfortunately,
3.9% of the seropositive and 10.2% of the seonegative clients who received post-test
counseling returned to the STD clinic with probable STDs. This may mean that the one-
on-one education about risk reduction provided during the post-test is not having an
strong impact on reduction of sexually transmitted diseases-or high risk sexual behavior
(Zenilman, J.M., Erickson, 8., Fox, R., Reichart, C.A., & Hook, E.W., 1992).

germanium

One of the most important preventive behaviors beer promoted is condom use.
Schechte and their colleagues (1989) studied the patterns of condom use in a cohort of
homosexual men. The subjects were recruited through private physicians.
Questionnaire responses from April 1984 to March 1985 wee compared to responses
from October 1986 to September 1987. The researches found that seronegative
subjects reported no condom use with regular partners more frequently than the
seopositives (55.7% vs. 23.4%). Among subjects with the most contact, 33.3% of the
seronegatives, and 29.2% of seopositives did not report usual condom use during
receptive anal intercourse.

Usually condom use is promoted through educational interventions. Solomon and
Dejong (1989) assessed the impact ofa soap-opera style videotape on inner city STD
clients' browledge and attitudes about condom use and willingness to redeem coupons
for free condoms. Subjects who agreed to participate in the research were randomly
assigned to watch the videotape. Two studies were conducted from these data: one
assessed attitudes toward condom use and the second one used cards that the subjects
could exchange for condoms. Each subject had two cards, one that they could redeem in
peson and another that could only be redeemed by mail. The ﬁrst study found more
browledge about AIDS and more accepting attitudes among those who saw the
videotape. The intevention was most effective among the less educated, among those
who reported less frequent use of condoms, and those involved with fewer sex partners.
The second study found that subjects who saw the videotape wee more likely to redeem
coupons for condoms—ever though both groups redeemed a high numbe of cards.
Interestingly, the highest number of condoms redeemed was at the clinic (60%) as
opposed to by mail 1.1% (13.7% redeemed coupons at the clinic and by mail).
Regression analysis showed that three background characteristics interacted with the

42

Vic

1111

m.

mkmhh

the

43

videotape to predict browledge about AIDS, education, previous used of condoms and
numbe of sexual partners; subjects with less formal education, subjects who had never
used condoms, and subjects with only one sexual partner in the previous month learned
more about AIDS. The variables interacting with the intervertiorr in the prediction of
more accepting attitudes about condoms wee education—those with less education-and

birthplace-those subjects who were not native born.

MW

Iaura Leviton (1989) classiﬁed the theories used in the prevertion area as: (a)
cognitive decision-making (including theories of risk communication, the health beliefs
model and the theory of reasoned action); (b) learning theories,(i.e., operant
conditioning, and social learning; (0) theories of motivation and emotional arousal, (i.e.,
fear and fear arousing communication); and (d) persuasion and communication. As will
be discussed in the following sections two of the theories classiﬁed as cognitive decision
making theories--health beliefs model and theory of reasoned action- propose models
that combine attitudes and beliefs to get to the health behavior. Programs designed to
promote health behavior based on these models md to provide information-because
thee is a browledge comporren -- and to promote conditions in the social environmert
that could facilitate subjective norms, perception of less barries to undetake the health
behavior, peception that the bereﬁts exceeds the expenses, and general health values
conductive to the health behaviors. learning and motivation theory provide alternative
frameworks for the organization of information and the type of message that could be
transmitted. The communication and pesuasion theories provide frameworks on how
the browledge could be disseminated to the people but also, on diffeent ways through
which the adquisition of browledge could affect and be affected by the social

mis

envrronnren' t and theefore have an impact on the individual variables vulnerable to
social inﬂuerces in the health beliefs and reasoned action models.
Q ”DH-111' 1] .

Cognitive decision-making theories assume that people will make choices they
believe will increase their likelihood of obtaining valued goods or expeierces, and it is
just ignorance regarding the health behaviors or biases in thinking, that prevent people
from healthy behaviors (Ieviton, 1989). Most educational interventions are based on
these theories. Leviton (1989) identiﬁed one of the problems in the application of these
theories to HIV/AIDS prevention is that the theories rely on people weighting
consequences. With the long dorrrrancy period of HIV the individual faces too many
conditions of uncertainty, such as whether or not the potential sexual partrre is infected,
and whethe to delay gratiﬁcation based on a probability, or take the chance of getting
infected. Another problem in the application of these theories to HIV/AIDS prevention
is that ofter times there are social and economic conditions propitiating the high risk
behaviors and individuals -in addition to lack of knowledge-and individuals nad
resources and skills to counteract those inﬂuences.

One example of cognitive decision-making theories is the theory of risk
communication. According to Ieviton (1989) this theory suggests that people perceive
grater danger when a risk is both unbrown and dreaded. It is the situation with AIDS
because among other things, the risks are unbrown—not observable—and dreaded, since
the risks are not controllable and the consequerces are fatal Inteestingly, Ieviton
(1989) proposed that the search for control over draded risk could explain the many
mistaken beliefs about HIV transmission. This could be one of the reasons why
misconceptions about HIV transmission were found among adolescents with high
browledge about AIDS (discussed arlier in this chapter). Also, DiClemente et.al.'s
(1988) ﬁnding a negative correlation between perceived risk of HIV infection and

45

knowledge about AIDS, and a positive correlation between peceived risk of HIV and
misconceptions about AIDS support the assumption regarding a sarch for control over
draded risk. Still, the authors do not provide any hypothesis about why sometimes
people have browledge about accurate prevention behaviors and continue to have
nrisconceptiorrs about transnrission and the effects of the need to reduce draded risk on
behavioral changes.

Another example of cognitive decision-making theories is the halth beliefs model.
This is a causal model hypothesizing the elements that make a person assume cetain
halth behaviors. The model explains that the main elemerts that could make a peson
behave in cetain way regarding halth issues, are: (a) the belief that thee is a risk, and
(b) the belief that there is a speciﬁc health behavior that will reduce the risk. At the same
time, these two elements are inﬂuenced by other elements. The belief that there exists a
risk is inﬂuenced by: (a) gereral health values, (b) beliefs regarding vulnerability, and
(c) beliefs regarding the seveity of the disordes. The belief that a speciﬁc health
behavior reduces risk is inﬂuenced by: (a) the belief that the masure will be effective,
(b) the belief that the beneﬁts exceed the expenses, and (c) the perceived barries to
undertake the halth promoting or preventive behavior. Ieviton (1989) provided an
example of the adaptation of the halth belief model to HIV/AIDS prevention; " the
likelihood of condom use as a means of preventing HIV infection, will be grate when
people perceive themselves as susceptible to HIV infection, perceive the consequences
of HIV infection as vey sevee, peceive protective action as very effective, see few
costs or barriers to self-protection, have a cue to action and are enabled to protect
themselves” (p.51). Among the main criticisms to the health beliefs model are that
nothing is said about how external factors affect the speciﬁc halth beliefs and behaviors
of the individual and that different questions are used to masure the same variables.

Therefore, it is difﬁcult to compare the results of the application of the model. Also,

46

this model does not specify what type of behavior could be expected wher one of the
conditions is absent -e.g., the perception of protective action as vey effective.

looking again at Ieviton's example, social inﬂuences, cultural factors and
economic conditions could have a strong impact on the individuals' peception of costs
or barries to protection and therefore the ability to protect themselves. Moreover, Janz
and Becker (1984) reviewed 46 investigations related to the halth beliefs model,
computing a ”signiﬁcant ratio”-the result of dividing the numbe of positive statistically
signiﬁcant ﬁndings for a dimersion of the halth beliefs model by the total numbe of
studies reporting signiﬁcance levels for that dimension-and organizing the studies
according to the topics examined and if they wee prospective or retrospective. Janz and
Becker's (1984) analysis found: (a) that the peceived barriers proved to be the most
poweful of the health beliefs model dimersions in explaining preventive halth
behaviors, (b) that the perceived seveity of the disorde was the one with the lowest
signiﬁcance ratio, but still strongly related to sick role behaviors; and (c) that the
peceived susceptibility was a good predictor of both, preventive halth behavior and
sick role behavior. Speciﬁc examples of how this model explains the AIDS related
behavior of Hispanics are not found in the literature, however some hypothesis could be
mentioned.

Mays and Cochran (1988) explained the situation regarding the AIDS threat to
black and Hispanic women mainly in terns of: (a) women not peceiving themselves at
risk, (b) women underestimating the risks involved in AIDS as compared to the risks
that poor women faad eveyday, and (c) women thinking that the beneﬁts of not
engaging in the preventive halth behaviors—the economic bereﬁts of drug daling and
selling sex as well as the social and emotional "beneﬁts” of having a male partrre,
which is supposed to bring them status even if it is a drug user-outweight the risk of
changing their behavior. Clearly, Mays and Cochran are talking about the perception of

47

susceptibility, the comparison of the bereﬁts vesus the expenses of ergaging into the
health behaviors and the perceived barries to health behavior. Research evaluating the
halth beliefs model in regard to black and Hispanic womer behavior is necessary and
will probably show a need for inteventions at levels othe than the individual cognitive
level in order to promote halth behavior.

A third example of a cognitive decision-making theory is the theory of reasoned
action (Fishbein & Ajzen, 1975). This theory suggests that the person's intention to act
is the immediate deterninant of behavior and that four pesonal variables affect the
intertion to behave: (a) the attitudes toward the behavior, (b) the beliefs about the
behavior, (c) the perception of subjective norms, (d) and the value that the person places
on approval by othes. The rrrain advantage of this theory over the halth beliefs theory
is that it recognizes the inﬂuence of subjective norms (Ieviton, 1989). One example of
an application of this theory to HIV/AIDS prevertion is: " a gay man who values the
approval of his peers, believes that they endorse safer sex, and also believes that safe
sex can be enjoyable, would be more likely to engage in safe sex compared to men who
do not have these beliefs” (Ieviton, 1989, p. 53).

I . I] .
Learning theories, instead of emphasizing behavioral change as the outcome of an
individual cognitive rational process, emphasize the identiﬁcation of environmental cues
and reinforcements promoting the adquisition and maintenance of behavior. One of the
basic learning theories is that of operant conditioning (Ferster & Skinne, 1957), which
states that it is mainly elements of the environmert that act as reinforcers for individual
behavior. It follows that individuals will get control ove their behavior if they manage
their reinforcements (Leviton, 1989). The operant conditioning theory could be
appliable to the design of secondary prevention programs for intravenous drug uses,

48

whee reinforces and contingencies of reinforcements can be identiﬁed. For instance
the reinforcers could be the state of physical arousal, elemerts of the environment whee
the individual uses the drugs and/or the avoidance of stressful life situations.

Another learning theory used in the design of prevertion programs is Bandura‘s
(1977) social learning approach. This approach differs from the operant conditioning
approach in that it assumes that individuals do not need to expeierce reinforcements
directly to larn about contingercies, but can learn from what they see that happel to
other people-modeling. This could be the basic theory underneath videotapes and
movies for AIDS education which present the story of a family, couple or individual.
Anothe example of social learning in HIV IAIDS prevention is through the basketball
player Magic Johnson who is infected with HIV. It is possible that he already had a
vey strong impact in prevention behaviors because the numbe of phone calls to the
AIDS information lines and the number of HIV antibodies test performed in Michigan
was much higher the days following the news about his infection with HIV (Bruni,
1991).

I I . . 1]
A third category of theories used by Leviton (1989) is motivation. The main
characteristic of the approaches classiﬁed on this category is the assumption that interral

individual's processes cause the behaviors. Leviton chose to discuss fear as a
motivation and described it as a drive, and as a set of responses. Far as a drive
becomes an aversive internal state to be reduced and avoided. In the same way as with
the risk reduction theory, if the information about AIDS produces far because of the
peception of been at high risk of infection, it could be expected that people will eithe do
something to reduce the fear--not to be at risk of HIV—or to avoid baring information

about AIDS.

€11

he

mu.

mimhrm

%

49

Leviton (1989) reported that the grate the fear generated in a person or group, the
more self-protective behavior results, but that sometimes regardless of the fear aroused,
people show grate acceptance of the halth behavior when they perceived it as
effective. For example, thee is evidence that individuals at high risk of HIV infection
are afraid of antibody testing. From this point of view it is argued that the
consequerces of a positive test result will negatively affect social relationships,
employment, and psychological states and there is nothing that can be done that will
help them if they are found to be seropositive in the HIV antibodies test.

' n ' Th 'es

Communication and persuasion theories are used as a basis of hwm education
programs. In addition, approaches such as social marketing, and community
organization have been used in the design of prevertive programs because of the
potential for involvement of the community and because it has beer identiﬁed that the
social ervironmert inﬂuelce critical individual variables that could be related to halth
behaviors. McGuire (1985) identiﬁed the elements included in a complex
communication as input and output variables. The input variables are the source,
message, channel, receive, and target characteristics. The output variables are steps
mediating attitude or behavioral change: (a) exposure to the message, (b) attention to the
it, (c) liking the message, (d) understanding the content, (e) geneation of thoughts about
the message, (i) acquisition of relevant skills, (g) agreerrrent with the communication,
(h) storing of the content in memory, (i) using the information to make decisions, 0)
acting in agreemert with the decisions made and reappraisal of new pattern of action.
One rrrain disadvantage of this process is that the individual might fail at any of the steps.
Further, it is necessary to detemine the speciﬁc conditions that will move individuals
from one step to the other successfully (Ieviton, 1989). Some of the characteristics of

50

information appals that have been found to erhance the effectiveness of the messages
are: (a) colorfulness and attractiveness of the presentation, (b) discussion of both sides
or one side of the issue depending on the predonrinant attitudes, (c) mertion of the most
important arguments at the beginning and at the end of the message, (d) brevity, clarity
and directness of the message, (e) conclusions should be said or written explicitly, and
(0 messages should not reﬂect only extreme positions.

Valdiseri (1989) discussed the social marketing strategy as it is used in the halth
education and prevention aras. The social marketing approach uses the traditional
marketing strategies of market resarch, product development, use of incentives to
increased the desirability of the behavior or idea promoted, and facilitation. The main
characteristic is that in social marketing, the product is a behavior, sevice or social ida.
One of the basic assumptions of social marketing theory is as Valdiserri said that : ”the
'product 'should be acceptable to the target group" (p.95). Earlier in this chapter barries
to prevention programs were mentioned, one of which is that the prevention behaviors
are highly controversial for many communities. It is in dealing with groups that might
have difﬁculties accepting the prevertive behaviors that educational programs providing
basic information about a halth issue will need to be supplemented. This will
necessarily include elemerts that will increase their incorporation into the range of
culturally accepted behaviors for that particular community.

The diffusion of innovation theory assumes that necessary innovations move
through a natural diffusion process and that the goal of the researcher, marketer or
designer of a program is to speed-up the process. The diﬂusion process includes the
same stages if it is toward the adoption and implementation of new programs in
organizations as if it is about the adoption and acceptance of new ideas. Thee are three
main fatures of the diffusion processucurve»: (a) the characteistics and distribution of
individuals or organizations according to their relative time of adoption, (b) the lag time

51

between awareness and adoption, and (c) the forces pushing the diffusion process
forward and those holding it back at each stage (Rogers, 1983). Two main vmiables
affect the diffusion process signiﬁcantly, the satisfaction of the early adopters and the
timing and placing of the inteveltion. As mentioned earlier in this chapte ,the

HIV [AIDS epidemic is more complex than any othe disease. In terms of the diffusion
of innovation theory, one of the prevention behaviors is not new to many groups in the
population and has been rejected by the public dming many years-use of condoms. In
a situation like this, we would not expect that the innovation--the use of condoms to
prevent the sprad of HIV—will progress through the natural diffusion of innovation
process the same way as other innovations, even though the browledge about AIDS will
probably progress according to the diffusion of innovation curve.

Anothe approach that Leviton (1989) classiﬁed within the communication and
persuasion approaches was, community organization. Community organizers see
individual behavior as a reﬂection of community behavior and in order to change
unhealthy behaviors the approach is to change the behavior in the social setting. This is
similar to social marketing but requires more involvement -and decision making--from
the community.

Carlaw (1982) said that the common some of change to organize a community
for halth are dissatisfaction and aspiration. Dissatisfaction that could arise ﬁom an
assessmert of the community health that will promote reﬂection on needs or problems,
and aspiration that may come from emulation of the example set by anotlre community
or from a local lade. The three rrrain strategies of social change appliable to halth
education are: (a) The Collaborative Strategy, assumes that the educators and the
community share the same values and is basically an educational intervertion at the
community level; (b) The Campaign Strategy, assumes that the values are not too
diffeent. It suggests that the deteminants of success are tradition, apathy, or

52

ignorance; and (c) The Conﬂict Strategy, consists of the use of social protest, civil
disobedience, and strikes. These approaches are necessary because changes in the
distribution of power and decision making are required for change (Warren, 1975).
Solomon and Dejong (1986) reported that the gay community organized its support for
AIDS action in a vey effective way, providing services for persons diagnosed with HIV
and supporting prevention activities.

A method of community organization not mentioned by Leviton (1989) or Warren
(1975) is Paulo Freire's method of education. Freire's method was originally developed
for the purpose of literacy training. It is a process of problem solving, dialogue,
reﬂection and action (Freire, 1970). Pruitt (1980) said: "Freire viewed the act of
acquiring browledge as a mans through which people can analyze critically the culture
which has shaped them and move toward reﬂection and positive action upon their
world” (p.3). Freire's method uses symbols or codes to be uncoded by the group
through idertiﬁcation with a particular situation which at the same time promotes
understanding of community problems. This type of approach could be successful with
communities that are not used to traditional educational methods, do not peceive their
membes at high risk of HIV infection, could perceive the preventive behaviors as
opposite their beliefs, or valued community support and respect.

A study that used an approach similar to Paulo Freire's is discussed by Marrow
(1969). Marrow discussed Kurt Lewin's experiment to compare the effectiveness of
authoritarian and democratic styles of leadership in pesuading housewives to serve
organ meats to their families. Some groups of womer hard a lectru'e by an expert on
the subject, others took part in group discussions in which women expressed their own
opinions about the need to change food habits and took over the responsibility for doing
something about the problem. The group discussions proved to inﬂuence more the
housewives' decisions than the expert lecture Ieviton (1989) identiﬁed characteristics

53

that favor group situations for the promotion of changes in health behaviors: (a) when
the relationship between the lader and the group members is good, (b) when the task is
clear, (c) wher the lader has some type of power ove the group, and (d) wher the
group has the ability and motivation to geneate relevant information. Moreove, many
resarches (Friedman, Des Jarlais, & Sothean, 1986; Baldwin & Baldwin, 1988;
Siegel, 1988; Crawford, Jason & Salina, 1990) have stated that passive didactic
approaches alone are not as effective as participatory (democratic) approaches in
promoting prevertive behaviors.

One example of a participatory approach is a program directed to promote family
discussion of AIDS (Crawford, Jason, & Salina, 1990). This project presented
information about AIDS and conducted execises to promote communication about
AIDS, sexuality, drugs, and decision making. All the activities were conducted within
the family context. The behavioral execises included: AIDS family IQ test, role
playing, imaging one's heroes and/or heoines responding to pee pressure situations,
discussing how information about the number of individuals diagnosed with AIDS
makes one feel, and drawing pictures of germs, viruses and diseases. Siegel (1988)
also emphasized, that the participatory approaches were important because they
represent a way to exploit the potential of social norms and sanctions to constrain or

promote halth behaviors.

Summary and The Need for Furthe Research
The programs described above target individuals identiﬁed as performing certain
high risk behaviors. These type of programs are just beginning to be evaluated but the
data suggests that reductions on risk behaviors are been obtained. Still, there is the
disadvantage that these programs have been designed for people with brown risk and
not for the geneal population, and that nothing is reported regarding how and if the

54

programs will have to be implemented in diffeent ways depending on the ethnicity or
culture of the cliertele. It will be important to brow-for the purpose of HIV/AIDS
prevertion—if the individual's attitudes and behaviors will be more affected by his/her
identiﬁcation with a group that is at high risk because of the pe'formance of high risk
behaviors, or by his/he identiﬁcation as a member of an ethnic group.

A review of the theories related to prevention-learning theories, motivation theory,
communication and persuasion approaches-to follow eithe the halth beliefs model or
the theory of rasoned action they also depend on the population that is going to be
targeted, on the way the risk behavior is deﬁned for the speciﬁc population and on the
variables that one wants to affect— information about HIV/AIDS, social inﬂuences, or
both-in order to promote health behavior. Figures 1 and 2 show the different elements
of the halth beliefs model and the rasoned action theory that could be consideed to be
affected by browledge or social inﬂuences.

55

Social inﬂuences Information about HIV/AIDS

 

 

  
  
 

General Health values , Beliefs about
Beliefs
severity of disorder
about
ulnerability
/
D

 

Belief that a risk exist

Health behaviors

Belief that the specific health
behavior reduces risk

/ \

Perceived Belief that
barriers to the beneﬁts
undertake exceed the

behavior expenses

 
  
 

   

    

Belief that the
measure will be
effective

      
 

  
       
 

        
  

    

lnfonnation about HIV/AIDS

Social inﬂuences

m1. Elements of the Health Beliefs Model affected by information and social
ln uences

56

Prevention programs testing the assumptions of the Health Belief Model should
include didactic components regarding the severity of the disorder and the beliefs about
vulnerability as well as information to promote the belief that the measure will be
effective in preventing the disease. But the programs should also include elements to
promote conditions in the social environment that will facilitate the individual's
perception of less barriers to undertake the preventive behavior, beliefs that the beneﬁts
excwd the expenses and general health values.

 

 

 

lnforrnation about HIV/AIDS Social inﬂuences
Evaluation of results of the Normative beliefs
behavior
Beliefs regarding Motivation to
the rims press
Attitudes towards action Subjective norms

 

 

 

 

 

 

\ /

Behavior Intention

Emmi Elements of the theory of reasoned action affected by Social inﬂuences and
information about HIV/AIDS

In the design of programs based on the reasoned action theory ,the didactic
component should provide information helpful in the evaluation of results of the
behavior in terms of facts and beliefs about consequences, but should also work with the
elements of the social environment that could promote normative beliefs in the direction
of the health behaviors or the motivation to please when pleasing others will mean
performing the health behaviors.

57

Looking at the previous ﬁgures, it could be argued that including the speciﬁc
information indicated by each model (either following learning or motivation theories),
designing the program in a way that involves the community (Paulo Freire, collaborative
strategy), or altering the social environment (conﬂict strategy, eampaign strategy), the
models should achieve their goals. However, there are some major areas of uncertainty
that need to be addressed.

First of all, there is neither enough data indicating the speciﬁc elements of the
social environment that inﬂuence normative beliefs, motivation to please, general health
values, beliefs about vulnerability, the perception of barriers and the belief that beneﬁts
exceed expenses, nor information on how to affect the elements of the social
environment to promote all the things mentioned above. The other major problem is
that one time educational interventions might not be enough to obtain behavioral change.
It could be added that one time interventions might not be enough to promote social
inﬂuence in the positive direction. Maybe the major area of uncertainty that makes these
theories extremely difﬁcult to test is the fact that the time that it will take for the health
beliefs, perceptions or attitudes to develop is not speciﬁed. Since these are the results of
information and social inﬂuences it is reasonable to believe that all the necessary
conditions might not be happening at the same time. The models do not propose how
the beliefs, attitudes and perceptions are weighted by the individual in order for him/her
to be able to still do some health behavior when some of the elements of the model are
not positive (e.g., normative beliefs, or general health values may not be present).

The process to obtain behavioral change in terms of prevention of risk behaviors
seems to take time for the repen'tion of the information in different ways and for the
social environment to be affected positively—e.g.,public policies, education--and
negatively--high numbers of people affected physically, economieally and emotionally
by the consequences of a behavior. It is proposed that short term or one-time prevention

 

58

programs include as their outcome variables elements that will show disposition to
receive more information about the disease and its prevention and that will show a
potential effect on the social environment. The outcome variables for these programs
could be openness to information about the disease and its prevention and awareness of
the importance of learning about the topic for the speciﬁc community. In this sense, it
could be expected that a program that provides information about HIV/AIDS in a
community environment should promote openness and awareness. Openness to
information facilitates the future-and continuous in the ease of HIV/AIDS—education of
the individual, and the awareness of the relevance of the topic for the community should
facilitate the acceptance of prevention behaviors in the social environment and the
integration of the behaviors into the life of the community. The following ﬁgure shows
the model discussed.

Knowledge about AIDS
Openness Awareness
More T'me Somal
knowledge inﬂuences
Behavior" intention
Health behavior

Em}, A model of health behavior through the promotion of openness and

awareness.

59

Depending on the type of knowledge that continues to be communicated and the
way that the social environment is affected by the information and the disease, the
behavior intention and the health behavior will develop in the individual following the
theory of reasoned action and/or the health beliefs model.

If a short term or one-time intervention program is going to be implemented and
the promotion of openness and awareness becomes part of the objectives of the
program, it is necessary to identify methods that will promote those two variables. The
review of the methods commonly used in prevention programs and of typieal
interventions for HIV IAIDS prevention, showed that no one single method seems to ﬁt
best for the design of all HIV/AIDS prevention programs. The critical variable for
selecting which method should be followed in the implementation of a programs—even
more critieal than some of the objectives-4s the speciﬁc population. For instance, the
issues that might represent a barrier to openness to information about AIDS could be
different for different populaﬁons--e.g., language, values, economic conditions, access
or patterns of utilization of health care services.

N ilken (1987) said that AIDS prevention requires the application of theories about
human behavior depending on the culture and special circumstances of individuals. It
was discussed earlier that this is necessary in order for the individuals to integrate the
information and new behavior into the range of accepted and desirable behaviors for
his/her culture. The next section discusses the rationale for the design and experimental
evaluation of a one-time HIV/AIDS prevention program for Hispanic migrant families
that includes the promotion of openness to information about AIDS and awareness of
the importance of learning about AIDS for the Hispanic community as the two
behavioral goals.

 

 

Leviton (1989) identiﬁed three steps in the design of prevention programs: (a)
identiﬁcation of aspects of high risk behavior that really pose the risk, (b)
characterimtion or description of the behaviors, and (c) determination of the theories that
ﬁt the behaviors ["as opposed to making the behaviors ﬁt the theories” (Leviton, 1989,
p.46)]. This section used the information discussed earlier in this chapter to introduce
the design of the prevention program for migrant workers-mainly Mexiean or Mexiean
American—implemented in Michigan.

A. Identiﬁcation of aspects of high risk behaviors that really pose risk

The cumulative incidence of AIDS among Hispanics in the Midwest is much
higher than the cumulative incidence for white non-Hispanics in Michigan (Torres, R.,
l990a, l990b;Michigan Department of Public Health, January, 1992). The risk of
AIDS for Hispanics was three times higher than the risk for non-Hispanic whites (Selik,
1989). Iafferty (1991) identiﬁed risk behaviors in a sample of migrants-mainly
Iatinos—z (a) 36.8% of the adults having two or more sexual partners during the
previous year, (b) 25% having multiple partners without the use of condoms, (c) 13%
reported intercourse with women who sell sex, and (d) 20.3% having used self-
injecting antibiotics and vitamins-from which 3.5% reported having injected antibiotics
and vitamins with a shared needle. The main risk behaviors are therefore: unprotected

sex and use of needles for self-injection of antibiotics and vitamins.

B. Characterization of risk behaviors
Both risk behaviors are greatly affected by social norms and expectations. The
cultural values discussed earlier that could be related to HIV/AIDS prevention are:

sexuality, religiosity, ”familismo”, "simpa ", ”respeto", ”machismo", and

60

w' w .9 -7 . . ._. _ .

 

 

-._.———o-" u.._ ., ..

61

”marianismo". Also, the hypotheses that the attitudes toward homosexuality and that
elements of the socioeconomic environment could be related to knowledge about AIDS
were discussed.

The unprotected sex could be supported by the: (a) "familismo", in talus of the
desire to have children; (b) ”machismo", in terms of the idea that men will have sex with
women who sell sex (even though there is no data about the use of condoms in these
situations); (c) "marianismo", in terms of the submissiveness and naivete expected in
the women, and ; (d) the sexuality, in terms of the patterns of communication about
sexual matters. Still, in the previous discussion of cultural values, I discussed how each
of the values could also have a positive inﬂuence in AIDS prevention. For example,
menandwomen couldbemoremotivatedtoteachtotheirchildrenandtolearnabout
HIV/AIDS prevention for the sake of their families (”familismo"), men could be
motivated to use protection when having sex also as part of their role to defend the
family (”machismo") , and women could take action and promote the use of condoms
and other prevention behaviors as part of the other face of the "marianismo", the
”hembrismo". The behavior of sharing needles for antibiotics and vitamins could be
relamd to the ”simpatia" script and to socioeconomic conditions such as the lack of
access to health services. None of the two risk behaviors identiﬁed in the migrant
population could be classiﬁed as gambling behavior, instead these behaviors could be
considered habits strongly affected by these elements of the social environment.
Moreover these social inﬂuences could interfere with the openness to information about
AIDS and with the way the information is interpreted by the individual.

C. Theories that ﬁt the behaviors
It is important to note that since the risk behaviors are social behaviors, and
migrantsathigherriskarenottobe identiﬁed,theinta'vention wasdesignedtobe

62

implemented in a social groups—meetings with several families. The section on
Hispanics' knowledge and attitudes about AIDS identiﬁed some areas of concern and
opportunity for prevention programs. These included the observations that: (a) subjects
of Hispanic origin are less knowledgeable about AIDS than non-Hispanics; (b) a high
percentage of Hispanics reporting having read AIDS brochures; (c) a small number of
Hispanic adults identiﬁed condoms as an effective prevention method, and a high
number of them thought that monogamy is an effective prevention method; (d) that the
perception of risk of HIV was not found frequently among Hispanics and when it was
found it was negatively correlated with knowledge about AIDS and positively correlated
with misconceptions about AIDS; (e) very limited knowledge about prevention methods
existed among Hispanics , and (f) a small number of Hispanics identiﬁed AIDS as a
problem in the Hispanic community and knowing that there is no cure for AIDS. Other
critieal ﬁndings were the areas in which Mexican Americans showed disadvantaged
when compared to other Hispanic groups: (a) knowledge about AIDS and prevention
behavior, (b) talking to children about AIDS, (c) number of misconceptions about
AIDS, and (d) skepticism regarding government advice about AIDS (AIDS Community
Research Group, 1988; Cristo Rey and SOAP, 1989; Dawson & Hardy, 1989; De la
Cancela, 1989; Marin & VanOss Marin, 1989; Bletzer, 1991).

A need for education about HIV and AIDS was identiﬁed from the literature and
next, it was necessary to ﬁnd out the best way to provide education. Since social factors
that could inﬂuence openness to the information and the interpretation of the information
were also identiﬁed it was necessary to develop an intervention method to provide
knowledge and also work with the social values and potential inﬂuences on behavior.

Siegel's (1988) suggested that, ”If we are to induce and maintain change... in any
social group, we must ﬁnd some way to tie the desired change into the group's own

value and belief system”(p. 643). The theories of communication and persuasion,

.m—

 

63

specially in the area of community organization with the Paulo Freire's theory, provided
the background for the design of the educational method. The Freire approach has been
recommended for populations that are not used to traditional educational environments.
It provided opportunities for the community to discover the issues and present them to
themselves from their own perspective. This approach was considered a method of
empowerment.

Since it is known that most migrant workers do not have a traditional educational
background and that there are many social issues related to the issue of AIDS it is better
to propitiate an environment where those issues can be brought up. It was also thought
to be helpful for the community to discover the facts throughout the recognition of their
experiences and feelings about the different aspects of the AIDS epidemic.

Before further elaboration on how the intervention was implemented, it is critical to
discuss the method and problems reported in the only published study of AIDS and
migrant workers in Michigan (Bletzer, K., 1991). The study aimed at the assessment
of migrants’ knowledge about AIDS. The researcher distributed a one-page
questionnaire (ten yes-no items) at the start of educational sessions to 297 migrant
workers at 21 camps. The instrument was read aloud in English and Spanish to help
those who wanted to follow the order of the questions. Thirty-ﬁve of the instruments
were returned with only demographic data, 76 completely unmarked, and 186 contained
answers to all or some of the knowledge questions. Obviously, this is a very low
response rate. There was no post-test because different types of interventions were
used, and because the researcher indicated that sometimes the presentations lasted close
to two hours and it was not feasible to administer the instrument. Keith Bletzer
discussed the difﬁculties in getting the participants to attend the meetings. When they
did come, they often came late or were coming in and out of the presentation and could

not complete the questionnaire. Besides the speciﬁc ﬁndings about migrants'

 

knowledge about AIDS, Bletzers study shows how there might not be openness to
information about AIDS or awareness of the need to learn about it. As further learned
measures will be extremely difﬁcult to administer in a presentation, and that even very
short instruments asking general information about knowledge might not be accepted by
the community. Unfortunately, Bletzer’s (1991) did not describe the recruitment
technique for the presentations nor details about the activity that could have make it more
or less attractive for the people at the camps.

Consequently, the participatory educational technique that was going to be
designed and implemented at migrants camps faced the following challenges: (a) the
meetings needed to be attractive to the people; (b) it was necessary to be able to compare
the ﬁndings without the reliance on pro-post test administration (due to the
inconveniences that Bletzer identiﬁed, and because of the high mobility of migrant
families); and (c) the instruments needed to be perceived as non-threatening and easy to
respond to--it was not going to be possible to gather data on individual risk behaviors.
But the intervention also needed to provide adequate information effectively and to
propitiate an environment for the exploration of individual's attitudes towards AIDS
related topics--i.e., homosexuality, drug use, people with AIDS—and for the discussion
of social norms that could be related to preventive behaviors. The information should
also produce comfort with the discussion of the topic and therefore, openness to further
information and awareness of the nwd to learn about it. Figure 4 summarizes the

potential inﬂuences on knowledge about AIDS identiﬁed or hypothesized for the
Hispanic population .

 

Social influences

 

‘ General health
values

* Cultural beliefs
'simpatia"
'respeto'
sex roles
religiosity

 

 

 

Openness

Knowledge about AIDS

/

65

Individual variables

 

 

" Attitudes toward:

Homosexuals
PWAs

Dnlg users
* Ace

* Education

 

/

\

Awareness

/ Social influences

Elm. Model for the prevertion program implemented

Behavior intention

Health behaviors

Finally, with these challenges in mind, and due to the high incidence of AIDS

among Hispanics, their low scores on attitudes and knowledge about AIDS, and the

poor success of current educational efforts the following objectives were chosen for the

program: (a) to increase knowledge about AIDS, (b) to promote the subjects exploration

of their attitudes toward people with AIDS, homosexuals and drug uses, (c) to

motivate more openness to receive information about AIDS, and (d) to increase

awareness of the importance of AIDS education for the Hispanic community.

In order to evaluate the participatory edueational intevention another educational

method was used-a lecture type presentation~, and both methods wee implemented in

migrants' eamps in Michigan as an experimental ﬁeld evaluation. The recruitment

 

process included an initial visit (no AIDS discussion) between the educator and the
migrant families, and a second visit to invite the families to an entertainmelt activity that
was going to include a 20 minute presentation about a critical health issue. Each housing
unit on the expeimental eamps was randomly assigned to one of three groups:
participatory learning group, didactic learning group-lecture type edueation—or control
group—just the entertainment activity and data collection. Two camps were included in
the design as non-equivalent control camps.

In the participatory learning group the participants guided the discussion of the
information through their interpretation of AIDS related issues shown to them in posters
developed by the American Red Cross known as the "talking posters”. Immediately
afterwards, a variety show was played with the interruptions for public service
advertisements about AIDS. The didactic learning group was a passive approach, very
similar to the current AIDS education to which Hispanics have more access, because it
comprises a brief discussion of AIDS and the presentation of a variety show with
interruptions for the presentation of four public service advertisements about basic
information regarding AIDS issues. A week after the group's meetings the researcher
went back to the camps and the subjects had the opportunity to display behaviors
showing openness to AIDS information and awareness of the need to learn about AIDS,
in exchange for entries into a rafﬂe. The original proposal mentioned that gender
differences wee going to be evaluated. The analysis showed that gender was not a
signiﬁcant factor on any of the relationships studied. As a result gender was dropped
from this dissertation. The following questions and hypotheses wee examined in the
study :

1. What do migrant workers know about AIDS (transmission, preventive

behaviors, prevalence among Hispanics and other ethnic and/or minority groups)?

 

67

H1. Thee will be a signiﬁcant diffeence between the rrrigrant workes' knowledge
about HIV/AIDS after the educational experience in the two experimental conditions as

compared to the control groups.

H2. Migrant workers in participatory learning group will show higher knowledge than
those participating in the didactic learning group which will also be higher than subjects
in the control group.

2. What attitudes do migrant workes have towards people with AIDS?

H3. Thee will be a signiﬁcant difference between migrant workers' attitudes towards
people with AIDS after the educational experiences, compared to the participants in the

control conditions.

H4. Thee will be a positive signiﬁcant relationship between knowledge and attitudes
toward people with AIDS and the knowledge about AIDS.

H5. There will be a signiﬁcant relationship betweer attitudes towards people with
AIDS and the behaviors of: requesting of written materials about AIDS, volunteering to
distribute written rmterials to other people, bringing someone to receive information
about AIDS, and requesting more information about condoms and spermicides.

3. What attitudes do migrant workers' have towards homosexuals and drug users
in relation to AIDS ?

H6. There will be a signiﬁcant difference between attitudes towards homosexuals of
migrant workers in the experimental conditions, and the attitudes towards homosexuals
in the control groups.

H7. Thee will be a signiﬁcant difference between the attitudes of migrant workers
towards drug users in the expeimental conditions, and the attitudes toward drug users

of migrant workers in the control groups.

H8. There will be a positive signiﬁcant relationship betweer migrant workers' attitudes
towards homosexuals and their knowledge about HIV /AIDS.

H9. There will be a signiﬁcant relationship between rrrigrant workes attitudes toward
drug uses and their knowledge about HIV/AIDS.

H10. There will be a signiﬁeant relationship betweer migrant workers' attitudes toward
drug users and their attitudes toward people with AIDS.

H11. There will be a positive signiﬁcant relationship between migrant workers'

attitudes toward homosexuals and their attitudes toward people with AIDS.

5. Would the participation in the participatory or didactic learning groups
increase migrant workers' openness to AIDS information as measured by their
behavior?

H12. There will be a signiﬁcant difference in the number of subjects requesting more
written information about AIDS, and the number of subjects requesting more

69

information about condoms and spermicides between the experimental education
conditions, and the experimental control group.

6. Would the participation in the participatory or didactic learning groups increase
the migrant workers‘ awareness of the importance of education about AIDS?

H13. There will be a signiﬁcant difference between the migrant workers' report of
interest in distributing information to other people, and disposition to bring someone
they know to receive information at the end of the intervention in all conditions, and the

difference will be higher for the experimental education groups.

Qualitative information about the participants' satisfaction with the edueational
experience, their sex roles behaviors related to the project, and the questions that were
asked more frequently during the educational experiences was gathered and analyzed
The next chapter describes the method followed in conducting this ﬁeld experiment.

CHAPTER IV
METHODS

This project was supported by the AIDS Awareness Ofﬁce from Cristo Rey
Community Center, the Iansing Chapter of the American Red Cross, the Special Ofﬁce
on AIDS Prevention from the Michigan Department of Public Health and the Psychology
Department from Michigan State University. All the lectures and or participatory
meetings were conducted in Spanish by this researcher (female). The AIDS Awareness
Coordinator, a man, attended to all activities and was a resource when younger men
wanted speciﬁc information and preferred to ask a man. In the following pages I will
refer to both ofus as the educators and use the words researcher or AIDS coordinator

when it is necessary to be more speciﬁc describing sorrre of the interactions.

Setting

All the activities were conducted at eight migrants camps in Michigan. A
nrigrant camp is a small area on a farm with small housing units (mobile homes, wood
houses or large warehouse constructions divided for different families) occupied by
seasonal agricultural workers. Six of these camps were included as experimental
camps, and two as control camps. The decision of whether a camp was included as an
experimental or control condition was based on its location and the eamp similarity in
terms of situational and environmental characteristics. Camps that wee too close to each
other wee not included. The two eamps that are farthest from the other eamps were
assigned to the control conditions (one other camp was chosen for the pilot test of the
whole procedure).

The housing units are often arranged in the ramp in the shape of a rectangle or

circle and the space in the center is used for showers or washing machines. Most

70

71

farmers receive money ﬁom the government to provide housing to their workers during
the summer. However, sometimes the migrant families have to pay rent to the farmers
to stay in the housing units. Moreover, on some farms, people are not hired if they are
not going to live in the housing units owned by the farmer.

The camps included in the study had between seven and sixteen housing units.
In two of the camps the housing units had just one room with one or two mattresses on
the ﬂoor, a table, some chairs and an old stove and refrigerator. In most of the other
camps the housing units were still very small but had one or two rooms--sometimes
without doors, and separated with curtains. Half of the camps visited (three) did not
have showers inside the housing units, and only three or four water-closets for the
community. Only one of the camps had speciﬁc areas which were clean and prepared
for the children to play. One of the camps visited had much better housing units than any
other camp-~made out of bricks, larger, painted and with sidewalks—this is the camp that
also had areas for the children to play and a basketball court.

With the exception of two camps (working on lettuce and onions) all camps
worked in pickles. Usually one of the members of the family is contracted by the
farmer who pays the worker according to the number of pounds of the crops picked
daily. Therefore, it is convenient for the families to have many members going to work
at the ﬁelds.

None of the families live permanently in Michigan: they spend half of the year
working and living in either Texas or Florida--just two families had come directly from
Mexico. All families drove to Michigan and moved into the housing units during the
ﬁrst few weeks of May (especially those working on pickle farms). The crops are ready
to be picked during the last weeks of June or the ﬁrst week of July. Meanwhile, the
workers could be eithe hired to help cultivate the crops, or unemployed until the crops
are ready to be picked.

72

No people of non-Mexican ancestry were found working in any of the camps.
Most of the families have been coming to work in Michiganuwith the same farmer--
consecutively during many years and in most of the camps, many families were related.

The type of family living in the same housing unit was either nuclear—just the
parents and children--or extended-including grandparents, nieces, nephews, etc..
Nuclear families were found more often in individual housing units when other nuclear
families related to them were also living at the same camp. When extended families wee
found living in the same housing unit, usually the families living in the othe' housing
units at that camp were not related. Still, it was clear that the families travel to Michigan
in extenmd families and usually worked for the same farme'.

It was not necessary to request permission from the farmers to conduct the
activities at the camps—the activities were not going to interfere with the farm work and it
was up to the migrants to refuse to have the activities near their housing units. Still, all
the farmers were notiﬁed about the program a month before it started, and had the
opportunity to ask questions and meet with the educators. Only one farmer contacted the
educators requesting an interview with us before any contact with the migrants living at
his camp. This research will not identify the camps assigned to each condition or

identify the results from particular camps.

Research Participants
The ﬁrst visit to each camp had the following objectives: (a) to meet migrant
families, (b) to establish contact persons, (c) to determine the number of families in the
camps, (d) to determine the location for the tent, (e) to obtain a camp phone number, (f)
to ﬁnd out when the workers were going to start working at the farms, (g) to identify if
the people wee interested in the project activities, and (h) to discuss any objections that

poteltial participants had.

73

The ﬁrst visit usually lasted between one and two hours (from 6:00PM. to
8:00PM.) and the interaction was mainly with women and children because they were
the ones at the camp. Still, all the adults present at the camp wee met during this initial
visit. It was common to ﬁnd groups of women sitting in front of a housing unit or
playing Bingo. During the time that I was talking to the women, the AIDS coordinator
often was able to distribute candies to the children. When the men were at the camp
they were found usually near a truck listening to music in Spanish or doing some work
ﬁxing one of the vehicles. They usually heard the information that was given to the
women. Usually a men was invited to be the contact personnthe oldest or one related to
different families living at the camp--; in their absence, a woman was invited to be the
contact person. The men was approached ﬁrst because recalls of experiences from
people who have done migrant AIDS education in the past, informed me that getting the
men to participate was a very difﬁcult and that if they do not agree with the conduction
of the activity the participation of their farrrilies or peers was also difﬁcult.

The role of the contact person was to introduce the educators to other families
(sometimes walking with me door to door) and to express any concerns about the
activity or presentations that he/she perceived that the people had. The contact person
also provided information on any change in plans that required a rescheduling of the
meetings.

The people contacted in all the ramps showed a lot of interest in the activity-
speciﬁeally in the videotapes of Tex-Mex bands-and suggested days and times for the
meetings. The activity sounded ve'y appealing because in most of the camps the ﬁrst
visits were conducted during the second and third week of June and at that time the
migrants had not started working. They did not have many options for entertainment.

Even though most of them had television, they didn't have any Spanish channels. The

74

videotapes that were offered for the meetings included a musical show that most of
them watched daily while in Texas or Florida.

Within three days after the ﬁrst visit, each housing unit at the eamp was visited
again. This time I talked with the adults about the activity and gave them an invitation.
At the same time, records wee kept of the number of men and women older than
thirteen years old living on each housing unit, of the surname of the family, and of the
color of the invitation left.

On each of the experimental camps, three colors of invitations were distributed.
The color coded invitations were used to randomly assign housing units to the control
group, participatory learning group, or didactic learning group. Only one color of
invitation was distributed in the control camps—because there was going to be one type
of meeting. Everyone at the camps was assigned to the meeting that his/her housing unit
was included in. It was speciﬁed that the size of the tent used for the presentations
dictated the number of people that could be invited. It is important to note that complete
families could show-up for the presentations but only subjects 13 years old or older
participated in data collection activities.

The invitations for the experimental groups speciﬁed that during the meeting
a critical health issue and information about a study that was gathering information to
beneﬁt migrant workers were going to be discussed brieﬂy. The invitation also
described the names of the bands included in the videotapes, the date of the presentation,
the fact that refreshments were going to be provided, and the afﬁliation and names of
the educators. Interestingly, nobody ever asked what health issue was going to be
discussed. Appendix A displays the format and content of the invitations.

Sample

The participants in this experiment wee Mexican Ameican migrant workes in
Michigan. Migrants tlrirteer years and older wee invited to participate in either the
education (182 invited to educational conditions didactic or participatory, of whom 84
came to the activities) or control meetings (131 migrants invited and 68 participated). In
total, the project approached 313 migrant workers and received the collaboration of 139
subjects (89 females, 50 males).

The following table (1) displays the number of people invited to each group (N)
and the males and females who attended and the percentage of participants from each
camps. The camps are designated by letters.

 

 

 

 

 

Table 1. , ' fmi . '
Groups
Exp. camps Control Didactic learning Participatory learning
N F M % N F M % N F M %
A 226 445 3517357 293 528
B 213119 132554 133131
C 145357 111118 102020
D 164238 92356 115155
E 125475 62150 125475
F 104 040 131223 205130
Totals 9.51m 87 25 14 45 W
Group totals: 42 39 35

 

Non-equivalent N F M %
control group

 

G 22 8 5 59
H 14 5 5 29
TotalsailLJJJZ

Group Totals: 24

 

More females than males attended the meetings: (a) in the control group,74% of
the womer and 25 % of the men invited to the meetings attended; (b) in the didactic
learning condition, 71% of the women and 31% of the men invited to the meeting

75

76

attended; and, (c) in the participatory learning condition, 52% of the women and 24% of
the men invited to the meeting attended.

The demographic characteristics of the sample were: (a) age, X: 27.8 years
(S.D.=14.2, min.=13, max.=76); (b) education , X=8.13 years (S.D.=3.59, min.=no
education, max.=4 years of university); (c) marital status, married=77, single=52, living
together=4, widow/widower=2; (d) cultural/ethnic group, Mexican=76, Mexican-
American=57 and Chieano=2; and, (e) preferred language, English=8, Spanish=61,
English and Spanish=68.

Table 2 displays the means for age and education for each of the conditions and
Table 3 displays the distribution of responses on language, marital status and cultural

 

 

and ethnic identity.
Table 2. WWW.

Conditions
Variables PL DL CG NBC
Age 25 .69 28.28 26.12 32.52
Education 7.91 8.32 8.21 8.00

 

Note. PL= participatory learning group, DL=didactic learning group, C: control group,
and NBC= non—equivalent control group.

 

 

Table 3. Distribution of remngs on nggraphic characg’stics by group.
Conditions
Variables PL DL CG NEC
language preferred
English 3 l 2 2
Spanish 15 16 14 16
Both 2 22 25 6
Marital status
Married 19 20 25 13
Single l2 17 14 9
living together 1 1 - 2

Widow/widower 1 1 - -

77

Table 3 (cont'd.)

Cultural and ethnic identity
Mexican 22 23 2O 1 1
Mexican-American l 1 15 19 12
Chieano - 1 - 3

 

Note. PL: participatory learning group, Die-didactic learning group, C: control group,
and NEC= non-equivalent control group.

The migrants discussed many of their needs with the educators and since there
were consistencies in the things that they reported, the subjects' needs were considered
important situational variables. The main needs mentioned wee: (a) furniture, especially
cradles, chairs and mattresses; (b) medical services--sometimes thee were conﬂicts
between the schedule of the clinics available, and migrants' work hours, also, some
clinics that visit the camps during the Summer were not announcing their visits; (c) food-
especially during the month of June when many of the migrants wee not been paid; (d)
televisions or radios; (e) toys; (1) kitchen appliances; and (g) a washing machine for the
camp. Also, even though it was not mentioned by the workers, we observed during the
visits that the electricity generators in some camps wee very old and frequently stopped
working and that three camps sometimes did not have water running inside the housing
units.

The Chi-square test of independence is used to study the null hypothesis that the
categorical variables: education, gender, preferred language , marital status, age, and
cultural and ethnic identity, and number of previous sources of information about
AIDS are independent of the conditions (groups) in the study. None of the Pearson

Chi-square coefﬁcients computed was signiﬁcant.

Research Design

The evaluation of the two AIDS education processes was done as a ﬁeld
experiment with four conditions. The housing units on each of six migrant camps were
randomly assigned to the control group or to one of two learning groups. All the
housing units in two other camps were assigned to a non-equivalent control group. The
non-equivalent control group is a condition were only the entertainment activity and the
post-test were conducted. It is named non-equivalent beeause the participants in these
groups wee not randomly assigned to the condition. The dependent variables,
knowledge about AIDS and behaviors showing openness to information about AIDS
and awareness of relevance of educating the community about AIDS, wee assessed
after the inte'ventions in the experimental edueational conditions A and B and after the
meetings in the control conditions. Hence, the research design was a post only design.

Figure 1 displays the experimental design.

Groups

.. . . Non-equivalent
Partlcrpatory Drdactlc Control

control

 

 

 

 

 

«:1:ng
Timon!!!)

 

 

 

 

 

figure; Research design.

78

Procedure

One of the two educational methods consisted of a lecture and the presentation
of public service advertisements about AIDS (in Spanish) inserted in a videotape of
entertainment, which was presented after the lecture. The key messages provided in the
lecture are outlined in appendix B and the information about the public service
advertisements is displayed in appendix C.

The second educational method consisted of a modiﬁcation of the Paulo Freire
model, where the participants watch symbols that are meaningful to them and that help
them to relate to the information that the educator wants them to discover. The
implementation of this type of educational intervention in this research relies on a
participatory approach to the presentation of the information prompted by ”talking
posters" (developed by the American Red Cross). For descriptions of these posters,
see appendix D. Participants in the second learning group were also exposed to the
entertainment videotape with the public service advertisements about AIDS.

Each of the conditions on each eamp met on a different day and had education
(participatory or didactic format) and entertainment (the videotapes), or just the
videotapes (the control conditions). All participants answered the same questionnaire at
the end of the meeting. Five to six visits to each of the experimental camps and four
visits to the control camps necessary. The purpose of the ﬁrst two visits was discussed
earlier in this chapter. The following table (4) indicates the purpose of each of these

visits.

79

80

Table 4. WWW

 

Visit

Purpose

 

III

- Meet migrant families.

— Establish contact persons.

- Determine number of families in the camp.

- Determine location for tent.

- Attain camp phone number.

- Find out the date when the workers will start picking-up the crops.
- Identify if the people are interested in the activities planned.

- Meet or get re-acquainted with migrant families.

- Handout color coded invitation to housing units recording the
number of people older than 13 years old on each housing unit, their
surname and the color of the invitation distributed to them.

- Conﬁrm tent site, contact person, & number at site.

- Conduct AIDS presentation for control group.
- Provide AIDS information materials.

- Conduct AIDS presentation for participatory or didactic conditions.
- Provide AIDS information materials.

- Conduct AIDS presentation for corresponding participatory or
didactic condition.
- Provide AIDS information materials.

- Hold rafﬂe—to provide an incentive for migrants to return
behavioral change cards.
- Provide AIDS information materials.

 

The ﬁrst meeting on each experimental camp was the one with the control

group. The order of the meetings for the other two conditions varied: in three of the

camps the meeting of the didactic learning group was the second one, and in the other

three camps the meeting of the participatory learning group was the second one. The

number of planned visits to the camps was 44 (20 visits for the meetings of the different

conditions). However, sometimes meetings had to be rescheduled due to unexpected

81

circumstances such as: (a) a birthday party going on at the day and time of the meeting;
(b) a baseball game between all the men in the camp and a neighbor eamp; (c) the
decision of the farmer to request the migrants to work until late in the evening; (d) all the
women at a camp going out together to buy groceries--on the same night; (e) failure of
the video equipment and the television; (0 severe rain, or : (g) simply not ﬁnding
anyone at the camp. For instance, in one camp two meetings had to be done in the same
day. The following paragraphs describe each group.

As soon as we (researcher and AIDS coordinator) arrived at the camp the children
came to us and started to help unloading the truck. Before we set up the tent, I went to
each of the housing units assigned to the meeting-escorted by the children-- and
checked if the family was at the camp. The families wee told that the presentation was
going to start in 25 minutes. Most of the time we had to start much later than the
scheduled time, waiting for families assigned to the meeting who were either grading
the crops or out of the camp doing some errands, but had speciﬁed that they were
coming back for the presentation.

The children were very excited about the activity --specially about the
refreshments and the tent-and we waited for their parents playing baseball or soccer
with them or watching some additional videotapes on the television that we brought to
the camps. It was difﬁcult to convince the children that they needed to come to the
meeting to which their housing unit received the invitation. Therefore, wherever we had
enough space children under 13 years old were allowed inside the tent to watch the
videotapes and have some refreshments. We did not allow children of those ages inside
the tent during the brief discussions about AIDS, unless an adult from their housing
units decided that the child could listen to the information.

The people invited to each meeting usually sat on the carpet inside the tent or

brought chairs from their houses. They received refreshments as they came into the tent

82

and the ﬁrst ﬁve or ten minutes wee dedicated to informal conversation and jokes. In
order for the subjects to be fully informed of their rights before they choose to provide
data, they were informed that the presentations were also part of a study of methods of
AIDS education for Hispanic families and that at the end of the meeting they we'e going
to be given the option to participate in the study. The rest of the procedure varied
depending on the type of meeting (control or participatory or didactic education).

The meeting ofﬁcially started with an introduction of the activities that were
going to take place and their purpose (i.e., information about AIDS, presentation of
the show and data collection). At this time, I speciﬁed that someone who did not wish
to hear the information about AIDS could wait 10 to 15 minutes outside the tent and
come back for the presentation of the television shows. The adults attending the
meeting had the chance to decide if they wanted any of their children to stay outside
while the information about AIDS was discussed-—if that was the option, we provided
drawings and crayons for them to color while they waited to get back into the tent.

None of the adults chose not to listen to the information about AIDS, but most of the
time they asked the little children--under ten years old--to stay outside until the
discussion about AIDS was ended.

The discussion was introduced saying that the presentation was going to be done
by going through a set of posters. It was evident that some people felt nevous about the
type of posters that were going to be used, and smiled and showed their relief when they
saw the ﬁrst poster of two children playing. The discussion of each poster started by
asking the participants to create a story based on the picture. Since the subjects knew
that the topic of the presentation was AIDS, they always try to create stories related to

this topic, even when that was not part of the instructions for the development of the

stories. Most of the posters had four boxes and there is not a correct sequence to read
the boxes and develop the stories. There was a lot of participation in the discussion of
the posters and since the task was easy--to create a story or just to name the people in the
story—everybody felt entitled to an opinion and sometimes the stories were very

elaborate. The following topics were discussed throughout the posters:

1. Poster of a Mexican boy and a girl playing with marbles.

This poster was used to present: (a) the responsibility to learn about AIDS as
something everyone should do for the future of the Hispanic community; (b) the duty to
protect and teach the children; (c) epiderrriology of AIDS in the Hispanic community;
and, (d) clariﬁcation of myths about groups that some participants regarded as the only
ones getting infected with HIV.

2. Poster of a Mexican family in a party with a piﬁata.

This poster helps in the discussion of the supportive role of the Mexiean family
whenever there is an illness in the family and of how that could be the same if the
relative has HIV infection. Also, the characteristics and differences between HIV and

AIDS were discussed.

3. Poster of two arms and a syringe.

This poster guides the discussion of: (a) intravenous drug use and syringe
sharing; (b) sharing of syringes for medicines or vitamins; (c) stereotypes about drug
users; and (d) methods to clean the syringes.

83

4. Poster of a couple going out.

The other main method of transmission of the AIDS virus was discussed in the
stories developed for this poster: unprotected sexual intercourse. The safe and unsafe
sexual practices were identiﬁed as well as the reasons that will make someone engage in
any of these type of behaviors. It was very interesting to see how much women and
men coincided in the type of conversation that they said that the couple in the story was
having. Almost everybody mentioned that the man was suggesting or asking the woman
to have sex with him and that since she was not sure that she wanted to do that, he tried
to get her to drink a lot and make her more vulnerable to agree to his request. This was
one of the posters that prompted the longest discussion because of the many different
elements that it included, such as alcohol, cigarettes, a couple that could have had sexual

intercourse and a woman that seemed worried.

5. Poster with a big monster, a little monster and a teddy bear.
This poster was used to ask the participants to mention different types of
behaviors related to sexual relationships and drug use and to classify the behaviors as

no risk, moderate risk or safe behaviors in regard to possibilities for HIV infection.

6. Poster of the people in the park.

The subjects started by making a list of everything that is happening in the poster.
When everything had been mentioned, they began to realize all the activities mentioned
had something in common, and that it is that all the activities mentioned are casual
contacts throughout which HIV had not been found to be transmitted. The reasons why
it is difﬁcult to get HIV from these type of interpersonal behaviors were explained. The
participants asked a lot of questions regarding this poster.

85

At the end of the discussion of these posters, the children came back into the tent
and the presentation of the videotapes started. After the ﬁrst 15 minutes of the show two
consecutive public service advertisements (20 seconds each) about AIDS were shown.
When the public service advertisements were shown the participants paid a lot of
attention and sometimes made comments about them and asked questions even though
they were not prompted by me to watch the advertisements. Appendix C describes the
content of the public service advertisements. After the next 15 minutes of the show a
second pair of public service advertisements about AIDS was presented and the
participants were asked if they would like to pause and complete the questionnaires and
then continue with the videotapes.

The consent forms were distributed--read in Spanish and English-and the
subjects rights were explained (conﬁdentiality, anonymity, possibility to receive
information about the results of the study and, opportunity to withdraw from the study at
any time without any penalty). Appendix D displays the English and Spanish versions
of the consent forms. The consent form for children under 18 years old needed to be
signed by the parent and the child--these forms are also shown on appendix D.

All the participants signed the forms, but some of them asked the person siting
next to them to write their name in the form because they did not know how to write.
After the consent forms were collected, the questionnaires with the corresponding
behavioral cards were distributed in either English or Spanish—according to the subject's
preference (appendix E). The questionnaire was read in Spanish for those who wanted
to follow the order of the items, and the instructions of each section were read and
explained aloud to the whole group. If someone needed the questionnaire to be read to
him/her in English, the AIDS coordinator read the items and explained the instructions to

them outside of the tent.

86

Some older subjects asked if I could write their responses for them. In those
cases, the subject had the alternative of completing the questionnaire later, privately, as
an interview. If they did not care about other people hearing their responses, I wrote
their responses while I was reading the questionnaire to the whole group.

When the subjects were done answering the questionnaire, they heard the
explanation of the ﬁve color-coded cards (See Appendix F for a sample of the cards).
It was explained that one week after the third group meeting at the camp, the educators
wee coming again «at an speciﬁc day and time—to visit each housing unit and that
those who completed the questionnaire had the option to do one or more of the
behaviors mentioned in the cards, and would receive one ticket for the rafﬂe of a fan for
each color coded card that they bring-each behavior they chose to do. There was also
one card which said that the subject was not interested in any of the behaviors mentioned
in the other cards, but would like to receive a ticket for the rafﬂe of the fan. The rafﬂe
was held during that visit to the camp, after all the housing units were visited. The
behaviors mentioned in the cards were the following:

1. Green card: "I want to receive more written information about AIDS for me."
2. Yellow card: "I will like to receive copies of written materials about AIDS to
distribute among people I know."

3. Gray card: "I will bring someone I know on the day of the rafﬂe to receive
information about AIDS from the educators" (if the worker chooses to do that, the
additional persons would also have a chance to participate in the rafﬂe).

4. Red card: "I will like to receive more information about condoms or
spermicides."

5. Blue card: "I am not interested on doing any of the behaviors suggested in the
othe' four cards, but 1 will like to receive a ticket to participate in the rafﬂe of the

fan.

87

Each card was explained in Spanish and in English and it had a drawing of the
behavior on the back .

Warmth

There was a main difference between the procedure followed with the groups
assigned to participatory learning group and the procedure followed with groups
assigned to didactic learning group. The didactic learning group listened to educational
information on the same topics covered with the participatory learning group, but
instead of using posters the presentation was done as a brief lecture before the
presentation of the videotape, without any participatory exercises. The subjects in the
didactic learning group watched the same videotape of shows--with public serviCe
announcements "PSAs" inserted--presented to participatory learning groups. The
didactic learning groups were also very attentive to the public service advertisements and
asked questions or made comments about those messages.

After the second interruption for PSAs, the subjects were invited to pause and

complete the consent forms and questionnaires. They completed the consent forms and
the questionnaire and receive ﬁve cards throughthe same procedure used in the

adrrrinistration of these forms to the experimental groups A.

maximum
At the beginning of their meeting, the control groups listened to the same
information about their opportunities and rights to provide or not data for the study
discussed with the experimental groups A and B. The videotape presented to the control
groups did not have the PSAs inserted. The consent forms, questionnaires and the
cards were administered in the same way that it is done with groups A and B, but

instead of after the second interruption for PSA's--since the PSA's were not shown to

88

control conditions-the forms wee administered aﬁer the ﬁrst half hour of the

videotape.

Measures
Quantitative and qualitative data was gathered during this research. The
quantitative data was gathered in questionnaires administered to the participants in all the
conditions, and throughout the study the subjects had the opportunity to bring back the
behavioral eards during the follow-up--while doing the behavior written on the card.
The qualitative data was gathered in ﬁeld notes of every visit to a camp, dictated to a
recorder and later classiﬁed in different categories of information. The following

sections provide more speciﬁc information on each of the data collection instruments.

Th . .
A two-page, two sided questionnaire was developed for the study (see appendix
F for the Spanish and English versions of the questionnaire). The instrument was
developed in Spanish and an English translation--not directly equivalent because of lack
of correspondence between the two languages for some words and phrases--was
prepared and offered to subjects that preferred to read English. This questionnaire
gathered information on: (a) knowledge about AIDS, (b) attitudes towards AIDS
patients, (c) attitudes towards homosexuals, (e) attitudes towards drugs users, (1)
awareness of the relevance for the Hispanic community of learning about AIDS, (g)
interest in receiving information about AIDS, (h) sources of previous information about
AIDS, and (i) demographic information. The following table displays the main sections
included in the instrument and the numbers corresponding to the items used to assess the

different variables.

89

Table 5. WWW

 

Sections
Item number

Type of response

 

General knowledge about AIDS
I 1 , 12, I3a-i

Knowledge about prevention
In 1-5

Attitudes towards AIDS patients
Ill-118

Attitudes towards homosexuals
V1, V2, V3, V4, V10

Attitudes towards drugs uses
V5, V6, V7, V8, V9

Awareness of the relevance for the Hispanic
community of learning about AIDS
V12. V14

Interest in receiving information about AIDS
VI 1 , V13
Sources of previous information about AIDS

V15, V16, V17, V18

Dichotomous (yes-no)

1-3 Likert scale (never effective to very effective)

1-4 Likert scale (strongly disagree to strongly agree)

1-4 Likert scale (strongly disagree to strongly agree)

1-4 Likert scale (strongly disagree to strongly agree)

Dichotomous (yes-no)

Dichotomous (yes-no)

Dichotomous (yes-no)

 

Demographic information Categorical information
IVl-IV6
gleam; knowledge smut AIDS. The items to assess knowledge about AIDS assess

general knowledge about AIDS and misconceptions about AIDS transmission. Some of

these items were from the survey developed by the Michigan Department of Public

Health and the Hispanic Community. Even though information on the reliability of the

scales was not reported, the instrument was used during 1989 and 1990 with Hispanics

at Cristo Rey and showed that they were able to understand the language. The scores

on general knowledge about AIDS were coded as one when the subject answered "yes",

and two if the subject answered "no." A highest score indicated more correct

responses about AIDS (three items were eliminated beeause of their low item -total
correlation: 11,12 and 131). The table in appendix H displays the item -total correlation
of each of the items included in the score on general browledge about AIDS—the mean
inter- item correlation for the scale is .19. With items 11, 12 and 13f eliminated, the
scale‘s Alpha coefﬁcient was .65. The mean score on the scale was 15.13, with a
standard deviation of 1.33. The maximum and minimum possible scores were 8 and 16.

Table G-l displays the responses on knowledge about AIDS.

WW1; Five behaviors were included on the section on
knowledge about prevention. The instructions were to circle the number that best
indicated the subject's perception of the effectiveness of each of the methods in regard to
prevention of HIV infection. The coding of the responses to these items was done
assigning a value of two to the best response, a value of one to the next best response,
and a value of zero to the option that is a wrong response to the item. Item number ﬁve
was eliminated from the seale due to its low item-total correlation and it should also be
reported that the item was not clear enough for the subjects while they were answering.
The scale's coefﬁcient Alpha is .54. The mean score is 4.70 with a standard deviation
of 1.91. The minimum and maximum possible scores were zero and eight, respectively.
The following table displays item-total correlations. The mean inter-item correlation is

.23.

 

 

Table6.l m— latin fr nknwl
Items Item-total correlation
1111. Not to have sexual relationships .31
1112. To use a condom .31
1113. To clean needles with clorox before injecting drugs .33

1114. To use an spermicide .36

 

91

A ' s l wi AID Items regarding attitudes about AIDS and
attitudes toward people with AIDS were studied in the same section. Attitudes towards

AIDS were assessed with three items answered on a 1-4 Likert scale (strongly
disagree to strongly agree). Attitudes towards people with AIDS were assessed with
seven items answered on a Likert scale (strongly disagree to strongly agree) and based
on Larsen, Serra, and Long's (1990) "Attitudes Towards AIDS Victims Scale" (ATAV).
The original scale (ATAV) comprised 20 items and the coefﬁcient Alpha reported by the
authors was .91 (p < .001). Since the Alpha coefﬁcient of the whole scale was high
and the part-whole correlations of the items were almost all higher than .70, only a
selection of the items was included in this instrument. The items with the highest part-
whole correlations in the ATAV scale were chosen and the wording changed slightly
when the items were written in Spanish.

The score on attitudes towards people with AIDS combined the responses on
items about attitudes about AIDS and attitudes towards people with AIDS. Only one of
the eight items was eliminated from the computation of the score (item 116) because of its
low item-total correlation. The mean score on the scale was 18.94 with a standard
deviation of 3.86. The mean inter-item correlation was .13, and the coefﬁcient Alpha
for the seale was .50. The following table displays the item total correlations of the

items in this scale.

92

 

 

Table 7. I m- 1a ' n f r n ' de towar 1e wi AID .
Items Item-total
correlation
111. People with AIDS should be isolated from the community. .46
112. AIDS is not a common disease among the Hispanics . 13
113. AIDS is a punishment from God. .36
114. Needles should be provided to drug users to prevent spread of the infection .07
115. If someone gets infected with the AIDS virus it is because she/he have been .1 1
behaving immorally
117. I would open my house to someone infected with the AIDS virus .08
118. I would not want a person with AIDS to touch me. .41

 

W. The attitudes towards homosexuals were studied with
items developed after the review of several studies (Aguero, J.E., Bloch, L., & Byrne,
D., 1984; Herek, G.M., 1984; Larsen, K.S, Serra, M., & Long, E., 1990). These
items were answered in a 1-4 Likert scale (strongly disagree to strongly agree). The
mean score on the scale was 11.97 with a standard deviation of 3.59. The maximum
and minimum possible scores were 5 and 20, respectively . The mean inter-item
correlation was .29, and the Alpha coefﬁcient was .67. The following table displays the

item-total correlation for the score on attitudes towards homosexuals.

 

 

Table 8. Item-total melagms fgr scare on attitudes towards homosexuals.
Items Item-total correlation
V1. I would feel uncomfortable if I were in the bathroom and a .39
homosexual were there too
V2. I would not like to have a homosexual as my neighbor .67
V3. Homosexuals are born that way .32
V4. The police should arrest homosexuals .42

V 10. A homosexual person should not be allowed to take care of his children .35

 

Attitudes toward; drug users. No measures of attitudes towards drug users were found
in the literature. Therefore, information about how this group is stigmatized was used
to develop a set of items to assess those attitudes. The mean score on attitudes towards

drug users was 10.93 and the standard deviation was 3.68. The maximum and

93

minimum possible scores are 20 and 5 respectively. The mean item-total correlation was
.35, and the coefﬁcient Alpha for the scale was .73. The following table displays the

item-total correlations for the scale on attitudes towards drug users.

 

 

Table 9. I m- o 1 'on for n ' des to
Items Item-total
correlation
V5. Drug users are persons that do not know how to handle their problems .44
V6. Drugusersare criminals .59
V7. It is impossible to be a friend of a drug addict .52
V8. The government should separate the children of drug users from their .5 7
parents
V9. A drug user cannot stop his/her addiction . 35

 

mm: sources Qf informgg’gn my; AIDS. Four items were included to assess the
number of different types of previous sources of information about AIDS. The items
asked if the subject had heard information about AIDS on the radio, watched
advertisements about AIDS on the television or read brochures of information about
AIDS. A fourth question asked the subjects to circle other sources ﬁom which they
might have received information about AIDS. The options were friends, clinics, school,

clinical laboratories, pharmacists or other.

f l f 'n mm ' ut AID . The awareness of the

relevance for the Hispanic community of AIDS education was assessed in two ways:
with two items in the questionnaire, and with two behavioral cards during the follow-
up. The items in the questionnaire asked if the respondent was interested in introducing
someone to the educators to be informed about AIDS and if the respondent was
interested in distributing copies of written information about AIDS to people that they
know. During the follow-up, the subjects had the opportunity to do one or both of the

94

behaviors. In both cases (items and cards), the responses were gathered as dichotomous
variables. The following chapter describes how the tetrachoric correlation coefﬁcient
was computed for each card;its corresponding item in the questionnaire and the
correlations were very low. For interest in distributing information about AIDS to other
people and the request of copies of information about AIDS to distribute to people that
they know the rt: .14. For the interest in introducing someone to the educators to
receive information about AIDS and the actual behavior of introducing someone to the

educators to receive information about AIDS the rt=.01.

aness to infgrmag’gn 3mg; AIDS. The subjects' openness to information about

AIDS was assessed in two ways, with two items in the questionnaire and with two
behavioral cards. The items in the questionnaire were dichotomous (yes-no) and asked
if the subject was interested in more written information about AIDS for him/herself and
if the subject wanted more information about condoms or spermicides. The behavioral
cards gave the option to the subject to request more written information about AIDS (by
returning the green card)or request more information about condoms or spermicides (the
red card). If the subject returned the red card he/she was given the option of listening
privately to information or to receive a sealed envelope with samples of condoms and
spermicides with written instructions on how to use them. Since the relationship
between the items in the questionnaire and their corresponding cards dining the follow-
up were low (.28 for the card and items about condoms, and .10 the item about more
written information for the individual and the request of written information), the
information from the items in the questionnaire and the information from the cards was

used separately in further analysis presented in the results chapter.

pr:

am

ch

als

sh.

nig

du

dis

The ' tive servations

The researcher carried a rnicro-cassette recorder to the camps and on the way back
dictated main observations. The observations were about the objectives of the visit (if
they wee accomplished or not), any problems encountered, conversations with the
migrants, speciﬁc events taking place during the visit, sex roles and health and possible
cultural beliefs. The day and the time when each visit started and the time when we left
the camp were recorded. Special attention was paid to record any information that could
possibly be related later to attendance to the meetings. It was assumed that sex roles
and health beliefs could have an effect on the implementation of the program and for this
reason the researcher was attentive to any information related to sex roles and health
beliefs.

Since it was discovered during the follow-up that people's dissatisfaction with
previous AIDS education programs could become a barrier to future AIDS education,
and since it is known that one-time interventions are not likely to achieve behavioral
changes, it became critieal for me to leave the subjects at the camps with a positive
attitude towards AIDS prevention and AIDS edueation. Therefore, observations wee
also made on the subjects' satisfaction with the intervention. For example, any anecdote
showing satisfaction or dissatisfaction of the subjects with the activities were recorded.
The process of dictating observations lasted between 15 and 20 minutes. That same
night or the next day , I typed the notes and elaborated more on the observations made
during the visit. Typing the notes and elaborating on them lasted between 15 and 45
minutes depending on the type of visit (if there was a meeting or if it was just to
distribute invitations, etc.).

At the end of the project, the notes were classiﬁed into major topics and situations

that happened at least once in each of three or more camps. There were situations when

95

96

that could affect the interpretation of the results of the study, it was not classiﬁed. If the
same situation did not happen at least once in two more camps, it was not reported in the
section of qualitative observations. After the observations matching the requirements in
terms of frequency were identiﬁed, I looked into the notes for experiences that could

reject the possible interpretations of the observations. Even if the experience contrary to

the observations classiﬁed as major topics happened only once, and in one camp, it was

reported and interpreted.

CHAPTER V
RESULTS

This research provides a combination of qualitative and quantitative data. The
data reported on the section titled ”Quantitative ﬁndings," involves parametric statistical
analysis. The section titled ”Exploratory analysis" displays analysis of additional
quantitative data; and, the section titled "Qualitative observations," describes
satisfaction with the educational interventions, sex roles behaviors, and questions about

HIV and AIDS and comments on othe" cultural beliefs and general health values.

Quantitative Findings
Kngwlmge mat AIDS

Two sections in the questionnaire assessed knowledge about AIDS. One
was a section on general knowledge about AIDS which asked about main characteristics
of the syndrome, routes of contagion, and myths. The other section was about
knowledge of the effectiveness of different prevention behaviors. No signiﬁcant effect
due to gender was found on general knowledge about AIDS or geneal knowledge
about prevention.

The score on general knowledge was computed adding the responses to
dichotomous (Yes-No) items . Table G-2 in the appendix displays the percentage of
correct and incorrect responses on each item from each group . With the exception of
one item (31‘), the percentages were higher for the correct responses. The maximum and
minimum possible scores were 8 and 16. Table 11 displays the average score on

gereral knowledge about AIDS for each group.

97

98

done assigning a value of two to the best alternative, a score of one to the next best
response and a score of zero to the option that was not adequate. Table GB in the
appendix displays the values assigned to each item. Table 10 displays the distribution
of responses given by each group to each of the items on prevention of AIDS.

It is important to note that item #5 (" Having sexual relationships only with
someone you know well") was clariﬁed during the administration of the instrument. It
was speciﬁed that it refers to having sexual relationships with someone that you know
well and whom you do not suspect that may be incurring in any of the risk behaviors.
Still, this item was eliminated from the scale when the score was calculated because of
its low correlation with the other items.

The following table displays the average scores on knowledge about AIDS on

each of the four conditions in the study.

Table 10. Avmge 3cm: m knowledge a_bgut AIDS gm each my

 

 

Groups
PL DL CG NBC
General knowledge 15.47 15.25 14.81 14.91
Knowledge about prevention 5.36 5.18 3.55 4.76

 

1191;. PL: Participatory learning group, DIP-Didactic learning group, CG=Control
group, NEC=Non-equivalent control group.

This research evaluates two hypothesis about differences between conditions on
knowledge about AIDS.
H 1: There will be a signiﬁcant difference between the migrant workers' knowledge
about AIDS after the edueational experience in the two experimental conditions as
compared to the control groups.
The evaluation of this hypotheses requires the computation of different tests, some

using the score on general knowledge about AIDS and others regarding the knowledge

othe
four

C011

sub;
of V
the
test

was

about prevertion methods (there was a very low correlation—.07--between the two sets
of scores). The analysis of general knowledge about AIDS by groups starts with the
Kruskal-Wallis one-way analysis of variance by ranks. This non-parametric test was
used beeause the Barlett-Box test showed that the homogeneity of variance was violated
(F=2.28, p=.08). The null hypothesis in this analysis was that there is not going to be
any association between the scores on knowledge about AIDS and the different
conditions. The assumptions of this non-parametric uncorrelated statistic are that the
samples have similar distributions, are drawn at random, and are independent from each
other. The value of the Kruskal-Wallis statistic (H) is 6.8 (p>.05). A ceiling effect is
found in the scores on general knowledge about AIDS, because even the non-equivalent
control group had a very high score (14.91).

The knowledge about prevention behaviors was studied separately. Each
subject's responses to each item were added to form the subject's score and the analysis
of variance procedure was used to evaluate the hypothesis that there was no difference in
the mean scores on knowledge about prevention between conditions . The Barlett-Box
test of homogeneity of variance suggested that the homogeneity of variance assumption
was not violated (2.05, p=.105). The following table displays the means on knowledge
about prevention and the summary Anova table.

100

Table 11. AN VA f kn wled e about evention

 

 

 

 

Groups
PL DL CG NEC
Means 5.36 5.18 3.56 4.76
Sources D.F. SS MS F ratio P Eta2
Between groups 3 70.67 23.56 7.16 .0002 .15
Within groups 124 408.05 3.29
Total 127 478.72

 

m. PL: Participatory learning group, DL=Didactic learning group, CG=Control
group, NEC=Non-equivalent control group.

A main effect from groups was identiﬁed. Therefore, the results of the analysis
of variance supported the rejection of the hypothesis that there is no difference in the i
mean scores on knowledge about prevention methods in the different conditions.

The contrast of the two experimental conditions with the two control conditions
on the score of knowledge about prevention yields the following results: Contrast=2.23,
standard error=.66, T=3.38, degrees of freedom=124, and T probability=.001.
Therefore, the null hypothesis that there is no difference in means on prevention about
AIDS between the experimental and control conditions was rejected. The mean score
on knowledge about prevention was higher for the experimental conditions than for the
control conditions, and this difference was signiﬁcant (p<.05).

The Scheffé procedure was used to study all possible pairs of comparisons
between conditions on knowledge about prevention, and signiﬁcant differences are
found at less than .05 probability between the control group and the participatory
learning group, and between the control group and the didactic learning group. In both

101

comparisons the scores for the learning groups were higher than the score for the control
group.

H2: Migrant workers in participatory learning groups will show higher knowledge than
those in the didactic learning group and the subjects in the control group.

The data on general knowledge about AIDS was evaluated with the Jonckheere
trend test which is used as an extension of the Kruskal-Wallis one way analysis of
variance. The Jonckheere trend test evaluates the predicted trend across the scores of
different conditions. The predicted trend in this case is speciﬁed in hypothesis 2, which
suggests an increase in scores on knowledge in the following order: non-equivalent
control group, control group, didactic learning group and participatory learning group.
The null hypothesis for this test is that in the scores on general knowledge about AIDS
differences among the four conditions are random. The value of the S statistic is 975,
which results in a Z score of 2.39. The probability table for the Z scores shows that a

value of 2.39 has probabilities smaller than .05, at .01 and .05 one-tailed tests of
. signiﬁcance respectively. Therefore, the null hypothesis was rejected and it is concluded
that the score on general knowledge about AIDS is associated with the conditions.

The analysis of the difference in knowledge about prevention between
conditions was signiﬁcant. The two pairs of conditions found to be signiﬁcantly
different at a probability of less than .05 were: (a) control group and participatory
learning group , and (b) didactic learning group and control group. Therefore, this test
on knowledge about prevention-and our previous description of the groups with higher
scores on each pairnindieates that the expeimental conditions did bette than the control
group, but no evidence was found that participatory learning group did better than the
didactic learning group or that the learning groups did better than the control group in
knowledge about prevention.

102

MW

H3: There will be a signiﬁcant difference between migrant workers' attitudes towards
AIDS patients after the educational experiences, and the participants in the control
conditions. The following table displays the means and the analysis of variance

summary table. Table G-5 in appendix G displays the responses to each item about

 

 

attitudes towards people with AIDS.
Table 12. AN VA of re on ttitude war 1 wi A DS b o .
Groups
PL DL CG NBC
X n X n X n X n
14.45 33 17.00 36 16.34 35 16.50 20
DR 33 MS Fratio P Etaz

Between 3 123.54 41.18 2.89 .04 .07
Within 120 1711.07 14.26
Total 123 1834.60

 

ME X= Mean on attitudes towards people with AIDS, n=group size. PL:
Participatory learning group, DL=Didactic learning group, CG=Control group,
=Non-equivalent control group.

The null hypothesis that there is no signiﬁcant difference in the mean scores on
attitudes towards people with AIDS between groups is rejected because a signiﬁcant
main effect is found. When the Scheffé analysis was conducted on the one-way
analysis of variance of the scores on attitudes towards AIDS patients and groups, none
of the pairs of groups was signiﬁcantly different at less than .05. When the scores on
attitudes towards people with AIDS of participatory and didactic learning groups wee
contrasted with the scores of the two control conditions, the T value and T probability
for the pooled variance procedure were -.995 and .322, respectively. Therefore, using
this test, the null hypothesis for the contrast between the mean scores on attitudes
towards AIDS victims between the experimental groups—participatory and didactic—,
and the two control groups-control group and non-equivalent control group-- was not

signiﬁcant. However, when the scores of experimental groups participatory and didactic

103

were compared, the T value and T probability were 2.80 and .006, respectively. Thus,a
signiﬁcant difference is found in attitudes towards people with AIDS between
participatory and didactic learning groups with the participatory learning group having

the lowest scores on attitudes towards people with AIDS.

Knowl bout AID and a itudes towards 1e with AID
H4: There will be a positive signiﬁeant relationship between attitudes towards people
with AIDS and knowledge about AIDS.

The Pearson correlation coefﬁcient was computed with scores on general
knowledge about AIDS and attitudes towards people with AIDS and the coefﬁcient was
.46 (p<.05). The higher the score on general knowledge about AIDS (meaning more
knowledge) the higher the score on attitudes towards people with AIDS (more positive
attitudes), which supports the relationship hypothesized.

The Pearson correlation coefﬁcient was also calculated for the scores on
knowledge about prevention and the scores on attitudes towards AIDS patients and was

. 10 and non-signiﬁcant.

A ' estowars lewithAIDS dbehvir r1 nn 53 w n 5
H5: There will be a signiﬁeant relationship between attitudes towards AIDS patients and
the behaviors of: requesting written materials about AIDS, volunteering to distribute
written mateials to other people, bringing someone to receive information about AIDS,
and requesting more information about condoms and spermicides.

Two of these behaviors were regarded as displays of openness to information
about AIDS: the request of written materials about AIDS, and the request of more
information about condoms and spermicides. The other two behaviors were considered

indicators of awareness of relevance of educating the community about AIDS. These

104

behaviors were: the request of written information about AIDS to distribute to others,
and the behavior of bringing someone to talk to and receive information about AIDS
from the educator. The following table displays the number of people returning the

cards related to openness and awareness.

Table 13. Frmuencies on anness and awgeness,

 

 

 

Responses Frequencies %
Openness
No cards returned (or all cards missing) 75 54
Only one card returned 25 18
Two cards returned 39 28
Awareness
No cards returned (or all cards missing) 89 64
Only one card returned 41 30
Two cards returned 9 7

 

The data about each behavior performed by the subjects was recorded as a
dichotomous categorical variable. Four analyses of variance were conducted, one
between attitudes towards people with AIDS and each of the behaviors associated with
openness or awareness--no analysis of variance was conducted with the blue card. On
each analysis the null hypothesis evaluated was that there was no difference between
people who perform the behavior and people who did not perform the behavior in their
mean scores on attitudes towards people with AIDS. No signiﬁcant differences were
found on any of the four analyses of variance. Therefore, the null hypothesis studied as
an evaluation of hypothesis 5 , was not rejected. Also the correlation between attitudes

towards people with AIDS and the variables openness and awareness (each variable

HD

~

NaD

Tr
0°

N.

V3

Sig

105

comprising two items) was studied and the attitudes toward people with AIDS were
signiﬁcantly correlated with awareness of need to learn about AIDS for the Hispanic

community (r.=20, p<.05)

Attitudes mwgds homosexgls and d_rgg usgs

Table 14 displays the mean scores on attitudes towards homosexuals and drugs
users on each group. Tables G-6 and G7 display the responses to the items about

attitudes toward homosexuals and drug users.

Table 14. Mean group score on attitudes towgds homosexuals and ﬂag um .

 

 

Groups
Attitudes towards PL DL CG NEC
Homosexuals 11.64 13.45 13.70 13.14
Drug users 13.48 14.83 13.72 14.29

 

Egg. The scales are worded in the positive direction. PL: participatory learning group,
DL=didactic learning group, CG=control group, and NEC=Non—equivalent control
group.

A possible difference in the attitudes towards homosexuals and attitudes towards
drug users due to gender of the subjects was evaluated with analysis of variance.
Neither of the two analyses reﬂected a signiﬁcant variance among groups due to gender.
Also the correlations between attitudes towards drug users and homosexuals and the

variables openness and awareness were studied and found to be very low and non-

signiﬁcant.

H6: There will be a signiﬁcant difference between attitudes towards homosexuals of
migrant workers in the experimental conditions, and the attitudes towards homosexuals

of migrant workers in the control groups.

106

First, the one-way analysis of variance procedure was used to study the null
hypothesis that the mean scores on attitudes towards homosexuals are similar for the

four groups. The between-groups variance on this analysis was not signiﬁcant.

H7: There will be a signiﬁcant difference between the attitudes of migrant workers
towards drug users in the experimental conditions, and the attitudes towards drug users
of migrant workers in the control groups.

The one-way analysis of variance was used to study if there was a signiﬁcant
difference between the four conditions in the study and their scores on attitudes towards

drug addicts. The between groups variance was not signiﬁcant.

H 8: There will be a positive signiﬁcant relationship between migrant workers’ attitudes
towards homosexuals and their knowledge about AIDS.

The Pearson correlation coefﬁcient was computed for the scores on attitudes
towards homosexuals and general knowledge about AIDS. The coefﬁcient was .21
(p<.05). Higher scores on general knowledge about AIDS were related to higher scores
on attitudes towards homosexuals (more positive attitudes). Therefore, the null
hypothesis was rejected and hypothesis 8 is supported by the correlation coefﬁcient.

A similar positive correlation was found between attitudes towards homosexuals
and the knowledge about prevention (Pearson=.23, p.<.05) indicating that the higher the
knowledge about prevention methods the more positive the attitude towards
homosexuals. Therefore, hypothesis 8 was also supported by the analysis of

knowledge about prevention and attitudes towards homosexuals.

107

H9: Thee will be a signiﬁcant relationship betweer migrant workers attitudes towards
drug users and their knowledge about AIDS.

The Pearson correlation coefﬁcient is calculated for the score on attitudes towards
drug users and the score on geneal knowledge about AIDS; Pearson: .38, p<.05. The
coefﬁciert indicates that more knowledge will be related to more positive attitudes
towards drug users. Therefore, the null hypothesis is rejected and the data from geneal
knowledge about AIDS supports hypothesis 9. A positive correlation was not found
between knowledge about prevention and attitudes towards drug users (r=.074).

H10: Thee will be a signiﬁcant relationship between migrant workers' attitudes
towards drug uses and their attitudes towards people with AIDS.

This hypothesis is supported by the Pearson correlation coefﬁcient calculated with
the scores on attitudes towards drug users and attitudes towards AIDS victims. This
coefﬁcient is .38 (p<.05). This suggests that the more positive the attitude towards
drug uses, the more positive the attitude towards people with AIDS.

H11: Thee will be a positive signiﬁcant relationship between migrant workers' attitudes
towards homosexuals and their attitudes towards people with AIDS.

The direction and strength of the association between the scores on attitudes towards
people with AIDS and attitudes towards homosexuals was studied with the Pearson
correlation coefﬁcient. The hypothesis was supported by the data with a correlation
coefﬁcient of .32 (p<.05). The more positive the attitudes towards AIDS patients, the

more positive the attitudes towards homosexuals.

nn inf ' n t AID and w ness f the relevance of tin
mmuni
As described earlie in this chapter two pairs of behaviors were regarded as

displays of either operness to information about AIDS or awareness of the relevance of
educating the community about AIDS. Two variables were created (openness and
awareress), each one including the number of occurrences of the value l—meaning the
behavior was displayed-on each of the two behaviors corresponding to the new
variables. These two new variables are used in the analysis of the following two
hypothesis. Table G-4 in the appendix displays the values and frequencies for the

variables openness and awareness.

H12: There will be a signiﬁcant difference in the number of subjects requesting more
information about AIDS and the number of subjects requesting more information about
condoms and spermicides, between expeimental the participatory learning group, the
didactic learning group and the experimental control.

A Chi-square test is used to study the independence of the two variables. The
Chi-square value is 1.57 with 3 degrees of freedom and it is not signiﬁcant (p>.05).
Since a difference between groups on openness is not supported, no further analysis is

conducted to evaluate hypothesis 12.

H13: There will be a signiﬁcant difference between the migrant workers' report of
inteest in distributing information to other people, and disposition to bring someone
they know to receive information at the end of the intervention in all conditions, and the
diffeerce will be highe for the expeimental groups.

The Chi-square test of independence on awareness by groups identiﬁed a Chi-
square value of 3.92 with 3 degrees of freedom and it is not signiﬁcant (p>.05).

108

Summag 9f guang'tative ﬁngﬁngs

Through the analysis of the research hypotheses the following results were found
to be signiﬁeant: (a) migrant workers' knowledge about prevention differed between
the experimental and control conditions--the experimental groups showed higher
knowledge about prevention—; (b) the difference in knowledge about prevention
between the participatory learning group and the control group--the participatory learning
group having the higher scores on knowledge about prevention-and also between the
didactic learning group, and the control group--the didactic learning group having
highest scores than the control group-; (c) a main effect between groups on attitudes
towards people with AIDS--the participatory learning group having the lowest score on
attitudes towards people with AIDS--; (d) a positive relationship betweer attitudes
towards people with AIDS and general knowledge about AIDS; (e) a positive
relationship between attitudes towards homosexuals and general knowledge about AIDS;
(f) a positive relation ship between attitudes towards homosexuals and browledge about
prevertion; (g) a positive relationship between attitudes towards drug users and general
knowledge about AIDS; (h) a positive relationship between attitudes towards drug users
and attitudes towards people with AIDS; and, (i) a positive relationship between attitudes

towards homosexuals and attitudes towards people with AIDS.

Exploratory Analysis
The data from this research allowed for the study of other relationships. Of
special interest are the relationships between: (a) age, education, and knowledge about
AIDS; (b) age, education and attitudes towards AIDS patients, homosexuals, and drug
uses; (c) the number of previous sources of information about AIDS and knowledge
about AIDS; (d) the items about interest in doing the awareness and openness related

behaviors and the cards used in doing the behaviors; (e) the behavioral cards and gereal

109

110

knowledge about AIDS and knowledge about prevertion; and, (f) the regression
analysis of independent variables into general knowledge about AIDS and knowledge
about prevention.

W

The Pearson correlation coefﬁcients were -.34 (p<.05) and -. 18 (p<.05) for age
and general knowledge about AIDS, and age and knowledge about prevention,
respectively. The older the subject, the lowe' the score on geneal knowledge about
AIDS. Older subjects had lower scores on knowledge about prevention.

The correlation coefﬁcients for the relationship betweer gereal knowledge about
AIDS and education was .35 (p<.05), meaning that the higher the number of years of
education the higher the score on geneal knowledge about AIDS. The relationship

betweer knowledge about prevertion and education was non-signiﬁcant.

! I . l . l
The relationships between age and education and attitudes towards AIDS patients,

attitudes towards homosexuals and attitudes towards drug users are displayed in the

following table.

 

 

 

Attitudes
Homosexuals Drug users People with AIDS
Age -.28 (p<.05) -.38 (p<.05) -.35 (p<.05)
Education .29 (p<.05) .32 (p<.05) .44 (p<.05)

 

The correlations of attitudes with age show that the higher the age the less positive
the attitudes towards homosexuals, drug was and AIDS patients. The correlations of

111

attitudes and education indicate that the higher the numbe of years of education the more
positive the attitudes towards homosexuals, drug users and AIDS patients.

 

One item of the questionnaire asked the subject to circle the sources from which
helshe had received information about AIDS. later, a variable is calculated counting the
number of different types of sources indicated by each subject. The correlation between
diffeent types of previous sources of information about AIDS and general knowledge
about AIDS was non-signiﬁcant . However, the relationships between the number of
diffeert types of previous sources of information about AIDS and knowledge about
prevention is .18 (p<.05) and the relationship between attitudes towards homosexuals
and the number of different types of previous sources of information about AIDS is .34
(p<.05). This indicates that the higher the number of different types of previous sources
of information about AIDS, the higher the score on knowledge about prevention, and
that the higher the number of different types of previous sources of information about
AIDS, the higher—more positive-the score on attitudes towards homosexuals. The
relationships between the number of different types of previous somces of information
about AIDS and attitudes towards drug users and people with AIDS were studied and

both relationships are non-signiﬁcant.

 

The questionnaire had four dichotomous items (Yes-No), each one asking the
subject if she/he was interested in doing the following behaviors: (a) request more
written information about AIDS for him/herself, (b) distribute copies of written
information about AIDS to others, (c) receive more information about condoms
orspermicides, and (d) introduce someone he/she knows to the educators to listen to the

112

information about AIDS. A week after the subjects completed the questionnaires, they
had an Opportunity to do any or all of the four behaviors. The Tetrachoric correlation
coefﬁcient is used to study the relationship betweer each of the four questions about
behaviors in the questionnaire and their corresponding follow-up behaviors. The
correlation coefﬁcient was ve-y low and non-signiﬁcant for the following relationships:
(a) interest in receiving more information about AIDS and the request of more written
information about AIDS (r=-. 10); (b) interest in introducing someone to the educates
and the behavior of introducing someone to the educators to be instructed about AIDS
(r=.01); and, (c) interest in receiving copies of writter information about AIDS to
distribute to others and the actual request of writter information about AIDS to be
distributed (r=.14). The correlation between the inteest in getting more information
about condoms or spermicides and the request of information on condoms or
spermicides was signiﬁcant (r=.28). This suggests a relationship between interest in
information about condoms or spermicides and request of information about those

topics.

1' ' or .1." u; 5. -.~ 1 I; or 0m v.1 r. ._ . tartan, m w acg- rlm - In!)

The Point-biserial correlation was used to study the relationship betweer the
return of behavioral cards (the performance of behaviors) and the scores on knowledge
about AIDS.

Only two relationships were signiﬁcant. One was the relationship between the
behavior of requesting copies of information about AIDS to distribute and the score on
knowledge about prevention (X ret. card=5.22, X=did not ret. card=3.45, rpb=.51,
T=5.53, Tm,=l.99). The group of people who returned the card had higher scores on
knowledge about prevention. The null hypothesis saying that the return of the card

113

requesting written information about AIDS to distribute to others was not related to the
score on knowledge about prevention was therefore rejected.

The other relationship that was signiﬁcant is between the behavior of introducing
someone to the instructors and knowledge about prevention. The mean is 5.75 for
those who did not return the card, and 5.44 for those who did return the card. The
correlation coefﬁcient was .56, the T observed was 6.29 and the T crit.=l.99. The null
hypothesis about absence of a relationship between introducing other people to the
instructors to be educated about AIDS, and the score on knowledge about prevention

was rejected.

 

General knowledge about AIDS was studied as the dependent variable and
attitudes towards homosexuals, attitudes towards drug users, age and education were
introduced into the regression equation as the independent variables (stepwise method).
Two independent variables can be used to predict the scores on geneal knowledge
about AIDS and are signiﬁcant at less than .05 probability: attitudes towards peeple with
AIDS and education. The multiple regression coefﬁcient was .41 and the adjusted R
square was .16 when attitudes towards people with AIDS were introduced. The
multiple regression coefﬁcient was .47 and the adjusted R square was .20 when
education was introduced into the equation. The following table displays the analysis of

variance and statistics for the independent variables.

114

Table 16. W5.

 

 

 

ANQYA
ATTPWA SS Df MS F sig.F
Regression 22.75 1 22.75 19.85 .0000
Residual 113.48 98 1.15
ANQXA
Education SS DF MS F sig.F
Regression 28.98 2 14.48 12.97 .0000
Residual 104.94 96 l .12

B SE T sig.T
ATI'PWA .097 .029 3.40 .001
Education .089 .036 2.49 .015

 

Note. ATTPWA refers to attitudes towards people with AIDS.

When krnowledge about prevention is studied as the dependent variable and the
variables, attitudes towards homosexuals, attitudes towards AIDS patients, attitudes
towards drug users, age, education and geneal krnowledge about AIDS were included in
the regression equation as the independent variables—~using the stepwise method-~the
only variable that can be used to predict the scores on knowledge about prevention is
attitudes towards homosexuals. The multiple regression coefﬁcient was .22 and R
square was .05. The following table shows the analysis of variance for the regression
and the statistics for the independent variable.

 

 

 

 

Table 17. WW
Analysis of variance

85 Df MS F sig. F
Regression 16.82 1 16.82 4.62 .034
Residual 345.83 95 3.64
Attitudes B SE 'r sig.T
towards homosexuals .11 .051 2.15 . 34
WW

Dnning the exploratory analysis the following relationships were found to be
signiﬁcant: (a) negative relationships between age and geneal krnowledge about AIDS,

115

and between age and krnowledge about prevention; (b) a positive relationship between
geneal krnowledge about AIDS and education; (c) negative relationships between age
and attitudes towards homosexuals, attitudes towards drug users and attitudes towards
AIDS patients; (d) positive relationships between education and attitudes towards
homosexuals, attitudes towards drug uses, and attitudes towards AIDS patients; (e) a
positive relationship between krnowledge about prevention and the number of previous
sum of informatiorn about AIDS; (0 a signiﬁcant positive relationship between
attitudes towards homosexuals and the number of types of previous sources of
information about AIDS; (g) a positive relationship between the interest in receiving
more information about condoms or spermicides and the behavior of requesting more
information about condoms or spe'micides; (h) a sigrniﬁcant positive relationship
between the request of copies of information about AIDS and the score on krnowledge
about prevention—those who requested mateials had higher scores on krnowledge about
preventio --; (i) a positive signiﬁcant relatiornship between awareness of the need to
learn about HIV/AIDS for the Hispanic commurnity and the atittudes toward people with
AIDS; and, (j) a relationship between introducing someone to the educator and the score
on knowledge about prevention—the ones with higher scores on krnowledge about
prevention were the ornes who more often did not return and introduce anyone to the
educator.

Also regression analysis was conducted for geneal krnowledge about AIDS and
krnowledge about prevention. The signiﬁcant predictors of geneal krnowledge about
AIDS were the scores on attitudes towards AIDS patients and attitudes towards drug
users. The only sigrniﬁcarnt predictor of knowledge about prevention was the score on

attitudes towards homosexuals.

Qualitative Observations
I could not reach a full understanding of this research and educational
intervention without the critical analysis of the ﬁeld experiences with members of
migrant families. Qualitative observations provided information about the participants'
satisfaction with the educational expeience, their sex role behaviors related to the
project, and the questions that were asked more frequently during the educational
experiences. These observations are also the basis for comments regarding the cultural

’ﬂ"

beliefs of ”simpatra , respeto" and religiosity.

'3 ° n wi ca ' x 'en

Baltimore and Wolff (1986) stated that it is unrealistic to believe that the spread of
HIV infection is likely to be stopped by simple one time education efforts, but that still,
these efforts needed to be undetaken with hope and conviction because the most
effective measures to reduce the spread of HIV infection are education and voluntary
behavioral changes, and we krnow that the chances of achieving voluntary behavioral
changes without education are minimum.

Nevertheless, since the public is receiving information about AIDS continuously
from the media, it is assumed that a one time intervention could be helpful if at least it
clariﬁes the information to community members and helps them to relate the infornnation
to their lifestyles. When this happens, and the participants walk out of the presentation
feeling satisﬁed with the way the information was presented, they might also be more
open, interested and able to understand information about AIDS in the future and to
participate in further AIDS education programs. For instance, while doing this research
the resistance and negative attitude of migrants in one camp—the pilot camp—due to

negative previous expeiences with AIDS education presentations was a strong barrier

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to attendance at meetings. For this reason, the researcher observed the participants'
reactions to the presentations-and the presente--to assess their satisfaction.

It is thought that the participants in this research wee satisﬁed with the
educational experiences because: (a) thee wee no complaints about the presentation and
people did not leave early; (b) sometimes people watched the presentations twice; (c)
there wee no reports of a man prohibiting children or women to attend the second
educatiornal meetingineachcamp—in fact,morewomenthan menattended the
meetings--; and, (d) at the end of the meetings, the participants showed their
appreciation of the activity.

Some of my major concerns dnning the project were to avoid making arnyorne feel
uncomfortable during the educatiornal activities and to promote openness and acceptance
of the discussion of the topic of AIDS. Moreover, it was intended to leave the
participants with a good attitude towards future AIDS education efforts. There are

seveal experiences which suggests that those objectives were accomplished.

1. There were no people leaving the presentation early or feeling upset.

The participants told the educators about previous educational activities that they
disliked. They identiﬁed the elements that they found offensive on prior presentations
and none of those elements was part of the educational inteventions in this project. The
participants mentioned their discomfort with educational presentations including : (a) the
use of rubber models of the penis and vagina, (b) the use of sexually explicit vocabulary
and information about how to "have fun with safe sex” in ﬁont of a mixed audience of
men and women, (c) the distribution of condoms to everybody-—including children-and
(d) a lack of discussion of alterrnatives to condoms for women. Therefore, the lack of
complaints regarding the style of presentation or any othe aspect of the presentatiorn is
not attributed to the ”simpatia" script of "respeto" but to satisfaction with the expeience.

118

2. In most of the camps (ﬁve of the six expeimental camps) the people kept coming to
talk to the educators, and oﬁen stayed dining the presentations about AIDS and musical
videotapes (for a second time) after having gone through their assigned meetings.

It was common for people who had seen the presentation previously to watch the
activities for a secornd time, either sitting inside the tent or watching through the tent's
windows . It can be hypothesized that the incentive of watching the musical videotapes
was strong enough to counterbalance for any possible discomfort with the topic. Still, if
that was the case, the fact that the information about AIDS was accepted can't be denied.
In fact, it suggests that the combination of elements—entertainment and education-4n
this intervention was adequate and propitiated the environment for the discussion of
HIV/AIDS.

3. Thee was very good attendance of children and women at the second educational
meetings on each camp.

This fact was an important achievement because afte' the ﬁrst educational
meeting it was evident that information was disseminated through the camp and most
adults knew that the health topic that was going to be discussed was AIDS. If they had
received negative information about the activity, it is probable that children and women
would not have attended the meetings. This could have been expected in the event of
negative reports of the activity, because women indicated that in previous educational
presentations about AIDS (in Texas, Michigan and Florida) the men felt upset with the
corntent and methods used and forbade the women and children to interact with the
educators. For this reason, it is thought that people assigned to the second educational
meeting wee probably informed that there was going to be inforrrnation about AIDS, but
did not hear negative comments about the way the information was presented. Also,

119

during the ﬁrst two visits to the camps many men indicated to the women (irn front of the

educators) that they wanted them to attend the meetings.

4. At the end of the meetings the participants showed their appreciation of the activity
and of the effort that was made in bringing all the things that wee necessary for the
presentation.

Even though Hispanics have been regarded as displaying the ”simpatia" script, if
the participants would have felt offended, they would not have been so grateful, or
would not have said anything about the activity; in contrast, the participants even
provided food, asked if it was possible to come again, and helped to load our truck.

Finally, a comment by one of the participants regarding the combination of the
variety show (videotape of Tex-Mex bands) provides an illustration on a possible reason
why the intervention was accepted and appreciated by the community. She said,
”gracias por traemos las peliculas y esruw buena la pmsentacién se ve que la preparamn
para que nos dindniemmothhanks for bringing the movies and the presentation was
good, it was evident that you wanted us to enjoy it]." This suggests that maybe the fact
that it was evident that this was a complicated activity to conduct (in terns of all the
equipment and the number of visits to the cannps) made them feel that they should
participate in the activity and be grateful.

Same:

Women differed ﬁonn men in some behaviors, comments and reactions. This
information is useful for understanding characteristics of sex roles in migrant families
that need to be considered in designing AIDS education programs for Hispanic migrarnt
families. The following are behaviors or comrrnents found among womer, men or

couples of diffeent ages in at least three diffeent camps :

W n' ' n h vi
1. Women but not men described the nwds of the families and asked for help.

Many needs were reported to me in each camp (the needs were discussed in the
methods chapter), but there was not one case of a man coming forward with this
information, even when sometimes the nwds were completely related to the man. For
instance, a woman came and discussed her husband's need for a referral to be seen by
an ophthalmologist, and her son's need for a cast for a twisted ﬁnger. It might be
thought that the women came and discussed their needs because most of the inte'action
was with myself. Still, this explanation is not too plausible because often times when I
did not know the answer or a resource to refer them to, the women talked with the

AIDS coordinator (a man).

2. Women between the ages of 26 and 45 years sometimes reacted to the information
with feelings of helplessness regarding opportunities to protect themselves ﬁom HIV
infection, and with anger about the possibility of been at risk because of their partners'
behaviors.

Comments such as "esto del SIDA esrd canijo, quién sabe si ya a uno Io
enfermaron y ahora ya ni cuidarse [this thing about AIDS is bad, who knows if one has
already gotten the illness, and now not even the precautions will help] ," showed
helplessness. Comments such as, "el hombre puede hacer lo que quiera por ahi y no
importa lo bueno que uno se pone se puede enfermar y morir de eso también [the man
can do what he wants and it does not matter how well you behave, you can also get it
and die of this]" showed anger and concern.

I tried to emphasize the concept that prevention is the responsibility of both
individuals engaging in sexual behaviors, but that the woman should not feel helpless if

the man does not want to prevent HIV because there are things that women can do to

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121

protect themselves and decrease their probabilities of HIV infection—such as using
spermicides or lubricants with nonoxynol 9. Sometimes since most of the participants
were women I also had the opportunity to discuss with the women ways to communicate
with their partners about HIV prevention. These views will be discussed We in the
next chapter, but it is worth noting here that worrnen feel helpless and angry regarding
the possibility of AIDS infection.

3. Older women (more than 45 years old) wee ve'y interested in learning all the
information arnd often mentioned that they needed to learn in order to be able to teach
children how to prevent the HIV infection.

I perceived that even though it was not easy for some women to ask questions
about sexual behaviors arnd condoms, they followed all the explanations mindfully, and
felt that it was their responsibility to do so. For instance, once the educators went to a
housing unit for the follow-up visit, and the only person thee was the grandmother.
She expressed concern that her daughter and granddaughter wee not there to get the
information. She asked me to explain everything about condoms and to review the
information on prevention with her. She also requested c0pies of brochures and
samples of condoms and spe'micides for the two women who were not tlnere. Since she
showed interest in learning what to say to the other two women, I helped her to practice
the information to make sure that she understood and krnew what she was going to tell
them.

Similarly, during the educational meetings, the oldest women (60 years of age or
more) geneally participated a good deal by making comments about the informatiorn
being presented—especially in support of prevention behaviors. These interventions
wee highly valued by us educators, because they continuously related the information

to situations in the camps or in the areas where they live in the winter-Florida, Texas-

122

even providing examples of situations that put people that they krnow at risk of HIV
infection and other diseases. This type of participation made the communication much

easier because the message was even more real for the participants.

1. In mostofthecampsthecontactpersonwasa man.

It was more difﬁcult to convince women to be contact persons and to introduce us
to the other families. Women who agreed to be contact persons were much less
expressive than men in introducing us educators-«usually they just said that the we
worked at Cristo Rey Community Cente and wanted to talk to them.

Whenamenwasthecontactperson he introducedustothediffeentfarniliesina
very supportive way, encorn'aging the youngsters and women to come to the meetings-
as though he had krnown the educators for a long time. It was also easier to get other

men to participate when the contact person was a man, instead of a woman.

2. When men were the only ones at the meetings, they responded to the information
with denial, resignation, and jokes.

Dming the meetings, men reacted diffeently when there wee no women in the
audience than when they attended mixed meetings. They teased each other, guessing
which one of them was more at risk of having been infected with HIV, and while doing
this, they named women which they thought were at risk, and accused each other of
being either alcohol abuses or homosexuals. I did not try to stop the jokes. But
instead used them to clarify myths and to provide information about the behaviors that
were being brought up. For instance, I discussed alcohol as a factor that can increase
theprobabilityofunsafe sex and drug use, and thath alsodecreasetlne strength ofthe

immune system.

123

Efforts to make the participants realize that it is not just the individual who is at risk
but that he might also be risking the life of his current or future wife or permanent
partner did not clearly show success. Some representative reactions to the appeal to
guilt wee: (a) if that is what God decides, thee is not much that you can do to avoid it;
and, (b) the couple is married until death separates them, and that if the man is going to
die, it is reasonable for the woman to share his fate. The way in which the statements
wee made, in a boastful manne, and the negation of them by other men, indicated that
they did not whole-heartly accept the statements. It was apparent that the comments
were made partially to challenge me as a woman.

MW:

1. Young couples (men and women 17 to 25 years old) usually came to the meetings
togethe—often with their babies—and participated by asking questions and making
jokes.

The couples answered together during the follow-up visits, and both the woman
and man often brought the red cards (the ornes requesting more information about
condoms or spermicides). In those cases, the subjects answered that they did not want
or need to listen to the information on how to use the condoms and spermicides,
separately. Neither women nor men showed that the decision about which cards to
return was affected by the presence of the spouse, for instance, spouses often brought
different cards.

l u l 2 1 m r '
1. Older couples (men and women 26 years old and over) came together to the meetings
less frequently.

In those instances, the men asked more questions than the women and were
usually the ones participating more. Frequently, women from these older couples came
alone or with the children to the educational meetings. On the other side, sometimes
men from these couples came to the meetings when their spouses were not coming to the
meetings (happened less often than with the women). When these older couples had to
bring back the behavioral cards--during the follow-up—they wee not comfortable
bringing the red card in front of their respective partrners. Consequently, the educators
had to ﬁnd opportunities to interview the participants regarding their behavioral cards
privately, and under these conditions, some women went back to their spouses asking

them which card to retum--those cards were marked as missing data.

1 1i f
In chapter III some cultural traits that have been hypothesized as related to AIDS
prevention were identiﬁed ("simpatia", "respeto" and religiosity). Some of the
observations about satisfaction with the intervention and sex roles were discussed in the
previous section in their relationship to ”simpatia" and "respeto". Still, it is pertinent to
make more general comments here on how these two beliefs and the religiosity could

have been related to the implementation of the AIDS education project.

W. The members of migrant families were vey helpful and friendly
with us. Also, the avoidance of direct conﬂict was observed twice; once when it was
evident that a woman was very shy and undecided about attending to the presentation,

but there was no way to engage her into a discussion of the reasons why this had been a

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125

difﬁcult decision for her, and anothe time at a diffeent camp when the same situation
was faced with a group of three men who said that they did not know if they were

coming to the presentation and when I asked them why, I got many smiles and people
looking down or telling me: "bueno quiet: vayamos ahon‘ra ", [well, maybe we will go

in a while].

W. We wee treated as people with a diffeent status. We did not made any
particular efforts to be peceived as peers but we avoided the use of any symbols that
could imply that we haddiffeent status due to education, socioeconomic conditions or
jobs. Some examples of this were: (a) people asking us to provide advice to youngsters
about the relevance of studying in order to get good jobs in the futnne or about how is
the life of a college student; (b) people listening to the information discussed never
saying or displaying non-verbal behaviors reﬂecting distrust in the information
presented-even though sometimes my age, gender, or the erroneous information about
AIDS sometimes presenmd in the media could have made someone have doubts about
the accuracy of the information presented—; (c) the fact that most of the time the
participants dress up to come to the meetings—including the children—, and; (d) the fact
that when were invited to come into any of the houses we wee always offered the best
chairs and when we wee invited to share food with any of the families we always had
the best plates and cups. It is suspected that the difference in status was probably related
to our job as educators, because I remember being krnown in diffeent camps as "la

nnaestrita puertorriqueﬁa" [the Puertorican teacher].

W. Most of the families considered themselves afﬁliated with religious groups.
This was obsve in: (a) the presence of small crosses in some houses, (b) the

participation of many women and children in a religious ritual in one of the camps at the

126

time of one of 0m visits, (c) a request that a Spanish-speaking priest visit a camp, (d)
requests of inforrnatiorn about the closest churches with Spanish-speaking priests by
people in different camps, and (e) the behavior displayed toward a priest who visited the
camps. Still, it is very interesting that we never had any comments during the
presentations or follow—up visits regarding religious beliefs opposed the information
discussed about HIV prevention. This could be interpreted in terms of religiosity not
being a factor (or banie) to HIV education or prevention. An alternative explanation is
that since the educational program was sponsored by Cristo Rey Community Center the
participants might have thought that all the content presented was acceptable at least to
the Catholic church.

Warm
There wee not enough comments about health values to allow identiﬁcation of

healtln values. However, some observations should be discussed. I was interested in
identifying folk healers to see if they have particular opinions about HIV. None of the
camps visited had someone whom the people identiﬁed as a healer except that in one
camp there was an olde' woman that some women identiﬁed as the person they go to
ﬁrst when any of the children get sick, but these women also speciﬁed that when the
child's illness seems serious or the person with the illness is an adult, they go to a clinic.
It was observed that access to medical care was difﬁcult for the migrant families.
As it was discussed in the section about needs reported, often times the clinics visiting
the camps did not announce the visits in advance. Other problems were that sometimes
migrant workers requiring follow-up care had difﬁculties getting prescriptions or referal
to specialists because their medical ﬁles wee lost—from visits to the clinics the previous
year-and then often they had to drive long distances to the clinics during work hours.

127

Therewasnoevidenceofalackoftrustin western medicineoralackofconcern about
health issues.

Wrestlers

It is important to review the questions that participants of diffeent genders and
age groups asked. The following questions were asked by participants in at least two
camps.
1. Is it really true that Hispanics can get AIDS?

This was asked more frequently by men (all ages) and older women (more than
45 years old).
2. Is AIDS also a problem in Mexico?

Some older women mentioned not having heard about AIDS when they wee
growing up in Mexico; they were the ones asking this more often.
3. Is AIDS only a problem of the black community arnd will Hispanics only get it
through sexual relationships with a black person?

This was asked by some men and women, and there was not a particular age
group asking this question more often.
4. Could someone get AIDS from a dentist's work?

There was a lot of curiosity about the case of a dentist in Florida who died of
AIDS and had eight of his clients infected with HIV. People of all ages and both
genders asked about this.
5. Could someone get AIDS from mosquito bites?

This question was very typical of the children attending to the meetings. Only
oncearnadultaskedabouttlﬁsanditwasaman talkingaboutasmalltowninFlorida
that was said to had a high number of people infected with HIV throughout mosquito

bites.

128

6. Whee does AIDS come from?

People all ages and gendes were interested in krnowing if AIDS developed ﬁonn
Haitians, monkeys, or African tribes.

7. Could someone get AIDS drinking ﬁom the sanne water fountain at school?

Children wee par1icularly interested in this information arnd wee the only ones
asking about this way of contagion.

8. At what age should children start learning about AIDS, and what is being done at
schools to teach them about prevention?

Men and women asked about this regardless of the gender or age of the othe
participarnts in the meetings-~wether the participants were a mixed group of women and
men or wether tlney were in a single sex meeting.

9. Is it correct to assume that sonneone is not infected if the individual was tested as part
of the procedures for his/her legalization of imrrnigrant status and was not corntacted by a
government agency or denied permission to stay in the United States.

A group of women mentioned having gone through HIV testing to legalize their
status in the U.S., that they never went back for the results, and that they assume that
they were not infected because they were not contacted or thrown out of the country.

The behavioral observations provided information about the participants'
satisfactiorn with the educational expeience, their sex roles behaviors, some cultural
beliefs, health beliefs and the questions asked more frequently.

Theparticiparntsweefoundtobe satisﬁed with tlneeducational expeienceon the
basis of several consistent characteistics including: (a) no complaints about the
presentation; (b) no people leaving early; (c) sometimes people watched the presentations
twice; (d) thee wee no reports of men prohibiting children or women to attend to the

129

second educatiornal meeting on each camp—more women than men attended to the
meetings»; and, (e) at the end of the meeting, the participants showed their appreciation
of the activity.

The following table lists the main roles played by women and men during the
presentations.

Table 18. WW
Observations

 

 

Women
1. The women wee the ones describing the needs of the families and asking for
resources.

2. Older women wee vey interested in the infornnation and help to teach
about AIDS and prevention behaviors.

3. Women between 26 and 45 years old sometimes reacted to the information with
feelings of helplessness.

Men
1. In mostofthecampstlnecontactperson wasaman,becausemenagreedtobe
contact persons much more easily than women.

2. When both wee attending to the same meeting, older men asked more questions
than women.

3. When men were the only ones in the meeting, they reacted to the
information with denial, resigrnatiorn and jokes.

 

An interesting diffeence was found between the participation and reactiorns of
younger and older couples. The younger couples came together to the meetings and
often requested more information about corndorrns in front of each other, while the older
couples came togethe' to the meetings less frequently, and showed discomfort
requesting information about condoms in front of their partrners.

Examples of the traits 'simpatia" and "respeto" wee found and discussed in

relation to the implementation of the inteventiorn. Religious beliefs wee not discussed

130

at any tinne in relation to HIV/AIDS prevention, sexual behavior, and evidence of
difﬁculties in accessing health care were identiﬁed.

The questions asked frequently during the meetings can be classiﬁed as: (a)
geneal information about the epidenniology of AIDS; if Hispanics can get AIDS, if
AIDS is a problem in Mexico and if AIDS is just a problem of the black community; (b)
myths about ways of contagion: if you can get AIDS from a dentist's work, if you can
get AIDS from mosquitoes' bites, and if one can get AIDS drinking from the water
cooler at school; (c) geneal information about AIDS: where does AIDS comes from;
and, (d) government measures regarding AIDS: at what age children should start
learrning about AIDS; what is being done at schools to teach them about AIDS, and if it
is possible to assume that someone is not infected because the individual was tested as
part of the immigration procedures and was neither contacted nor denied the permission

to stay in the United States.

CHAPTER VI
DISCUSSION

This chapte discusses and summarizes the answers to the research questions
and hypotheses found in quantitative and qualitative data. Limitations and questions
for furthe research are presented and ﬁnally information from each of the diffeent
data scenes is used to analyze if the four objectives of the prevention program wee
accomplished.

Research Questions
What do migrant workes krnow about AIDS?

Similar to Dawson and Hardy (1989), and Cristo Rey and HAPIS survey in
1989, the participants in this study obtained very high scores on geneal knowledge
about AIDS, and lower scores on knowledge about prevention. The ﬁrst hypothesis
stated that there was going to be a signiﬁcant difference between the migrant workers'
krnowledge about AIDS after the educational experience in the two experimental
conditions as compared to the control groups. The results showed no signiﬁcant
diffeences on general krnowledge about AIDS between conditions, and a sigrniﬁcant
difference in krnowledge about prevention between conditions. Signiﬁcant differences
were identiﬁed in krnowledge about prevention between the expeimental educational
conditions and the control conditions.

The analysis of the score on geneal krnowledge about AIDS between conditions
did not support the ﬁrst hypothesis because the scores on that scale were very high
among all the subjects, and the potential impact of the educational inteventions was
diminished. However, a trend analysis of the score on general krnowledge about AIDS

between conditions was signiﬁcant, meaning that the scores for the different

131

132

conditions followed a predicted order: participatory learning group, didactic learning
group, control group and non-equivalent control group.

The trend arnalysis supported the second hypothesis which proposed that nnigrant
workers in the participatory learning group wee going to have highe scores on
knowledge about AIDS than the subjects in the didactic learrning group and the control
group. The analysis of knowledge about prevention identiﬁed signiﬁcant differences
in two pairs of combirnations: (a) participatory learrning group and the control group,
and (b) didactic learning group and the control group. There was no evidence that the
participatory learning group knew more about AIDS prevention than the didactic
learning group.

The ﬁnding of high scores on general knowledge about AIDS and lower scores
on knowledge about prevention suggests that different variables or processes might be
interfering with the adquisition of knowledge about AIDS, depending on wethe the
inforrrnation was general or preventive.

Psychosocial factors could be interfering with the understanding, perception or
receptiveness of information about the preventive behaviors. This study also looked at
the relationship of some of the psychosocial factors with knowledge of preventive
behaviors: ideas about sexuality (sex roles) and the use of condoms, attitudes towards
homosexuals and attitudes towards drug users. However, the qualitative observations
of sex roles did not show the avoidance of sex topics and lack of communication
between mm as a general characteristic-it was found in older couples-that is often
mentioned in the liteature. Also, a positive signiﬁcant correlation was found between
the number of people saying that they wanted more inforrrnation about condoms and
the numbe of people requesting condoms.

The only attitudinal variable that was signiﬁcantly and positively related to
knowledge about prevention, was the attitudes towards homosexuals (also the only

133

predictor of knowledge about prevention in the regression analysis). It is interesting to
note that thee was also a positive signiﬁcant correlation between attitudes towards
homosexuals and geneal knowledge about AIDS. These two ﬁndings support the
research hypothesis (H3) which proposed a signiﬁcant relationship between
knowledge about AIDS and attitudes towards homosexuals, and does not contradict
Stipp and Kerr's (1989) ﬁnding of people with anti-gay attitudes being less responsive
to information about AIDS. It is possible that if the subjects thought of HIV/AIDS as
a disease of people labeled as homosexuals, their perception of their own vulneability
to the infection is not high enough to realize a need to learn about prevention
behaviors. Also, exploratory analysis identiﬁed that the attitudes towards
homosexuals were sigrniﬁcantly correlated to the number of previous sources of
information about AIDS. .

Cristo Rey and HAPIS survey (1989) found a positive correlation between
peceived risk of developing AIDS and knowledge about prevention. This research
found support for the statement that the perceived vulnerability might be related to
knowledge about prevention behaviors since one of the items more frequently
answeed incorrectly was: " AIDS is a problem for the Hispanic community " (this
replicated the ﬁnding of Marin and VanOss Marin, 1989). It might well be that
increasing the knowledge about AIDS, speciﬁcally clarifying the subjects'
vulnerability to the infection, makes it more relevant for them to learn about
prevention, and for this reason signiﬁcant diffeences were found between the
experimental and control conditions on knowledge about prevention.

Another alternative explanation for these ﬁndings is a lack of trust of the sources
of information regarding prevention behaviors, or simply not enough previous and
clear information about prevention behaviors. The late could be supported by the
ﬁnding of a positive sigrniﬁcant correlation between knowledge about prevention and

134

the number of types of previous sources of infornnation about AIDS and of a very low
correlation between the general knowledge about AIDS and the number of types of
previous sources of information about AIDS. It was also mentioned earlier that Mays
and Cochran (1988) stated that the culture and beliefs of Hispanics have not been
considered in the design of most educational campaigns and that it is therefore, vey
difﬁcult for them to relate to the information.

It is important that the participants in the experimental educational conditions
showed higher scores on knowledge about prevention, because since this study lacks a
pretest, the fact that the scores on knowledge about prevention were lower in the
control conditions suggests that the educational inteventions clariﬁed or taught tlnese
critical information to the participants. Also, the fact that the scores on general
knowledge about AIDS followed the expected trend—with highe scores on
expeimental educational conditions-suggests that maybe a larger sample would have
shown sigrniﬁcant differences between conditions. Still, it is necessary to remember
that a signiﬁcant trend was identiﬁed between the conditiorns in geneal knowledge
about AIDS, but that a non-parametric test was used to test the diffeence between the
conditions (because of violation of the homogeneity of variance).

The mean score on attitudes towards peOple with AIDS was 18.94 (the highe
the score the more positive the attitude) and the maximum possible score was 28. The
third research hypothesis proposed that there was going to be a sigrniﬁcant difference
in the attitudes towards PWAs between experimental and control conditions. This
hypothesis was not supported by the data. The attitudes towards PWAs of subjects in
the participatory learning group were signiﬁcantly different from the attitudes of
subjects in the didactic learning group with the later group having the highest scores.
Even though a signiﬁcant diffeence in scores on attitudes towards people with AIDS

was found, thee wee no signiﬁcant differences between experimental and control

135

conditions, and the group that was expected to have the highest score, the
participatory learning group, was in fact the group with the lowest scores. The reason
why it was expected that this group was going to have the highest scores was because
it was hypothesized that there was going to be a positive relationship between
knowledge about AIDS and attitudes towards PWAs and the participatory condition
was designed to be more effective increasing the participants' knowledge about AIDS.
Moreover, a sigrniﬁcant positive correlation (.46) between general knowledge about
AIDS and attitudes towards PWAs was found, and this variable was one of the two
predictors of general knowledge about AIDS in the regression analysis. Theefore, the
unexpected ﬁnding can not be attributed to discomﬁrnnation of the fourth hypothesis
about a relationship between knowledge about the topic and attitudes towards PWAs.
It is furtlner explained late how the elements of the participatory intervention related to
attitudes towards people with AIDS did not work as expected in propitiating the
environment for the discussion of the topic.

The discussion of attitudes towards people with AIDS in this group depended on
the subjects' mention of comments related to the topic and it usually did not happen.
This lack of interventiorn to work on attitudes could be in part responsible for
disconﬁrrnation of the expectatiorn of higher scores on attitudes towards people with
AIDS in the participatory learning group. However, the ﬁnding of signiﬁcatively
lower scores on attitudes towards people with AIDS in the group that was identiﬁed
with highest scores on general knowledge about AIDS-~in a trend- and in knowledge
about prevention, is difﬁcult to explain with the data available. Furtlne research
should explore the possibility of an irnitial decrease in positive attitudes-or increase in
negative attitudes—towards people with AIDS, homosexuals and drug users as a result
of exposure to information about AIDS and large improvements in knowledge about
AIDS. Changes over time or the amount of change in the general knowledge about

136

AIDS could account for the still positive correlation between knowledge about AIDS
and attitudes towards people with AIDS.

Othe- variables that wee found to be positively and sigrniﬁeantly correlated with
attitudes towards PWAs were the attitudes towards drug addicts (.38) and the attitudes
towards homosexuals (.32). However, since none of the two experimental
edueational conditions included a module or speciﬁc exercises to change or support
positive attitudes towards PW As, homosexuals or drug use's (othe' than the sections
in the questionnaire, that subjects in all conditions completed) and, there wee not
many comments showing attitudes towards PWAs during the sections (it was expected
that the participants were going to show their attitudes towards PWAs more often and
that it was going to be the opportunity to talk about some myths and promote more
accepting attitudes) there was almost no intervention regarding attitudes. This is
probably the main reason why signiﬁcant diffeences wee not found between the
conditions on attitudes towards PWAs.

A ﬁfth hypothesis expected to ﬁnd a signiﬁeant relationship between attitudes
towards PWAs and the behaviors of: requesting written materials about AIDS,
volunteering to distribute written mateials to other people, bringing someone to
receive information about AIDS and requesting more infornnation about condoms arnd
spermicides. None of the relationships was found to be signiﬁcant, probably beeause
the intervention was not strong regarding attitudes towards PWAs and because of the

reduction of the sample due to missing data in the cards from the follow-up.

What attitudes do nnigrant workers have towards homosexuals and drug users in
relation to AIDS?

The attitudes towards homosexuals and drug users wee found to be moderately
positive: attitudes towards homosexuals X=13, attitudes towards drug users, X=14.

137

The maximum possible score on both scales was 20. The hypotheses that tlnee were
going to be signiﬁeant diffeences between conditions on attitudes towards
homosexuals and drug uses wee botln rejected. The diffeences wee not found
probably for the same reason that sigrniﬁeant differences wee not found between
conditions on attitudes towards PWAs. Still, the ﬁnding of modeately positive
attitudes towards homosexuals agrees with Stipp and Ker (1989) assertions regarding
the existence of conservative and progressive attitudes towards homosexuals in the
Hispanic community and Marin (1990) statement regarding the existence of an
homophobic component in the Hispanic culture. Unfortunately, the possibility of a
response bias in subjects answering the way they thought that the educators would
like then to respond was not tested. This is particularly critieal with controvesial
issues such as homosexuality and drug use: specially, because it has been discussed
that some of the characteistics of the Hispanics could make them more motivated to
please other people (e.g., ”simpatia" script and ”respeto"). There is no way to know
if the attitudes towards homosexuals and drug users are really more negative but were
attenuated by a response bias. It could have been that the subjects in the participatory
learning group felt less pressure to develop a response bias when answering the
questionnaire because they talked more and it was easie for them to peceive
acceptance and inteest in their own opinionns from us educators, tlmn the othe groups
which did not have the experience of discussing many of their point of views with us,
before the completion of the questionnaire.

It was discussed earlier that attitudes towards homosexuals were found to be
positively and signiﬁcantly related to geneal knowledge about AIDS and knowledge
about prevention. Hypothesis nine evaluated the relationslnip between attitudes
towards drug users and knowledge about AIDS. In this analysis the attitudes towards
drug users wee only related to geneal knowledge about prevention, which was also

138

one of the predictors of geneal knowledge about AIDS in the regression analysis (the
other predictor was attitudes towards PWAs). A possible reason for not ﬁnding a
signiﬁcant relationship between attitudes towards drug users and knowledge about
prevention is that usually just one or two behaviors (not to share needles, or to clean
the needles) are identiﬁed with drug use, as opposed to more preventive behaviors for
safer sex which be could mistakenly related to homosexuals—even though the use of
drugs could also be related to unsafe sexual behavior. Anothe situation that could
have interfeed with the ﬁnding of a relationship between attitudes towards drug uses
and knowledge about prevention is that only one item clearly related to drug use was
included in the assessment of prevention behaviors-{leaning the needles with bleach
before injecting drugs. Future studies should include items such as not to use
intravenous drugs, and not to share needles, in the section about peceived
effectiveness and knowledge of prevention behaviors.

Interestingly, the attitudes towards drugs users and the attitudes towards
homosexuals were signiﬁcantly and positively correlated to attitudes towards PWAs
(hypothesis 10 and 11). This was expected, particularly because Lawrence, Husfeldt,
Kelly, Hood and Smith (1990) expeimentally found that when patients wee
portrayed as homosexuals, the subjects consideed them as more deserving and
responsible for their disease, more deserving to die, more dangerous and deserving to
be quarantine, less entitled to work, and of less intrinsic worth. In othe words the

attitudes towards the patients wee more negative.

Would the participation in the participatory and didactic learning groups increase
migrant's openness to AIDS information as measured by their behavior?
The hypothesis regarding this research question was that there was going to be a

sigrniﬁcant diffeence in the number of subjects requesting information about condoms

139

and spemicides, between the participatory and didactic learning groups and the
control group. This hypothesis was not supported by the data. The method used to
collect data regarding Openness behaviors faced difﬁculties that limit its reliability-«Le,
people losing their cards, people not been at the eamps at the time of the follow-up.

Exploratory analysis found a positive signiﬁeant relationship between the
reported interest in getting more information about condoms and spermicides—iten in
the questionnaire-and the behavior of requesting samples or information about
condoms during the follow-up. This ﬁnding and qualitative observations, indicated
that people wee open to the information about AIDS. For instance: in most camps
the people kept coming to talk to the edueators and often stayed during the
presentations about AIDS and musical videotapes (a second time) after having gone
through their assigned meetings; many people attended the second educational
meetings on each camp afte having participated in the ﬁrst one; the subjects asked
many questions during the presentations,and; most of the subjects who returned cards
dnrring the follow-up requested more written materials. It could be thought that the
subjects chose the request of written information because it was an individual
behavior, not as intimidating as requesting information about condoms, or taking
someone to the educator to receive information. However, it is necessary to
remember that the subjects had the option of bringing a card to get into the rafﬂe
without doing any of the behaviors, and also that in some cases subjects who lost
their cards requested the brochures as well as people who did not participate in the
presentations-because they wee not at the camps.

A possible explanation for not ﬁnding differences in openness between
conditions could be that since the whole camp was involved in activities related to
AIDS education (even the controls which only completed the questionnaire and the
follow-up), the retm'n of the cards and performance of the different behaviors wee

140

connsidered as acceptable behaviors by the community. It could have also been that the
subjects in the control group displayed the behaviors used to assessed openness out of
curiosity because they knew that otlne people at the camp receive more informatiorn
about AIDS. Thus, the involvement of the whole camp in the AIDS edueation
program and expeiment could have been more effective promoting openness to the
topic of AIDS among everyone in the eamp than the interventions with the
experimental conditions. Summarizing, if the migrant workers wee open to
information about AIDS—a ceiling effect—if would have been unreasonable to expect
major changes in the display of behaviors related to openness during the follow-up.
Still, it was not tested if performing the behaviors regarded as displays of openness to
informatiorn about AIDS meant more openness to information about AIDS than the
subjects' participation in the AIDS education activity. Also, the involvement of the
whole eamp in AIDS education activities could have promoted social acceptance of the
topic and elicited openness to the topic equally across all groups

Would the participation in the participatory and learning groups increase the rrnigrant
workers' awareness of the importance of education about AIDS for the Hisparnic
population?

The hypothesis proposing a signiﬁeant difference in the migrant workers' report
of interest in distributing information to other people, and disposition to bring
someone to receive information between the conditions was rejected. Sonne of the
alternative explanations presented in the previous hypothesis apply to this situation: the
reduction in the sample size during the follow-up and the possibility of an effect on
awareness of the importance to edueate the community about the topic due to the
involvement of the families at the camp in the HIV/AIDS prevention program.

141

Similarly to what happened witln qualitative obsevations of openness,
qualitative data indicated awareness of the need to edueate the community about AIDS.
Adult women and nnen showed interest in having their families listen to the information
about AIDS and asked questions regarding when the children should begin to learn
about the topic.

Another interesting ﬁnding is that the exploratory analysis found a signiﬁcant
relatiornship between the request of copies of information about AIDS to be distributed
and the score on knowledge about prevention, and between the behavior of
introducing someone to the instructors and the knowledge about prevention. Those
who requested nnaterials for distribution wee the ones with highe scores on
knowledge about AIDS, and those who accomparnied someone to receive information
about AIDS from the educators wee the ornes with lower scores on knowledge about
prevention. The second relationship was found in a very small sample, and usually the
subjects who brought someone to receive information wee amorng the oldest in the
camp, and stayed during the short explanation provided to the person that they
brought. Meaning that they could have brought the othe person out of interest in
having this other person educated about AIDS, or maybe because of the subjects'
peception tlnat they did not knew or understood enough to communieate the
information themselves.

Thee are many possible explanations for the relationship between knowledge
about prevention and the request of copies of information to distribute. For example,
it could be that the undestanding of information about prevention increases the sense
of self-efﬁcacy or the peception that the infection could be avoided. As a
consequence it becomes more relevant to educate other people about the disease, or it
could be that the understanding of more information about AIDS promotes more
accurate assessments of risks and the peception that people that they know in the

142

community could be at risk becomes more clear. Theefore, increasing the nwd to
protect them through education was reﬂected in the inteest to have others leanning
about HIV/AIDS. More information about the community dynamics regarding
disseminatiorn of information about AIDS would be extremely useful in the design of

prevention programs.

The variables age and edueation

The lite'ature review provided evidence of how the variables age and ednncation
have been found to be related to having more information about AIDS in the general
publicnthe more educated and the younger knowing more—(Singe, Rogers, &
Corcoran, 1987) and in the Hispanic community (Dawnson & Hardy, 1989: Cristo
Rey and HIV [AIDS Prevention and Intervention Section, 1989). This research also
found a negative signiﬁcant correlation between age and geneal knowledge about
AIDS and age and knowledge about prevention, and sigrniﬁcant positive correlations
between educatiorn and geneal knowledge about AIDS and edueation and knowledge
about prevention.

. It is important to note that a negative signiﬁcant correlation was found between
age and education in the sample of migrant workers (~53)--the younger the subject,
the more educated. This ﬁnding probably accounts for the correlations between
knowledge about AIDS and age and education; younger subjects have more education
and could eithe receive more inforrrnation about AIDS or understand it better.

Previous research explained this ﬁnding in cornnectiorn with the variable
language. The rationale has been that subjects with more edueation and younge
completed the questionnaires in English and that it could be assumed that they had
access to more information about AIDS—since most of it is in English. The present

research included one item in the questiormaire whee the subjects indieated the

143

languagethattheypreferredtospeakanditwasnotfoundtoberelatedtoany ofthe
othe variables in the study. Also, the choice of the English or Sparnish--88 chose the
Spanish version and 51 chose the English version-questionnaires was studied as an
indicator of the language that the subjects feels helshe ean undestand bette and thee
was not a signiﬁcant diffeence between the subjects who chose any of the versions
and the geneal knowledge about AIDS. The means on geneal knowledge about
AIDS were 15.06 for the people who answered in Spanish and 15.27 for those
answering the English translation of the questionnaire.

The variables age arnd education wee also related to the attitudinal variables.
Age was signiﬁcantly and negatively related with attitudes towards homosexuals, drug
users and PWAs. Education was signiﬁcantly and positively related to attitudes
towards homosexuals, drug users and PWAs.

Qualitative observations also suggested relationships with the variable age. The
participation and reactions of younger and olde couples wee diffeent. The younger
couples came togethe to the meetings and often requested more information about
condoms in ﬁont of each otlner, while the olde couples came togethe to the meetings
less frequently, and showed discomfort requesting information about condoms in hunt

oftheirpartrners.

Summary of ﬁndings

This research identiﬁed the following main ﬁndings:
1. That the rnnigrant workes knew rrnost of the general information about AIDS, but
wee less knowledgeable about prevention belnaviors.
2. That the participatory and didactic learning inteventions wee effective in
increasing knowledge about prevention, and showed more geneal knowledge about

144

AIDS than the control group and non-equivalent control group (this found in a trend
analysis).

3. The participatory education was not better than the lectnne type education in the
dissenination of information about prevention.

4. Thee was a sigrniﬁcant diffeence between conditions on attitudes towards PWAs
but it was not in the predicted directiorn (the participatory learning group had lower
score than the didactic learrning group).

5. The attitude towards PWAs was not found to be related to any of the behaviors
related to openness and awareness and studied during the follow-up.

6. The attitudes towards homosexuals were positively and signiﬁeantly related to
general knowledge about AIDS and knowledge about preventiorn.

7. The attitudes towards drug users wee related to geneal knowledge about AIDS.
8. The attitudes towards drug uses and homosexuals were signiﬁcantly and
positively correlated to attitudes towards people with AIDS.

9. The subjects in the experimental conditions did not show more openness to
informationabout AIDS or awareness of the nwd to edueate the community about
AIDS.

10. Thee was a signiﬁcant negative correlation between age and education, and
between age and geneal knowledge about AIDS and knowledge about prevention.
11. There was a signiﬁcant positive correlation between education and geneal
knowledge about AIDS and knowledge about prevention.

12. Age and education wee signiﬁcantly related with attitudes towards homosexuals,
people with AIDS and drug users: age was negatively related to the attitudes and
edueation was positively related to the attitudes.

13. The younge couples came together to the meetings and often requested more
information about corndoms in front of each othe, while the olde couples came

145

togethe to the meetings less frequently, and showed discomfort requesting
information about condoms.

14. The women and men reacted in diffeent ways to the presentations: women with
helplessness,or anger , and men with boastful comments trying to challenge me or to
minimize the relevance of the information arnd the peceived threat of HIV/AIDS. Also
more women than men invited to the presentations attended.

15. Thee was no evidence of religious beliefs conﬂicting with the HIV/AIDS
prevention information.

16. Behaviors that could be attributed to the "simpatia" script and the ”respeto" wee
identiﬁed in people's reactions to the project. For instance, a couple of times people
with concens about participating in the presentations will not discuss their objections
to the educational intevention with us. Also, thee were many examples of a
peceived difference in status between myself and the family membes probably due to
my job as educator and this could have limited the discussion of individual concens
about HIV/AIDS. The following diagram shows the relationships that were identiﬁed
with this study.

146

     

 

 

32* ATTITUDES
ATTITUEEVi;OWARD TOWARDS
HOMOSEXUALS
.38” .33»
ATTITUDES TOWARDS .Io KP .2l*GK PREVIOUS
DRUG ADDICTS .46*GK .23*KP SOURCES
.38,.“ OF INF. AIDS
.07KP
-.34*GK _ KNOWLEDGE ., .
—. am: . . 9KP
AGE ' ‘ ABOUT <—°———> EDUCATION
.I8*GK .02GK
-.02KP .22KP
.40*
‘ AWARENESS
OPENNESS
28/ ATTITUDE \28 30),! ATTITUDE \30
INTEREST INTEREST INTEREST INTEREST
WRITTEN INFORMATION INFORMATION BRING
INFORMATION CONDOMS OTHERS SOMEONE
.05 t test! .I4 t t .05
REQUEST REQUEST REOUEST
WRITTEN INFORMATION INFORMATION BRING
INFORMATION CONDOMS OTHERS (““595
OPENNESS 64* AWARENESS
BEHAVIOR 6 + BEHAVIOR

 

1" - SIGNIFICANT AT D < .05
GK ' GENERAL KNOWLEDGE ABOUT AIDS
KP ' KNOWLEDGE ABOUT PREVENTION

Liam. Relationship Between Variables.

147

This ﬁeld experiment was designed to test the effectiveness of a participatory
educatiorn approach in promoting openness to information about AIDS and awareness
Of the need to learn about AIDS. The participatory learning condition was expected to
be more effective than didactic, control and non-equivalent control cornditions, because
of its potential to inﬂuence social norms and facilitate the intepnetation of the
information about prevention according to the subjects' living conditions and previous
expeiences. Some attitudinal variables that have been hypotlnesized in the literature as
having an impact on Hispanics' knowledge about AIDS wee studied. The top half Of
ﬁgure 6 shows the relationship between attitudes towards PWAs, homosexuals and
drug users and knowledge about AIDS . These attitudinal variables wee positively
and signiﬁcatively correlated with eitlne general knowledge about AIDS ( attitudes
towards drug addicts, PWAs, and homosexuals) or knowledge about prevention
(attitudes towards homosexuals). The attitudes towards PWAs wee positively and
signiﬁeatively correlated with attitudes towards homosexuals and drug users. Two
demographic characteistics were also correlated with geneal knowledge about AIDS
(edueation—-positively correlated—and age-negatively correlated). One othe
background characteistic studied was the numbe Of previous sources Of information
about AIDS. Inteestingly, this variable was sigrniﬁcatively correlated with knowledge
about prevention and with attitudes towards homosexuals. The bottom half of the
ﬁgure displays the relationships between knowledge about AIDS and attitudes and
behaviors assess as indicators of openness and awareness. The only signiﬁcant
relationship between knowledge about AIDS and eithe openness or awareness
attitudes and behaviors was between general knowledge about AIDS and Openness as
an attitude measured with two written items (inteest in written information about
AIDS and interest in more information about condoms). For each of the four written

items used as indicators of eithe openness or awareness thee was one corresponding

148

behavior. The only signiﬁcant relationship between the written items and the
corresponding behaviors was found between the inteest in receiving condoms and the
request of condoms. Still, it is important that Openness and awareness, as attitudes
wee signiﬁcantively correlated (.40) and that Openness and awareness as behaviors
wee also signiﬁcatively correlated (.64). If the relationship were found only in the
behaviors it would have been possible to argue that maybe people just tend to bring
cards classiﬁed unde any Of the categories—wee not discriminating-when they
decided to bring a card. Howeve, this was not the case because Openness and
awareness wee also correlated when assessed as attitudes.

The ﬁnding of sigrniﬁcant relationships between the attitudinal variables and
knowledge about AIDS suggests potential areas of intevention for future prevention
programs and research. It is encouraging to think that working with peoples' attitudes
towards homosexuals drug users or persons with AIDS could have an impact on
knowledge about prevention behaviors and general knowledge about AIDS, because
the only othe variables that have been continuously identiﬁed as related with
knowledge about AIDS are age and education of the subjects and tlnose variables are
out of the researche's control. Still, if the reason why education and age are related
with knowledge about AIDS is because younge and more educated people have better
understanding of the English language, then these two variables will not impact on
knowledge about AIDS as more information about AIDS is disseminated in Spanish.
Howeve, this study did not found signiﬁcant differences in knowledge about AIDS
due to the reported language that the subjects preferred to speak or the language chosen

to answe the questionnaire.

Limitations Of the Study

The method used to implement the educational sessions at the camps imposes
certain limitations to this research. First Of all, it was necessary to have random
assignment Of the families on each housing unit to each of the three expeimental
conditions in orde to have families from the same environment and with the same
potential opporturnities receive information about AIDS on each Of the expeimental
groups. Still, this poses the risk that by the time of the follow-up people from control
conditions could have talked about AIDS with participants in the educational
conditions and then their return of cards during the follow-up could have been affected
by curiosity to learn about a topic that was discussed with some of their neighbors or .
by interest in ﬁnding out the answers to the items that they completed in the
questionnaires. In fact, qualitative Obsevations reported in the previous chapter
indicated that this could have happened. For instance, sometimes members of the
control groups asked the researche for the correct responses to the questionnaires or
came to the presentations for the educational groups-4n this later ease their follow-up
cards were not included in the data set.

Anothe area whee the research faced limitations was in tems of data collection
techniques. Maybe it would have been bette tO' use longe instruments assessing self-
reported preventive behaviors, using multidimensional seales and assessing peceived
risk of HIV/AIDS to have scales with highe reliability. Howeve, most Of the
participants did not have strong educational backgrounds and sometimes had
difﬁculties reading questionnaires and getting used to the type Of execises. Also,
given the fact that talking about AIDS was expected to be intimidating and that the
intervention was not going to include any speciﬁc elements to change risk behaviors,
othe than the provision of knowledge, items about personal risk taking behaviors

wee not included. Anothe reasons why this type of questions was not used was

149

150

that it was critical for this program that subjects who answe the questionnaire and
participate in the ﬁrst presentations, do not feel uncomfortable because otherwise, an
attendancetofuture meetingsatthatcarnpcould havebeenaffected, andalsothatldid
not want to rrnake the nnigrant families feel that they were being ”checked” on their
behavior to be criticized, or furtlne stigmatized. Still, sorrne areas of the questionnaire
should be improved, like the section on knowledge about prevention that needs to
include more items about needle sharing behavior, and a section should be added on
behaviors that the individual thinks that it will be possible for him/he to do in the
future to prevent getting infected with HIV and furthe research should explore if it
will be possible to ask those type of questions without affecting negatively the
attendance to presentations in that community.

The reliance on the subjects bringing up comments related to attitudes towards
homosexuals, drug users and people with AIDS was not the best way to get an
opportunity to talk about the topic and clarify myths. There were simply not enough
comments on those topics. Different symbols or execises with key terms can be
included in the future to promote the discussion Of those topics.

Finally, the measures Of Openness to information about AIDS and awareness of
the need to educate the community about AIDS wee difﬁcult to adrniniste because
some people lost their cards and some fannilies wee not at the camps at the time of the
follow-ups, and since the follow-up visit also included a rafﬂe it was not possible to
reschedule that visit.

Issues for Furthe Research
Several areas of furthe research wee identiﬁed through this study. First, the
ﬁnding of signiﬁcant correlations between knowledge about AIDS and attitudes
towards homosexuals, people with AIDS and drug addicts suggests that the potential

151

impact of more positive attitudes on knowledge about HIV/AIDS and knowledge about
prevention should be studied. It will be important to know if when the public is
exposed to sources Of information about AIDS aiming at the development or
reinceforcement of more positive attitudes towards homosexuals, drug uses or people
with AIDS, knowledge about AIDS and preventive behaviors and behavioral change is
more probable. These attitudes could be interfering with the subjects' interpretation
and integration of the information about AIDS that helshe had received.

Anothe area for furthe research is the study of the community dynamics on
how and what information about AIDS is disseminated within the camp—by the
migrants «before and afte educational interventions. This type Of information,
together with individual assessments of the perceived social norms associated with
AIDS issues will bring information conducive to learning more about how to inﬂuence
the social environment to have an impact on individuals' knowledge, attitudes and
behaviors regarding AIDS. It will be inan to answe if the involvement of the
whole camp in HIV/AIDS edueation activities have an impact in promoting more
Openness to inforrrnatiorn about AIDS in the community. If this were the case, the
potential Of community involvement in the promotion of more speciﬁc behavioral
changes could be used for HIV prevention.

Earlie in this chapter the need to identify preventive behaviors peformed by the
migrants before and afte expeimental implementation of educational inteventions
was mentioned. Also, the intentions to do the preventive behavior, and the subjects'
peceptions of their ability to do the preventive behaviors should me measured. It was
discussed earlie that asking for individual risk taking behaviors might not be feasible
in some programs. Moreove, the intentions to do a preventive behavior are not
always correlated with the peformance Of the behavior. An alternative will be the
longitudinal administratiorn Of surveys regarding community norms regarding risk

152

behavior, and the peception Of risk of infection in the particular camp. This will be
useful in two ways, identifying the current community norms, and providing an
estimate of risk behaviors Of migrant workes without having to ask each individual
about his/he sexual and needle sharing behavior.

The next section draws conclusions based on this research and makes

suggestions for future programs of education of Hispanic migrant families.

Conclusions and Recommendations for Future Programs

This dissetation discussed earlie how social inﬂuences and knowledge could
affect the beliefs and values that should impact on health belnavior or intentions to
behave according to the health beliefs model and the reasoned actiorn theory. It was
suggested that the diffeent conditiorns and elements Of this model take time and require
the repetition-acme researchers said saturation—Of the messages and an strong impact
of the disease on the social environment for knowledge to be assimilated and for social
inﬂuences to push in the direction Of preventive behaviors.

A need Of AIDS preventiorn initiatives for the Hisparnic migrant community in
Michigan-and for Hispanics in geneal—was described and the elements of the social
environment and individual's attitudes hypothesized in the literature as potentially
related with AIDS prevention behaviors in the Hispanic commurnity wee identiﬁed
(cultural values such as, ”machismo", ”marianismo", "respeto", ”simpatia script",
religiosity and sexuality, and individual attitudes such as those towards homosexuals,
drug uses and people with AIDS). I

A one-time edueational intervention for the Hisparnic migrant commurnity was
designed to provide information about AIDS and incorporating Openness to .
information about AIDS and awareness of the importance of learning about AIDS for
the community as goals Of the edueational interventions. The Objectives of the

153

program were : (a) to disseminate knowledge about AIDS, (b) to promote the subjects'
exploration of their attitudes towards people with AIDS, homosexuals and drug uses,
(d) to motivate more Openness to receive information about AIDS, and (e) to increase
awareness of the importance of AIDS education for the Hispanic community.

The method prefered for the educational intervention was a participatory
approach based on Paulo Freire method Of using symbols to help the mic identify
the information that they rneed at the same time that they relate the concepts to their own
lifestyles and experiences. In order to evaluate this educational method the
inteventiorn was implemented as a ﬁeld comparison Of this type Of education with the
usual dithctic—lecture type— of presentation.

The participants in the study had a fair amount of geneal knowledge about AIDS
even in the control conditions. For this reason tlnere wee not large and signiﬁcant
diffeences between conditions. The area of knowledge about prevention--which was
identiﬁed in the literature as the area of weakness for Hispanics—showed the expected
differences between the experimental and control cornditions.

Thee wee doubts regarding if the subjects had enough opportunity to explore
their own attitudes towards homosexuals, drug users and people with AIDS. Even
though all the participants had the opportunity to complete the questionnaire asking
about their attitudes, there was almost no discussion regarding this attitudes during the
meetings.

The level of awareness of the need to educate the community about AIDS and the
Openness to the information about AIDS could not be conﬁrmed by the quantitative
behavioral measures used. Howeve, qualitative data suggested that both Objectives
could have been accomplished through: (a) the whole camp involvement in the
HIV/AIDS education program—it was probably appropriate to talk about the topic and
ask about it beeause eveybody was doing it and people wee having fun in tlne

154

activities whee they talked about it—;(b) the subjects' satisfaction with the educational
expeience, identiﬁed through the absence Of complaints and people leaving the
presentations, people who watched the presentations twice, the attendance of many
women and children to the meetings,and the collaboration of the participants with the
educators during evey visit.

Even though the participatory educatiorn was only identiﬁed to be supeior to the
othe conditions in general knowledge about AIDS in a trend, and showed to be
sigrniﬁcantly bette than the didactic education, it worked out extremely well in getting
the family members to talk about AIDS in a non-threatening atmosphere. The use of
the talking posters is a vey effective edueation method for the Hispanic migrant
families, and has the advantage we the didactic learning presentations Of allowing
family membes to hear what membes of their family think or feel about AIDS. For
the sanne reason, it is highly recommended that future programs condnnct the education
with families instead Of the common way Of doing it which is separate meetings for
women and men. This research expeience showed, that even though it is harde to
get the participation Of men in nnixed meetings, by using adequate recruitment
techniques (i.e., Oldest or inﬂuencial men as contact pesons, entertainment activites
and men from the camp recruiting otlne men) they did attended with their families.
Also, the role of the fatlne and the mothe on AIDS education were vey clear. Not
having the opportunity to Offe diffeent training semirnars to the women or men about
how to talk to each othe about AIDS or how to communicate about AIDS with their
children, it was very beneﬁcial to have mixed groups wee men could lnear women
concens and vicevesa. Anothe reason why separate groups are not encouraged is
beeause the information that is discussed among the men is sometimes more sexually
explicit and in a diffeent tone than the way the information is discussed with a group

of women. Men tend to forbid women to attend to meetings about AIDS when they

feel that they are going to be attending presentations presenting sex issues that way--
this was learned from the participants' reactions to presentations in the past.

The combination of an entertainment activity with the educational intevention is
highly recommended as an incentive, because it could help the participants peceive
the information about the topic as something more common. Furthe, it can be used as
a way to get the community an opportnunity to make decisions regarding the
implementation Of the program. In the current research, even though the migrants did
not decide the type of educational program that they wanted to have at their camps,
they participated in the decision regarding the shows that they wanted to watch on the
television-—they chose between comedies, Mexican music, Tex-Mex music, or
contemporary latino music.

Previous visits to get acquaintance with the migrant families and the disposition
to help them with referrals for services or in doing some of their tasks, the openness
to inteact with the children, and the inteest in talking and sharing a meal with some
families, wee spontaneous activities that became very important in orde to be trusted
and accepted by the community, which in this study seem tohave developed the
Opinion that they were coming to the educational meeting to collaborate with the
educator and to show appreciation.

For these reasons the participatory approach of AIDS edueation is recommended
for migrant families and should be implemented as part of an entertainment activity of
inteest to the migrants and with attention paid to get the educator to be known and
trusted by the migrant families. This approach was more effective for the
communication Of information about prevention of AIDS and providing a forum for
the discussion of AIDS and its related issues at a community and family level. This
allowed the participants to integrate the information to their expeiences, and could

have an impact on social norms or in the perception Of social norms about AIDS

155

related issues. It is also important to note that since the individual attitudes studied in
their potential relationship with knowledge about AIDS were found to be related with
eithe general knowledge about AIDS or knowledge about prevention, future
educational interventions should promote more positive attitudes towards
homosexuals, drug users and people with AIDS.

A program that will continue with the effort initiated with the current research
will be implemented during the Summe Of 1992, tlnrough Cristo Rey Community
Center, and sponsored by the HIV/AIDS Prevention and Intevention Section of the
Michigan Department of Public Health. This year, each Of the camps included in the
previous study, and four new camps will be visited and the people older than 13 years
Old will be interviewed regarding their participation in the educational program
implemented last Summe, and about knowledge about AIDS. The six eamps with the
lowest scores on knowledge about AIDS will be chosen for the migrant education
program. A couple from each camp included in the new study will be hired to attend a
one day workshop tO be trained to conduct a participatory educational presentation
about AIDS at their camp. This type of program promises the beneﬁt of developing
two permanent resonn'ce persons (the trained couple) that might be able to answer
future questions about AIDS (eithe because Of their knowledge of the information or
because of their contact with AIDS coordinators or AIDS information networks) to the
community. Also, part of the data gathered during the Summe 1992 will help to

estimate long term effects of the educational intervention discussed in this dissertation.

156

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cf ﬂiclic Health, 8_J(10),1247-1249.

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Y k fM i 'n ,642-646.

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cf bulic Hﬂtln, 8_1(10), 1273- 1279.

161

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APPENDICES

APPENDIX A

Appendix A
Format and Content of the Invitation

; LES ESPERAMOS !
3 NO nos fallen!

WE ARE GOING TO HAVE A GOOD TIME!

 

    

   

  
     

g 1.144. "III/swath rim! Ha- I' ',
mks-«laminammw mu 4 5;: y .
)2.

  
  
   

 

FAMILIA
, VBNGAN A on r m a.
‘1‘ 0"?
1.0‘ vroaos uusrcms on: o
{A mu um ocean r «o 0
”do
to". O T.
.7 “to, a runners as!"
r" t 4
IO ”beg, noeuru u roam census

 

Tatiana II case Ila canola ea se
cannpauearo at «Its .
a la:

 

 

Como la casa dc canals qua tees-nos no es
alienate-eat: grade y cease-es tenet algeaos
refuges-ies. eats-or iavilaado a algae: families
suistireadtaaeeabonyamssuistirm
dis 0 e are Incl-a.

Es my item qua erred y :- familia estate-
eldtaylalnonqeelesfeeasignadqueeuuesm
esta iavitaciOa.

 

 

 

162

APPENDIX B

Appendix B
Key Messages Provided in the Presentations

1. Basic information about AIDS
A. Diffeence between HIV and AIDS
B. How the virus affect the human organism
C. Spectrum of infection
D. Symptoms of infection
E. Symptoms Of the disease

11. Routes of transmission of the virus
A. Blood
B. Semen
C. Vaginal cervical secretions

111. Real vesus hypothetical risk
A. Casual contact and contagion
B. Other body ﬂuids

IV. Issues related to AIDS prevention
A. Communication between partnes
B. HIV test '
C. Othe as mentioned by the participants

V. Questions

163

APPENDIX C

Appendix ’ C
Summary of Content of Public Service ADVERTISEMENTS

All these public health advetisements were developed by the Department of Public Health,
they are in Spanish and played by actors with Mexican traits.

PSAs

1."Anita": This advertisement shows a Hispanic woman explaining that AIDS is a problem
for Hispanics and showing a picture of an adolescent (he niece) who looks healthy, but
who died Of AIDS.

2. "Words": This advertisement shows diffeent men which have been diagnosed having
AIDS explaying what is happening to them.

3. "Stand & Deliver": The same actors who played the role of the students in the movie
"Stand and Delive", are showed having a convesation clarifying misconceptions about

ways through which AIDS is and is not transmitted.

4. ”Morales”: Pueto Rican actor Fssai Morales talks about the risks of sharing needles
for drug use, tatoos, or ear piecing for the transmission of AIDS.

164

APPENDIX D

Appendix D
CONSENT FORM

You are been asked to collaborate in a study about methods Of education about AIDS for the migrant
population in Michigan. This study is sponsored by the AIDS awareness Ofﬁce of Cristo Rey Community
Center, the Special Ofﬁce Of AIDS Education of the Public Health Department, the American Red Cross
and the Psychology Department at Michigan State Univesity. The information that will be gatheed in
this survey will help in the development of effective methods of education about AIDS. Your answers are
really important and valuable, and your participation should be COMPLETELY VOLUNTARY. Thee
will be NO PENALTIES for anyone to refuse to participate in the study. The completion Of the
questionnaire would not take more than 20 minutes, if you follow the educator as she reads the instrument
aloud. If you work on the questionnaire independently, you might ﬁnish in 10 or ﬁfteen minutes.

Even though the topic Of the questionaire that you will be asked to answe is AIDS, you will not ﬁnd any
questions about your individual sexual behavior, or about drugs and/or alcohol use. The items that you will
be anweing are about knowledge about AIDS, and your attitudes and beliefs about cetain issues related to
AIDS. Howeve, if you feel uncomfortable with an item or question you may CHOOSE NOT TO
ANSWER THE ITEM. You could also CHOOSE TO WITHDRAW FROM THE STUDY at any time
without any penalty.

THIS IS A CONFIDENTIAL SURVEY. This means that you will not be asked to write your name, or
any information that could be used to identify you. An identiﬁcation numbe has been assigned to each
questionnaire for the purpose of matching the responses from each subject to his/he responses in a second
exercise. Howeve, since the educators are not going to have a list matching the identiﬁcation numbers to
names, it will be IMPOSSIBLE TO IDENTIFY YOUR ANSWERS. THE RESPONSES ARE
ANONYMOUS. This means that the educators and researchers will not know the name Of any Of the

respondents.

If you understand this information and agree to complete the questionnaire, please sign the following
statement: " I have been informed Of my rights as a participant in the study and agree to collaborate

answering a questionnaire“

 

If you have any questions and/or concerns about the study Milagritos Gonzilez and/or Robert Patifno will be
glad to talk to you, and if you would like to know the results Of the study you can contact the Cristo Rey
AIDS Awareness Ofﬁce (372-4700).

YOUR COLLABORATION IS REALLY APPRECIATED.

165

 

Appendix D

CONSENT FORM FOR PARENTS OR GUARDIANS

I understand the information that was read to me about the rights of the participants in
the study and decided that my son and/or daugther can participate providing data to the
educators given that his/her participation in the study only implies the completion of a
questionnaire and decisions regarding a set of cards, and that the information will be kept
conﬁdential and anonymous and that my children can refuse to answer any item and/or
resign from the study at any time without any consequence.

My child age is and my name is

 

166

APPENDIX E

Appendix E
ENCLEST A PARA TRABAJADORES AGRICOLAS SOBRE EL SIDA

Las siguientes preguntas buscan conocer mejor qué piensan y qué saben los trabajadores agricolas hispanos
sobre el SIDA/AIDS. Usted solamente tendra que escribir un circulo alrededor de su respuesta. No escriba
su nombre en el cuestionario. Las respuestas son completamente conﬁdenciales (nadie sabra qué usted
respondio) y anonimas (nadie sabra quién contesto cada cuestionario). Si tiene alguna duda sobre la manera
de responder alguna secci6n de este cuestionario o si no entiende la pregunta, por favor pidale a uno de los

educadores que le explique lo que tiene que hacer.

 

 

I. Lea cada una de las siguientes declaraciones e indique si cada una es CIERTA O
FALSA, circulando su respuesta. ‘
1. Al presente no hay cura para el SIDA. CIERTO FALSO
2. Una mujer embarazada que tiene el virus del CIERTO FALSO
SIDA puede pasarlo a su bebé sin que este haya
nacido todavia.
3. Una persona puede infectarse del virus de SIDA si...
a. ...trabaja cerca de alquien infectado(a) con el virus CIERTO FALSO
del SIDA.
b. ...asiste a la escuela con alguien infectado(a) con CIERTO FALSO
e1 virus del SIDA.
c. ...una persona con el virus del SIDA le estornuda CIERTO FALSO
cerca.
d. ...comparte platos, tenedores o vasos CIERTO FALSO
con alguien que tiene el virus del SIDA.
e. ...usa baﬁos publicos. CIERTO FALSO
f. dona o recibe sangre en una clinica. CIERTO FALSO
g. ...besa a una persona con el virus del SIDA en la CIERTO FALSO
mejilla.
h. ...comparte agujas para inyectarse CIERTO FALSO
drogas con una persona infectada con el virus del SIDA.
i. ...tiene relaciones sexuales con una CIERTO FALSO

persona infectada con el virus del SIDA.

 

167

 

168

II. Lea, por favor, [as siguientes oraciones y para cada una indique cuan dc acuerdo 0
en desacuerdo esta usted con cada una, circulando el numero correspondiente: 4=Muy
de acuerdo, 3=De acuerdo, 2=En desacuerdo y 1=Muy en desacuerdo.

 

 

Muy De acuerdo En desacuerdo Muy
De acuerdo en desacuerdo
1. Las personas que tienen 4 3 I
SIDA deben ser separadas
de la comunidad.
2. El SIDA no es una 4 3 l
enfu'medad muy
comi'm entre los hispanos.
3. El SIDA es un 4 3 l
castigo de Dios.
4. Las agujas deberian ser 4 3 l
regaladas a los drogadictos
para evitar que se contagien.
5. Si una persona se infecta 4 3 2 1
con SIDA , es porque ha
llevado a cabo oonductas
inmorales.
6. Las victimas del SIDA 4 3 l
representan un 81111”
no atendido en nuestra sociedad.
7. Yo recibiria en mi casa a 4 3 2 1
una persona que tiene SIDA.
8. Yo no quisiera que una 4 3 2 l
persona con SIDA me tocara.

 

III. Circule el m’rmero que mejor indica cuan efectivo cree usted que es cada uno de los
siguientes métodos para prevenir el SIDA. El m’rmero 3= Muy efectivo, el 2=Mas o
menos efectivo, el l=Nunca efectivo.

1. No tener relaciones sexuales.
2. Usar un condon.
3. Limpiar Ias agujas

con cloro antes de inyectarse

(h'ogas.
4. Usar un espermicida.
5. Tener relaciones solo

con una persona que
conocemos bien.

MUY EFECTIVO
3

3

MAS O MENOS
EFECT'IVO

2

2
2

NUNCA
EFECTIVO
l

l

l

169

IV. Escriba la respuesta a cada una de las siguientes preguntas.
1. (Que edad tiene usted?
2. Circule el ultimo grado de educacién que usted completo.

Escuela primaria: K 1 2 3 4 5 6 7 8
Escuela seetmdaria: 9 10 l I 12

Universidad/Colegio: l 2 3 4 5 6+

Escuela vocacional: l 2 3 4

3. Circule el idioma que usted preﬁere hablar

Ingles Espaﬁol Espaﬁol e inglés Otro (mencione, por favor)
4. Circule cual es su sexo: Femenino Masculino
5. Circule su estado civil: casado/casada soltero/soltera viviendo jtmtos

separado/separada viudolviuda divorciado/divorciada

6. Circule el grupoétnico/cultural al cual usted pertenece

a. mexicano/mexicana b. mexicano-americano/mexicana—americana c. chicanolchicana

d. cubano/cubana e. puertorriqueﬁo/puertorriqueﬁa f. suramericano/americana

g. otro (mencione)

V. Lea, por favor, las siguientes oraciones y para cada una indique cuan de acuerdo 0

en desacuerdo esta usted con cada una, circulando el m’rmero correspondiente: 4=Muy de
acuerdo, 3=De acuerdo, 2=En desacuerdo y 1=Muy en desacuerdo.

 

 

Muy De awerdo En desacuerdo Muy
De acuerdo en desacuerdo
1. Me sentiria incomodo 4 3 2 I
si estuviera en el baﬁo y
hubiera un homosexual.
2. No me gustaria vivir 4 3 2 1
con un homosexual de vecino.
3. Los homosexuales 4 3 2 I
nacen siendo asi.
4. La policia deberia arrestar 4 3 2 l

a los homosexuales.

170

 

 

Muy De acuerdo En desacuerdo Muy
De acuerdo en desacuerdo
5. Los adictos a drogas son 4 3 2 l
personas que no saben
manejar sus problemas.
6. hos/Ias adictos(as) a 4 3 2 l
drogas son criminales.
7. Es imposible ser 4 3 2 I
amigo(a) de un(a) adicto(a).
8. A las personas que usan 4 3 2 I
drogas e1 gobiemo Ies debe
quitar los hijos.
9. Una persona que usa 4 3 2 1
drogas puede dejar de ser
adicto.
10. A una persona 4 3 2 l

homosexual no se le debe
permitir criar a sus hijos.

 

VI. Responda SI 0 NO a las siguientes preguntas

 

1. (Le interesaria a usted recibir mis informacién escrita sobre el SIDA? 81 NO
2. (;Le gustaria distribuir copias de informacion escrita sobre el SIDA a

personas que usted conoce? SI NO
3. (Le interesaria recibir mas informacion sobre condones y SI NO
espermicidas?

4. {Le interesaria traer a personas que usted conoce a recibir informacion

sobre el SIDA de parte de los educadores? SI NO
5. (Ha oido usted informacion sobre el SIDA por radio? SI NO
6. (,Ha visto usted anuncios de television sobre el SIDA? SI NO
7. (;Ha Ieido usted informacion escrita sobre el SIDA? SI NO

8. Circule alguna otra ﬁlente de la cuil usted haya recibido informacién sobre el SIDA:
a. Amigos b. Clinicas c. Escuela d.Laboratorio e. Farmaceutico

MUCHISIMAS GRACIAS POR SU COOPERACION AL RESPONDER A ESTE CUEST'IONARIO.

SURVEY FOR MIGRANT WORKERS ABOUT AIDS

The following questions try to better understand what Hispanic migrant workers think and/or know about
AIDS. You will only have to draw a circle around your answer. Do not write your name in the
questionnaire. The answers are completely confidential (nobody will know what you

answered) and anonymous (nobody will know who answered each questionnaire). If you have any
doubts about the way to answer any of the sections of this questionnaire, or if you do not understand any
item, please ask one of the educators to explain the task to you.

 

I. Read each of the following statements and indicate if they are TRUE OR FALSE.

 

1. Currently there is no cure for AIDS. TRUE FALSE

2. A pregnant woman infected with the AIDS virus TRUE FALSE
could infect her baby before it is born.

3. A person could get infected with the AIDS virus ﬁ'om...

a. ...working with someone infected with TRUE FALSE
the AIDS virus.

b. ...going to school with someone infected TRUE FALSE
with the AIDS virus.

c. ...someone infected with AIDS sneezes TRUE FALSE
nearby.

(1. ...sharing dishes, forks or cups with TRUE FALSE
someone infected with the AIDS virus.

e. ...using public restrooms. TRUE FALSE
f. ...giving or receiving blood at a clinic. TRUE FALSE
g. ...kissing someone infected with the TRUE FALSE
AIDS virus on the cheek.

h. ...sharing needles with a drug addict TRUE FALSE
infected with the AIDS virus.

i. ...having unprotected sexual relationships TRUE FALSE

with someone infected with the AIDS virus.

 

11. Read each of the following statements and for each one, please indicate how
much do you agree andlor disagree, by drawing a circle around the number
corresponding to your answer: 4=Strongly agree, 3: Agree, , 2=Disagree,
l=Strongly disagree.

 

Strongly Agree Disagree Strongly
agree disagree

 

1. People with AIDS should be isolated 4 3 2 I
from the community.

171

172

 

 

Strongly Agree Disagree Strongly
agree disagree

2. AIDS is not a common disease among 4 3 2 l

the Hispanics.

3. AIDS is a punishment from God. 4 3 2 I

4. Needles should be distributed to drug 4 3 2 I

addicts to stop the spread of the disease.

5. If someone gets infected with the AIDS 4 3 2 1

virus it is because she/he have been

behaving immorally.

6. AIDS victims are a forgotten group of 4 3 2 1

the society.

7. I would open my house to someone 4 3 2 l

with AIDS.

8. I would not want a person with AIDS 4 3 2 l

to touch me.

 

III. Circle the number that best indicates your perception of how effective each of
the following methods is to prevent infection with the AIDS virusz3=Very
effective, 2=Somewhat effective, l=Never effective

VERY
EFFECTIVE

1. Not to have sexual relationships. 3
2. Using a condom. 3

3. Cleaning the needles with clorox 3
before injecting drugs.

4. Using an spermicide. 3

5. Having sexual relationships only 3
with someone you know well.

SOMEWHAT NEVER

EFFECTIVE

2

2

EFFECTIVE
I

I

I

 

IV. Answer each of the following questions.

 

I. How old are you?

 

I73

2. Circle the last level of education that you completed.

Elementary school: K I 2 3 4 5 6 7 8
Secundary school: 9 10 ll 12

University/College: I 2 3 4 5 6+

Vocational school: I 2 3 4

3. Circle the language that you prefer to speak:

a. English b. Spanish c. English and Spanish d.Other

4. Circle your gender:
a. Female b. Male

5. Circle your mrital status:
a. married b. single c. living together
(I. separated e.widow/widower f. divorced
6. Circle the ethnic/cultural group to whom you belong:
a. Mexican b. Mexican-ameriean c. Chicano
d. Cuban e. Puertorican f. South-American

g. Other (mention)

 

V. Please read each of the following statements and indicate how much do you
agree andlor disagree with each one, drawing a circle around the corresponding
number: 4=Strongly agree,3=Agree, 2=Disagree, 1=Strongly disagree.

 

 

Strongly Agree Disagree Strongly
agree disagree
I. I would feel uncomfortable 4 3 2 1
if] were in the bathroom and a
homosexual were there too.
2. I would not like to have a 4 3 2 l
homosexual as my neighbor.
3. Homosexuals have a mental 4 3 2 1
disease.
4. The police should arrest 4 3 2 1
homosexuals.
5.Drugusersarepersonsthatdo 4 3 2 1
not know how to handle their
problems.

6. Drug addicts are criminals. 4 3 2 I

I74

 

 

 

 

Strongly Agree Disagree Strongly

agree disagree
7. It is impossible to be a friend 4 3 2 1
of a drug addict.
8. The goverment should separate 4 3 2 l
the children of drug addicts from
their parents.
9. A drug addict cannot stop 4 3 2 1
his/her addiction.
10. A homosexual person should 4 3 2 1
not be allowed to take care of his
children.
VI. Answer YES or NO to each of the following questions.
I. Would you like to receive more written information about AIDS? YES NO
2. Would you like to distribute copies of written information about YES NO
AIDS to people that you know?
3. Would you like to receive more information about condoms and/or YES NO
spermicides?
4. Would you like to bring people that you know to receive information YES NO
about AIDS from the educators?
5. Have you heard information about AIDS on the radio? YES NO
6. Have you seen AIDS advertisements on television? YES NO
7. Have you read written information about AIDS? YES NO
8. Circle any other source from which you have received information about AIDS?

a. Friends b. Clinics c. School d. Laboratories

e. Pharmacist f. Other

THANK YOU VERY MUCH FOR YOUR COOPERATION ANSWERING THIS

QUESTIONNAIRE.

APPENDIX F

 

Appendix F
Examples of the color coded cards
GREEN CARD

 

ID number Group A B C

Por favor, recuerde traer esta tarjeta y llevar a cabo la conducta que se menciona en la misma, si usted
esta de acuerdo con ella.

La FECHA para traer la tarjeta es
Por cada tarjeta que usted traiga de vuelta llevando a cabo la conducta mencionada en la misma usted tendra

 

derecho a un boleto para la rifa de un abanico eléctrico que se llevara a cabo ese dia.
CONDUCTA:
DESEO RECIBIR MAS IN F ORMACION ESCRITA SOBRE EL SIDAIAIDS.

 

YELLOW CARD:

 

ID number Group A B C

Por favor, recuerde traer esta tarjeta y llevar a cabo Ia conducta que se menciona en la misma, si usted esta de
acuerdo con ella.
La FECHA para traer la tarjeta es

 

Por cada tarjeta que usted traiga de vuelta llevando a cabo la conducta mencionada en la misma usted tendra
derecho a un boleto para la rifa de un abanico eléctrico que se llevara a cabo ese dia.
CONDUCTA:

ME GUSTARIA RECIBIR COPIAS DE MATERIALES ESCRITOS SOBRE EL
SIDAI AIDS PARA DISTRIBUIRLOS A PERSONAS QUE CONOZCO.

 

175

176

GRAY CARD:

 

ID number Group A B C

Por favor, recuerde traer esta tarjeta y llevar a cabo la conducta que se menciona en la misma, si usted esta de

acuerdo con ella.
La FECHA para traer 1a tarjeta es

 

Por cada tarjeta que usted traiga de vuelta llevando a cabo la conducta mencionada en la misma usted tendra
derecho a un boleto para la rifa de un abanico eléctrico que se llevara a cabo ese dia.
CONDUCTA:

TRAIGO A ALGUI EN QUE CON OZCO PARA QUE USTEDES LE
INFORMEN SOBRE EL SIDAIAIDS.

 

RED CARD:

 

ID number Group A B C

Por favor, recuerde traer esta tarjeta y llevar a cabo la conducta que se menciona en la misma, si usted esta de
acuerdo con ella.
La FECHA para traer la tarjeta es

 

Por cada tarjeta que usted traiga de vuelta llevando a cabo la conducta mencionada en la misma usted tendra
derecho a un boleto para la rifa de un abanico eléctrico que se llevara a cabo ese dia.
CONDUCTA:

QUIERO RECIBIR MAS INFORMACION SOBRE CONDONES Y
ESPERMICIDAS.

 

177

BLUE CARD:

 

ID number Group A B C

Por favor, recuerde traer esta tarjeta y llevar a cabo Ia conducta que se menciona en la misma, si usted esta de
acuerdo con ella.
La FECHA para traer la tarjeta es

 

Por cada tarjeta que usted traiga de vuelta llevando a cabo la conducta mencionada en la misma usted tendra
derecho a un boleto para la rifa de un abanico eléctrico que se llevara a cabo ese dia.
CONDUCTA:

NO ESTOY INTERESADO(A) EN LLEVAR A CABO NINGUNA DE LAS
CONDUCTAS MENCIONADAS EN LAS TARJETAS, PERO DESEO OBTENER UN
BOLETO PARA LA RIFA DEL ABANICO.

 

APPENDIX G

Appendix G
Tables

Table G-l. Item-to correl ti n for re n eneralkn wled a out AID .

 

 

Items Item-total correlation

13a. Currently there is no cure for AIDS. .34

13b. A pregnant woman infected with the AIDS virus could infect her .31
baby before it is born.

* A person could get infected
with the AIDS virus from...

130. ...working with someone infected with the AIDS virus .52
13d. ...going to school with someone infected with the AIDS virus .42
I36. ...someone infected sneezes near you .30
13g. ...kissing someone infected with the AIDS virus in the cheek .26
13h. ...sharing needles with a drug user infected with the virus .3 1
131. ...having unprotected sexual relationships with someone infected .28

 

178

Table G-2. Percentage of correct and incorrect responses on each item by each group.

 

 

 

Groups
NEC CG DL PL
Items Y N Y N Y N Y N
1. Currently there is no cure for AIDS. 67% 33% 68% 27% 77% 21% 89% 9%
2. A pregnant woman infected 96 % 4% 93 % 7% 92 % 8% 97% 3%
with the AIDS virus could infect her
baby before it is born.
3. A person could get infected
with the AIDS virus from...
a. ...working with someone infected with 17% 79 % 17% 83 % 15% 85 % I I % 89 %
the AIDS virus.
b. ...going to school with someone 13% 83 % 12% 85% 8% 90% 14% 86%
infected with the AIDS virus.
c. ...someone infected with AIDS sneezes 25% 75 % 22% 73 % 8% 92 % 3 % 97 %
(1. ...sharing dishes, forks or cups with 21% 75 % 22% 76 % 13% 87 % 11% 89 %
someone infected with the AIDS virus.
e. ...using public restrooms. 29% 71 % 29% 66 % 15% 82 % 9% 91 %
f. ...giving or receiving blood at a clinic. 88% 8 % 83% 12 % 85 % 15 % 63% 31 %
g....kissing someone infected with the 88% 13 % 7% 93 % 8% 90 % 3 % 94 %
AIDS virus on the cheek.
h. ...sharing needles with a drug user 100 % -- 88 % 7% 95 % 5% 98 % 3%
infected with the AIDS virus.
i. ...having unprotected sexual 100 % --- 85 % 12% 92 % 8% 94 % 6%

relationships with someone infected with
the AIDS virus.

 

Note. The percentages highlighted show the correct answers to each item.
NEC=Non-equivalent control group, CG=control group, DL= didactic learning,

PL=participatory learning

179

Table G-3. Pergntages on Knowledge of prevention .

 

 

Conditions

Control Participatory Didactic Non-equivalent
Effectiveness NE SE VE NE SE VE NE SE VE NE SE VE
items
I. Nottohavesexual 32 29 37 15 28 54 6 31 57 21 25 54
relationships.
2. Usingacondom. 29 37 32 5 28 67 6 49 43 17 38 46
3. Cleaningneedles 51 27 22 10 23 67 17 20 60 38 29 33
with clorox if using
drugs.
4. Usingan 42 29 22 3 44 54 9 46 43 25 46 17
spermicide.
5. Having sexual 12 29 46 8 31 54 31 26 40 8 21 67
relationship only with
someone that you
know well.

 

Table 04. Frequency 9f @19me 9f mhaviors.

 

 

Behavioral cards
RD GRE YE GRA
Responses
YES 44 59 50 9
NO 53 7 38 47 88

 

180

Table G-S. Means on Am uggs 19m @QQIQ with AIDS

 

 

Groups
Items (13 PL DL E
'1. People with AIDS should be 2 2 3 3
isolated from the community.
‘2. AIDS is not a common disease 2 2 2 2
among the Hispanics.
‘3. AIDS is a punishment from God. 3 3 3 3
4. Needles should be distributed to 3 2 2 2
drus addicts to stop the spread of the
disease.
*5. If someone gets infected with the 2 3 2 3
virus it is because she/he have been
behaviong immorally.
6. AIDS victims are a forgotten group 3 2 2 2
of the society.
7. I would open my house to someone 4 2 2 2
with AIDS.
'8. I would not want a person with 3 4 3 3
AIDS to touch me.

 

* The responses for these items are recoded (4=strongly disagree, 3=disagree.
2=agree and 1=strongly agree). Higher scores in all the items correspond to
positive attitudes.

181

TableG-6.M nA‘ w h x I

 

 

Groups
Items (13 PL DL I~E
1. I would feel uncomfortable 2 2 2 2
if I were in the bathroom and a
homosexual were there too.
2. I would not like to have a 2 3 2 2
homosexual as my neighbor.
3. Homosexuals have a mental 3 3 2 3
disease.
4. The police should arrest 2 3 3 3
homosexuals.
10. A homosexual person should not 2 2 2 2

be allowed to take care of his children.

 

Note. The responses to all of these Items were recoded (4=strongly disagree.
3=disagree. 2=agree and 1$trongly agree). Higher scores mean positive
attitudes to homosexuals.

 

 

Table G-7. WW

Groups
Items (1': PL DL PE:
5. Drug users are persons that 2 2 2 2
do not know how to handle their
problems.
6. Drug addicts are criminals. 2 2 2 2
7. It is impossible to be a friend of a 2 3 2 3
drug addict.
8. The government should separate 2 2 2 3
the children of drug addicts from
their parents.
9. A drug addict cannot stop his/her 3 2 2 2

addiction.

 

Note. The responses to all of these items were recoded (4=strongly disagree,
3=disagree. 2=agree and 1=strongly agree). ngher scores mean positive
attitudes toward drug users.

182

aRIES

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312