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LIBRARY
Mlchlgan State
University

 

 

 

This is to certify that the

dissertation entitled

Acculturation and Mexican Culture:
IImplications for Culturally Appropriate
I HIV/AIDS Interventions

presented by

Christina Urrea Rodriguez

has been accepted towards fulfillment
of the requirements for

Ph.D. degree in Psychology

7

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1M W14

ACCULTURATION AND MEXICAN CULTURE: IMPLICATIONS FOR
CULTURALLY APPROPRIATE HIV/AIDS PREVENTION INTERVENTIONS

By

Christina Urrea Rodriguez

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Psychology

1998

ABSTRACT

ACCULTURATION AND MEXICAN CULTURE: IMPLICATIONS FOR
CULTURALLY APPROPRIATE HIV/AIDS PREVENTION INTERVENTIONS

By

Christina Urrea Rodriguez

HIV/AIDS prevention strategies are not very effective with Latinas because

gender and cultural factors are not typically considered in these programs (e.g., Amaro,
1995). Yet, few empirical studies have identified which aspects of Latino culture are
associated with risky sexual behaviors (e.g., Amaro, 1991). This study examined how
acculturation, through religion and sexual gender norms, leads to HIV sexual risk
behaviors among women of Mexican descent. This study also examined the potential
role alcohol and a partner’s sexual gender norms may have on risky sexual practices.
Face to face structured interviews with 90 Mexican and Mexican-American women,
residing in California, were conducted. The findings from these interviews reveal a more
complex relationship, than originally conceived, between acculturation level and risky
sexual behaviors. Acculturation level was found to be related to condom use in two very
different and paradoxical ways. Contrary to previous research, highly acculturated
Mexican and Mexican-American women were less likely to be in sexual relationships
where condoms were used. Further, revealing the complexity of this finding, Mexican
and Mexican-American women who were more highly acculturated were more likely to
have liberal sexual gender norms, and women with liberal sexual gender norms were

more likely to be in sexual relationships where condoms were used. Moreover, highly

acculturated Mexican and Mexican-American women were more likely to have engaged
in anal sex at least once, and tended to drink alcoholic beverages before sex which was
associated with having multiple sexual partners. Additionally, Mexican and Mexican-
American women with a strong fate orientation were less likely to be in sexual
relationships where condoms were frequently used. The implications of these findings

for the creation of culturally appropriate HIV/AIDS interventions are discussed.

ACKNOWLEDGMENTS

Mi familia, Mom, Dad, Adrian y los Ayalas, who have unconditionally loved,
and supported me while I pursue my graduate degree in Michigan. Thank you for all of
your thoughts and prayers. They really helped! Mi querido Alejandro, who has endured
three years of separation so that I could fulfill my dream of becoming a Ph.D. Knowing
that I was going back home to you kept me grounded in my studies, and gave me
something to strive for. Tu eres lo mejor de los hombres. Te adoro y amo! Gracias por
todo!!!!llllll Mis amigas/os in Michigan, Nicole, Diana, LGSA members, my cohort and
fellow eco-smdents, who have challenged, and supported me throughout this academic
adventure. Without your support I would have NEVER made it through this program.
Gracias por todo! Special thanks to Nicole for reading drafts of my proposal and
dissertation, and for reminding me that I am a competent researcher. I will miss our
coffee breaks at Emerald City Cafe and Beaners. Our deep discussions about life, our
research and our fiances will be missed tremendously! You have been instrumental in
my personal development. Of course, I am tempted to stay, given that LA cannot offer
me what you and Lansing can offer on a Friday night. (I couldn’t resist the urge!©) On a
serious note, I love you and will truly miss you. Un abrazo y beso para Diana. Gracias
por tu amistad! I cannot begin to tell you how wonderful it was to have a fellow Latina
to share my experiences with. Your strength and faith in me, really helped me through
this crazy process. I am so proud to know you, and am comforted to know that you will

be out in the community helping nuestra gente! Adelante, mujer! The Faculty at MSU, in

iv

particular the Ecological-Community Psychology faculty, who have always made time
for me, and have played a significant role in making me the community psychologist I
am today. Thank you for having faith in my abilities as a psychologist and researcher.
Special thanks to Pennie. Your feedback and guidance were instrumental in my
completing this program. Thank your for believing in me, and giving me the courage to
believe in myself. You have been a great role model and I look forward to sharing what
you have taught me to my students! Gracias! ! !! Maxine Baca Zinn; Que puedo decir?
You have profoundly influenced my way of viewing, and thinking about the world.
Thank you for contributing to the advancement of nuestra raza! Ann Millard and Isidore
Flores, thank you for providing me with a home away fiom home. The food, the love and
the fi'iendship were greatly appreciated. Bill Davidson, Rick DeShon and Tom Reischl -
WOW! What can I say? All three of you were instrumental in the completion of my
dissertation. Thank you. Special thanks to all the folks that helped with translation, data
collection, data analysis, and allowed me to share my ideas about my findings:
Interpreters - Adi Bautista, Patty De Robles, Mariposa Interpreting Services, Enrique
Olvera, and Racquel Garcia; Interviewers and trainers - Rocio Alvarez, Maria Solano,
Corina Benavides, Bertha Benavides, Minerva Castro, Annette Ayala, Brigette Ayala,
and Yvette Acosta; Statistical assistance - Michael Rodriguez, David Loveland, David
Chan, and Rick DeShon; Dissertation support group: Cheryl Sutherland and Ruben
Viramontez. Another special thanks to all the folks that helped me recruit participants
and to all the women that participated in my dissertation study. Without your honesty,

frankness and time, this would have never happened. MSU Psychology staff: Suzy

Pavick, Vicki Alexander, Sondra Higbee, and Cheryl Forcia. Thank you for your
patience, hand-holding and all the emotional support provided while I was a student at
MSU. Last, but not least, Mrs. Judy Meadows, Silvia Borjas, Blanca Ortiz, Dr. Gloria
Romero, Dr. Aghop Der-Karabetian, and Dr. Ann Wichman, for believing in me and

encouraging me to pursue graduate school. You have made a significant difference in my

life! ! !!

vi

TABLE OF CONTENTS

LIST OF TABLES ...................................................... xi
LIST OF FIGURES .................................................... xiv
INTRODUCTION ....................................................... 1
CHAPTER 1
LITERATURE REVIEW .................................................. 8
Importance of Considering Subgroup Membership ........................ 8
Sexual Risk for HIV within the Mexican and Mexican-American
Community ............................................... ll
Acculturation .................................................... 12
HIV Sexual Risk Behaviors ......................................... 16
Use of Condoms ............................................ 17
Anal Sex .................................................. 19
Multiple Sexual Partners ..................................... 19
Summary of Acculturation .................................... 20
Religion ........................................................ 21
Degree of Religiosity ........................................ 23
Relationship Between Acculturation Level and Religiosity .......... 26
Fate Orientation ............................................ 27
Relationship Between Acculturation Level and Fate Orientation ...... 28
Summary of Religion ........................................ 29
Sexual Gender Norms ............................................. 30
Sexual Behavior ............................................ 31
Relationship Between Acculturation Level and Sexual Gender
Norms .................................................... 34 '
Summary of Sexual Gender Norms ............................. 35
Moderating Variables .............................................. 35
Partners Sexual Gender Norms ................................ 36
Use of Alcohol ............................................. 39
Gender Norms Incongruency .................................. 40
Research Questions and Hypotheses .................................. 41
Acculturation and HIV Sexual Risk Behaviors .................... 41
Research Question #1 ................................. 42
Hypotheses .................................... 42
How Acculturation Level Impacts Sexual Risk Behaviors ........... 42
Research Question #2 ................................. 43
Hypotheses .................................... 43

vii

Contributions of the Proposed Study .................................. 46

CHAPTER 2 -
METHODS ........................................................... 48
Participants ...................................................... 48
Demographic Information .................................... 48
Sexual Risk History ......................................... 50
Partner Sexual Risk History ................................... 54
Procedure ....................................................... 56
Measurement .................................................... 61
Demographics ............................................. 62
Acculturation .............................................. 62
Sexual Gender Norms ....................................... 67
Religion .................................................. 74
Incongruency of Sexual Gender Norms .......................... 80
Partner’s Sexual Gender Norms ................................ 83
Use of Alcohol ............................................. 87
HIV Sexual Risk Behaviors ................................... 90
Use of Condoms During Vaginal Intercourse ..................... 91
Anal Intercourse ............................................ 92
Multiple Partners ........................................... 93
Pilot ........................................................... 94
CHAPTER 3
RESULTS ............................................................ 97
Descriptive Statistics .............................................. 97
HIV Sexual Risk Behaviors ................................... 97
Examining the Proposed Research Questions .......................... 100
Differences in HIV Sexual Risk Behaviors Due to Acculturation Level 100
Hypothesis la ....................................... 100
Hypothesis 1b ....................................... 103
Hypothesis 1c ....................................... 104
Direct Predictors of Religion, Sexual Gender Norms and the Use of Alcohol . 104
Hypothesis 2a ....................................... 104
Hypothesis 2b ....................................... 105
Hypothesis 2c ....................................... 105
Hypothesis 2d ....................................... 105
Direct Predictors of Risky Sexual Behaviors ........................... 106
Hypothesis 2e ....................................... 107
Hypothesis 2f ....................................... 107
Hypothesis 2g ....................................... 108
Hypothesis 2h ....................................... 108
Hypothesis 2i ....................................... 109

viii

Hypothesis 2j ....................................... 109

Hypothesis 2k ....................................... 110
Mediating Relationships .......................................... 110
Religion ................................................. 111
Hypothesis 21: Level of Religiosity .............................. 111
Hypothesis 2m: Fate Orientation ............................... 113
Hypothesis 2n .............................................. 1 15
Hypothesis 20 .............................................. 116
Summary of Religion ........................................ 117
Sexual Gender Norms ............................................ 1 18
Hypothesis 2p .............................................. 119
Hypothesis 2q .............................................. 123
Hypothesis 2r .............................................. 125
Summary of Sexual Gender Norms ............................. 126
Moderating Relationships ......................................... 127
Hypothesis 2s .............................................. 128
Hypothesis 2t ............................................... 129
Hypothesis 2u .............................................. 130
CHAPTER 4
DISCUSSION ........................................................ 131
To What Extent Does Acculturation Level Lead to Different HIV Sexual
Risk Behaviors .................................................. 132
Use of Condoms ........................................... 133
Anal Sex ................................................. 135
Multiple Sexual Partners .................................... 136
How does Acculturation Level lead to these Different Risky Sexual Practices 137
Mediating Relationships .................................... 137
Religion ........................................... 137
Woman’s Sexual Gender Norms ........................ 141
Moderating Relationships ................................... 145
Use of Alcohol ...................................... 145
. Partner’s Sexual Gender Norms ......................... 147
Implications for the Development of Culturally Appropriate HIV/AIDS
Prevention Interventions .......................................... 147
Acculturation ............................................. 148
Religion ................................................. 149
Sexual Gender Norms ...................................... 151
Limitations of the Present Study .................................... 152
Conclusion ..................................................... 155
APPENDICES
APPENDIX A: Figures 1- 5 ...................................... 157

ix

REFERENCES

APPENDIX B:
APPENDIX C:
APPENDIX D:

APPENDIX E:
APPENDIX F:

APPENDIX G:
APPENDIX H:

APPENDIX I:
APPENDIX J:

APPENDIX K:

APPENDIX L:

APPENDIX M:
APPENDIX N:
APPENDIX 0:

APPENDIX P:

APPENDIX Q:

APPENDIX R:
APPENDIX S:
APPENDIX T:

APPENDIX U:

Flyer (English Version) ............................. 163

Flyer (Spanish Version) ............................. 165
Phone Protocol (English Version) ..................... 167
Phone Protocol (Spanish Version) ..................... 171
Training Manual .................................. 175
Consent Form (English Version) ...................... 182
Consent Form (Spanish Version) ..................... 185
Demographics (English Version) ..................... 188
Demographics (Spanish Version) ..................... 191
Acculturation Measures (English Version) .............. 195
Acculturation Measures (Spanish Version) .............. 199
Religion Measures (English Version) .................. 203
Religion Measures (Spanish Version) .................. 208
Sexual Gender Norms Measures (English Version) ....... 213
Sexual Gender Norms Measures (Spanish Version) ....... 217
Gender Norms Incongruency Measure (English Version). . . 221

Gender Norms Incongruency Measure (Spanish Version) . . 224

Sexual Inventory (English Version) ................... 227
Sexual Inventory (Spanish Version) ................... 236
Multiple Partners Insert (English Version) .............. 246
................................................. 251

LIST OF TABLES

Table 1- Demographic Information ........................................
Table 2 - Participant Sexual Risk History ...................................
Table 3 - Partner Sexual Risk History ......................................

Table 4 - Percentage of Participants Obtained by Recruiting Strategy .............

Table 5 - Psychometric Properties of Short Phone Acculturation Scale ............
Table 6 - Acculturation Categories Determined by Phone Acculturation Measure . . .
Table 7 - Psychometric Properties of Anglo Oriented Subscale (AOS) ............
Table 8 - Psychometric Properties of Mexican Oriented Subscale (MOS) ..........
Table 9 - Psychometric Properties of 30-day Acculturation Scale ................
Table 10 - Acculturation Categories .......................................
Table 11 - Psychometric Properties of Participant’s Sexual Gender Norms Scale . . . .
Table 12 - Psychometric Properties of Participant’s Sexual Gender Roles Subscale . .
Table 13 - Psychometric Properties of Reproductive Attitudes Subscale ...........
Table 14 - Psychometric Properties of Double Standard Subscale ................
Table 15 - Psychometric Properties of Women’s Sexual Behavior and Knowledge
Subscale ............................................................
Table 16 - Psychometric Properties of Condom Negotiation with a New Partner
Subscale .............................................................
Table 17 - Psychometric Properties of Condom Negotiation with Boyfriend Subscale

Table 18 - Psychometric Properties of Religious Guidance and Involvement Scale . . .

xi

51

53

55

57

60

.60

63

64

66

67

68

70

70

71

71

73

74

75

Table 19 - Psychometric Properties of 30-day Participation Scale ................ 77

Table 20 - Psychometric Properties of Fate Orientation Scale ................... 78
Table 21 - Psychometric Properties of Personal Responsibility Subscale ........... 80
Table 22 - Psychometric Properties of Destiny Subscale ....................... 80
Table 23 - Psychometric Properties of Gender Role Conflict Subscale ............ 82
Table 24 - Psychometric Properties of Gender Role Limitation Subscale ........... 82
Table 25 - Psychometric Properties of Partner’s Sexual Gender Norms Scale ....... 84

Table 26 - Psychometric Properties of Partner’s Beliefs About Women Subscale . . . . 86
Table 27 - Psychometric Properties of Partner’s Beliefs About the Use of Condoms. . 86

Table 28 - Psychometric Properties of Partner’s Beliefs Regarding Having Children

Subscale ............................................................ 87
Table 29 - Summed Alcohol Scores Before Sex .............................. 89
Table 30 - Alcohol Use Before Sex Across the Four Dates ...................... 90
Table 31 - Frequency of Yearly Condom Use for Vaginal Intercourse ............. 92

Table 32 - Percentage of Condom Use for Vaginal Intercourse Across the Four Dates 93
Table 33 - Percentage of Other Risky Sexual Behaviors ........................ 95
Table 34 - Descriptive Statistics .......................................... 98

Table 35 - Zero-Order Correlations of Variables Used in Analyses and Significant

Demographic Variables ................................................. 99
Table 36 - Analysis of Covariance of Yearly Condom Use ..................... 101
Table 37 - Analysis of Covariance of Recent Condom Use .................... 102
Table 38 - Type of Contraception Across Acculturation Groups ................ 103

xii

Table 39 - Logistic Regression Analysis of Engaging in Anal Sex ............... 104

Table 40 - Mediation Effect of Religiosity on the Yearly Use of Condoms ........ 112
Table 41 - Mediation Effect of Religiosity on the Recent Use of Condoms ........ 113
Table 42 - Mediation Effect of Fate Orientation on Yearly Use of Condoms ....... 114
Table 43 - Mediation Effect of Fate Orientation on Recent Use of Condoms ....... 116
Table 44 - Mediation Effect of Religiosity on Anal Sex ....................... 117
Table 45 - Mediation Effect of Religiosity on Multiple Partners ................ 118

Table 46 - Mediation Effect of Sexual Gender Norms on the Recent Use Of Condom3120

Table 47 - Indicators of Cooperative Suppression for Hypothesis 2p: Recent Condom Use

Table 48 - Mediation Effect of Sexual Gender Norms on the Yearly Use of Condoms 124
Table 49 - Indicators of Cooperative Suppression for Hypothesis 2q: Yearly Use of
Condoms ........................................................... 124
Table 50 - Mediating Effect of Sexual Gender Norms on Anal Sex .............. 125
Table 51 - Mediating Effect Of Sexual Gender Norms on Multiple Sexual Partners . 126
Table 52 - Moderating Effect of Partner’s Sexual Gender Norms on Recent Use of
Condoms ........................................................... 129
Table 53 - Moderating Effect of Partner’s Sexual Gender Norms on the Yearly Use of
Condoms ........................................................... 129

Table 54 - Moderating Effect of Yearly Alcohol Use on Multiple Sexual Partners . . 131

xiii

LIST OF FIGURES

Figure 1- Conceptual Model ............................................ 157
Figure 2 - Reliabilities ................................................. 158
Figure 3 - The Use of Condoms .......................................... 159
Figure 4 - Multiple Partners ............................................. 160
Figure 5 - Anal Sex ................................................... 161

xiv

INTRODUCTION
Women comprise one of the largest HIV risk groups in this country (e.g., CDC,
1995; Amaro, 1995). Latina representation within this group is disproportionately large
considering that they constitute only 10.3% of the US. population of women (U .8.
Bureau of the Census, 1996), yet represent 24% of all women with AIDS (CDC, 1995).

Furthermore, the proportion of AIDS cases due to heterosexual transmission is greater
among Latinas (45%) than White (3 8%) or African-American (35%) women (CDC,
1996). These statistics demonstrate the need to develop HIV /AIDS interventions that
target Latinas (Amaro, 1988b; Amaro, 1995; Romero, Arguelles, & Rivero, 1993;
Romero et al., 1997; Weeks, Schensul, Williams, Singer & Grier, 1995).

Many HIV/AIDS prevention efforts have not been effective among Latinas
because they have failed to consider gender and cultural characteristics that influence
sexual practices within this population (e.g., Amaro, 1991; Amaro, 1995; Gomez &
Marin, 1996). AIDS education programs originally developed for white, gay men have
been applied to women of color with little success (e.g., Amaro, 1991; Amaro, 1995;
Hinojos, 1990; Ickovics & Rodin, 1992; Romero et al., 1993). Unlike the gay
community, AIDS knowledge among Latinas has not led to a corresponding reduction in
sexual practices that place them at risk for contracting HIV (e.g., Flores-Ortiz, 1994;
Ford & Norris, 1993b; Nyarnathi, Bennett, Leake, Lewis, & Flaskerud, 1993; O’Donnell,
San Doval, Vomfett, & O’Donnell, 1994). Hinojos (1990) argues that prevention
efforts with gay men were effective because many gay men were educated, and had

access to health care. In contrast, cultural factors within the Latino community, such as

religion and sexual gender norms that impact sexual behavior, may supersede any
knowledge-based efforts to change sexual risk behaviors (Amaro, 1995; Gomez &
Marin, 1996; Mays & Cochran, 1988). Therefore, in order to effectively reach Latinas,
HIV/AIDS prevention efforts must consider the cultural factors that contribute to sexual
decision making within this population (e.g., Amaro, 1991; Amaro, 1995; Land, 1994;
Marin, 1993; Mays & Cochran, 1988; Romero et al., 1993; Romero et al., 1997; Weeks
et al., 1995). However, few empirical studies have attempted to identify and understand
which Latinol cultural beliefs and practices influence HIV sexual risk behaviors among
Latinas (Amaro, 1988b; Amaro, 1991; de la Vega, 1990; Marin, Tschann, Gomez &
Gregorich, 1998; Mikawa et al., 1992).

An important first step in conducting research on Latinos is the examination of
intragroup differences, which impact cultural attitudes and beliefs (Marin, 1993; Marin
& Marin, 1991). Among these differences, acculturation level is a critical factor to
consider when designing culturally appropriate interventions (Amaro, 1991; Marin,
1993; Marin, Tschann, Gomez, & Kegeles, 1993; Romero et al., 1997). Acculturation is
the process by which attitudes and beliefs of immigrant groups change due to exposure
to a new culture (e.g., Marin & Marin, 1991). The process of acculturation is affected by
many factors (e.g., place of residency, education, number of years in new country,
citizenship, etc.) which result in a range of acculturation levels among Latinas (Cuellar,

Arnold, & Maldonado, 1995; Jimenez, 1987; Pavich, 1986). For example, a Latina born

 

' For the purpose of this paper, Latino(s) refers to Latino men and women. Latinas refers to
women.

and raised in the United States will probably be more acculturated to American culture
than a recently immigrated Latina, who was born and raised in Mexico. This suggests
that the endorsement of Latino cultural beliefs and attitudes will be affected by a
Latina’s level of acculturation (Marin & Flores, 1994; Mikawa et al., 1992; Romero et
al., 1997).

The existing literature on Latinas and HIV/AIDS has uncovered differences in
sexual risk behaviors due to acculturation level (e.g., Marin & Flores, 1994; Romero et
al., 1997; Sabogal, Perez-Stable, Otero-Sandoval & Hiatt, 1995). Although several
Latino cultural beliefs and attitudes have been cited as possible explanations for these
differences, the literature has yet to empirically determine how level of acculturation
leads to different HIV sexual risk behaviors for particular acculturation groups (Amaro,
1991). Considering the discouraging results of prior HIV/AIDS prevention efforts with
Latinas (Amaro, 1991; Amaro, 1995; Hinojos, 1990;1ckovics & Rodin, 1992),
understanding how acculturation level impacts the sexual practices of this population
may be a key component in developing effective and culturally sensitive interventions
(Amaro, 1991; Land, 1994). For example, current HIV/AIDS prevention strategies that
promote the use of a condom may not be effective with less acculturated Latinas due to
adherence to traditional sexual gender norms, which place constraints on their sexual
roles (e.g., Gomez & Marin, 1996; de la Vega, 1990; Worth, 1989). In contrast, this
cultural barrier is less likely to be encountered by highly acculturated Latinas since they
are likely to have more liberal sexual gender norms and have more freedom in their

sexual conduct (Marin & Flores, 1994; Romero et al., 1997). This implies that

differences due to acculturation level may undermine the effectiveness of a universal
strategy of AIDS prevention directed toward Latinas, and indicates that different
intervention strategies may be necessary for different acculturation levels (Amaro,
1988b; Amaro, 1991; Land, 1994; Marin, 1993; Mikawa etal., 1992; Nyamathi et al.,
1993; Romero et al., 1997). Yet, in order for this to occur, a better understanding of how
acculturation level impacts Latinas’ sexual practices is essential in developing effective
HIV/AIDS prevention interventions for this population.

National origin or background is another critical intragroup difference to consider
when designing culturally sensitive HIV/AIDS interventions (Deren, Sheldlin &
Beardsley, 1996; Land, 1994; Marin, 1993; Moore, Harrison, Kay, Deren, & Doll, 1995;
Romero et a1, 1993). Mexicans, Puerto Ricans, Salvadoreans and Peruvians are a few of
the subgroups that exist in the Latino community. Each Latino subgroup has different
cultural, social and economic characteristics that distinguish one group from another.
Furthermore, each subgroup has had different immigration experiences and different
influences on their documentation status (i.e., legal or illegal) in the United States.
Given that these experiences “impact an individual’s perceived personal power,” and a
Latina’s “ability to effect changes in her life” (Romero et a1, 1993, p.5), it is critical to
examine the role of subgroup differences on Latinas’ sexual decision making.

While the literature has stressed the significance of subgroup membership in
examining cultural differences, current HIV/AIDS studies have rarely considered the
influence of different Latino cultures on high risk sexual behaviors among Latinas

(Amaro, 1991; Deren et al., 1997; Romero et al., 1993). The majority of research has

categorized all Latinas into one homogenous group, or have acknowledged the different
subgroups within their sample, but have been unable to compare across subgroups due to
the composition of their sample (i.e., the majority of participants belong to one specific
subgroup and a smaller portion of their sample belong to other Latino subgroups).
Considering the diverse modes of HIV transmission among different Latino subgroups

(Diaz, Buehler, Castro, & Ward, 1993; Selik, Castro, Pappaionaou, & Buehler, 1989), a

better understanding of individual Latino cultures and their effect on HIV sexual risk
behaviors is vital in the creation of culturally appropriate interventions (Amaro, 1988b;
Amaro, 1991; Deren et al., 1996; Deren et al., 1997).

Therefore, the purpose of this study was to begin to identify which cultural
factors impact HIV sexual risk behaviors among women of Mexican descent (i.e., a
Latino subgroup), and how level of acculturation contributes to this relationship. By only
focusing on Mexican and Mexican-American women, one can begin to document the
cultural nuances that make this Latino subgroup distinct, and potentially, place them at
risk for HIV/AIDS. Moreover, given the dearth of research on the sexual practices of
adult Mexican and Mexican-American women (Romero et al., 1993), and the number of
AIDS cases due to heterosexual transmission among this population (Diaz et al., 1993;
Selik et al., 1989), this study focused on this subgroup of women to better understand the
cultural factors that contribute to their sexual risk for HIV.

In this study, two cultural mediators were investigated that might explain how
acculturation level is related to risky sexual behaviors of women of Mexican descent.

The first mediator was religion. Religion is an influential factor in the lives of many

Mexican and Mexican-American women which has the potential to affect their sexual
behavior (e.g., Catholicism prohibits the use of birth control) (de la Vega, 1990; Romero
et al., 1997; Worth, 1990). Yet, the importance of religion may diminish as a woman
acculturates to American culture (Gonzalez & LaVelle, 1985; Marin & Gamba, 1990;
Nyamathi, Flaskerud, Bennett, Leake & Lewis, 1994), indicating that a better
understanding of religion’s influence on the sexual practices of Mexican and Mexican-
American women may assist in developing effective prevention messages for this
population. For example, it may clarify whether or not prevention strategies should be
concerned with Catholicism’s ban on the use of condoms for Mexican and Mexican-
American women.

The second mediator examined was sexual gender norms. The impact of this
cultural factor is complex because the endorsement of certain sexual gender norms may
lead to different risky sexual behaviors (Romero etal., 1997). For example, women with
liberal sexual gender norms may acquire sexual freedom from gender role restrictions,
which may result in her and her partner using condoms, but also suggests that she may
engage in other risky sexual behaviors, such as anal sex and multiple sexual partners that
potentially place her at risk for HIV. In contrast, women with traditional sexual gender
norms may be less likely to have multiple partners and/or engage in anal sex due to
adherence to conservative gender roles. However, it also suggests that she may not be in
a position to negotiate the use of a condom which may result in her and her partner
engaging in unprotected sex. Given that acculturation is related to different sexual risk

behaviors among Latinas (e.g., Marin & Flores, 1994; Romero et al., 1997), sexual

gender norms could be the critical factor that explains how a Latina’s level of
acculturation leads to different HIV sexual risk behaviors.

This study also examined two moderators that might provide some insight into
other contextual factors that lead to risky sexual practices among Latinas. Specifically,
this study examined the moderating influence of alcohol use and a partner’s sexual
gender norms on the relationship between a woman’s sexual gender norms and risky
sexual behaviors. With regard to the use of alcohol, this study speculated that Latinas
who experienced gender norm incongruency (i.e., conflict between cultural and
mainstream gender norms) were more likely to drink before sexual intercourse to
alleviate this conflict. It was also expected that Latinas experiencing gender norm
incongruency were likely to have traditional sexual gender norms, and when under the
influence of alcohol would engage in risky sexual behaviors that were atypical of them.

The second moderator was a partner’s sexual gender norms. This study
hypothesized that a partner’s sexual gender norms would moderate the relationship
between a woman’s sexual gender norms and the use of condoms. Specifically, this
study proposed that this moderating effect would result in unsafe sex (i.e., condoms not
being used) for Latinas with liberal sexual gender norms who had partners with
traditional sexual gender norms. The premise for this moderating relationship is that a
Latina with liberal sexual gender norms may feel constrained in discussing the use of a
condom with her partner, when she believes her partner has traditional sexual gender
norms. This barrier emerges because of fear or concerns that her partner may consider

her forward and/or “loose” (Gomez & Marin, 1996; O’Donnell, San Doval, Vornfett, &

DeJong, 1994; O’Donnell, San Doval, Vornfett, & O’Donnell, 1994; San Doval, Duran,
O’Donnell, & O’Donnell, 1995; Worth & Rodriguez, 1987). Therefore, a partner’s
sexual gender norms were expected to moderate and lead to unsafe sex when a Latina
had liberal sexual gender norms and her partner had traditional sexual gender norms.
While a partner with liberal sexual gender norms may have a moderating influence for
Latinas with traditional sexual gender norms, this interaction is most likely to lead to the
use of condoms. Given that the use of condoms can reduce a woman’s sexual risk for
HIV (e.g., Amaro, 1995; Hinojos, 1990), a greater understanding of which factors serve
as barriers or contribute to the use of condoms is imperative.

In conclusion, this study addressed two research questions: 1) To what extent
does acculturation level lead to different HIV sexual risk behaviors? and 2) How does
acculturation level lead to these different risky sexual practices? With Latinas becoming
sexually infected with HIV at an alarming rate, it becomes paramount to better
understand how acculturation level affects sexual risk behaviors (Gomez & Marin, 1996;
Romero et al., 1997). Such information could better inform HIV/AIDS prevention
efforts, and may help reduce the rate at which Latinas contract HIV.

Literature Review
Immrtance of Considering Subgroup Membership

Although national origin or background is recognized as a critical intragroup
difference among Latinos (e.g., Amaro, 1991; Hinojos, 1990; Jimenez, 1987; Marin,
1993; Marin & Marin, 1991), very little research has specifically examined the influence

of subgroup membership on Latinas’ high risk sexual behaviors (e.g., Amaro, 1991).

While the literature examining this relationship is scarce, research does suggest that
there are differences among Latino subgroups on their use of condoms. For example,
Moore et a1. (1995) found that only 7% of the Mexican women in their sample reported
that they and their sexual partner always used condoms during vaginal intercourse,
compared to 17% of the Puerto Rican women and 21% of the Dominican women. Deren
et a1. (1997) found that among Latina prostitutes, 53% of the Dominican women always
used a condom, compared to 36% of the Mexican women and 10% of the Puerto Rican
women. These findings suggest that women of Mexican descent may be at risk for the
sexual transmission of HIV due to the infrequent use of condoms in their sexual
relationships.

Notwithstanding these studies, research on Latinos and HIV/AIDS has tended to
collect data on Latinos as a homogenous population by using the umbrella terms Latino
or Hispanic. This trend has served to limit the information available on sexual risk
behaviors specific to various Latino subgroups, and thus, has hindered prevention efforts
(Amaro, 1988b; Amaro, 1991; Deren etal., 1997; Land, 1994). An illustration of this
drawback can be found in epidemiological studies that have examined HIV transmission
trends among Latinos (Diaz et al., 1993; Selik et al., 1989). Place of birth and ethnicity
are ascertained when cases are reported to the Centers for Disease Control and
Prevention (CDC), but the umbrella term of Hispanic is used for all US. born Latinos,
and no data is collected on their subgroup membership. Although epidemiological
studies have been able to determine HIV/AIDS trends among foreign born Latinos, they

have not been able to document trends by national background among US. born Latinos.

This drawback does not allow for a clear picture to emerge on HIV transmission modes
among American born Latino subgroups, which curtails the effectiveness of prevention

efforts (Amaro, 1988b).

While epidemiological data on Latinos is limited, it does suggest that HIV

transmission modes do vary across subgroups (Chu, Peterrnan, Doll, Buehler & Curran,
1992; Diaz et al., 1993; Selik et al., 1989). For example, Diaz et al. (1993) found that

Dominican (40.5%) and South American women (40%) primarily contracted HIV
through sexual contact with an IV drug user. Puerto Rican women were more likely to
become infected with the AIDS virus through their own IV drug use (46.4%), followed
closely by having sex with an IV drug user (34.8%). Exposure to HIV varied greatly
among Cuban women: sex with an HIV positive male partner (19.5%), injection drug
use (17.1%), sex with an IV drug user (17.1%) and blood transfusions (14.6%). Similar
transmission modes were identified for Central American women. Mexican women
primarily contracted the AIDS virus through blood transfusions (33.7%) followed by an
undetermined mode of exposure (21.1%) and having sex with an HIV positive male
(19.5%). The variability in these findings further support the need to examine subgroup
differences among Latinos.

In summary, these findings suggest that there is variability between subgroups of
Latinas and their HIV/AIDS risk behaviors. Although these studies indicate that there is
variation between subgroups, they fail to explain why these differences emerge. In order
to better understand how subgroup cultures influence these types of differences, studies

need to be conducted that focus on one specific Latino subgroup at a time. This will

10

allow for a more thorough exploration and understanding of the influence of specific
Latino cultures on sexual decision making. This knowledge is important for HIV/AIDS
prevention efforts to be effective with Latinos (Amaro, 1991; Deren et al., 1997).
Sexual Risk for HIV within the Mexican and Mexican-American Community

Many Latinas are at risk for HIV/AIDS due to unprotected heterosexual
intercourse (Moore et al., 1995). With a significant number of HIV positive Mexican
men (68.6%) having contracted the AIDS virus through sex with other men, it is argued
that Mexican women may be exposed to HIV through the bisexual behavior of their
male sexual partners (Chu et al., 1992; Diaz et al., 1993). This supposition may
accurately pinpoint the manner in which many Mexican women are becoming sexually
infected with HIV, given that epidemiological data states that 21% of Mexican women
with AIDS do not know how they were infected and another 19% were infected by an
HIV positive male whose mode of transmission is undetermined (Diaz et al., 1993).
Moreover, since Mexican and Mexican-American women and their sexual partners
infrequently use condoms, sexual transmission of IHV is likely (Moore et al., 1995).
Therefore, it is imperative to determine the factors that influence the risky sexual
practices of these women. Cultural factors are particularly important given their strong
influence on Latinas’ sexual behaviors (Land, 1994; Pavich, 1986; Worth & Rodriguez,
1987). Uncovering the role of culture in the sexual lives of this population will provide
a greater understanding of the factors that contribute to sexual behaviors that put Latinas
at risk for HIV (e.g., Amaro, 1991). Given that a Latina’s level of acculturation

influences the importance of Latino culture (Jimenez, 1986; Mikawa et al., 1992;

11

Romero et al., 1997), a first step in understanding the role of culture on HIV sexual risk
behaviors is an examination of acculturation.
Acculturation

Acculturation level is an intragroup difference that significantly influences the
cultural beliefs and practices of Latinos (Marin & Marin, 1991; Marin, 1993).
Acculturation is a process by which native cultural beliefs and customs are modified,
and/or new ones are adopted due to a group’s interaction with another culture (e. g.,
Cuellar et al., 1995; Mendoza, 1989). In other words, acculturation is the means by
which cultural change occurs among immigrant and minority groups as they come into
contact with a new group. Several factors have been identified by researchers as critical
markers of the acculturation process among Mexicans and Mexican-Americans (e. g.,
Cuellar et al., 1995; Marin, Sabogal, Marin, Otero-Sabogal, & Perez-Stable, 1987).
These indicators are used to assess the degree to which Mexican and Mexican-
Americans have acculturated to American culture.

One such factor is the use of language. As Mexicans and Mexican-Americans
come into contact with US. mainstream society, they are more likely to speak English
than Spanish in order to communicate. This tends to be one of the first cultural changes
that occurs as a result of acculturation (Cuellar et al., 1995). Given this information,
several researchers have used language alone to measure level of acculturation among
Latinos (e.g., Marin & Marin, 1990; Marin & Posner, 1995). For example, Latinos that
have minimal contact with mainstream society are likely to only speak Spanish, and

therefore, are considered less acculturated. In contrast, Latinos that have extensive

12

interaction with Whites and other ethnic groups are more likely to speak English, and
therefore, are considered highly acculturated.

Another factor that is used as an indicator of acculturation level is ethnic
interaction (e.g., Cuellar et a1, 1995, Marin et al., 1987). As Latinos begin to interact
with Whites and people from other racial and ethnic backgrounds, they are more likely to
be exposed to other cultural beliefs and customs. The interaction with other groups
potentially leads to the modification and/or adoption of new values, attitudes and beliefs
among Latinos (Garza & Gallegos, 1995; Olmedo & Padilla, 1978; Teske & Nelson,
1974; Williams & Berry, 1991). In other words, they are likely to experience
acculturation. Thus, Latinos who have minimal interaction with other racial and ethnic
groups are considered less acculturated, and Latinos with extensive interaction with
other groups are considered highly acculturated (Cuellar et al., 1995; Marin et al., 1987).

Furthermore, ethnic identity and cultural traditions are used to assess a Latino’s
degree of acculturation (Cuellar et al., 1995; Cuellar, Harris, & Jasso, 1980 ). “Ethnic
identity is a virtually meaningless concept” for groups that belong to an “ethnically or
racially homogenous society” (Phinney, 1990, p. 501). However, considering that
Latinos are a subgroup of the larger US. society, their ethnic identity and/or cultural
heritage become more salient characteristics. In fact, researchers have focused on these
factors as indicators of acculturation level due to their saliency (Berry, 1980; Cuellar et
al., 1995). Although these characteristics are significant in the lives of many Latinos,
they are subject to change as their interaction increases with mainstream society (Berry,

Kim, Minde, & Mok, 1987; Clark, Kaufman & Pierce, 1976; DeVos & Romanucci-

13

Ross, 1982). Hence, Latinos that identify themselves solely as “Latinos” are considered
less acculturated, and Latinos that identify as “Americans” are considered highly
acculturated. Further, Latinos that maintain cultural traditions such as cooking and eating
Latino foods are regarded as less acculturated, and Latinos that do not foster Latino
traditions are regarded as highly acculturated.

These four indicators (i.e., language, ethnic interaction, ethnic identity and
cultural traditions) are typically used to classify Latinos into three acculturation groups:
low, moderate and high (e. g., Marin & Marin, 1991). Mexicans and Mexican-
Americans that are considered low in acculturation tend to speak Spanish, primarily
interact with other Latinos, identify ethnically as Mexican, and tend to uphold traditional
Mexican customs (Jimenez, 1987; Pavich, 1986). Moderately acculturated Mexicans and
Mexican-Americans are more inclined to be bicultural. They maintain aspects of both
Mexican and American culture, tend to be bilingual, and are inclined to identify as
Mexican-Americans (Jimenez, 1987; Pavich, 1986). In contrast, highly acculturated
Mexicans and Mexican-Americans have assimilated to mainstream society. They tend
not to follow Mexican customs, primarily speak English, and tend to identify as
Americans (Jimenez, 1987; Pavich, 1986).

Given that the process of acculturation leads to the integration of new cultural
norms and practices, it is not surprising that acculturation level is associated with
changes in Latino cultural attitudes, beliefs and behaviors. For example, acculturation
level has been found to be negatively related to Latino cultural social norms (e.g.,

Canino, 1982; Gonzalez, 1982; Kranau, Green, & Valencia-Weber, 1982) and Latino

l4

cultural values (e.g., Domino & Acosta, 1987; Sabogal, Marin, Otero-Sabogal, Marin,
& Perez-Stable, 1987), suggesting that as Latinos acculturate to American culture, they
are less likely to endorse Latino cultural beliefs and values. Acculturation level has also
been found to be positively related to the use of alcohol (e.g., Caetano, 1987; Gilbert,
1991; Marin & Flores, 1994) and the consumption of cigarettes among Latinas (e.g.,
Marin, Perez-Stable, & Marin, 1989; Marin, Marin, Otero-Sabogal, Sabogal & Perez-
Stable, 1989), indicating that highly acculturated Latinas are more likely to engage in
non-traditional behaviors for women. That is, they are less likely to follow traditional
Latino gender role behavior. This range of beliefs and behaviors due to acculturation
begets the question of how to best design HIV/AIDS prevention interventions for this
community. It implies that a general message of prevention may not be practical with
this population due to differences in language, culture, and behavior (Jimenez, 1987;
Marin, 1993; Worth & Rodriguez, 1987). In fact, the heterogeneity of this group
suggests that a better approach for prevention may be the development of group-specific
interventions for different acculturation levels (Marin, 1993; Mikawa et al., 1992).

The influential role of acculturation level in the lives of Latinos is well

documented in the literature investigating risky sexual behaviors (e. g., Flaskerud, Uman,
Lara, Romero & Taka, 1996; Ford & Norris, 1993a; Marin & Flores, 1994). For

example, research demonstrates that highly acculturated Latinas are more likely to
engage in risky sexual behaviors such as engaging in anal sex and having multiple sexual
partners, compared to less acculturated Latinas (e.g., Marin, Gomez & Hearst, 1993).

Less acculturated Latinas and their partners tend to infrequently use condoms, compared

15

to highly acculturated Latinas and their partners (e. g., Ford & Norris, 1993a). This
suggests that both less acculturated and highly acculturated women are engaging in
sexual behaviors that place them at risk for HIV (Romero etal., 1997). Moreover, it
indicates that different acculturation levels are associated with different risky sexual
practices. To begin to understand how these differences occur, an examination of the
existing research on acculturation level and HIV sexual risk behaviors is detailed below.
HIV Sexual Risk Behaviors

A range of sexual activities can place a person at risk for HIV if one is sexually
involved with an infected partner (N evid, Fichner-Rathus & Rathus, 1995). One such
activity is unprotected vaginal intercourse; the primary mode of sexual transmission of
HIV among women (Amaro, 1995; Bezemer, 1992; Osmond, 1990). Vaginal sex
without the use of a condom is considered a high risk sexual behavior for a woman.
HIV is more concentrated in semen than in vaginal fluids, and semen is likely to remain
in the vagina for a few days after intercourse, increasing a woman’s chances of
becoming infected with HIV (Bezemer, 1992; Nevid et al., 1995). Another manner in
which HIV is sexually transmitted is through unprotected anal intercourse (Bezemer,
1992; Osmond, 1990). Unprotected anal sex is a high risk sexual behavior due to the
possible exchange of blood and semen (Nevid et al., 1995). The recipient of anal
intercourse is most at risk due to the possible tearing of rectal tissue, which may allow
for the AIDS virus to enter the bloodstream. Furthermore, the risk of becoming infected

with HIV increases when a person has unprotected sex with multiple partners, because it

16

raises their chances of coming into contact with an infected person (N evid et al., 1995).

Given that the predominant mode of exposure to HIV among Mexican and Mexican-

American women is sexual contact (Diaz et al., 1993), a better understanding of what

sexual risk behaviors they engage in will assist prevention efforts with this population.

Use of condoms

Unprotected vaginal intercourse has been the primary focus of research on
Latinas and HIV risk behaviors. Studies have clearly established that Latinas and their
sexual partners do not use condoms on a fiequent basis (Catania et al., 1994; Deren et
al., 1996; Flaskerud & Nyamathi, 1989; Flaskerud et al., 1996; Ford & Norris, 1993b;
Ford, Rubinstein & Norris, 1994; Gomez & Marin, 1996; Marin, Gomez et al., 1993;
Marin, Tschann et al., 1993; Moore et al., 1995; Sabogal et al., 1995). Latinas and their
sexual partners are less likely to routinely use condoms, compared to White and African-
American women (e.g., Catania et al., 1994; Norris & Ford, 1991; Sabogal et al., 1995).
For example, Norris and Ford (1991) found that among young adults, Latinas (26.1%)
and their partners were least likely to have used a condom during their most recent
intercourse than were African-American women and their partners (44.3%). Sabogal et
a1. (1995) found that Latinas were least likely to be in a sexual relationship where
condoms were used when compared to White women. Similarly, in Catania et al.’s
(1994) study, three-fourths of the Latinas (76%) and their sexual partners never used
condoms. This was true for only about half of the White (48%) and African-American
(60%) women in their sample. While a handful of studies did find that, compared to

White women and their partners, both Latinas and African-American women were less

17

likely to be in sexual relationships where condoms were used (Catania et al., 1992;
Weinstock, Lindan, Bolan, Kegeles, & Hearst, 1993), the fact remains that Latinas and
their partners do not use condoms on a frequent basis. Given the low incidence of
condom use among Latinas, it is important to explore what might facilitate or contribute
to condom use with this population.

Research indicates that acculturation level is a key contributing factor (Ford &
Norris, 1993a; Marin & Flores, 1994; Marin, Tschann et al., 1993; Sabogal et al., 1995).
For example, Ford and Norris’ (1993a) research with young adults indicated that highly
acculturated Latinas and their partners were more likely to use condoms than less
acculturated Latinas. Marin and Flores (1994) also found that highly acculturated
Latinas were more likely to be in sexual relationships where condoms were used on a
consistent basis, compared to less acculturated Latinas. Similar results were identified
by Marin, Tschann et al. (1993) and Sabogal et a1. (1995). These research findings
suggest that as a Latina’s level of acculturation increases, the likelihood that she and her
partner will use a condom also increases.

In summary, compared to women from other ethnic groups, Latinas, particularly
those that are less acculturated, may be at a higher risk for the sexual transmission of
HIV due to the infrequent use of condoms in their sexual relationships. While it is
evident that acculturation level and the use of condoms are positively related, it is not
clear how acculturation contributes to this relationship. Additional research is needed to

explore this relationship, and reduce the prevalence of AIDS among Latinas.

l8

Anal sex

 

While Latinas, as a whole, are less likely to engage in anal intercourse (Ford &
Norris, 1993b; Erickson et al., 1995), differences do appear among Latinas when level of
acculturation is considered (Flaskerud et al., 1996; Ford & Norris, 1993a). For example,
Ford and Norris (1993a) found that highly acculturated Latinas and their partners were
more likely to engage in anal intercourse than less acculturated Latinas and their
partners. Flaskerud et a1. (1996) found that as level of acculturation increased, so did the
array of sexual behaviors a Latina engaged in, including anal sex. These findings
suggest that as Latinas become acculturated to American culture, they are more likely to
experiment sexually, and engage in other sexual activities such as anal intercourse.
Interestingly, in focus groups conducted by Kline, Kline and Oken (1992), a few Latinas
indicated that they had used anal sex as a form of birth control. Considering the high
risk involved in engaging in unprotected anal intercourse, a better understanding of the

factors that contribute to this behavior is necessary.

Multiple sexual partners

Although Latinas, compared to women from other ethnic groups, are less likely
to have multiple partners (Choi, Catania & Dolcini, 1994; Marin, Gomez et al., 1993;

Marin, Tschann et al., 1993; Nyamathi et al., 1993; O’Donnell, San Doval, Vornfett, &

O’Donnell, 1994), the literature indicates that there are varied sexual practices among
Latinas (Flaskerud et al., 1996; Marin & Flores, 1994; Marin, Gomez et al., 1993;

Marin, Tschann et al., 1993). For example, Marin, Tschann et al. (1993) found that

19

21% of the English-speaking Latinas in their sample (proxy for high acculturation level)
were more likely to have multiple sexual partners, compared to 5% of the Spanish
speaking Latinas (low acculturation level) in their sample. Marin and Flores’ (1994)
research indicated that highly acculturated Latinas (16%) were more likely to have
multiple sexual partners, compared to moderately acculturated Latinas (10%) and less
acculturated Latinas (3%). Concurrent results emerged for Flaskerud et al. (1996) and
Marin, Gomez et al. (1993). These findings further support the notion that as Latinas
become acculturated to mainstream culture, they are more likely to adopt more liberal
sexual behaviors, possibly increasing their risk for HIV.
Summgy of Acculturation

In summary, the existing research on acculturation level and HIV sexual risk
behaviors clearly establishes that Latinas are not a homogenous population. The
literature indicates that different sexual risk behaviors emerge between acculturation
groups. It appears that less acculturated Latinas may be at risk for HIV due to the
infrequent use of condoms by their sexual partners. As level of acculturation increases,
Latinas are potentially at risk for the AIDS virus because they are more likely to engage
in other high risk sexual behaviors such as multiple sexual partners and/or anal sex.
Although more acculturated Latinas are more likely to use condoms than less
acculturated Latinas, these results should be regarded with caution, since the overall use
of condoms by Latinas and their partners is low. These findings further highlight the
need to investigate the factors that contribute to Mexican and Mexican-American

women’s sexual risk for HIV.

20

While it is acknowledged that acculturation level is a predictor of HIV risk
behaviors among Latinas, few researchers have examined how acculturation level
contributes to these differences (Amaro, 1991). Understanding how acculturation level
influences risky sexual behaviors will assist in the identification of pertinent cultural
variables, which are necessary for HIV/AIDS prevention interventions to be culturally
sensitive and successful (e.g., Marin, 1993). With this in mind, this study has targeted
two mediating variables that may explain how acculturation level leads to different HIV
sexual risk behaviors: religion and sexual gender norms. These two cultural variables
were selected because of their potential to directly influence Latinas’ sexual behaviors
(Maldonado, 1990; Worth, 1990). Furthermore, religion and sexual gender norms play a
central role in Latino culture, and are directly related to acculturation level (Gonzalez &
LaVelle, 1985; Marin & Gamba, 1990; Marin, Tschann, et al., 1993). More specifically,
less acculturated Latinas are more likely to be highly religious, and have more traditional
sexual gender norms than highly acculturated Latinas. With AIDS being the fourth
leading cause of death among Latinos (Singh, Kochanek, & MacDorman, 1996), it is
imperative to better understand how acculturation level influences the risky sexual
practices of this population.

mm

Religion is an integral part of Mexican culture (Cadena, 1995; Isasi-Diaz, 1995;
Land, 1994; McCready, 1985). Mexicans and Mexican-Americans are highly religious
(Cadena, 1995; Gonzalez & LaVelle, 1985; Marin & Gamba, 1990; Princeton Religious

Center, 1988), and receive a significant amount of guidance in their life from their

21

religion (de la Garza, DeSipio, Garcia, Garcia & Falcon, 1992; Lifshitz, 1990). Many
Mexicans and Mexican-Americans are also Catholic (Bach-y-Rita, 1982; Cadena, 1995;
McCready, 1985; Mosqueda, 1986), and Catholicism supports conservative religious
beliefs, particularly in regard to sexual behaviors (Worth, 1990). For example,
Catholicism has prohibitions on the use of birth control, engaging in anal sex, and
extramarital sex. Further, although a significant number of Mexicans and Mexican-
Americans are Catholic, there has been a recent increase in the United States of Latinos
converting to fundamentalist Protestant churches (Amaro, 1991; Cadena, 1995). Similar
to the Catholic Church, many of these religions follow conservative religious doctrine on
sexual behaviors (Petersen & Donnenwerth, 1997). While it may seem like these
religious tenets serve as protective measures against the sexual transmission of the AIDS
virus, the ban on condom use by some religions (e.g., Catholicism) can undermine these
safeguards, and place religious Latinas at sexual risk for HIV (Lifshitz, 1990; Worth,
1990).2 That is, highly religious Latinas may become sexually infected with the AIDS
virus due to condoms not being used in their sexual relationships.

Additionally, it is important to note that religious constraints on sexual practices
may not be encountered by all Latinas. This differential experience may be due to the
acculturation process. Studies indicate that highly acculturated Latinas tend to be less

religious (Gonzalez & LaVelle, 1985; Marin & Gamba, 1990), and less religious women

tend not to adhere to their church’s edicts on sexual conduct (Studer & Thornton, 1987;

 

2 Although religious Latinas may wait to have sex until marriage, if their partner is HIV
positive and condoms are not used during intercourse, they are at risk of becoming
infected with HIV.

22

Thornton & Camburn, 1989). This implies that highly acculturated Latinas may
experience more sexual freedom because they are not limited by conservative religious
doctrine. However, this freedom from religious constraints may have adverse
consequences because it may increase the likelihood that highly acculturated Latinas will
engage in HIV sexual risk behaviors such as anal sex and/or multiple sexual partners.
Determining the extent to which religion influences different HIV sexual risk behaviors
may provide for a better picture as to the factors that contribute to the heterosexual
transmission of HIV among Latinas. Yet, a limited number of studies on Latinos have
advanced our knowledge of religion’s influence on risky sexual behaviors (Amaro,
1988b; Mikawa et al., 1992; Organista, Organista, Garcia de Alba, Moran & Carrillo,
1996; Organista, Organista, Garcia de Alba, Moran & Carrillo, 1997; Romero et al.,
1997; Worth, 1990). Given this lack of research, this study attempted to explore how
two elements of religion (i.e., degree of religiosity and fate orientation) contribute to
HIV sexual risk behaviors.
Degree of Religiosig

An important element of religion is degree of religiosity. Religiosity refers to the
guidance one receives from one’s religion (de la Garza, et al., 1992; Francis, 1997), and
the extent to which one participates in religious activities (Cadena, 1995; Kenny,
Vaughn & Cromwell, 1977). Research suggests that people who are actively involved in
their church and regularly attend religious services are more likely to be familiar with
and accept religious dogma due to frequent exposure to “religious messages” about

appropriate beliefs and behaviors (Thornton & Camburn, 1989). In fact, studies have

23

found that religiosity is closely related to an array of conservative attitudes and
behaviors. For example, religiosity has been found, among other things, to be associated
with attitudes about substance use (Francis, 1997), euthanasia (Gilman, 1997),
sociopolitical values (Dillion, 1996), abortion (Emerson, 1996), and behaviors such as
the use of alcohol (Amey, Albrecht & Miller, 1996; Bechtel & Swisher, 1992; Hanson,
1974)

Moreover, religiosity has been found to be related to sexual practices (Studer &
Thornton, 1987; Thorton & Camburn, 1989; Troiden & Jendrek, 1987; Wyatt et al.,
1997). For example, Thornton and Carnburn (1989) found that young White women who
were less active in their church were more likely to be sexually experienced than women
that were active church members. Similarly, Troiden and Jendrek (1987) found that less
religiously devout White women were more likely to have engaged in an array of sexual
behaviors, compared to those that were highly devout. These findings suggest that as a
woman’s level of religiosity decreases, she is more likely be sexually active which may
increase the likelihood that she will engage in risky sexual practices.

Research has also identified a relationship between religiosity and contraception
(Amaro, 1988a; Studer & Thornton, 1987; Wyatt et al. 1997). For example, Studer and
Thornton (1987) found that young White women, who regularly attended religious
services, were less likely to use effective forms of contraception than women who rarely
attended services. Wyatt et al. (1997) found that highly religious African-American
women were less likely “to believe that condoms were effective or acceptable in

preventing pregnancy or STDs” compared to less religious women. Amaro (1988a)

24

found that Mexican and Mexican-American women who frequently participated in
religious activities were more likely to have negative attitudes about contraception than
less religious women. The findings from these studies suggest that religious women may
be less inclined to negotiate the use of a condom with their partners due to religious
prohibitions about contraception.

To date, only a few studies have examined the relationship between religion and
the use of condoms by Latinas and their partners (Amaro, 1988b; Mikawa et al., 1992;
Organista, Organista, Garcia de Alba, Moran & Carrillo, 1996; Organista, Organista,
Garcia de Alba, Moran & Carrillo, 1997; Romero et al., 1997). Surprisingly, these
studies found that religiosity was not related to the use of condoms in a Latina’s sexual
relationship. For example, Romero et al.’s (1997) study with single and married Mexican
and Mexican-American women did not find a significant relationship between religiosity
and the use of condoms. Two other studies conducted by Organista et al. (1996; 1997)
with Mexican migrant workers found that neither the importance of religion nor being
Catholic predicted the use of condoms. Similar results with recently immigrated Latinos
emerged for Mikawa et a1. (1992). A possible explanation for these findings is that the
majority of these studies measured religiosity by asking participants only one question
about religiosity such as "How religious are you?", "How frequently did you attend
religious services?" or "How important is religion in your life?" Given that religiosity
entails much more than simply attending religious services or identifying oneself as
religious, additional research assessing different aspects of religious participation and

religious guidance is needed to clarify the role of religiosity on the risky sexual practices

25

of Mexican and Mexican-American women.

Relationship Between Acculturation Level and Religion

Although religion is a significant factor in the lives of many Latinos, the
importance of religion has been found to diminish as level of acculturation increases

among Latinos (Gonzalez & LaVelle, 1985; Marin & Gamba, 1990). For example,

Gonzalez and LaVelle (1985) used place of birth as a proxy for acculturation level, and
found that US. born Latinos were less likely to feel that religion was an important part
of their life compared to foreign born Latinos. Similarly, Marin and Gamba (1990)
found that among Latinos, acculturated Catholics were less likely to believe that religion
was an important factor in their lives, compared to Catholics that were less acculturated.
In addition, Gonzalez and LaVelle (1985) found that Mexican-American Catholics
(48%) were less likely to observe religious practices than Mexican born Catholics (76%)
(Gonzalez & LaVelle, 1985). The findings from these studies are indicative of the
cultural changes that occur due to the acculturation process. In fact, both of these studies
suggest that as Latinas become more acculturated to American culture, they are more
likely to reject Latino cultural practices such as religiosity.

In summary, the literature indicates that religiosity is associated with sexual
attitudes and behaviors that potentially place Latinas at sexual risk for the AIDS virus.
First, research suggests that as a woman’s level of religiosity decreases, she is more
likely to engage in high risk sexual behaviors (e. g., anal sex) that can lead to the sexual
transmission of HIV. Second, studies indicate that as a woman’s level of religiosity

increases, she is more likely to have views that oppose the use of contraception,

26

particularly the use of condoms which is a primary of mode prevention against the
sexual transmission of HIV. Lastly, research indicates that the relevancy of religion in a
Latina’s life will diminish as a woman’s level of acculturation increases, suggesting that
the influence of religiosity might vary due to a Latina’s level of acculturation. While
research with Latinos indicates that a unidirnensional measure of religiosity is not related
to the use of condoms, additional research with a multidimensional measure of
religiosity may explain the actual influence religiosity may have on the use of condoms
with this population.
Fate Orientation

Another aspect of religion is fate orientation (de la Vega, 1990; Worth, 1990).
Fate orientation is a deep philosophical approach and belief system within the Latino
community (Bach-y-Rita, 1982; Worth, 1990). As Bach-y-Rita (1982) describes it, fate
orientation is a belief that “God put us on earth, governs our lives, and ultimately takes
us from the world . . . ” (p.35). In other words, God is omnipotent, and controls one’s
destiny. This orientation may play an instrumental role in explaining why Latinas are at
sexual risk for HIV. Worth (1990) argues that a strong fate orientation can promote a
sense of powerlessness that one cannot control what happens in one’s life, and may
decrease the likelihood that condoms are used by Latinas and their sexual partners,
increasing their risk of becoming sexually infected with HIV.3 This suggests that fate

orientation is important on two levels. First, it indicates that fate orientation promotes a

 

3 The literature proposes that only the use of condoms is related to fate orientation.

27

general feeling that all aspects of one’s life are controlled by God. Second, it fosters the
sentiment that one cannot prevent the transmission of HIV because one may be destined
by God to have AIDS.

While very little research has examined fate orientation in relation to the use of
condoms (Mikawa et al., 1992), other research on preventive behaviors has examined a
similar construct called a locus of control. Locus of control refers to an expectation that
the results of one’s actions are under one’s own control (i.e., an internal locus of control)
or beyond one’s control (i.e., an external locus of control) (Travis & Wade, 1995). For
example, research on personal health and locus of control indicates that people with an
external locus of control are less likely to engage in preventive health behaviors than
people with an internal locus of control (e.g., Wallston & Wallston, 1984). This seems to
suggest that individuals who believe that God, or others, controls their destiny (i.e., an
external locus of control) may not take the precautionary steps necessary to prevent their
possible infection of HIV (i.e., using condoms).

Relationship between Acculturation and Fate Orientation

Research with Latinos indicates that there is a negative relationship between
acculturation level and fate orientation (Marin, Tschann et al., 1993, Mikawa et al.,
1992). For example, Mikawa et al. (1992) found that less acculturated Latinos felt
powerless over the transmission of the AIDS virus, compared to highly acculturated
Latinos. Similarly, Marin, Tschann et al.’s (1993) results indicated that Spanish
speaking (i.e., a proxy for low acculturation) Latinos were less likely to believe they

could prevent the transmission of HIV, compared to English-speaking Latinos. The

28

results from these studies suggest that less acculturated Latinas are more likely to believe

that if God intends it, they will become infected with HIV. These findings are not
surprising given that. less acculturated Latinas are more likely to maintain Latino cultural
beliefs compared to highly acculturated Latinas.
Summg of Religion

In summary, degree of religiosity and fate orientation may contribute to Latinas’
diverse sexual behaviors, and may explain how acculturation influences risky sexual
activity. For example, given that less acculturated Latinas are likely to be religious and
fate oriented, religion may contribute to the infrequent use of condoms in their sexual
relationships. This may occur for several reasons. First, religious prohibitions against the
use of birth control may discourage a less acculturated Latina and her partner from using
condoms in their sexual relationship. Second, beliefs that God controls her destiny (i.e.,
high fate orientation) may cause a Latina to feel powerless over the transmission of HIV,
and may deter her and her sexual partner from using condoms. In addition, given that
degree of religiosity is likely to decrease among highly acculturated Latinas, it suggests
that their sexual behavior may be less likely to be restricted by religious edicts and
beliefs. This may explain why highly acculturated Latinas are more likely to engage in
other HIV sexual risk behaviors such as anal sex and multiple sexual partners. Overall,
these findings suggest that religion may be a factor that helps explain how acculturation

level leads to different HIV sexual risk behaviors among Latinas.

29

Sexual Gender Norms

Gender roles are an important component of a Latino’s identity (e. g., Gomez &
Marin, 1996; Pavich, 1986). There are two traditional gender roles dominant in Latino
culture: machismo and marianismo. Machismo refers to the traditional gender role
Latino men are expected to follow (e.g., de la Vega, 1990; Espin, 1995; Mikawa et al.,
1992). Machismo consists of a man maintaining the role of “provider” and “protector”
of his family (Mikawa et al., 1992). In addition, Latino men are supposed to be
dominant, virile, and womanizers (de la Vega, 1990; Espin, 1995; Mikawa et al., 1992).
In contrast, marianismo refers to the traditional gender role Latinas are expected to
follow (de la Vega, 1990; Singer et al., 1990). This role definition includes
characteristics such as modesty, innocence, virginity, submissiveness, and motherhood
(e.g., de la Vega, 1990; Espin, 1995; Gonzalez, 1982; Worth & Rodriguez, 1987). It
also includes meeting the needs of one’s husband and children before one’s own (e. g.,
Nevid et al., 1995).

Both marianismo and machismo hold specific assumptions about appropriate
sexual behavior for men and women (e. g., de la Vega, 1990; Lifshitz, 1990; Mikawa et
al., 1992; Worth, 1990; Worth & Rodriguez, 1987). Latinas are supposed to be virgins
until marriage, naive about sex, submissive to their partner’s sexual desires, and mothers
in the context of marriage. In comparison, Latino men are supposed to be sexually
promiscuous, knowledgeable about sex, sexually aggressive and procreating.
Unfortunately, these sexual gender norms can potentially lead to unsafe sex among

Latinas (e.g., Romero et al., 1997; Worth, 1990). To better understand how this may

30

occur, an examination of the existing literature on sexual gender norms and risky sexual
behaviors is detailed below.
Mm

Although researchers have yet to examine the influence of sexual gender norms
on sexual practices among Latinas, there are speculations regarding how sexual gender
norms place Latinas at sexual risk for HIV. With regard to Latinas with traditional
sexual gender norms, the literature proposes that gender role constraints are placed on
Latinas’ sexual behaviors (Flaskerud et al., 1996; F lores-Ortiz, 1994; Gomez & Marin,
1996; Marin, 1990; Mays & Cochran, 1988; Moore et al., 1995; Worth & Rodriguez,
1987). For example, traditional Latinas may feel it is inappropriate sexual conduct for a
woman to have multiple sexual partners, to engage in anal sex, and to ask her male
partner to use a condom because she is supposed to be inexperienced and naive about
sex. Second, in traditional Latino culture it is the male’s responsibility to initiate sexual
decision making, not a woman’s (Gomez & Marin, 1996; Worth & Rodriguez, 1987).
Thus, within this traditional perspective of sexuality, sexually active Latinas who
attempt to negotiate the use of a condom or have more than one sexual partner run the
risk of being labeled promiscuous, dominant, or aggressive by their sexual partner
(F lores-Ortiz, 1994; Mays & Cochran, 1988; Weeks et a1, 1995; Worth & Rodriguez,
1987). Clearly, a Latina’s beliefs about appropriate sexual gender norms for women and
men will influence whether or not condoms are used in her sexual relationship.

Another component of sexual gender norms that may lead to unsafe sex is a

Latina’s belief not only about the appropriateness of requesting the use of a condom, but

31

her capacity to ask her partner to use one (i.e., condom self-efficacy). Specifically,
condom self-efficacy refers to an individual’s perceived ability to ask a sexual partner to
use a condom (Gomez & Marin, 1996; Marin, Tschann, Gomez & Gregorich, 1998;
Weinstock et al., 1993). This includes being able to ask that a condom be used in various
situations (e.g., under the influence of alcohol, when in love with a partner) and with
different partners (i.e., a steady partner or new partner). Studies demonstrate that Latinas,
who do not feel capable of asking their sexual partner to use a condom, are less likely to
be in sexual relationships where condoms are used (Gomez & Marin, 1996; Marin,
Tschann, Gomez & Gregorich, 1998; Weinstock et al., 1993). For example, Gomez and
Marin (1996) found that Latinas, who perceived themselves as ineffectual in requesting
that a condom be used, were less likely to practice safer sex. Concurrent results emerged
for Weinstock et al. (1993) and Marin et al (1998). These research findings indicate that
Latinas, who experience less condom self-efficacy, may be at risk for the heterosexual
transmission of the AIDS virus due to the infrequent use of condoms. Thus, when
examining Latinas’ sexual gender norms, it is critical not only to look at what Latinas
perceive as appropriate for men and women, but also whether they feel able to initiate
condom use.

It is important to note, however, that sexual gender norm restrictions may not be
experienced by all Latinas (Espin, 1995; Maldonado, 1990). The literature proposes that
as Latinas become more acculturated to mainstream society, they are more likely to
adopt liberal sexual gender norms (e.g., Gomez & Marin, 1996; Marin & Flores, 1994;

Romero et al., 1997). This, in turn, leads to more sexual freedom and experience, which

32

is likely to lead to condoms being used in a Latina’s sexual relationship (Marin & Flores,
1994; Nyamathi et al., 1993; Sabogal et al., 1995). However, the sexual freedom
obtained from following non-traditional sexual gender norms may place these Latinas at
possible risk for HIV due to their engaging in additional high risk sexual behaviors such
as anal sex and multiple sex partners (Ford & Norris, 1993a; Marin & Flores, 1994;
Marin, Gomez et al., 1993; Marin, Tschann et al., 1993; Nyamathi et al., 1993; Sabogal
et al., 1995).

While there is a paucity of empirical data available on how sexual gender norms
affect risky sexual practices among Latinas, studies do indicate that there is a
relationship between gender role attitudes and sexual behaviors (J adack, Shibley Hyde,
& Keller, 1995; Radlove, 1983; Smith, Resick, & Kilpatrick, 1980; Whitley, 1988). For
example, Smith et a1. (1980) found that college women with liberal sex role attitudes
were more likely to be sexually experienced than women with traditional attitudes.
Jadack et al. (1995) also found that college women who identified with liberal gender
roles were more likely to engage in sex than women with traditional gender roles.
Similar results emerged for Whitley (1988). In addition, Troiden and Jendrek (1987)
found that women with more liberal sexual views were more likely to have engaged in
different sexual activities. Furthermore, Radlove (1983) found that women who
endorsed traditional gender roles were less likely to initiate sexual activities with their
sexual partner. The findings from these studies provide some empirical support for the
conjectures made by researchers about Latinas’ sexual gender norms and risky sexual

behaviors. Latinas who identify with traditional gender roles may feel confined by their

33

sexual gender role, which may result in condoms not being used in their sexual
relationships. Latinas with liberal sexual views and gender role beliefs are more likely to
be sexually experienced, and may not experience the same sexual limitations as
traditional Latinas. This suggests that they may be more inclined to sexually experiment,
which may increase the likelihood that will engage in high risk sexual behaviors such as
anal sex and/or multiple sexual partners.
Relationship between Acculturation Level and Sexual Gender Norms

While traditional sexual gender norms are salient characteristics of Latino culture
(Gomez & Marin, 1996), not all Latinas endorse these beliefs. In fact, level of
acculturation may contribute to the range of sexual gender norms among Latinas (Marin
& Flores, 1994; Romero et al., 1997). For example, Tharpe et al. (1968) found that less
acculturated Mexican-American wives were more likely to follow traditional marital
roles than highly acculturated Mexican-American wives. Kranau et al. (1982) found that
less acculturated Mexican-American women were more likely to have conservative
attitudes about women, and were more likely to participate in traditional gender roles in
the home than highly acculturated Mexican-American women. Further, Canino’s (1982)
work with Puerto Rican women indicates that island born Puerto Ricans (a proxy for low
acculturation) were more likely to have conservative sex roles than Puerto Ricans’ born
in the United States. Torres-Matrullo (1980) also found similar results. These findings
indicate that less acculturated Latinas are apt to have traditional attitudes about women,
and are likely to engage in traditional gender role behaviors. This suggests that as

Mexican and Mexican American women become acculturated to American culture, they

34

are less likely to have traditional gender roles, which potentially translate to liberal
sexual gender norms.
Summm of Sexual Gender Norms

In summary, the literature suggests that a Latina’s sexual gender norms may
place her at sexual risk for HIV in several ways. For less acculturated Latinas that are
likely to adhere to traditional sexual gender norms, the risk for HIV may come from the
difficulty of negotiating the use of a condom with their sexual partner. For more
acculturated Latinas with liberal sexual gender norms, the risk for HIV may emerge from
engaging in additional high risk sexual behaviors such as anal sex and multiple sex
partners. Further research on sexual gender norms is necessary in providing additional
insight into how acculturation level influences different HIV risk behaviors. This may be
a critical piece of information that may help reduce the heterosexual transmission of the
AIDS virus among Latinas. For example, if less acculturated Latinas are following
traditional sexual gender norms, prevention messages for this group may be better
directed toward their male sexual partners, who are likely to be responsible for sexual
decision making. Given that the literature on sexual gender norms and HIV risk has
primarily been speculative, empirical examination of this relationship is essential in
discerning the sexual risk factors for this population (Amaro, 1991).

Moderating Variables

The current literature on Latinas and HIV/AIDS has just begun to identify the

factors that impact Latinas’ risky sexual practices. While the literature suggests there is

a link between a Latina’s sexual gender norms and HIV sexual risk behaviors (e.g.,

35

Gomez & Marin, 1996; Worth & Rodriguez, 1987), there are two critical factors that
may impact this relationship: a partner’s sexual gender norms and the use of alcohol.
First, the literature proposes that Latinas with liberal sexual gender norms are less likely
to be in sexual relationships where condoms are used when they have partners with
traditional sexual gender norms (Gomez & Marin, 1996). In fact, this interaction may
explain why the overall use of condoms is low among Latinas, regardless of their
acculturation level. Second, the literature speculates that Latinas experiencing gender
norms incongruency, and who typically observe traditional sexual gender norms, may
not do so when under the influence of alcohol. This, in turn, may result in their engaging
in risky sexual behaviors such as anal sex or multiple sexual partners, behaviors that they
might not have engaged in otherwise (Flores-Ortiz, 1994). Given that a significant
number of Latinas with AIDS were infected through sexual contact, and that little is
known about how these factors influence HIV sexual risk behaviors, further
investigation of these potential interactions is critical in understanding what contributes
to the sexual transmission of HIV among Latinas.
Partner’s Sexual Gender Norms

The influence of a Latina’s partner on the use of condoms in their relationships is
a new area of research in the HIV/AIDS literature. To date, few studies have examined
the potential role this factor may have on the use of condoms by Latinas and their

partners (Gomez & Marin, 1996; Moore et al., 1995).4 For example, Gomez and Marin

 

4 The literature on Latinas and HIV/AIDS does not suggest that a partner’s sexual
gender norms will moderate the relationship between a woman’s sexual gender norms
and anal sex or between a woman’s sexual gender norms and multiple sexual partners.

36

(1996) found that the use of condoms was infrequent among Latinas and their partners
when Latinas believed their partner would react negatively if they were to ask their
partner to use a condom. Similarly, Moore et al.’s (1995) results indicated that when a
Latina believed her partner would respond negatively, she was less likely to request that
her partner use a condom. A Latina’s belief that her partner would react negatively
might emerge from her perception that her partner adheres to traditional sexual gender
norms and may not think it appropriate for a woman to be asking a man to use a condom.
Some focus group data supports this supposition. For example, focus groups conducted
by O’Donnell, San Doval, Vomfett and DeJong (1994) indicated that many Latinas were
afraid that their partner would think they were “unclean” or “bad” women if they
requested the use of a condom. These findings are particularly interesting, given that the
majority of these participants were bilingual or English only speakers. This suggests that
they were probably more acculturated Latinas and therefore, likely to have liberal sexual
gender norms; yet these findings indicate that their willingness to pursue the use of a
condom may be hampered due to concerns about what their sexual partner thinks.
Additional support for these findings emerges from focus groups conducted by
Flores-Ortiz (1994). She found that Chicana college students were interested in asking
their partner to use condoms, but worried about asking their partner because it might “be
misunderstood as indicating they had ‘a past’ or distrusted the male” (Flores-Ortiz, 1994,
p.1166). This suggests that some Latinas may have the desire to introduce condoms into
their sexual relationships, but may not do so if they believe their partner has traditional

beliefs about what is sexually appropriate for a woman (F lores-Ortiz, 1994; Gomez &

37

Marin, 1996; Mays & Cochran, 1988; O’Donnell, San Doval, Vomfett & DeJong, 1994;
Worth, 1990; Worth & Rodriguez, 1987).

Forrest, Austin, Vales, Fuentes and Wilson (1993) provide further support for
this premise with focus groups conducted with primarily foreign-bom Latino men.
When focus group participants discussed their perception of women, many men
expressed traditional views of women and made negative comments about women that
tried to negotiate the use of a condom. Many felt that it was indicative of a woman’s
sexual promiscuity and the likelihood that she had a sexual disease. Moreover, many of
the men in this sample infrequently used condoms. Interestingly, one man indicated that
he would consent to use a condom prior to intercourse, but once engaged in sexual
intercourse would decline from actually putting on a condom. This suggests that a
woman’s desire to have her partner use a condom may be dismissed or circumvented
when her partner has traditional sexual gender norms.

In summary, these findings indicate that while a woman with liberal sexual
gender norms might be expected to be in a sexual relationship where condoms are used,
this may not be the case if her partner has traditional sexual gender norms. This
moderating effect may occur because Latinas feel uncomfortable negotiating the use of a
condom with a partner that endorses traditional sexual gender roles. Alternatively, she
may feel comfortable asking her partner to use a condom, but her partner may disregard
her request to use a condom which places her at risk for HIV. Furthermore, although the
literature does not address the possible scenario of a woman having traditional sexual

gender norms and her partner having liberal sexual gender norms, one might argue that

38

his beliefs may moderate the relationship between her sexual gender norms and the use
of condoms. However, in this case it would result in condoms being used in the sexual
relationship. Considering that the primary method of prevention for HIV among sexually
active individuals is the use of a male condom, and that for women it requires the
cooperation of their male partner (Amaro, 1995), a greater understanding of what factors
prevent or promote their use is vital in reducing the prevalence of AIDS in the Latino
community.
Use of Alcohol

The use of alcohol before sexual intercourse may be another factor that
moderates the relationship between a Latina’s sexual gender norms and risky sexual
behaviors. This moderating relationship is based on the premise that Latinas trying to
maintain aspects of both Latino and American culture, may experience conflict regarding
sexual gender norms (i.e., gender norm incongruency) (de Anda, 1984; Pavich, 1986),
and may drink before sex to address this normative struggle (F lores-Ortiz, 1994).
Further, given that cultural sexual gender norms are difficult to modify (Gomez &
Marin, 1996), it is likely that Latinas experiencing gender norm incongruency actually
follow traditional sexual gender norms, but when under the influence of alcohol may
engage in unconventional risky sexual behaviors (Marin & Flores, 1994; Flores-Ortiz,
1994). For example, Latinas that typically would not engage in anal sex because of
adherence to traditional sexual gender norms may do so when alcohol is used before
sexual intercourse. Further investigation of the role of alcohol as a moderator is essential

because it may be a critical point of intervention.

39

Gender Norm Incongrpency. Focus group discussions led by F lores-Ortiz (1994)
provide some clarity regarding the potential moderating effect of alcohol use. Chicanas
in her focus groups commented that cultural gender norms created “an impossible
context for women” that were trying to live in both worlds (i.e., in Latino and
mainstream society) (p.1160). Many stated that they experienced feelings of conflict as
to which cultural gender norms to follow, particularly norms governing “appropriate”
sexual conduct (i.e., gender norm incongruency). In fact, some Chicanas shared that they
used alcohol before sex to alleviate their feelings of gender norm incongruency.

Further, many of these same women acknowledged that when under the influence
of alcohol, they were more likely to participate in sexual behaviors, they would not have
engaged in otherwise. For example, some participants stated they probably would have
remained virgins (i.e., a traditional sexual gender norm), but the use of alcohol made
them uninhibited, and provided them with the freedom to engage in premarital sex. This
suggests that when alcohol is used by Latinas experiencing gender norm incongruency,
although they may customarily follow traditional sexual gender norms, the use of alcohol
may result in their engaging in atypical risky sexual behaviors. That is, they may be more
likely to participate in anal sex and/or multiple sexual, which can place them at sexual
risk for HIV. In summary, different risky sexual behaviors may emerge when alcohol is
used prior to sexual intercourse.

While research indicates that the use of alcohol prior to sex contributes to risky
sexual behaviors (e.g., Bagnal, Plant & Warwick, 1990; Hingson, Strunin, Berlin, &

Heeren, 1990; Kraft, Rise & Traen, 1990; Leigh, 1990; Stall, Heurtin-Roberts,

4O

McKusick, Hoff, & Lang, 1990), little is known about the moderating effect of alcohol
use between a Latina’s sexual gender norms and HIV sexual risk behaviors. Considering
the use of illicit drugs is low among Mexican and Mexican-American women (Amaro,
Whitaker, Coffrnan, & Heeren, 1990; De La Rosa, Khalsa & Rouse, 1990; Rebach,
1992), and the literature on the use of alcohol and risky sexual behaviors has been
criticized for confounding the use of alcohol with drugs (Bolton, Vincke, Mak &
Dennehy, 1992), this study focused solely on the use of alcohol.
Research Questions and Hypotheses
Acculturation and HIV Sexual Risk Behaviors
In summary, the research on Latinas and HIV/AIDS provides evidence that
distinct sexual risk behaviors exist for different levels of acculturation. For example,
research reveals that as a Latina’s level of acculturation decreases, so does the likelihood
that she will be in a sexual relationship where condoms are used (e.g., Marin & Flores,
1994). However, the literature also suggests that while highly acculturated Latinas and
their sexual partners'are more likely to use condoms, the general use of condoms is low
among all Latinas (e.g., Catania et al., 1994). Furthermore, the literature demonstrates
that as a Latina’s level of acculturation increases, so does the likelihood that she will
engage in other HIV sexual risk behaviors such as multiple sexual partners and/or anal
sex (e.g., Sabogal et al., 1995), placing them at risk for contracting HIV. Given these
findings, the proposed study will address the following research question and

hypotheses:

41

Research Question #1

1. To what extent does acculturation level lead to different HIV sexual risk behaviors?
Hypotheses.
1a. As a woman’s level of acculturation decreases, she is less likely to use
condoms during vaginal intercourse.
1b. As a woman’s level of acculturation increases, she is more likely to
engage in anal intercourse.
1c. As a woman’s level of acculturation increases, she is more likely to have
multiple sexual partners.
How Acculturation Level Impacts Sexual Risk Behaviors
In order to better understand how acculturation level contributes to these
different HIV sexual risk behaviors among Mexican and Mexican-American women, a
general theoretical model of predictors was developed for the proposed study. This
model predicts that religion and a woman’ 3 sexual gender norms will mediate the
relationship between acculturation level and HIV sexual risk behaviors (see Appendix A
- Figure 1). In addition, this model proposes that women who experience gender norm
incongruency will be more likely to use alcohol before sex. Moreover, this model
postulates that the sexual gender norms of a Latina’s partner and the use of alcohol prior
to intercourse will moderate the relationship between a Latina’s sexual gender norms
and HIV sexual risk behaviors.
The premise of the proposed study was that a woman’s level of acculturation

would lead to different beliefs and experiences (i.e., religion, her sexual gender norms,

42

gender norm incongruency, her partner’s sexual gender norms and/or the use of alcohol)
which, in turn, will influence different HIV sexual risk behaviors. For example, less
acculturated Mexican and Mexican-American women are more likely to be highly
religious and have traditional sexual gender norms which are potential obstacles in the
use of condoms for this group of women. Furthermore, the use of alcohol prior to
intercourse may be a factor that contributes to unsafe sex practices with Latinas
experiencing gender norm incongruency. Among more acculturated women, being less
religious and following non-traditional sexual gender norms may increase the likelihood
that this group of women will engage in other sexual risk behaviors such as multiple
partners and/or anal sex. While more acculturated Latinas are more inclined to use a
condom (i.e., due to liberal sexual gender norms), having a sexual partner with
traditional sexual gender norms may decrease the likelihood that these women will be
able to persuade their partner to use a condom. Given that the influence of Mexican
culture is contingent upon a woman’s level of acculturation, a greater understanding of
how acculturation level contributes to sexual risk behaviors is necessary to reduce the
high prevalence of HIV among this population. Therefore, the second research question
of the proposed study is:

Research Questions #2

2. How does acculturation level lead to different HIV sexual risk behaviors?

Hypotheses

2a. As a woman’s level of acculturation increases, she is less likely to be

religious.

43

2b.

2c.

2d.

2e.

2f.

2g.

2h.

2i.

2j.

2k.

As a woman’s level of acculturation increases, she is less likely to be fate
oriented.

As a woman’s level of acculturation increases, she is less likely to have
traditional sexual gender norms.

The more a woman experiences gender norm incongruency, the more
likely she is to drink before sex.

As a woman’s level of religiosity increases, she is less likely to be in a
relationship where condoms are used for vaginal intercourse.

As a woman’s level of fate orientation increases, she is less likely to be in
a relationship where condoms are used.

As a woman’s level of religiosity increases, she is less likely to engage in
anal sex with her sexual partner.

As a woman’s level of religiosity increases, she is less likely to have
multiple sexual partners.

As a woman’s sexual gender norms become more liberal, she is more
likely to be in a relationship where condoms are used for vaginal
intercourse.

As a woman’s sexual gender norms become more liberal, she is more
likely to engage in anal sex with her sexual partner.

As a woman’s sexual gender norms become more liberal, she is more

likely to have multiple sexual partners.

44

21.

2m.

2n.

20.

2p.

2q.

2r.

23.

2t.

Religiosity will mediate the relationship between acculturation level and
the use of condoms for vaginal intercourse.

Fate orientation will mediate the relationship between acculturation level
and the use of condoms for vaginal intercourse.

Religiosity will mediate the relationship between acculturation level and
anal sex.

Religiosity will mediate the relationship between acculturation level and
multiple sexual partners.

Sexual gender norms will mediate the relationship between acculturation
level and the use of condoms for vaginal intercourse.

Sexual gender norms will mediate the relationship between acculturation
level and anal sex.

Sexual gender norms will mediate the relationship between acculturation
level and multiple sexual partners.

A partner’s traditional sexual gender norms will moderate the relationship
between a woman’s liberal sexual gender norms and the use of condoms
during vaginal intercourse. That is, women with liberal sexual gender
norms are less likely to be in sexual relationships where condoms are
used, when their partner has traditional sexual gender norms.

The use of alcohol will moderate the relationship between a woman’s
traditional sexual gender norms and anal intercourse. That is, women with

traditional sexual gender norms are more likely to engage in anal sex,

45

when alcohol is used prior to sexual intercourse.

Zn. The use of alcohol will moderate the relationship between a woman’s
traditional sexual gender norms and multiple sexual partners. That is,
women with traditional sexual gender norms are more likely to have
multiple sexual partners, when alcohol is used prior to sexual intercourse.

Contributions of the Proposed Study

In conclusion, the contributions of this study are twofold. First, this study
provides a conceptual model of how Mexican culture affects both sexual risk behaviors,
and a woman’s ability to take precautionary steps to reduce her risk of becoming
infected with HIV. Given that the current understanding of sexual risk practices has
primarily focused on individual behavior (Amaro, 1995; Mann, 1991), this study is
significant because it provides a broader framework for understanding sexual decision
making. It furthers our comprehension of how cultural beliefs influence sexual
behavior, and how they may impose barriers for women of Mexican descent who attempt
to negotiate safer sex with their sexual partner, and why they may be likely to engage in
other sexually risky behaviors. Considering that the prevailing theories (e. g., health
belief model, theory of reasoned action, social learning theory), which have guided
current HIV/AIDS prevention efforts, have had limited success with Latinas (Amaro,
1995), this theoretical model may provide the insight necessary to create effective
prevention strategies for this population.

The second contribution of this study lies in its ability to inform prevention

efforts for Latinas. In fact, this type of study is a critical first step in creating culturally

46

appropriate HIV/AIDS interventions (Amaro, 1991; Marin, 1993). The proposed study
will inform the development process in several ways. First, by examining how
acculturation level impacts sexual practices, one can begin to discern which cultural
values contribute to the diverse sexual practices of Mexican and Mexican American
women. This information may assist in tailoring interventions to meet the specific needs
of particular acculturation groups. For example, prevention efforts directed toward less
acculturated Latinas may have to consider the strong influence culture has on this
group’s sexual behavior, and may have to design strategies that incorporate these values
(e.g., Gomez & Marin, 1996). In addition, given that the primary method of protection
against HIV is the use of a male condom, a better understanding of the factors that
influence a woman’s ability to negotiate the use of a condom is imperative, if the
heterosexual transmission of the AIDS virus is to be reduced (e.g., Amaro, 1995). The
identification of culturally based safer sex barriers may help Latinas to develop the skills
needed to protect themselves from the AIDS virus. It may also encourage the
development of prevention efforts aimed at heterosexual and bisexual men since their
cooperation is needed for safer sex to be practiced. Finally, this study may clarify how
the use of alcohol may contribute to HIV risk behaviors among Mexican and Mexican
American women. This information could help inform the design of interventions for
women experiencing gender norm incongruency. By obtaining a better understanding of
how culture impacts sexual beliefs and behaviors, practioners can create interventions

that are culturally competent and appropriate.

47

Methods
Participants

Considering that few studies have focused exclusively on single Latinas (Flores-
Ortiz, 1994; Marin, Tschann, et al., 1993; Marin et al., 1998), and that dating
relationships may contribute to risky sexual practices among heterosexual couples
(F lores-Ortiz, 1994; Wyatt et al., 1997), only unmarried women of Mexican descent
were targeted for this study. Interviews were conducted in California with a
convenience sample of 111 Mexican and Mexican-American women. For the current
study, women who had not engaged in vaginal and/or anal intercourse in the last year did
not meet the study’s requirements, and were subsequently excluded from these analyses
(n=2 1).
Demoggphic Information

Several demographic characteristics differentiate the present sample from other
research samples that have focused on Latinas and HIV/AIDS. First, the present sample
was exclusively Mexican and Mexican-American women; previous research in the field
has not been population specific, and has included other Latino subgroups (e.g., Central
Americans, Puerto Ricans) in their samples (Deren et al., 1996; Flaskerud et al., 1996;
Ford, Rubenstein, & Norris, 1994; Gomez & Marin, 1996). Second, the present study
consisted of only single women. Prior studies did not differentiate between married and
single women, and combined them as one sample (Gomez & Marin, 1996; Flaskerud et
al., 1996). Third, the majority of women in the current study were young adults (mean

age = 24.39, SD = 2.71), whereas in other studies, samples consisted of either

48

adolescents (F lores-Ortiz, 1994; Ford et al., 1994) or adults with a mean age in the early
thirties (Gomez & Marin, 1996; Marin & Flores, 1994; Marin, Tschann, et al., 1993).
Consequently, a benefit of the current study is an opportunity to investigate the
predictors of HIV sexual risk behaviors with a population that has not been closely
examined.

Table 1 contains demographic information pertaining to the 90 women in this
study. While the majority of participants have never been married (96%), four women
identified themselves as divorced. In addition, 77% of the participants stated that they
were involved in a steady relationship when interviewed. The length of these
relationships ranged from 1 month to nine years, with a mean of 3.07 years (SD=2.3 7).
Women ranged in age from 21-30, with a mean age of 24.39 (SD = 2.71). The majority
of participants (72%) were born in the United States, with 28% of the sample being born
in Mexico. In regard to employment, 44% of the women worked full-time, 36% worked
part-time, 10% were unemployed, 7% were keeping house and one woman was a
seasonal employee. The mean for years of education was 13.70 (SD=2.76), and 52% of
the sample were attending school at the time of the interview (i.e., undergraduate
courses, ESL classes). Household income levels ranged from $400 to $10,666 a month,
with a mean of $1,934.58 per month (SD=1597.03). The majority of women were
Catholic (82%), with the remaining participants either being Protestants (13%),

agnostics (1%), or having no religious affiliation (4%).

49

Sexual Risk Histo

Additional information was acquired from participants to assess their risk for
HIV/AIDS (see Table 2). In regard to their use of birth control, 49% of the women
interviewed had partners that used condoms, 46% used birth control pills, 20% of the
women were not using any form of birth control when interviewed, 12% used the
withdrawal method, 7% used Depro Provera, 4% used the rhythm method, 2% of the
women were sterilized, 2% used spermicide, one woman used an IUD, and another
woman had a male partner that was sterilized. Twenty-nine percent of the women
interviewed (n=26) used more than one form of birth control. Of these women, 92%
used two forms of birth control (e. g., birth control pills and condoms), and 8% used
three forms of birth control (e.g., birth control pills, condoms and spermicide). Forty-
three percent of the women had experienced at least one pregnancy. (Data were not
collected as to how many of these pregnancies had resulted in births, miscarriages, or
abortions.) Two thirds of the sample had been tested for the AIDS virus (63%) and STDs
(67%). None of the women were HIV positive, and of those who had been tested for
STDs, 17% indicated that they were infected at some point with an STD. Only one
woman indicated she had a blood transfusion between 1977 and 1985. None of the

women interviewed had used intravenous drugs.

50

Table 1

Demoggrphic Information

 

 

Characteristics N %
Marital status
Never been married 86 96
Divorced 4 4
Current relationship status
Not involved in a steady relationship 21 23
Involved in a steady relationship 69 77
Length of relationship
0 thru 2 years 30 33
over 2 years thru 4 years 14 16
over 4 years thru 6 years 16 18
over 6 years thru 8 years 8 9
over 8 years thru 10 years 1 1
Age
21 15 17
22 13 14
23 14 16
24 9 10
25 8 9
26 7 8
27 11 12
28 5 6
29 3 3
30 5 6
Place of birth
United States 65 72
Mexico 25 28
Employment status
Working full-time 40 44
Working part-time 32 36
Unemployed 9 10
Keeping house 6 7
Other - Seasonal employee 1 l

 

51

Table l (cont’d)

 

 

Characteristics N %
Years of education
0 - 6 years 3 3
7 - 12 years 22 24
13 - 16 years 58 64
17 - above 7 8
Student status
No 43 48
Yes 47 52
Monthly income -
$400 - $999 27 30
$1000 - $1,999 26 29
$2,000 - $2,999 19 21
$3,000 - $3,999 11 12
$4,000 - $4,999 2 2
$5,000 - $5,999 2 2
$6,000 - $6,999 2 2
$10,000 - $10,999 1 1
Religion
Apostolic 1 l
Agnostic 1 1
Baptist 1 1
Catholic 74 82
Christian (N on-denominational) 5 6
Church of Christ 1 1
Jehovah Witness 1 1
Mormon 1 1
7th Day Adventist 1 1
No religious affiliation 4 4

 

52

Table 2

Participant Sexual Risk History

 

 

Characteristics N %
Current type of contraception

Birth control pills 41 46

Condoms 44 49

Depro Provera 6 7

Female sterilization 2 2

IUD 1 1

Male sterilization l 1

Spermicide/ cremes/ jellies 2 2

Rhythm method 4 4

Withdrawal method 1 1 12

No method 18 20
Pregnancy

No 5 1 57

Yes 39 43
HIV testing

No 33 37

Yes 57 63
HIV test results (n=5 7)

Negative 57 100

Positive 0 0
STD testing

No 30 33

Yes 60 67
STD results (n=60)

Negative 50 83

Positive 10 17
Blood transfusion*

No 88 99

Yes 1 1
Injected drugs

No 90 100

Yes 0 0

 

53

Partner Sexual Risk Histogy

In addition to their own sexual risk history, participants were asked to share their
knowledge of their male partner’s sexual background (see Table 3). Four percent of the
women interviewed indicated that their partner was sexually involved with another
woman, and another 8% were not sure. Of the women who knew their partner had sex
with other women, two stated that their partner did not use a condom with these other
women, and two did not know whether or not condoms were used in these other sexual
relationships. Compared to other studies on Latinas, the number of male partners with
multiple sexual partners in this sample is low; other studies have documented that
between 30 and 40% of their sample report having male partners who were sexually
involved with another woman (Deren, Shedlin, & Beardsley, 1996; F laskerud et al.,
1996)

F ifty-nine percent of participants had partners who were tested for HIV, 29% had
partners that had not been tested, and 12% of participants did not know if their partner
had or had not been tested. Of those who had been tested, 98% were HIV negative and
2% of participants were unaware of their partner’s HIV status. Forty-three percent of the
women were involved with men who had been tested for STDs, and 5% of these men
had been infected at some point with an STD. Two percent of the women had partners
who had received a blood transfusion between 1977 and 1985, and 13% did not know if
their partner had received a blood transfusion during this time frame. In regard to their
partner’s IV drug history, two participants commented that their partner had injected

drugs with a needle that were not prescribed by a doctor, and six participants did not

54

Table 3

Partner Sexual Risk Histog (n=99)

 

 

Characteristics N %
Multiple sexual partners

No 87 88

Yes 4 4

Does not know 8 8
Use of condoms with other partners

No 2 50

Yes 0 0

Does not know 2 50
HIV testing

No 29 29

Yes 58 59

Does not know 12 12
HIV test results

Negative 57 98

Positive 0 0

Does not know 1 2
STD testing

No 33 33

Yes 43 43

Does not know 23 23
STD results

Negative 4O 93

Positive 2 5

Does not know 1 2
Blood transfusion

No 84 85

Yes 2 2

Does not know 13 13
Injected drugs

No 91 92

Yes 2 2

Does not know 6 6

 

55

Table 3 (cont’d)

 

 

Characteristics N %
Sex with other men
No 96 97
Yes 0 0
Does not know 3 3
Jail
No 58 59
Yes 35 35
Does not know 6 6

 

know about their partner’s IV drug use. Ninety-seven percent of the sample stated that
their sexual partner was not sexually involved with men, and 3% said that they did not
know. A third of the women interviewed (39%) had sexual partners who had been in jail
at one point in time, and 6% of the women did not know about their partner’s jail
history. (No data were collected as to the length of time in jail or reason for
imprisonment).

Overall, the sample (n=90) for this study was reasonable and fairly representative
of the Mexican and Mexican-American women in southern California. Further, all
variables under investigation were normally distributed.

Procedure

Participants were recruited from schools (i.e., ESL classes, undergraduate
courses), social groups, churches and community agencies in California. Staff,
counselors, pastors and group leaders at each site identified and recruited women who
were potentially eligible for the study. Leaders were asked to use the following criteria

to identify potential participants: (1) must be an unmarried woman of Mexican descent,

56

(2) must be between the ages of 21 and 30, and (3) must be involved in a heterosexual
relationship. In addition, the primary investigator for this study made several
presentations at churches, undergraduate courses and social groups to reth potential
participants. Furthermore, participants were recruited through flyers distributed and
posted at churches, colleges, community agencies, laundromats, and stores that serviced
a predominantly Latino population (see Appendix B & C). Lastly, a snow-ball technique
was utilized to obtain respondents. Table 4 contains the percentage of women obtained
for this study using the various recruiting techniques.

Table 4

Percentage of Participants Obtained by Recruiting Strategy

 

 

Recruiting Strategy N %
Snowball 40 44
Referral by agency staff /leader of social organization 23 26
Class presentation by researcher 14 16
Posted or distributed flyer 8 9
Church presentation by researcher 5 6

 

Once potential participants were identified, they were referred to the primary
researcher who then contacted them by phone to arrange for an interview date and time.
For those women responding to the distributed or posted flyer, they initiated the phone
contact with the primary researcher by using the 800 telephone number provided on the
flyer. During the initial phone contact, potential participants were informed about the

study, and asked if they were interested in participating (see Appendix D & E). If they

57

consented, respondents were asked to verify their ethnic background, age, marital status,
and whether they were involved in a romantic heterosexual relationship, or in a sexual
relationship with a man. If the respondent did not qualify for the study, the researcher
informed the respondent why she was not eligible for the study, and the respondent was
thanked for her interest. Of the 144 women that called, ten did not qualify for the study
because they did not meet one or several of the criteria for participation.

If a respondent met the criteria for the study (n=133), she was questioned further
to determine her level of acculturation. This was done to assure variability in level of
acculturation. Participants were given a shortened acculturation scale developed for
phone interviews (Marin et al., 1987) (see Appendix D & E). An English and Spanish
version of the measure was developed by Marin and his associates. The measure
consisted of five questions about the use of language: (1) In general, what language do
you read and speak?, (2) What was the language(s) you used as a child? (3) What
language do you usually speak at home?, (4) In which language do you usually think?,
and (5) In which language do you usually speak with your fi'iends? The scale was scored
on a 5-point Likert type scale ranging from (1) only Spanish to (5) only English, and an
average of the five responses resulted in an acculturation score. Table 5 contains the
psychometric properties and internal consistencies of this acculturation scale (alpha =
.92). Using Marin’s cutoff scores, a score of 1 thru 2.33 was categorized as someone low
in acculturation, a score of 2.34 thru 3.66 as moderately acculturated, and a score of 3.67
thru 5 as highly acculturated. Table 6 contains the percentage of women that were

identified as low, moderately or highly acculturated through this initial screening

58

process.

Although 133 women qualified and consented to be interviewed, sixteen women
either canceled with no desire to reschedule or were no shows for the appointed
interview time, and did not return calls when attempts were made to reschedule. In
addition, the research team was unable to contact seven women that had originally
consented to participate in the study. Furthermore, of the 111 women interviewed, 23
interviews were excluded from analysis because respondents had not participated in
vagina] or anal sex in the last year of being interviewed.

Face to face structured interviews were conducted by the researcher and four
research assistants that were trained and supervised by the primary researcher. All
research assistants were bilingual, Mexican or Mexican-American women. Two of the
research assistants were college graduates with previous interviewing experience, and
the remaining research assistants were senior level undergraduates obtaining degrees in
psychology. Training for this study consisted of a three hour meeting in which assistants
reviewed a training manual with the researcher (see Appendix F), obtained interview
supplies (e.g., interview protocol, consent forms), and participated in two mock
interviews. These interviews were recorded and the audio tapes were reviewed by the
primary researcher. Interviews were reviewed for the accuracy of coding and
interviewing technique. Any necessary feedback was given to the research assistants
after listening to the audio tapes. Research assistants did not conduct interviews until

after the primary researcher reviewed the audio taped mock interviews.

59

Table 5

Psychometric Promrties of Short Phone Acculturation Scalp

 

 

 

 

 

Scale Items Item Item SD Corrected Item-
Means Total Correlations
1. In general, what language do you read 3.46 1.05 .84
and speak?
2. What was the language(s) you used as a 2.58 1.54 .78
child?
3. What language do you usually speak at 2.98 1.41 .80
home?
4. In which language do you usually think? 3.52 1.25 .79
5. What language do you usually speak with 3.60 1.17 .79
your friends?
Alpha = .92 Scale Mean = 16.33 Scale SD = 5.62
Table 6
Acculturation Categories Determined by Phone Acculturation Measure
Level of Acculturation N %
Less acculturated 28 21
Moderately acculturated 59 44
Highly acculturated 46 35

 

The primary researcher maintained weekly contact with the research assistants either

by phone, or by personal visits to their home, or school. During this weekly contact, the

researcher would provide assistants with an updated list of participants they were to

interview, followed-up with interviews already assigned, discussed the reliability of

previous interviews conducted, answered questions, and resolved other issues with

60

regard to interviews, or to the coding of the responses.

Eighty-three percent of the interviews were conducted by the primary researcher,
with the remaining interviews being conducted by research assistants (17%). All
interviews conducted by the research assistants (n=15) were audio taped and the primary
researcher reviewed each audio tape to verify the accuracy of participant’s responses.
Interviews ranged from 20 to 90 minutes and were conducted at a location convenient to
the participant. Furthermore, participants chose to be interviewed either in English or
Spanish. Participants were reimbursed $15 for their time, and consent was obtained
prior to the interview (see Appendix G & H).

Measurement

All measures were in English and Spanish. All items, except for the Short
Acculturation Scale and the Acculturation Rating Scale for Mexican Americans - II
(ARSMA-II) which have an English and Spanish version, were translated into Spanish,
and back-translated into English by several bilingual, bicultural translators to assure
proper translation and equivalency in meaning (Marin & Marin, 1991). Instruments
were than modified for language clarity and cultural appropriateness. The interview
instrument included questions on demographic characteristics, acculturation level,
participant and partner’s sexual gender norms, gender norms incongruency, religion, the
use of alcohol, and HIV sexual risk behaviors.

Demogpaphics
For descriptive purposes demographic information on marital status, education,

employment, monthly income, age, place of birth, generational status, and participant

61

and partner sexual risk history (e. g., whether or not they had been tested for HIV/AIDS)
were collected during the interview (see Appendix I & J).
Acculturatipn

Acculturation level was assessed using two measures (see Appendix K& L:
Acculturation Measures). The first measure consisted of Scale 1 of the Acculturation
Rating Scale for Mexican Americans-II (ARSMA-II) (Cuellar et al., 1995). The scale has
four dimensions: (1) language usage and preference, (2) ethnic identity, (3) cultural
heritage and ethnic behaviors, and (4) ethnic interaction. The items on this measure
were scored on a 5-point Likert type scale ranging from (1) not at all to (5) extremely
often/almost always. The measure has two subscales: (l) a Mexican orientation subscale
(MOS) and (2) an Anglo orientation subscale (AOS).

The original AOS was comprised of 13 items. Two items with low item-total
correlations were deleted: (1) I like to identify myself as an American (r=.50) and (2) I
like to identify myself as an Anglo-American (r=.30). Sample items from the A08
include “I speak English” and “I associate with Anglos.” The A08 score was obtained
by averaging across the remaining 11 items. The internal consistency of the subscale was
acceptable (AOS Cronbach alpha = .91). The original MOS consisted of 17 items.
Seven items with low item-total correlations were eliminated (see Table 8). Sample
items from the MOS» include “I speak Spanish” and “My family cooks Mexican foods.”
The remaining 10 items were averaged to create an MOS score. An alpha coefficient of
.91 was established for this subscale. A difference score between the A08 and the MOS

was computed as the women’s linear acculturation score (i.e., ARSMA-II score). Low

62

acculturation scores represented individuals that were “Mexican oriented”, and high
acculturation scores represented individuals that were “Anglo oriented.” Tables 7 and 8
contain the psychometric properties and internal consistencies of the ADS and MOS.

Table 7

Pachometric Promrties of Anglo Oriented Subscale (AOS)

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. I speak English. 4.26 1.00 .85
2. I associate with Anglos. 3.09 1.31 .63
3. I enjoy listening to English language music. 4.14 1.01 .57
4. I enjoy English language TV. 4.06 1.14 .65
5. I enjoy English language movies. 4.51 .88 .60
6. I enjoy reading (e.g., books in English). 3.91 1.26 .71
7. I write (e.g., letters in English). 3.85 1.41 .77
8. My thinking is done in the English language. 3.98 1.33 .69
9. My contact with the USA has been... 4.60 .86 .59
10. My friends, while I was growing up, were of 2.36 1.16 .57
Anglo origin.
11. My fiiends now are of Anglo origin. 2.56 1.05 .57
Alpha = .90 Scale Mean = 41.32 Scale SD = 9.02

 

63

Table 8

Psychometric Promrties of Mexican Oriented Subscale (MOS)

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

l. I speak Spanish. 3.66 1.17 .81

2. I enjoy speaking Spanish. 4.11 1.20 .73

3. I associate with Mexicans and/or Mexican 4.43 .84 .20
Americans. *

4. I enjoy listening to Spanish language music. 4.21 1.19 .69

5. I enjoy Spanish language T.V. 3.29 1.35 .68

6. I enjoy Spanish language movies. 2.82 1.20 .53

7. I enjoy reading (e.g., books in Spanish). 2.67 1.37 .73

8. I write (e.g., letters in Spanish). 2.50 1.38 .73

9. My thinking is done in the Spanish language. 3.03 1.27 .74

10. My contact with Mexico has been... 3.19 1.19 .55

11. My father identifies or identified himself as 4.63 .85 .37
“Mexicano.” *

12. My mother identifies or identified herself as 4.39 1.25 .42
“Mexicana.” *

13. My friends, while I was growing up, were of 4.06 1.00 .40
Mexican origin. *

14. My family cooks Mexican foods. 4.61 .71 .54

15. My fiiends now are of Mexican origin.* 4.15 .89 .47

16. I like to identify myself as a Mexican 4.02 1.46 -.08
American.*

17. I like to identify myself as Mexican.* 4.08 1.14 .42
Remaining 10 items: Alpha = .91 Scale mean = 34.09 Scale SD = 9.02

 

Note. "‘ Item removed from subscale due to low corrected item-total correlations.

Given that acculturation is a global construct, and that the outcome variables for
this study are time-specific (i.e., their last four sexual encounters), a second scale was
constructed to measure acculturation as a time specific variable. A five-item scale was
developed to measure a participant’s level of acculturation in the last 30 days. The items
for this scale were adapted from Marin et al.’s (1987) shortened acculturation scale. This
measure was comprised of the following five questions: (1) In the last 30 days, what was
the primary language(s) you spoke at home?, (2) In the last 30 days, what was the
primary language spoken in the movies and T.V. programs you watched?, (3) In the last
30 days, what language were the radio programs you usually listened to?, (4) In the last
30 days, the people who have visited you or who you have visited were primarily?, and
(5) In the last 30 days, the social gatherings/parties which you have attended have
primarily been? The items were scored on a 5-point Likert type scale ranging from (1)
only Spanish to (5) only English for the first three questions and (1) All
Latinos/Hispanics to (5) All Americans for the last two questions. An average of the
five responses resulted in a 30-day acculturation score, with higher scores meaning
highly acculturated. An alpha coefficient of .79 was obtained for the current study. The
psychometric properties and internal consistencies of this measure can be found in Table
9.

An overall linear acculturation score was obtained for participants by
standardizing their ARSMA-II score and their 30-day acculturation score (r = .96,
p<.01), and than averaging the two scores. A low score represented a woman who was

less acculturated and a high score represented a woman who was highly acculturated.

65

Table 9

chhometric Promrties of 30-day Acculturation Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

1. In the last 30 days, what was the primary 3.14 1.30 .60
language(s) you spoke at home?

2. In the last 30 days, what was the primary 3.89 1.05 .63
language spoken in the movies and T.V.
programs you watched?

3. In the last 30 days, what language were 3.26 1.27 .60
the radio programs you usually listened?

4. In the last 30 days, the people who have 1.98 .94 .55
visited you or who you have visited were
primarily:

5. In the last 30 days, the social gatherings/ 2.08 .96 .57

parties which you have attended have
primarily been:

Alpha = .79 Scale Mean = 14.34

Scale SD = 4.17

 

Then, in order to compare differences between groups, this linear acculturation score

was used to create acculturation categories. Marin et al.’s (1987) method for creating

acculturation groups was utilized in this study. Three acculturation groups of low,

moderate, and high were established by dividing the range of acculturation scores (range

= 4.622) by three. This created the following cut off scores: -2.272 thru -.731 = less

acculturated, -.730 thru .811= moderately acculturated, and .812 thru 2.353 = highly

acculturated (see Table 10 for frequencies). The acculturation group score was used for

the ANCOVA and the mean linear acculturation score was used with the regression

analyses.

66

Table 10

Acculturation Categories (n=90)

 

 

 

Level of Acculturation N %

Less acculturated 18 20

Moderately acculturated 56 63

Highly acculturated 16 18
Sexual Gender Norms

Sexual gender norms was measured using two scales (see Appendix M & N:
Sexual Gender Norms Measures). The first scale was an 18-item scale constructed to
measure a participant’s attitudes and beliefs about sexual gender roles. Items were
created by reviewing and extracting statements from the literature on Latino gender roles
(e.g., Flaskerud et al., 1996; Flores-Ortiz, 1994; Marin, 1990; Marin, Gomez, Tschann,
& Gregorich, 1996; Mays & Cochran, 1988; Moore et al., 1995; Pavich, 1986; Worth &
Rodriguez, 1987). Participants were asked to identify the degree to which each item
characterized their beliefs and attitudes about sexual gender roles by using a 6-point
Likert scale of (1) strongly disagree to (6) strongly agree. In order for a high score to
represent liberal (i.e., non-traditional) sexual gender norms 11 of the 18 items were
recoded (see Table 11 for recoded items).

Given low corrected item-total correlations on this scale (see Table 11), a factor
analysis using a varimax rotation was conducted to determine if the scale was

unidimensional. Seven items did not load highly on any of the generated factors so they

67

Table 11

Psychometric Propgrties of Participant’s Sexual Gender Norms Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

1. Women should be virgins until they get 3.92 1.43 .31
married. (R)*

2. A woman should ask her partner to use a 5.46 .93 .27
condom.

3. A woman should know very little about sex 5.39 1.21 .25
until marriage. (R)

4. It is acceptable if a woman does not want to 4.83 1.34 .51
have children.

5. A “good” woman would not have anal sex. 3.96 1.56 .26
(R) "‘

6. A man should determine whether or not birth 5.23 1.23 .38
control is used. (R)*

7. A woman that carries condoms in her purse 5.03 1.23 .42
is “loose.” (R)

8. It is acceptable for a man to have many 2.06 1.46 .33
sexual partners.

9. It is a woman’s responsibility to buy 2.58 1.55 .01
condoms.*

10. It is important for a woman to have children. 3.39 1.56 .40
(R)

11. A man should determine how often a couple 5.50 .88 .45
has sex. (R)

12. It is acceptable for a woman to have many 2.50 1.40 .41
sexual partners.

13. Only “loose” women have oral sex. (R) 5.36 .87 .41

14. Birth control should not be used so that a 5.30 1.14 .38

woman can bear her partner many children.

(R)

68

Table 11 (cont’d)

 

 

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
15. A “good” man always uses a condom.‘ 4.19 1.34 -.01
16. It is appropriate for a man to ask his partner 3.29 1.49 .08
for anal sex.*
17. A woman should comply with her partner’s 4.20 1.34 .22
wishes to have sex. (R) *
18. It is disrespectful for a man to talk about sex 4.94 1.16 .28
with a woman. (R)
Alpha = .70 Scale Mean = 77.44 Scale SD = 9.40
Note. (R) = Item was reverse scored.
"' = Item removed from measure due to low factor loadings.

were removed from the measure (see Table 11 for deleted items). A second factor
analysis was conducted with the remaining items, and it yielded four factors. The first
factor included 4 items (alpha = .69) regarding the participant’s perception of sexual
gender roles (e. g., A man should determine how often a couple has sex; It is
disrespectful for a man to talk about sex with a woman). The second factor included
three items (alpha = .72) regarding the participant’s reproductive attitudes (e.g., It is
important for a woman to have children; It is acceptable if a woman does not want to
have children). The third factor included 2 items (alpha = .77) regarding the participant’s
view of the double standard (i.e., It is acceptable for a woman to have many sexual
partners; It is acceptable for a man to have many sexual partners). The fourth factor
included two items (alpha = .63) regarding the participant’s beliefs about women’s
sexual behavior and knowledge (i.e., A woman should ask her partner to use a condom;

A woman should know very little about sex until marriage). Means for these four

69

subscales were computed, and were used to calculate an average sexual gender role
score. Tables 12 to 15 contain the psychometric properties and internal consistencies of
the four subscales.

Table 12

Psychometric Properties of Participant’s Sexual Gender Roles Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. A woman that carries condoms in her purse 5.50 .88 .56
is “loose.” (R)
2. A man should determine how often a couple 5.36 .87 .51
sex.
3. Only “loose” women have oral sex. (R) 4.94 1.16 .41
4. It is disrespectful for a man to talk about sex 5.03 1.23 .46
with a woman. (R)
Alpha = .69 Scale Mean = 20.83 Scale SD = 3.01

 

Note. (R) = Item was reverse scored.

Table 13

Psychometric Properties of Reproductive Attitudes Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. It is acceptable if a woman does not want to 4.83 1.34 .67
have children.
2. It is important for a woman to have children. 3.89 1.56 .52
(R)
3. Birth control should not be used so that woman 5.30 1.34 .48
can bear her partner many children. (R)
Alpha = .72 Scale Mean = 13.52 Scale SD = 3.27

 

70

Table 14

Psychometric Progrties of Double Standard Subscale

 

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

1. It is acceptable for a man to have many 2.06 1.46 .63
sexual partners.

2. It is acceptable for a woman to have many 2.50 1.40 .63
sexual partners.
Alpha = .77 Scale Mean = 4.56 Scale SD = 2.58

Table 15

Psychometric Prop_erties of Women’s Sexual Behavior and Knowledge Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. A woman should ask her partner to use a 5.46 .93 .47
condom.
2. A woman should know very little about sex 5.39 1.21 .47
until marriage. (R)
Alpha = .63 Scale Mean = 10.84 Scale SD = 1.84

 

Note. (R) = Item was reverse scored.

The second scale used to measure sexual gender norms was a 10-item scale
developed for this study to measure situation specific gender role behavior. Specifically,
this measure assessed a participant’s ability to negotiate the use of a condom (i.e.,
condom self-efficacy). Four of the items were obtained from the AIDS Related Self-
efficacy Scale (Esteban, 1993), and the remaining six items were adapted from condom

self-efficacy scales developed by Gomez and Marin (1996) and Marin, Gomez, Tschann,

71

et al. (1996). Utilizing a 5-point Likert type scale of (1) never to (5) always, participants
were asked to indicate the extent to which each item described their ability to negotiate
the use of a condom. Two items were reverse coded so that a low score represented low
self-efficacy and a high score represented high self-efficacy: (1) It is difficult for me to
ask my boyfriend to use a condom, and (2) If I were going on a date, and I thought that
we might have sex, I would bring a condom with me.

To ascertain if the scale was unidirnensional a factor analysis was conducted
using varimax rotation. Three items did not load highly on any of the yielded factors so
they were eliminated fi'om the scale: (1) I feel comfortable asking a new partner to use a
condom, (2) If someone I loved complained that he did not like to use a condom, I would
be persuaded not to use one, and (3) Even if I had been drinking, 1 would ask my
boyfiiend to use a condom. A second factor analysis with the remaining items identified
three factors. The first factor included 3 items (alpha = .74) assessing the participant’s
ability to negotiate the use of a condom with a new partner (i.e., Even if I had been
drinking, I would ask a new partner to use a condom; If I was about to have sex with
someone, I would suggest using a condom to protect us both). The second factor
included two items (alpha = . 67) assessing the participant’s ability to negotiate the use
of a condom with her boyfi'iend (i.e., It is difficult for me to ask my boyfriend to use a
condom; I would be able to refuse to have sex with my boyfiiend if he would not use a
condom). The third factor included two items (alpha=.51) regarding the participant’s
ability to buy and carry condoms (i.e., I would go to a store, ask a clerk for help if

needed, and buy condoms; If I were going on a date, and I thought that we might have

72

sex, I would bring a condom with me). Given the poor internal consistency of this
subscale (i.e., Factor 3) and low corrected item-total correlations (.34 and .34
respectively for each item), it was eliminated from this measure. Means were established
for the two remaining subscales and were than averaged to create a condom self-efficacy
score. The psychometric properties and internal consistencies of the two subscales can
be found in Tables 16 and 17.

To represent a participant’s sexual gender norms score, the participant’s sexual
gender role score and condom self-efficacy score (r=.80, p<.01) were standardized to
compute an average scale score. Low scores represented traditional sexual gender norms,
and high scores indicated liberal sexual gender norms. The mean sexual gender norms
score was used with the regression analyses.

Table 16

Psychometric Promrties of Condom Negotiation with a New Partner Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. Even if I had been drinking I would ask a 4.49 1.03 .59
new partner to use a condom.
2. If I was about to have sex with someone, I 4.71 .71 .62
would suggest using a condom to protect us
both.
3. I feel comfortable telling a new partner that I 4.56 .95 .54
will not have sex unless we use a condom.
Alpha = .74 Scale Mean = 13.76 Scale SD = 2.20

 

73

Table 17

Psychometric Properties of Condom Negotiation with Boyfriend Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. It is difficult for me to ask my boyfriend to 4.34 1.14 .51
use a condom. (R)
2. I would be able to refuse to have sex with my 3.72 1.33 .51
boyfriend if he would not use a condom.
Alpha = .67 Scale Mean = 8.07 Scale SD = 2.15

 

m, (R) = Item was reverse scored.
Mam—n

Religion was assessed for this study using three scales (see Appendix 0 & P:
Religion Measures). The first scale assessed degree of religiosity, and consisted of a
modified version of Kenny, Vaughn and Cromwell’s (1977) religious inventory. The
measure has three dimensions: (1) guidance and participation in personal and family life
(e.g., I pray privately; My life is guided by the religious beliefs I learned when I was
young), (2) media forms of religion (e.g., I watch religious services on television; I listen
to religious music), and (3) participation in religious community (e.g., I attend religious
services; I take part in various activities offered at my church). Several of the original
items were reworded for this study so that they would be in the present tense. In
addition, one item was added to the original scale: “My religious beliefs help guide my
everyday behavior.” The modified scale has 13 items to which participants responded
using a 5-point Likert type scale of (1) never to (5) always (alpha = .87). To assess

respondent’s religious attitudes and activities, an average scale score of all 13 items was

74

computed, with a high score indicating strong religious guidance and active church
participation. Table 18 contains the psychometric properties and internal consistencies of
the scale.

Table 18

Pachometric Properties of Religious Guidance and Involvement Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

1. I attend religious crusades, revival meetings 1.71 .88 .87
or missions.

2. I attend religious services. 2.94 1.17 .86

3. I watch religious services on television. 1.43 .69 .88

4. I pray privately. 4.08 1.05 .87

5. I pray with my family. 2.31 1.23 .87

6. I listen to religious music. 1.61 .81 .87

7. My religious beliefs have helped me 3.26 1.18 .85
understand my life.

8. I contribute money to my church. 2.78 1.17 .86

9. I take part in various activities offered at my 1.94 1.06 .86
church.

10. My life is guided by the religious beliefs I 3.08 1.20 .86
learned when I was young.

11. I feel that religion has helped my 2.62 1.28 .85
relationship with my partner.

12. I feel that religion has helped me get ahead 3.25 1.23 .85
in life.

13. My religious beliefs help guide my everyday 3.13 1.14 .85
behavior.
Alpha = .87 Scale Mean = 34.15 Scale SD = 8.94

 

75

Given the time specific nature of the outcome variables for this study, a second
scale was developed to assess degree of religiosity as a time specific construct. A five-
item scale was created to measure a woman’s level of religious involvement and
guidance, in the last 30 days of being interviewed (see Appendix G: Religion Measures).
Items from Kenny, Vaughn and Cromwell’s (1977) religious inventory were adapted to
include this time factor (e.g., In the last 30 days, how often did you pray with your
family?; In the last 30 days, how often did you contribute money to your church?) To
improve the internal consistency of this scale, three items were deleted due to corrected
item total correlations below .40: (1) In the last 30 days, how often did you pray with
your farnily?, (2) In the last 30 days, how often did you listen to religious music?, and
(3) In the last 30 days, how often did your religious beliefs help you understand your
life? Responses for the two remaining items ranged from (1) never to (5) daily, with
higher scores indicating active participation in religious activities (alpha = .80). The 30-
day religiosity score was the mean of the two items. Table 19 contains the psychometric
properties and internal consistencies of the scale.

The last measure used to assess religion was a 16-item scale constructed to
examine the degree to which a respondent believed in fate orientation. Many of the
items were adapted from locus of control scales on health beliefs (Castro, Furth, &
Karlow, 1984; Wallston & Wallston, 1984). In addition, several items were modified
from the Health Responsibility Scale developed by Castro et al. (e.g., I am responsible
for my own health; Illness occurs because God wills it) (1984), and some items were

adopted from existing an fate orientation scale (e. g., I can avoid becoming infected with

76

Table 19

Psychometric Promrties of 30-day Participation Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. In the last 30 days, how often did you attend 1.96 .86 .67
religious services (e.g., mass, bible class)?
2. In the last 30 days, how often did you 1.74 .75 .67
contribute money to your church?
Alpha = .80 Scale Mean = 3.70 Scale SD = 1.48

 

HIV) (Marin et al., 1993b). A 6-point Likert scale of (1) strongly disagree to (6) strongly
agree was used for this measure. Nine items were reverse coded so that a high mean
score would represent a woman who believed God controlled her destiny (see Table 20
for items that were reverse coded).

Given low corrected item-total correlations on this scale (see Table 20), a factor
analysis using a varimax rotation was performed to determine if the scale was
unidimensional. Six items did not load highly on any of the generated factors so they
were removed from the measure (see Table 20 for deleted items). A second factor
analysis yielded four factors. The first factor included 3 items (alpha = .66) regarding the
participant’s personal responsibility for becoming infected with HIV (e.g., I am to blame
if I become infected with the AIDS virus; I am responsible for not becoming infected
with HIV). The second factor included 2 items (alpha = .56) regarding a participant’s
perception of God’s control over her destiny (i.e., I have no control over my life because

God control’s my destiny; I control my destiny, not God). The third factor included three

77

Table 20

Psychometric Promrties of Fate Orientation Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

1. I am responsible for what occurs in my life. 1.46 .69 .25
(R) *

2. I have no control over my life because God 2.65 1.42 .37
controls my destiny.

3. Good things occur in my life because God 4.07 1.24 .13
wills it. *

4. I control my destiny, not God. (R) 3.34 1.34 .24

5. It is a matter of chance, if good things 2.99 1.27 .21
happen in my life. *

6. It is God’s will if bad things happen in my 3.18 1.47 .20
life. "‘

7. If I take the right actions, I can prevent bad 2.59 1.09 .29
things from occurring in my life. (R) *

8. I have the ability to make good things 1.97 .88 .25
happen in my life. (R) *

9. I am to blame if I become infected with the 2.32 1.16 .34
AIDS virus. (R)

10. People become infected with HIV because 3.00 1.54 .17
they do not take care of themselves. (R) *

11. It is a matter of chance if you become 2.78 1.42 .41
infected with the AIDS virus. *

12. I am responsible for not becoming infected 1.97 .80 .46
with HIV. (R)

13. People can control whether or not they 2.71 1.34 .29

become infected with HIV. (R) "'

 

78

Table 20 (cont’d)

 

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
14. If I take the right actions, I can avoid 1.99 .94 .40
becoming infected with the AIDS virus. (R)
15. If it’s meant to be, I will become infected 2.94 1.39 .52
with HIV. *
16. People get infected with HIV because God 2.12 1.13 .52
wills it. *
Alpha = .71 Scale Mean = 42.07 Scale SD = 8.43
Note. (R) = Item was reverse scored.
* = Item removed from measure due to low factor loadings or low subscale

items (alpha = .41) regarding the participant’s belief in luck (e. g., It is a matter of
chance, if good things happen in my life; If I take the right actions, I can prevent bad
things from occurring in my life). The fourth factor included 2 items (alpha = .40)
regarding the participant’s personal sense of responsibility for her life (i.e., I am
responsible for what'occurs in my life; I have the ability to make good things happen in
my life). Given the poor reliabilities of Factors 3 and 4 and low corrected item total
correlations ranging from .23 to .26, they were eliminated from this measure (see Table
20 for deleted items). A mean fate orientation score was computed by averaging the
means of Factor 1 and 2. Tables 21 and 22 contain the psychometric properties and
internal consistencies of these two subscales. Two separate religion mean scores were
used for this study. The first score used for analyses was the mean fate orientation score.
A second religion score which indicated degree of religiosity, was created by averaging

the religious inventory mean score with the 30 day religiosity mean score. Both mean

79

Table 21

Psychometric Promrties of Personal Resmnsibility Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
l. I am to blame if I become infected with the 2.32 1.16 .67
AIDS virus. (R)
2. I am responsible for not becoming infected 1.97 .80 .44
with HIV. (R)
3. If I take the right actions, I can avoid 1.99 .94 .58
becoming infected with the AIDS virus. (R)
Alpha = .66 Scale Mean = 6.28 Scale SD = 2.26

 

Note. (R) = Item was reverse scored

Table 22

Psychometrig Promrties of Destiny Subscale

 

Item Corrected Item-
SD Total Correlations

 

Scale Items Item
Means
l. I have no control over my life because God 2.64
controls my destiny.
2. I control my destiny, not God. 3.34

Alpha = .56 Scale Mean = 5.98

1.42 .39
1.34 .39
Scale SD = 2.31

 

scores were used for the regression analyses.

Incongruency of sexual gender norms

Incongruent sexual gender norms was measured using an 8-item scale developed

specifically for this study (see Appendix 0 & P: Sexual Gender Norms Incongruency

Measure). The eight items were produced by reviewing and obtaining statements from

the literature on the struggle Latinas experience trying to adhere to traditional Latino

80

roles for women (Flores-Ortiz, 1994; Marin & Flores, 1994). Utilizing a 6-point Likert
scale (1= strongly disagree, 6 = strongly agree), participants were asked to identify the
extent to which each item described their conflict regarding traditional gender roles. To
determine if the scale was unidimensional, a factor analysis using varimax rotation was
conducted. Two items did not load highly on any of the generated factors so they were
deleted from the measure: (1) Sometimes my desire to be a “ good” Mexican woman
conflicts with what I want to do sexually and (2) Sometimes I feel obligated to follow
Mexican customs about how women should act even though I disagree with them. A
second factor analysis yielded two factors. The first factor included 4 items (alpha = .76)
regarding gender role conflict (e. g., I have a difficult time accepting Mexican values
about what is appropriate sexual conduct for a woman; I want to be a “good” Mexican
woman, but sometimes I feel constrained by Mexican culture). The second factor
included 2 items (alpha = .77) regarding gender role limitations (i.e., Mexican culture
limits my ability to do things in my life because I am a woman; Sometimes I feel like
experimenting sexually, but my cultural values make it difficult for me to do this).
Tables 23 and 24 contain the psychometric properties and internal consistencies of these
subscales. A mean was computed for each factor and these two means were than used to
compute an overall average score for incongruency. Participants with high scores were
more likely to have experienced incongruency than participants with low scores. The

average incongruency score was used in the regression analyses.

81

Table 23

Psychometric Promrties of Gender Role Conflict Subscale

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations

 

1. I have a difficult time accepting Mexican 3.71 1.49 .49
values about what is appropriate sexual
conduct for a woman.

2. I want to be a “good” Mexican woman, 3.87 1.51 .67
but sometimes I feel constrained by
Mexican culture.

 

3. I struggle trying to follow Mexican beliefs 3.91 1.58 .56
about how women should act.
4. I find my views about the role of women 4.01 1.41 .53
to be in conflict with my cultural
background.
Alpha = .76 Scale Mean = 15.50 Scale SD = 4.57
Table 24

Psychometric Promrties of Gender Role Limitation Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. Mexican culture limits my ability to do 2.78 1.59 .63
things in my life because I am a woman.
2. Sometimes I feel like experimenting 2.58 1.44 .63
sexually, but my cultural values make it
difficult for me to do this.
Alpha = .77 Scale Mean = 5.36 Scale SD = 2.74

 

82

Partner’s Sexual Gender Norms

A partner’s sexual gender norms score was assessed using an l8-item scale
developed to examine attitudes and beliefs about sexual gender roles (see Appendix S &
T: Sexual Inventory). This scale is identical to the participant’s sexual gender roles
scale. However, in this case participants were asked the degree to which each item
characterized the gender role beliefs and attitudes of their sexual partner. That is, they
were asked to share their perception of their partner’s sexual gender norms. Moreover,
this scale was administered each time a woman identified a new sexual partner.
Responses for the items ranged from (1) strongly disagree to (6) strongly agree. In
addition, 11 of the 18 items were recoded so that high scores indicated liberal sexual
gender norms (see Table 25 for items that were reverse coded).

Due to low corrected item-total correlations (see Table 25), a factor analysis
using a varimax rotation was performed to determine if the scale was unidimensional.
Seven items did not load highly on any of the generated factors so they were eliminated
from the measure (see Table 25). A second factor analysis yielded four factors. The first
factor included 5 items (alpha = .73) regarding beliefs about sexual norms for women
(e. g., Women should be virgins until they get married; A woman should know very little
about sex until marriage). The second factor included 2 items (alpha = .67) regarding
partner’s beliefs about the use of condoms (e. g., A woman should ask her partner to use
a condom; A “good” man always uses a condom). The third factor included 2 items
(alpha = .61) regarding partner’s beliefs about having children (e.g., It is acceptable if a

woman does not want to have children; It is important for a woman to have children).

83

The fourth factor included 2 items (alpha = .27) regarding appropriate gender roles (e. g.,
It is a woman’s responsibility to buy condoms; It is appropriate for a man to ask his
partner for anal sex). Given the poor reliability of Factor 4 and low corrected item total
correlations (of .03 and .03 respectively), this subscale was removed from the overall
measure (see Table 25 for deleted items). Tables 26-28 contain the psychometric
properties and internal consistencies of the three remaining subscales. An overall mean
score representing a partner’s sexual gender norms was computed using the subscale
means from Factor 1, 2, and 3 for each sexual partner identified. This mean score was
used for the regression analyses.

Table 25

Psychometric Properties of Partner’s Sexual Gender Norms Scale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. Women should be virgins until they get 4.40 1.36 .47
married. (R)
2. A woman should ask her partner to use a 3.99 1.47 .51
condom.
3. A woman should know very little about 4.80 1.18 .58
sex until marriage. (R)
4. It is acceptable if a woman does not want 3.58 1.56 .37
to have children.
5. A “good” woman would not have anal 4.20 1.40 .32
sex. (R)
6. A man should determine whether or not 4.29 1.44 .52

birth control is used. (R) *

7. A woman that carries condoms in her 3.86 1.49 .43
purse is “loose.” (R) *

 

84

Table 25 (cont’d)

 

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
8. It is acceptable for a man to have many 3.29 1.55 -.02
sexual partners. *
9. It is a woman’s responsibility to buy 2.57 1.12 .02
condoms. *

10. It is important for a woman to have 2.64 1.39 .26
children. (R)

11. A man should determine how often a couple 3.90 1.52 .39
has sex. (R) *

12. It is acceptable for a woman to have many 1.88 .99 .38
sexual partners. *

13. Only “loose” women have oral sex. (R) 4.92 1.06 .51

14. Birth control should not be used so that a 4.92 1.15 .39
woman can bear her partner many children.
(R)

15. A “good” man always uses a condom. 3.71 1.42 .35

16. It is appropriate for a man to ask his partner 3.83 1.41 -.12
for anal sex. *

17. A woman should comply with her partner’s 3.60 1.45 .29
wishes to have sex. (R)*

18. It is disrespectful for a man to talk about sex 4.90 1.19 .14
with a woman. (R)*
Alpha = .73 Scale Mean = 68.45 Scale SD = 10.44

Note. (R) = Item was reverse scored.

* = Item removed from measure due to low factor loadings or low subscale

alphas. '

85

Table 26

Psychometric Properties of Partner’s Beliefs about Women Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. Women should be virgins until marriage. (R) 4.38 1.37 .47
2. A woman should know very little about sex 4.80 1.17 .53
until marriage. (R)
3. A “good” woman would not have anal sex. 4.16 1.40 .45
(R)
4. Only “loose” women have oral sex. (R) 4.89 1.09 .63
5. Birth control should not be used so that a 4.91 1.18 .42
woman can bear her partner many children.
(R)
Alpha = .73 Scale Mean = 23.15 Scale SD = 4.33

 

Note. (R) = Item was reverse scored

Table 27

Psychometric Properties of Partner’s Beliefs About the Use of Condoms Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. A woman should ask her partner to use a 3.97 1.47 .50
condom.
2. A “good” man always uses a condom. 3.62 1.46 .50
Alpha = .67 Scale Mean = 7.59 Scale SD = 2.54

 

86

Table 28

Psychometric Prop_erties of Partner’s Beliefs Regarding Having Children Subscale

 

 

Scale Items Item Item Corrected Item-
Means SD Total Correlations
1. It is acceptable if a woman does not want to 3.59 1.56 .44
have children.
2. It is important for a woman to have children. 2.66 1.40 .44
(R)
Alpha = .61 _ Scale Mean = 6.26 Scale SD = 2.51

 

Npte, (R) = Item was reverse scored
Use of Alcohol

The alcohol measure used in this study is a modified version of Bolton et al.’s
(1992) alcohol index. This adapted index was used to assess the participants’ use of
alcohol before intercourse during two time frames: (1) in the last year, and (2) at their
last four sexual encounters (see Appendix S & T- Sexual Inventory). The index
measuring their use of alcohol during the last year consisted of the following questions:
(1) Now I would like you to think about the last 12 months and the times that you have
had an alcoholic beverage. How often did you drink an alcoholic beverage such as beer,
wine or liquor (e.g., mixed drinks, shots) before having sex?, (2) On average during the
last 12 months, how many drinks would you say you had before having sex?, and (3)
Think about those times that you drank before having sex, how many times were you
drunk enough so that you were unable to drive a car or walk straight? For questions 1
and 3, participants responded by using a 5-point Likert type scale of (1) never to (5)

almost always. For question 2, participants responded using a 4-point Likert type scale of

87

(1) 1-2 drinks to (4) more than 6 drinks. In regard to their use of alcohol for their last 4
sexual encounters, participants were asked the following series of questions for each
date: (1) On this date did you drink an alcoholic beverage such as beer, wine or liquor
(e. g., mixed drinks, shots) before having sex?, (2) How many drinks did you have?, and
(3) Were you drunk enough so that you were unable to drive a car or walk straight? For
questions 1 and 3, participants responded (0) no or (1) yes. For question 2, participants
responded using a 4-point Likert type scale of (1) 1-2 drinks to (4) more than 6 drinks.
Although it had been the researcher’s original intent to create sum scores using
the three questions for the yearly use of alcohol and the four dates, the non-normal
distribution of summed scores indicated the need to use an alternative scoring method
(see Table 29 - Summed Scores for Alcohol Use Before Sex). Consequently, the
frequency of alcohol use before sex was used to create a yearly alcohol score (see
Appendix U & V: Sexual Inventory, item F In). The responses to this item were recoded
into a three item variable: (1) never drank before sex, (2) rarely or sometimes drank
before sex, and (3) almost half of the time, or almost always drank before having sex.
Furthermore, given that more than half of the women did not drink before having sex for
each of their last four sexual encounters, and that few women did drink more than once
across the four dates (see Table 30 - Alcohol Use Before Sex Across Four Dates), it was
determined that the best scoring method for these data was a dichotomous variable that
recognized the use of alcohol across the four dates. In other words, respondents received
a score of “0" if they did not drink across the four dates, and a score of “1 " if they had a

drink on any, or all four of the dates. For the purpose of analyses, the yearly alcohol

88

Table 29

Summed Alcohol Scores Before Sex

 

Time Period

Summed Alcohol Score

2

 

Date #1

Date #2

Date #3

Date #4

Yearly

.00
2.00
3.00
4.00
6.00

.00
2.00
3.00
6.00
Not Applicable*

.00
2.00
3.00
4.00
Not Applicable“

.00
2.00
3.00
5.00
6.00
Not Applicable”

.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
11.00
12.00

r—It—toog

Nu—wqfi

m~—\r\r% wwwxofi

 

Note. *

Two women could only remember their last sexual encounter.

** Three women could only remember their last three sexual encounters.

89

Table 30

Alcohol Use Before Sex Across the Four Dates

 

 

Use of Alcohol N %
No alcohol 52 58
Alcohol consumed on one date 23 26
Alcohol consumed on two dates 9 10
Alcohol consumed on three dates 4 4
Alcohol consumed on all four dates 2 2

 

score was used for the regression analyses examining the yearly use of condoms, anal
sex and multiple sexual partners. The dichotomous alcohol score (i.e., recent alcohol use
score) was used only for the regression analyses examining the women’s most recent
condom use score.
HIV Sexual Risk Behaviors

In order to acquire information on the sexual practices of this sample, an
inventory of their sexual history was obtained (see Appendix S & T - Sexual Inventory
and Appendix U & V: Multiple Partner Insert). This inventory chronicled information
for the last year and the last four times a participant had sex. The purpose of collecting
data across these time frames was to ensure variability in the outcome variables. This
measure documented the following information: (1) relationship status, (2) length of
relationship, (3) type of relationship, (4) type of intercourse they engaged in (i.e, vaginal
and anal sex), (5) participants’ use of condoms, (6) number of times they had sex across
their last four sexual encounters, (7) type of sexual intercourse they engaged in across

these four dates (i.e., vaginal and/or anal sex), (8) the number of times penetration

90

occurred without the use of a condom, and (9) the number of sexual partners they have
had in the last year and across the four dates. Furthermore, this sexual inventory
documented descriptive information on the participant and participant partner’s sexual
risk history.

Use of condoms during vaginal intercourse. Two separate condom use scores
were created for this study: a yearly condom use score and a recent condom use score
representing their use of condoms in their last 4 sexual encounters. In order to assess
participants’ use of condoms for vaginal intercourse in the last year, women were asked
the following question, “In the last 12 months, how often have you used a condom
during vaginal intercourse?” Participants responded using a 5-point Likert type scale of
(1) never to (5) always. Yet, given the non-normal distribution of this item (see Table 31
- Frequency of Yearly Condom Use), responses were recoded as a three-level variable of
(1) never, (2) sometimes (i.e., rarely, sometimes, and most of time), and (3) always.

In addition, a condom use score for participant’s last four sexual encounters was
calculated by asking participants whether or not they used condoms during their last four
sexual encounters. Specifically, for each date, respondents were asked how many times

they had vaginal intercourse and of those times identified, how many times they actually
used a condom. This set of questions was asked for each date specified. A condom use
score for each date was computed by dividing the number of times a woman had vaginal
intercourse by the number of times she used a condom. Given the non-normal

distribution of these data (see Table 32 - Percentage of Condom Use Before

91

Table 31

Frequency of Yearly Condom Use for Vaginal Intercourse

 

 

Use of Condoms N %
Never 21 23
Rarely 18 20
Sometimes 10 11
Most of the time 24 27
Always 17 19

 

Vaginal Intercourse Across the Four Dates), these responses were recoded as a three-
level variable of condom use across the four dates: (1) never used a condom, (2)
sometimes used a condom, and (3) always used a condom. For the purpose of analyses,
both the yearly condom use score and the most recent condom use score (i.e., across the
four dates) were used for the AN COVA and regression analyses.

Anal Intercourse. Given the small number of women that had participated in
anal intercourse in the last year and across the four dates (see Table 33 - Percentage of
Other Risky Sexual Behaviors), it was decided to examine what factors predicted
whether or not a woman had ever engaged in anal sex. This decision was based on the
larger number of women (n=32) who answered “yes” to the following question: “Have
you ever had anal sex or anal intercourse - that is when your partner inserts his penis into
your bottom, behind or rectum?” A woman was assigned a score of “0" if she had never
engaged in anal intercourse, and a score of “1 " if she had engaged in anal intercourse at

some point in her life. Logistic regressions were conducted using this anal sex score.

92

Table 32

Percentage of Condom Use for Vaginal Intercourse Across the Four Dates

 

 

 

Time Period Percent of Time Condom Used N %
Date #1 0 51 57
50
66 1 1
100 35 39
Date #2 0 46 51
33 1 1
50 2 2
100 37 41
Not Applicable* 4 4
Date #3 0 49 54
25 1 1
50 1 1
67 1 1
100 36 40
Not Applicable 2 2
Date #4 0 49 54
20 1 1
50 2 2
67 2 2
100 3 1 34
Not Applicable" 5 6

 

Note. "' Two women could only remember their last sexual encounter, and two
women only engaged in oral sex on this date.
** Three women could only remember their last three sexual encounters.
Multiple Partners. Given that only two women had multiple partners, and that
few women (n=7) had different partners across the four dates (see Table 33 - Percentages

of Other Risky Sexual Behaviors), it was determined that for the purpose of analyses,

only the number of partners a respondent had in the last year would be examined. One

93

item was used to assess this outcome: “In the last 12 months, how many male sexual
partners have you had?” While it had been the researcher’s intent to use the response to
this question as a continuous variable, the non-normal distribution of responses made
this impossible. Consequently, it was decided to dichotomize responses using the
following criteria; if a participant had more than one partner a score of “1 " was assigned,
and a score of “0" was assigned if she only had one partner. This score was used for the
logistic regressions.

PA);

Four pilot interviews were conducted to determine whether or not participants
would be able to identify the last six times they had sex and to test the measures
developed by the primary researcher for this study (i.e., sexual gender norms scale,
gender norms incongruency scale, 30-day items for each construct). Interviews ran
anywhere from 25 minutes to an hour. In addition, interviews were conducted with
women from different acculturation levels; two interviews were conducted with
bilingual, Mexican-American women (i.e., moderately acculturated), one Mexican-
American woman that only spoke English (i.e., highly acculturated), and one Mexican
woman that primarily spoke Spanish (i.e., less acculturated). These women were
recruited from the primary researcher’s own personal network in Los Angeles, and were
interviewed via the phone. The women were asked to comment on any sections, or items

they felt were unclear, and/or difficult to answer.

94

Table 33

Percentage of Other Risfl Sexual Behaviors

 

 

Risky Sexual Behaviors N %
Anal sex across the four dates

No 81 90

Yes 9 10
Anal sex in the last year

No 73 81

Yes 17 19
Use of condoms during anal sex in the last year (n=17)

Never 6 35

Rarely 3 17

Sometimes 2 12

Always 6 35
Ever engaged in anal sex

No 58 64

Yes 32 36
Currently having sex with more than one person

No 88 98

Yes 2 2
Number of partners across the four dates

1 83 92

2 6 7

3 1 1
Number of partners in the last year

1 64 71

2 13 14

3 10 11

4 1 1

5 1 1

6 0 0

7 1 l

 

95

Once the interviews were completed, the primary researcher reviewed and
discussed her findings at a meeting with her dissertation chair, and another member from
her dissertation committee. All of the women interviewed had a difficult time
remembering the last six times they had sex. Given that most of the women were able to
remember the last three to four times they had sex, it was decided to only ask
participants’ about their last four sexual encounters. Furthermore, it was determined that
additional questions should be added to the Sexual Inventory measure to assess
participants’ use of condoms across the four dates, and to assess whether or not they had
sex with more than one person on any of the dates specified. For each date, the following
questions were added to the measure: (1) Were there any times during this encounter
when there was penetration (i.e., penis entering the vagina) without the use of a
condom?, (2) Did he ejaculate inside of your vagina?, (3) Were there any times during
this encounter when there was penetration (i.e., penis entering the anus/rectum) without
the use of a condom?, (4) Did he ejaculate inside of your anus/rectum?, and (5) Did you
have sex with more than one person on this date?

Problems also emerged when participants were asked the 30-day religion
questions. The questions were open-ended, and many of the women were unable to give
an exact number. Therefore, it was decided to make this section close-ended by
providing respondents with the following Likert like scale of: (1) never, (2) l to 3 times
in the last month, (3) once a week, (4) several times a week, and (5) daily. In addition, a
few translation problems were identified in the incongruency scale and gender norms

scale. A bilingual Mexican woman was consulted to identify more suitable language for

96

those problematic items. After some discussion, more appropriate terminology was
identified, and these items were modified accordingly.
Results
Descriptive Statistics
The standard deviations and means for all variables in the conceptual model are
presented in Table 34. Table 35 includes the zero order correlations of these variables.
Furthermore, overall alphas for all measures can be found in Appendix A - Figure 2.
HIV Sexual Risk Behaviors
Overall, the data suggests that a high percentage of subjects are engaging in risky
sexual practices. In the last year, 23% of the women and their partners never used
condoms during vaginal intercourse and 20% rarely used condoms. Across their last four
sexual encounters, 41% of the women and their partners never used a condom. In
addition, 17 participants (36%) had engaged in anal sex at least once in their life. Of the
women that had engaged in anal sex during the last year, condoms were never used by
35% of the women’s partners and 18% rarely used condoms. Nine of the women
interviewed had participated in anal sex during their last four sexual encounters and
approximately half of them had partners that never used condoms during anal sex.
Furthermore, only two women had multiple partners at the time they were interviewed.
In the last year, 28% of the women interviewed had more than one sexual partner. Of
these women, seven identified two sexual partners, and one woman identified three

parmfls across their last four sexual encounters.

97

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Examining the Proposed Research Questions

This study attempted to answer the following two research questions: 1) To what
extent does acculturation level lead to different HIV sexual risk behaviors? and 2) How
does acculturation level contribute to these differences. In order to answer these
questions, an AN COVA and several regression analyses (i.e., logistic and hierarchical)
were conducted. To check for a normal distribution of the data, frequencies, means and
standard deviations for all demographic and survey items were performed. Histograms
and scatter plots were also conducted to evaluate the normality of the variables used in
these analyses.

Since education, as with prior research (Mikawa et al., 1992), was found to be
positively related to the use of condoms (r=.21, p<.05), it was covaried from the
subsequent analyses where the use of condoms was the outcome variable. This decision
was made to better understand the predictors of condom use, above and beyond the
variance due to education level.

Differences in HIV Sexual Risk Behaviors Due to Acculturation Level
Hypothesis 1a

The first hypothesis proposed that less acculturated Mexican and Mexican-
American women were less likely to use condoms than more acculturated women of
Mexican descent. In order to test this hypothesis, an AN COVA was conducted with the
yearly use of condoms as the outcome variable, the categorical acculturation score as a
predictor, and education as a covariate. Although significant results emerged, they were

contrary to the hypothesis. Even after controlling for education [F(1 ,89) = 12.46, p<.01],

100

the analysis resulted in a significant effect of acculturation level on condom use [F(2, 89)
= 6.74, p<.01] (see Table 36). Post hoc analysis (i.e., Tukey-HSD) demonstrated that
significant differences (mean difference =.54, p<.05) existed between women that were
highly acculturated (Mean = 1.63) and women that were less acculturated (Mean = 2.17),
with lower levels of acculturation being associated with more condom use.

Table 36

Analysis of Covariance of Yearly Condom Use

 

 

 

Source of Variance SS df MS F (92
Education 4.46 1 4.46 12.46* .1 1
Acculturation 4.82 2 2.41 6.74* .1 1
Explained 7.05 3 2.35 6.57* .16
Residual 30.76 86 .36
Total 37.82 89 .43

* p<.01

Similar results emerged in a second AN COVA which used the recent condom
use score as the outcome variable, the categorical acculturation score as a predictor, and
education as a covariate. Even after controlling for education [F (1, 89) = 7.89, p<.01],
the analysis resulted in a significant effect of acculturation level on condom use [F(2, 89)
= 2.19, p<.05] (see Table 37). The results from these analyses suggest that less
acculturated and highly educated Mexican and Mexican-American are more likely to be
in sexual relationships where condoms are used compared to highly acculturated and less

educated women of Mexican descent.

101

Table 37

Analysis of Covariance of Recent Condom Use

 

 

 

Source of Variance SS df MS F (1)2
Education 4.89 1 4.89 7.89* .07
Acculturation 4.40 2 2.20 3.55" .05
Explained 7.06 3 2.35 3.79* .09
Residual 53.35 86 .62
Total 60.40 89 .68

* p<.01

** p<.05

The results do not support the proposed hypothesis and contradict the findings of
previous research which have found a positive relationship between acculturation and
condom use (e.g., Ford & Norris, 1993a; Marin & Flores, 1994; Marin, Tschann et al.,
1993; Sabogal et al., 1995). In order to better understand this contradictory finding,
additional analyses were conducted to interpret these results. Given that other studies
have found that using other forms of birth control reduces the likelihood that a woman
and her partner will use condoms (Gomez & Marin, 1996; Maticka-Tyndale, 1991),
frequencies on birth control type by level of acculturation were conducted. Although no
significant differences emerged between acculturation groups, the frequencies did reveal
that 50% of the highly acculturated women tended to use other forms of birth control
(e. g., birth control pills, Depro Provera, etc.), suggesting that the use of other forms of

contraception may interfere with the use of condoms. (see Table 38).

102

Table 38

Type of Contraception Across Acculturation Groups

 

 

 

Acculturation (%)
Less Moderately High
(n=1 8) (n=5 6) (n=1 6)
Contraception beside condoms 22 29 50
(e.g., birth control pills)
Only use condoms 61 50 31
Currently not using contraception 17 21 19

 

Hyp_othesis 1b

The second hypothesis proposed by this study was that as a Mexican or Mexican-
American woman’s level of acculturation increased, she was more likely to engage in
anal sex. This hypothesis was examined by conducting a logistic regression with anal sex
as the dependent variable, and the linear acculturation score as the independent variable.
The results from this analysis supported the hypothesis. Highly acculturated Mexican
and Mexican-American women are more likely to engage in anal sex than less

acculturated women (pseudo-Rz=.Ol , p <.05)5 (see Table 39).

 

5 Since these are logistic regressions, the standard R2 is not appropriate. However, in

SPSS, a pseudo-R is provided (SPSS Manual, 1994), and the square of that is
analogous to the R2 statistic.

103

Table 39

Logistic Reggession Analysis of Engaging in Anal Sex

 

 

 

Variables B Wald Exp (B) pseudo-R2 x2
Acculturation .46 3.59 1.58 .01* 3 .78*
Constant -.62 7.50

* p.<05

Hyppthesis 1c

This study also hypothesized that as a Mexican or Mexican-American woman’s
level of acculturation increased, she was more likely to have multiple sexual partners. A
logistic regression was performed to test this relationship. The predictor was
acculturation (i.e., linear score), and the outcome was multiple sexual partners. The
analysis indicated that there was no significant relationship between acculturation level
and multiple sexual partners (pseudo-Rzr-00, p<.34).

Direct Predictors of Religion, Sexual Gender Norms and the Use of Alcohol

In order to evaluate the first half of the conceptual model, hierarchical
regressions were conducted to examine the impact of acculturation level on religion and
participant’s sexual gender norms. In addition, a hierarchical regression was performed
to test the relationship between gender norm incongruency and the use of alcohol.
Hypothesis 2a

This study proposed there would be a negative relationship between acculturation
level and religiosity. A standard hierarchical regression was conducted to test this
hypothesis. The linear acculturation score was the independent variable and level of

religiosity was the dependent variable. The regression results indicated that

104

acculturation level was not significantly related to level of religiosity ([3= -.10, t=-.93,
p<.35).
Hyppthesis 2b

In addition, this study hypothesized that highly acculturated Mexican and
Mexican-American were less likely be fate oriented than less acculturated women. To
examine this relationship, a hierarchical regression was conducted with acculturation
level (i.e., the linear acculturation score) as the independent variable and fate orientation
as the dependent variable. Acculturation level was not significantly related to fate
orientation ([3=.13, F120, p.<.23). The results do not support the hypothesis that
acculturation level predicts fate orientation.
Hyppthesis 2c

It was also hypothesized that as Mexican and Mexican-American women
acculturated to American culture, they were more likely to adopt liberal sexual gender
norms. A hierarchical regression, with acculturation level as the independent variable
and sexual gender norms as the dependent variable, was utilized to test this hypothesis.
The regression results support the hypothesis that highly acculturated Mexican and
Mexican-American women are more likely to have non-traditional sexual gender norms
than less acculturated women (B=.46, t=4.81, p<.01).
Hymthesis 2d

Moreover, this study hypothesized that there would a positive relationship
between gender norm incongruency and the use of alcohol. Separate multiple regressions

were conducted for the two alcohol use scores. A logistic regression was conducted to

105

test this relationship with the recent alcohol use score as the outcome (i.e., their use of
alcohol prior to sex across their last four sexual encounters) and gender norm
incongruency as the predictor. The regression results indicate that gender norm
incongruency was not significantly related to whether or not a Mexican or Mexican-
American woman drank alcohol before her most recent sexual encounters (pseudo-
R’=.00, p<.91). A second analysis using hierarchical regression was performed to
investigate this relationship with the yearly use of alcohol score (i.e., the frequency of
alcohol use before sex in the last year). Similar findings emerged. Gender norm
incongruency was not related to the yearly use of alcohol (fl=.05, p<.60). These findings
suggest that feelings of conflict over sexual gender norms are not related to Mexican and
Mexican-American women drinking alcohol before sexual intercourse.

Given that alcohol use prior to sexual intercourse can potentially lead to risky
sexual behaviors (F lores-Ortiz, 1994) and that previous research has found an
association between acculturation level and alcohol use (e. g., Flores & Marin, 1994), this
relationship was explored by examining the correlation between degree of acculturation
(i.e., the linear score) and yearly alcohol use. The correlation was positive and significant
(r=.22, p<.05), suggesting that as Latinas acculturate to American culture, they are more
likely to drink alcoholic beverages before having sex.

Direct Predictors of Rislgg Sexual Behaviors

In order to evaluate the second half of the conceptual model (see Figure 1),

multiple regressions were performed to examine the impact of a woman’s sexual gender

norms and religion on her risky sexual practices.

106

Hypothesis 2e

This hypothesis proposed that as a woman’s level of religiosity increased, she
was less likely to be in a relationship where condoms were used during vaginal
intercourse. To address this hypothesis, a hierarchical regression was conducted with the
yearly use of condoms as the dependent variable, level of education as the covariate in
block one, and religiosity as the predictor in block two. The regression results from this
analysis (B=.07, t=.73, p<.46) do not support the hypothesis. Similar results emerged
when conducting a second hierarchical regression with the recent condom use score as
the outcome variable, level of education as the covariate in block one, and religiosity as
the predictor in block two. The findings indicate that level of religiosity is not related to
the use of condoms (B=.01, t=.07, p<.94). This suggests that being religious is not
related to whether or not a women and her partner will use condoms.

Hymthesis 2f

This study also proposed that Mexican and Mexican-American women with a
greater fate orientation were less likely to be in a relationship where condoms were used
during vaginal intercourse. Separate hierarchial regressions were conducted to examine
the relationship between fate orientation and the two use of condom scores. The first
regression utilized hierarchical regression with the yearly use of condoms as the
outcome variable, level of education as the covariate in block one, and fate orientation as
the predictor in block two. The findings indicated that even after controlling for
education ([3=.20, t=2.11, p<.05), fate orientation was negatively related to the yearly use

of condoms (B=-.27, t=-2.79, p<.01). The second hierarchical regression using the recent

107

condom use score as the outcome variable indicated a trend that fate orientation was
negatively related to the use of condoms ([3=-. 16, t=-1.65, p<.10). These findings suggest
that women who have a greater fate orientation (i.e., believe that God control’s their
destiny) are less likely to be in sexual relationships where condoms are used.
Hypothesis 2g

This study also hypothesized that as a Mexican or Mexican-American woman’s
level of religiosity increased, she was less likely to engage in anal sex. A logistic
regression was conducted which included religiosity as the predictor and anal sex as the
outcome. The regression results indicated that there was no significant relationship
between religiosity and engaging in anal sex (pseudo-Rz=.OO, p<.7l). The regression
results suggest that a woman’s level of religiosity has no bearing on whether or not she
engages in anal sex with her partner.
Hymthesis 2h

Furthermore, this study hypothesized that highly religious women were less
likely to have multiple sexual partners than women that were less religious. A logistic
regression was conducted which included multiple partners as the outcome and
religiosity as the predictor. The findings demonstrate that religiosity is not significantly
related to having multiple sexual partners (pseudo-REDO, p<.75). The findings suggest
that level of religiosity does not impact a woman’s decision to have multiple sexual

partners.

108

Hyp_othesis 2i

It was also hypothesized that Mexican and Mexican-American women with
liberal sexual gender norms were more likely to be in relationships where condoms were
used than women with traditional sexual gender norms. To test this hypothesis, separate
hierarchical regressions were performed for each condom use score. The first
hierarchical regression included two blocks. The first block included education as a
covariate, the second block included sexual gender norms with the recent condom score
as the outcome. This analysis revealed that even afier controlling for education (B=.09,
t=.76, p<.45), liberal sexual gender norms were positively related to the recent use of
condoms ([3=.25, t=2.10, p<.05). Furthermore, a similar hierarchical regression analysis
with yearly use of condoms included as the outcome variable suggest there is a weak
relationship between sexual gender norms and the use of condoms (B=.20, t=1.71,
p<.09). These findings support the hypothesis that as a woman adopts more liberal
sexual gender norms, she is more likely to be in a sexual relationship where condoms are
used.

Hymthesis 21'

Moreover, this study proposed that there would be a positive relationship
between sexual gender norms and anal sex. This hypothesis was examined by
conducting a logistic regression with anal sex as the dependent variable and sexual
gender norms as the independent variable. The analysis indicated that there was no

relationship between sexual gender norms and anal sex (pseudo-REDO, p<.45).

109

Hyppthesis 2k

In addition, this study hypothesized that sexual gender norms would be positively
related to a woman having multiple sexual partners. In order to test this hypothesis, a
logistic regression was conducted with multiple sexual partners as the dependent
variable and sexual gender norms as the independent variable. The results indicate that a
woman’s sexual gender norms are not related to whether or not a woman has multiple
sexual partners (pseudo-R2300, p<.87).

Mediating Relationships

In order to test the mediating hypotheses in this study, a sequence of regressions
were conducted using Baron and Kenny’s (1986) procedure for examining mediating
relationships. Specifically, three regressions were performed to assess mediation
between various predictor variables and outcome variables. The first regression analysis
regressed the mediator onto the predictor variable, the second regressed the outcome
variable onto the predictor, and the last regressed the outcome variable on both the
predictor and mediator. According to Baron and Kenny (1986), mediation occurs when
the regression coefficients from the first two regressions are found to be significant, and
in the third regression the mediating variable remains significant, even after the predictor
variable is entered into the regression equation. Additionally, in the third regression, the
beta coefficient between the predictor and outcome variable should decrease, and
become insignificant in the presence of the mediator. If all three criteria are met, full

mediation has occurred.

110

scrim

The conceptual model for this study speculated that religious orientation would
mediate the relationship between acculturation level and risky sexual behaviors. In
particular, this model proposed that religiosity would mediate between three
relationships: (1) acculturation level and use of condoms, (2) acculturation level and anal
sex, and (3) acculturation level and multiple sexual partners. In addition, fate orientation
would mediate the relationship between acculturation level and the use of condoms. A
series of multiple regressions were conducted to test these mediating relationships.

Hypothesis 21: Level of Religiosig. To test the mediating potential of religiosity
between acculturation level and the yearly use of condoms, a set of hierarchical
regressions were performed. Table 40 contains the standardized and unstandardized
regression coefficients, t-tests, R2 and F test for the regression analyses examining the
mediating effect of religiosity between acculturation level and the yearly use of
condoms. The findings do not provide evidence for mediation as only one of the three
criteria was met. Acculturation level was negatively related to the yearly use of
condoms (B=—.27, t“= -2.48, p<.01). Acculturation level was not related to religiosity
([3=-.10, t=-.93, p.<.35) and religiosity was not related to the yearly use of condoms
(B=.05, F48, p<.63). The findings suggest that religiosity does not mediate the
relationship between acculturation level and the yearly use of condoms.

Another series of regressions were conducted to investigate if religiosity explains
how acculturation level influences the recent use of condoms. The standardized and

unstandardized regression coefficients, t-tests, R2 and F test for this set of regression

111

analyses can be found in Table 41. The results from these regressions demonstrate that
level of religiosity does not mediate the relationship between acculturation level and the
recent use of condoms. Specifically, two of the three criteria needed for mediation were
not met; acculturation level was not related to religiosity ([3=-.10, t=-.93, p.<.35) and
religiosity was not related to the recent use of condoms ([3=-.02, p<.87). While
acculturation level was related to the recent use of condoms (B=—.28, F253, p<.01), it
was in the opposite direction of that hypothesized. The findings suggest that level of
religiosity does not mediate the relationship between acculturation level and the recent
use of condoms.

Table 40

Mediation Effect of Religiositv on the Yearly Use of Condoms

 

 

 

Outcome, Covariate and Predictors B B t R2 F
Step 1
Outcome: Religiosity
Predictor: Acculturation -.07 -.10 -.93 .10 .87
Step 2
Outcome: Yearly Use of Condoms
Covariate: Education .08 .35 3.21 "‘ * . 13 6.34" *
Predictor: Acculturation -.19 -.28 -2.61**
Step 3
Outcome: Yearly Use of Condoms
Covariate: Education .08 .33 3.03”“ "' .13 4.28* *
Predictor: Acculturation -.18 -.27 -2.48**
Religiosity .05 .05 .48
* p<.05, ** p<.01

112

Table 41

Mediation Effect of Religiosig on the Recent Use of Condoms

 

 

 

Outcome, Covariate and Predictors B B t R2 F
Step 1
Outcome: Religiosity
Predictor: Acculturation -.07 -. 10 -.93 . 10 .87
Step 2
Outcome: Recent Condom Use
Covariate: Education .09 .3 1 2.87“ * .1 l 5.42“ *
Predictor: Acculturation -.24 -.28 -2.56**
Step 3
Outcome: Recent Condom Use
Covariate: Education .09 .32 2.82" .1 l 3.58"
Predictor: Acculturation -.24 -.28 -2.53**
Religiosity -.02 -.02 -.17
*p<.01, ** p<.05

Hypothesis 2m : Fate Orientation. A series of multiple regressions were

conducted to test Hypothesis 2m which pr0posed that fate orientation would mediate the

relationship between acculturation level and use of condoms. Separate analyses were

performed for each condom use score (i.e., yearly and most recent condom use). Table

42 contains the standardized and unstandardized regression coefficients, t-tests, R2 and F

test for the regression analyses examining the mediating effect of fate orientation

between acculturation level and the yearly use of condoms. The results demonstrate that

fate orientation does not mediate the relationship between acculturation level and the

yearly use of condoms. Of the three criteria needed to support mediation, only two were

met. A woman’s level of acculturation was not significantly related to fate orientation

113

([3=.l3, p<.23). However, even after controlling for education ([5=.30, t=2.79, p<.01),

both fate orientation (B=—.25, t=-2.52, p<.01) and acculturation level (B=-.23, t=-2.17,

p<.05) were negatively related to the yearly use of condoms. Although fate orientation

did not mediate the relationship between acculturation level and the yearly use of

condoms, the results suggest that Mexican and Mexican-American women that are

highly acculturated or strongly fate oriented are less likely to be in sexual relationships

where condoms are used.

Table 42

Mediation Effect of Fate Orientation on Yearly Use of Condoms

 

 

 

Outcome, Covariate and Predictors B B t R2 F
Step 1
Outcome: Fate Orientation
Predictor: Acculturation .08 .13 1.20 .02 1.45
Step 2
Outcome: Yearly Use of Condoms
Covariate: Education .08 .35 3.21* .13 6.34“
Predictor: Acculturation -. 19 -.28 -2.61 *
Step 3
Outcome: Yearly Use of Condoms
Covariate: Education .07 .30 2.79* .19 6.60*
Predictor: Acculturation -.28 -.25 -2.52*
Fate Orientation -16 -.23 -2.17*
* p<.01

Another series of hierarchical regressions were conducted to investigate fate

orientation as a mediator between acculturation level and the recent use of condoms.

Table 43 contains the standardized and unstandardized regression coefficients, t-tests, R2

114

and F test for the regression analyses examining the mediating effect of fate orientation
between acculturation level and the recent use of condoms. The regression results do not
support the hypothesis that fate orientation mediates the relationship between
acculturation level and the recent use of condoms. Only one of the three conditions
needed for mediation was present; acculturation level was negatively related to the
recent use of condoms (0=-.25, t=-2.28, p<.05). A woman’s level of acculturation was
not significantly related to fate orientation (B=.13, p<.23) nor was fate orientation
related to the recent use of condoms (B=-. l 3, t=-1.28, p<.20). The findings suggest that
fate orientation does not mediate the relationship between acculturation level and the
recent use of condoms, but acculturation negatively impacts the use of condoms.
Hypothesis 2n. Multiple regressions were used to test hypothesis 2n which stated
that religiosity would mediate the relationship between acculturation level and anal sex.
Table 44 includes the regression results from these analyses. The findings reveal that two
of the three requirements needed for mediation were not present. Acculturation level
was not found to be significantly associated with level of religiosity (B=—.10, p.<.35) and
level of religiosity was not found to be significantly associated with whether or not a
woman engaged in anal sex (pseudo-REDO, p<.88). Acculturation level was found to
predict anal sex (pseudo-RED] , p<.05). The results suggest that religiosity does not

mediate the relationship between acculturation level and anal sex.

115

Table 43

Mediation Effect of Fate Orientation on Recent Use of Condoms

 

 

 

Outcome, Covariate and Predictors B [3 t R2 F
Step 1
Outcome: Fate Orientation
Predictor: Acculturation .08 .13 1.20 .02 1.45
Step 2
Outcome: Recent Condom Use
Covariate: Education .09 .31 2.87* .11 5 .42*
Predictor: Acculturation -.24 -.28 -2.56"‘
Step 3
Outcome: Recent Condom Use
Covariate: Education .09 .29 2.59“ .13 4.18*
Predictor: Acculturation -.22 -.25 -2.28*
Fate Orientation -19 -.13 -l .28
* p<.05

Hymthesis 20. A series of multiple regressions were conducted to test hypothesis

20 which proposed that religiosity would mediate the relationship between acculturation

level and multiple sexual partners. The results from these analyses can be found in Table

45. The results demonstrate that religiosity does not mediate the relationship between

acculturation level and multiple sexual partners. None of the three criteria needed to

support mediation were met; Acculturation level was not related to multiple sexual

partners (pseudo-R’=.00, p<.34), acculturation level was not related to religiosity (B=—

.10, p.<.35) and religiosity was not related to multiple partners (pseudo-R’aOO, p<.92).

The findings indicate that neither acculturation level or religiosity predict that a woman

having multiple sexual partners.

116

Table 44

Mediation Effect of Religiosig on Anal Sex

 

 

 

 

 

Outcome, Covariate and Predictors B [3 t R2 F
Step 1
Outcome: Religiosity
Predictor: Acculturation -.07 -.10 -.93 .10 .87
B Wald Exp(B) pseudo-R2 2;”
Step 2
Outcome: Anal Sex .46 3.59 1.58 .01* 3.78“
Predictor: Acculturation
Step 3
Outcome: Anal Sex
Predictor: Acculturation .45 3.49 1.58 .01* .02
Religiosity -.05 .02 .95 .00
* p<.05

Summm of Religion. In summary, the regression analyses do not provide

evidence that either fate orientation or level of religiosity mediate the relationship

between acculturation level and the use of condoms. However, the findings do suggest

though that fate orientation is directly linked to the use of condoms (i.e, the yearly use of

condoms), with women that are strongly fate oriented being less likely to be in

relationships where condoms are used. Moreover, the regression analyses do not provide

evidence that level of religiosity mediates the relationship between acculturation level

and engaging in anal sex or between acculturation level and multiple sexual partners.

ll7

Table 45

Mediation Effect of Religiosig on Multiple Partners

 

Outcome, Covariate and Predictors B [S t R2 F

 

Step 1

Outcome: Religiosity
Predictor: Acculturation -.07 -.10 -.93 .10 .87

B Wald Exp(B) pseudo-R2 X2

 

 

Step 2

Outcome: Multiple Partners

Predictor: Acculturation .23 .91 1.26 .00 .92

Step 3

Outcome: Multiple Partners

Predictor: Acculturation .23 .85 1.25 .00 .05
Religiosity —.08 .05 .92 .00

 

Sexual Gender Norms

Another component of this study’s conceptual model proposed that a woman’s
sexual gender norms would mediate the relationship between acculturation level and
risky sexual behaviors. Specifically, this model hypothesized that a woman’s sexual
gender norms would mediate the relationships between: (1) acculturation level and use
of condoms, (2) acculturation level and anal sex, and (3) acculturation level and multiple
sexual partners. In order to address these hypothesizes, a set of multiple regressions

were conducted. Separate analyses were conducted for each condom use score.

118

Hypothesis 2p. This hypothesis theorized that a woman’s sexual gender norms
would mediate the relationship between acculturation level and the use of condoms. A
series of regressions were performed for each condom use score. The first set of
regressions tested the hypothesis using a woman’s recent condom use score. The
unstandardized and standardized regression coefficients, t-tests, R2, and F tests for this
mediating analyses can be found in Table 46. The findings provide support for partial
mediation. Acculturation level was negatively related to the recent use of condoms (B=-
.37, t=-3.46, p<.01) and was positively related to a woman’s sexual gender norms
(B=.46, t=4.8 l , p<.01). A woman’s sexual gender norms were positively related to the
recent use of condoms ([3=.36, t=3.l2, p<.01). The results suggest that highly
acculturated women are less likely to use condoms than less acculturated women and are
more likely to have liberal sexual gender norms. Moreover, women with liberal sexual
gender norms are more likely to be in sexual relationship where condoms are used than
women with traditional sexual gender norms. Furthermore, when both acculturation
level and a woman’s sexual gender norms were entered into the regression equation,
acculturation level continued to remain significant and surprisingly increased in strength
([3=-. 37, t=-3.46, p<.01). The findings demonstrate that not only does a woman’s sexual
gender norms partially mediate the relationship between acculturation level and the
recent use of condoms, but a cooperative suppressor relationship also exists (Cohen &

Cohen, 1975).

119

Table 46

 

 

 

Mediation Effect of Sex Gender Norms on th Recent s f on oms
Outcome, Covariate and Predictors B [3 t R2 F
Step 1
Outcome: Sexual Gender Norms .31 .46 4.81 .21 23.15“
Predictor: Acculturation
Step 2
Outcome: Recent Condom Use
Covariate: Education .09 .31 2.87* .11 5.42*
Predictor: Acculturation -.24 -.28 -2.56*
Step 3
Outcome: Recent Condom Use
Covariate: Education .05 .17 1.52 .20 7.22*
Predictor: Acculturation -.32 -.37 -3.46*
Sexual Gender Norms .38 .36 3.12”“
*p<.01

According to Cohen and Cohen (1975), two factors denote the presence of

cooperative suppression. First, the independent variables are positively correlated with

one another, and one independent variable is negatively correlated to the dependent

variable and the remaining independent variable is positively correlated to the dependent

variable. Alternatively, the two independent variables are negatively correlated to one

another and are positively correlated to the dependent variable. Second, each

independent variable accounts for more variance in the dependent variable when it is in

the presence of the other independent variable “than it does alone” (p.91). In other

words, partialing out the variance of X2 fi'om X: that is not related to Y, allows for X: to

better predict Y. In the same fashion, partialing out the variance of X1 from X: that is not

120

related to Y, allows for X2 to better predict Y. This pattern can be identified by
examining the correlations between the independent variables and the dependent
variable, with the [3 of the independent variables once they have been entered into the
same regression equation. Specifically, cooperative suppression is present if the [3 of
each independent variable increases in “magnitude” from its zero-order correlation with
the dependent variable.

In the present study both criteria were met and assist in explaining the
contradictory results found when investigating the mediating effect of sexual gender
norms on the relationship between acculturation level and the recent use of condoms.
First, a correlation matrix of the three variables (with education partialed out) indicated
that acculturation level was negatively correlated to the recent use of condoms (r=-.26,
p<.01). Sexual gender norms were positively correlated to both the recent use of
condoms (r=.22, p<.05) and acculturation level (r=.29, p<.01). Second, the relationships
between the independent variables and the dependent variable increased in strength
when both acculturation level and sexual gender norms were entered into the regression
equation (See Table 47). The findings suggest that acculturation level and a woman’s
sexual gender norms serve as cooperative suppressors. In other words, when the variance
due to acculturation level that is not related to the use of condoms is partialed out from a
woman’s sexual gender norms, a woman’s sexual gender norms better predicts the use of
condoms. Similarly, partialing out the variance of a woman’s sexual gender norms that is
not related to the use of condoms from acculturation level, allows for acculturation level

to better predict the use of condoms.

121

Table 47

Indicators of Cooperative Suppression for Hymthesis 2p: Recent Condom Use Score

 

 

 

Correlations‘ 0
Independent and Dependent Variables 1 2 3 Use of Condoms
1 . Acculturation 1.00 .29* -.26* -.37*
2. Woman’s Sexual Gender Norms 1.00 .22* .36“
3. Recent Use of Condoms 1.00

 

* p<.05

Another series of regressions were executed to test if a woman’s sexual gender
norms mediates the relationship between acculturation level and the yearly use of
condoms. Table 48 contains the unstandardized and standardized regression coefficients,
t-tests, R2, and F tests for these regression analyses. Similar to the findings with the
recent use of condoms, the results provide support for partial mediation. Even after
controlling for education ([3=.34, t=3.21, p<.01), acculturation level was negatively
related to the yearly use of condoms (B=—.36, t=-3.36, p<.01). Acculturation level was
positively related to a woman’s sexual gender norms ([3=.46, t=4.8], p<.01) and a
woman’s sexual gender norms were positively related to the yearly use of condoms
(0=.31, t=2.70, p<.01). As with the previous findings (i.e., the mediating influence of
sexual gender norms on acculturation level and the recent use of condoms), the results
from these analysis reveal the presence of cooperative suppression. The two criteria

necessary for cooperative suppression to occur were present (see Table 49).

 

6 Education was partialed out of these correlations.

122

Hypothesis 2g. This study also hypothesized that a woman’s sexual gender norms
would mediate the relationship between acculturation level and whether or not a woman
engaged in anal sex. In order to address this hypothesis, a series of multiple regressions
were conducted. Table 50 includes the regression results from these analyses. Only two
of the three necessary criteria for mediation were present. Acculturation level was found
to be positively related to a woman’s sexual gender norms (B=.46, t=4.8], p<.01) and to
a woman having anal sex (pseudo-Rz=.OB, p<.01). A woman’s sexual gender norms were
not significantly related to a woman having anal sex (pseudo-R‘aOO, p<.11). The results
demonstrate that sexual gender norms do not mediate the relationship between
acculturation level and anal sex. However, the results do suggest that highly acculturated

women are more likely to engage in anal sex and have liberal sexual gender norms.

123

Table 48

Mediation Effect of Sexual Gender Norms on the Yearly Use of Condpms

 

 

 

Outcome, Covariate and Predictors B D t R2 F
Step 1
Outcome: Sexual Gender Norms .31 .46 4.81 .21 23.15"“
Predictor: Acculturation
Step 2
Outcome: Yearly Use of Condoms
Covariate: Education .08 .35 3.21* .13 6.34*
Predictor: Acculturation -.19 -.28 -2.61*
Step 3
Outcome: Yearly Use of Condoms
Covariate: Education .05 .22 1.97” .20 6.96*
Predictor: Acculturation -.24 -.36 -3.36*
Sexual Gender Norms .26 .31 2.70*
*p<.01, "p<.05
Table 49

Indicators of Coopgrative Suppression for Hymthesis 2g: Yearly Use of Condoms

 

Independent and Dependent Variables

 

 

l . Acculturation

2. Woman’s Sexual Gender Norms

3. Yearly Use of Condoms

Correlations8 0
1 2 3 Use of Condoms
1.00 .29* -.27* -.36*
1.00 .18” .31*
1.00

 

*p<.01, "p<.05

 

8 Education was partialed out of these correlations.

124

Table 50

Mediating Effect of Sexual Gender Norms on Anal Sex

 

 

Outcome, Covariate and Predictors B [5 t R2 F
Step 1
Outcome: Sexual Gender Norms .31 .46 4.81 .21 23.15*

Predictor: Acculturation

 

B Wald Exp(B) pseudo-R2 x’

 

Step 2

Outcome: Anal Sex

Predictor: Acculturation .46 3.59 1.58 .01" 3.78M
Step 3

Outcome: Anal Sex

Predictor: Acculturation .65 5.74 1.92 .03" 3.04

Sexual Gender Norms -.58 2.84 .56 .00

 

*p<.01, ** p<.05

Hymthesis 2r. Moreover, this study proposed that sexual gender norms would
mediate the relationship between acculturation level and multiple sexual partners.
Several multiple regressions were performed to test this hypothesis. The regression
results from these analyses can be found in Table 51. Of the three requirements needed
for mediation to occur, only one requirement was met; Acculturation level was found to
be positively related (to a woman’s sexual gender norms (B=.46, t=4.8l, p<.01). Neither
acculturation (pseudo-REDO, p<.34) nor a woman’s sexual gender norms (pseudo-
R’=.00, p<.80) were significantly related to a woman having multiple sexual partners.
The findings indicate that a woman’s sexual gender norms do not mediate the

relationship between acculturation level and multiple sexual partners.

125

Table 51

Mediating Effect of Sexual Gender Norms on Multiple Sexual Partners

 

 

 

 

Outcome, Covariate and Predictors B [3 t R2 F
Step 1
Outcome: Sexual Gender Norms .31 .46 4.81 .21 23.15*
Predictor: Acculturation

B Wald Exp(B) pseudo-R2 x2
Step 2
Outcome: Multiple Sexual Partners .23 .91 1.26 .00 .92
Predictor: Acculturation
Step 3
Outcome: Multiple Sexual Partners
Predictor: Acculturation .26 .95 1.30 .00 .06

Sexual Gender Norms -.08 .06 .92 .00

 

Summm of Sexual Gender Norms. In summary, the findings reveal the presence

of cooperative suppression when examining the mediating effect of a woman’s sexual

gender norms on the relationship of between acculturation level and the use of condoms.

The results demonstrate a paradoxical effect of acculturation level on the use of

condoms; acculturation level has an indirect positive and a direct negative effect on the

use of condoms. First, the findings indicate that acculturation level is negatively related

to the use of condoms. Women that are highly acculturated are less likely to be in

relationships where condoms are used. Second, the results demonstrate that acculturation

level indirectly impacts the use of condoms through a woman’s sexual gender norms.

However, this relationship is positive; highly acculturated Mexican and Mexican-

126

American women are more likely to have liberal sexual gender norms and Mexican and
Mexican-American women who endorse liberal sexual gender norms are more likely to
be in relationships where condoms are used. Additionally, the results demonstrate that a
woman’s sexual gender norms do not mediate the relationship between acculturation and
anal sex or the relationship between acculturation and multiple sexual partners. Yet, the
findings do suggest that acculturation positively predicts whether or not a woman had
ever engaged in anal sex.
Moderating Relationships

The moderating relationships proposed in this study were examined by observing
the following procedures recommended by Baron and Kenny (1986). First, for those
predictors or moderators that were not already standardized or coded as dummy
variables, a new mean score was computed for those variables by subtracting the overall
mean of the variable from each participant’s mean score. The procedure is known as
centering and is performed to reduce multicollinearity between the independent variables
and the interaction term when entered into the regression equation. Second, an
interaction term was created for each hypothesis by multiplying the centered predictor
and the centered moderating variable. Third, a hierarchical regression was performed for
each hypothesis with education as the covariate in block one, both the predictor and
moderator in block two and the interaction term in block three. Fourth, if the interaction
term was significant when the dependent variable was regressed on all three variables
(i.e., predictor, moderator and interaction term), it was established that moderation had

occurred.

127

Hymthesis 23

Hypothesis 28 theorized that a partner’s sexual gender norms would moderate the
relationship between a woman’s traditional sexual gender norms and the use of condoms
during vaginal intercourse. While testing for moderation, a partner’s sexual gender
norms score was centered by subtracting the overall partner sexual gender norms mean
score from each participant’s mean score for their partner’s sexual gender norms. This
new score along with the participant sexual gender norms score (which was previously
standardized) were used to compute the interaction term. The standardized and
unstandardized regression coefficients, t-tests, R’, and F test for the recent use of
condoms can be found in Table 52. The results demonstrate that a partner’s sexual
gender norms do not moderate the effect that a woman’s sexual gender norms has on the
recent use of condoms. The interaction term for a woman’s sexual gender norms and a
partner’s sexual gender norms was not significant ([3=.07, p<.58). Yet, a woman’s sexual
gender norms remained significantly related to the recent use of condoms (B=.29, t=2.48,
p<.01).

Similar results emerge when using the yearly use of condoms score as the
dependent variable. Table 53 contains the standardized and unstandardized regression
coefficients, t-tests, R2, and F test for the hierarchical regression using the yearly use of
condoms. The interaction term for a woman’s sexual gender norms and a partner’s
sexual gender norms was non-significant ([3=.11, p<.30). Once again, the results reveal
that a woman’s sexual gender norms remain positively related to the use of condoms

(0:.20, t=2.l7, p<.05). Overall, the findings suggest that a partner’s sexual gender

128

norms does not moderate the relationship between a woman’s sexual gender norms and
the use of condoms. This indicates that women with liberal sexual gender norms are not

less likely to use condoms because their partners have traditional sexual gender norms.

Table 52

Moderating Effect of Partner’s Sexual Gender Norms on Recent Use of Condoms Score

 

Outcome, Covariate and Predictors B [3 t R2 F

 

Step 1

Outcome: Recent Condom Use
Covariate: Education .02 .08 .73 .11 294*
Predictor: Woman’s Sexual Gender Norms .29 .29 2.48"

Partner’s Sexual Gender Norms -.08 -.07 -.76

Interaction Term .07 .06 .56

 

*p<.05. ** p<.01
Table 53

Moderating Effect of Partner’s Sexufl Gen_de_r Norm_s_ on the Yearly Use of Condoms

 

 

 

Outcome, Covariate and Predictors B (3 t R2 F
Step 1
Outcome: Yearly Condom Use
Covariate: Education .03 .11 1.03 .12 3.06*
Predictor: Woman’s Sexual Gender Norms .20 .25 2.17*
Partner’s Sexual Gender Norms -.06 -.07 -.72
Interaction Term .10 .10 1.04
*p<.05
Hymthesis 2t

This study also proposed that the use of alcohol would moderate the relationship
between a woman’s sexual gender norms and anal sex. Although it had been the

researcher’s intent to test this relationship, analyses examining this relationship were not

129

conducted due to the method used to score anal sex and the use of alcohol. A score for
anal sex was computed by examining one question which asked participants whether or
not they had ever engaged in anal sex. The use of alcohol scores were computed for two
time periods: across four dates and yearly use of alcohol before sex. Considering that the
scores captured different time frames, analyses using these scores would result in
erroneous conclusions. Subsequently, this hypothesis was not examined.
Hymthesis 2u

A hierarchical regression was conducted to examine the moderating effect of
alcohol use on the relationship between a woman’s sexual gender norms and multiple
sexual partners. If alcohol use moderates a woman having multiple sexual partners, then
the interaction effect between the yearly use of alcohol and a woman’s sexual gender
norms must be significant when multiple sexual partners is regressed on all three
variables (i.e., yearly use of alcohol, woman’s sexual gender norms and the interaction
term). Table 54 includes the standardized and unstandardized regression coefficients, t-
tests, R2, and F test for this regression. These findings indicate that the use of alcohol
does not moderate the effect of a woman’s sexual gender norms on multiple sexual
partners. The interaction term was not significant (pseudo-Rz=00, p<.60). However, the
results do demonstrate that the use of alcohol is directly related to whether or not a
woman has multiple sexual partners (pseudo-R2203, p<.01). This suggests that women

who drink more frequently before sex are more likely to have multiple partners.

130

Table 54

Moderating Effect of Yearly Alcohol Use on Multiple Sexual Partners

 

 

Outcome, Covariate and Predictors B Wald Exp(B) pseudo-R2 )6
Step 1
Outcome: Multiple Sexual Partners
Predictor: Woman’s Sexual Gender .11 .11 1.19 .00 .28
Norms 1.07 5.04 2.93 .03“
Yearly Alcohol Use -.29 .28 .75 .00

Interaction Term

 

*p<.01
Discussion

The findings from this study reveal a more complex relationship, than originally
conceived, between acculturation level and risky sexual practices. Specifically,
acculturation was found to have direct and indirect influences on risky sexual behavior.
For example, while acculturation level was negatively related to the use of condoms,
and when a key mediator was introduced, sexual gender norms, the indirect impact of
acculturation level on condom use was positive. More specifically, highly acculturated
Mexican and Mexican-American women were less likely to be in sexual relationships
where condoms were used. However, revealing the complexity of the relationship
between acculturation level and condom use, Mexican and Mexican-American women
who were more highly acculturated were more likely to have liberal sexual gender
norms, and women with liberal sexual gender norms were more likely to be in sexual
relationships where condoms were used. In addition, while more highly acculturated
women were less likely to use condoms, they were more likely to have engaged in anal

sex at least once, compared to less acculturated women. Highly acculturated women

131

were also more likely to use alcohol before sexual intercourse. This is particularly
concerning because women who used alcohol before engaging in sexual intercourse were
more likely to have multiple sexual partners. The results from this study suggest
prevention strategies must vary with acculturation level to be useful in preventing the
sexual transmission of HIV among women of Mexican descent.

Furthermore, the findings from this study support Marin’s (1993) claim that the
key factor in the development of culturally appropriate interventions is the identification
of cultural beliefs and norms that influence the “targeted” behavior of change. In
addition to sexual gender norms, Mexican and Mexican-American women with a strong
fate orientation were less likely to be in sexual relationships where condoms were
frequently used. This information allows for the creation of intervention strategies that
incorporate the group’s cultural values, creating a greater opportunity for successful
intervention because it is based on the “group’s subjective culture” (p. 155). While
additional research is necessary to better understand the factors that place Mexican and
Mexican-American women at sexual risk for HIV, this study provides a first step in this
process.

To What Extent Does Acculturation Level Lead to
Different HIV Sexual Risk Behaviors?

The results of the present study both contradict and support prior findings on the
risky sexual practices of Latinas. Previous studies on Latinas demonstrate that different
acculturation levels lead to different risky sexual behaviors. For example, less

acculturated Latinas were less likely, than highly acculturated Latinas, to be in sexual

132

relationships where condoms were used (Ford & Norris, 1993a; Marin & Flores, 1994;
Marin, Tschann et al., 1993; Sabogal et al., 1995). Further, highly acculturated Latinas
were more likely, than less acculturated Latinas, to engage in anal sex and/or have
multiple partners, compared to less acculturated Latinas (e.g., Marin & Flores, 1994;
Sabogal et al., 1995). Although this study does provide evidence supporting some of
these relationships, it also contradicts a well-established finding in the literature.
Use of condoms

Contrary to prior research (Ford & Norris, 1993a; Marin & Flores, 1994; Marin,
Tschann et al., 1993; Sabogal et al., 1995), the results of this study suggest that highly
acculturated Mexican and Mexican-American women were less likely, than less
acculturated women, to be in sexual relationships where condoms were used (see
Appendix A - Figure 3). A possible explanation for this finding is that highly
acculturated women may choose a form of contraception they have control over, which
inadvertently places them at sexual risk for HIV (Gomez & Marin, 1996). In the current
study, 63% of the highly acculturated women used a form of contraception that was their
responsibility (i.e., birth control pills and Depro Provera) compared to 33% of the less
acculturated women. This suggests that highly acculturated Mexican and Mexican-
American women may effectively reduce the likelihood of pregnancy, while increasing
their risk for the transmission of HIV and sexually transmitted diseases.

Another possible explanation is citizenship status. Given the current trend of

xenophobia in California (Romero, Wyatt, Chin & Rodriguez, 1998), and the unique

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immigrant experience of Mexicans7, citizenship status may play an important role in
determining what type of birth control these women can access (Romero et al., 1997).
For example, Mexican women may not have access to jobs that provide them with the
income to pay for contraception such as Depro Provera or birth control pills. Further, an
undocumented Mexican woman may not utilize the local public health clinic, which
provides a sliding scale fee for contraception, because of fear that she will be reported to
the INS (Immigration and Naturalization Services), and deported back to Mexico.
Therefore, Mexican women may rely upon the local pharmacy or grocery store for
contraception that is sold over the counter such as condoms and spermicide, which she
or her partner can purchase for a minimal cost, and without fear of being deported.

Since the use of condoms can reduce the likelihood of becoming sexually
infected with HIV (e. g., Hinojos, 1990), future research should investigate what factors
contribute to a woman’s decision to choose a particular form of birth control.
Specifically, researchers should ask about personal (e. g., control over contraception,
prevention of STDs, health factors, etc.) and external factors (e. g., cost, access to birth
control, partner’s reaction, etc.) that influence this decision. This may provide a critical
piece of information that can improve current HIV prevention efforts with highly

acculturated Mexican and Mexican-American women.

 

Compared to other Latino subgroups, Mexicans tend to immigrate to the United
States due to the poor economic conditions in Mexico, and come to this country
seeking employment opportunities. They also tend to enter the United States without
the proper documentation (F emandez Kelly, 1997; Romero et al., 1997).

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Consistent with previous research, this study also found that highly educated
women were more likely to be in sexual relationships where condoms were used
(Mikawa et al., 1992), and tended to be highly acculturated (e.g., Marin & Marin, 1991).
These findings may seem contradictory given that highly acculturated women were less
likely to use condoms, but when one considers that not all educated women are highly
acculturated (G. Romero, personal communication, August 8, 1998), these results are
reconcilable. For example, in the present study, the most highly educated woman (a
Ph.D.) was moderately acculturated. This finding highlights the complexity of the
acculturation process, and how education may have differential influence on Latinas’
cultural values and beliefs. Moreover, given that college settings promote safer sex
practices, and provide easy access to condoms at campus health centers, it is not
surprising that highly educated Mexican and Mexican-American women and their sexual
partners were more likely to use condoms.

Anal Sex

Supporting previous findings (Flaskerud et al., 1996; Ford & Norris, 1993a),

highly acculturated Mexican and Mexican-American women were more likely to have
enaged in anal sex at least once (see Appendix A - Figure 4). This finding suggests that
as Mexican and Mexican-American women acculturate to American culture, they may
acquire a “greater freedom” to sexually experiment (Romero et al., 1997). However, this
freedom may result in a greater likelihood of becoming sexually infected with HIV,
given that in the last year, two-thirds of the women in this study participated in unsafe

anal sex. Considering that unprotected anal sex is a high risk sexual behavior (e. g.,

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Nevid et al., 1995), future research should examine what factors predict the use of
condoms for anal sex. For example, the use of contraception other than condoms may
reduce the likelihood that a couple will have condoms handy (Gomez & Marin, 1996)
when engaging in anal intercourse. Couples may also engage in anal sex to prevent
pregnancy (Kline et al., 1992). Further, given that some women may engage in anal sex
against their will, their partners may not take the precautionary steps necessary to protect
them both from the AIDS virus (Romero et al., 1991).
Multiple Sexual Partners

Unlike earlier research (Marin, Tschann et al., 1993; Sabogal, Faigeles, &
Catania, 1993; Sabogal et al., 1995), acculturation level was not related to the number of
sexual partners a woman had in the last year (see Appendix A - Figure 5). Several
factors may account for this finding. First, the majority of women in this sample (77%),
regardless of acculturation level, were in steady relationships, and many (67%) had been
in these relationships for more than 2 years, suggesting that they were likely to be
monogamous (Sabogal et al., 1995). Second, the small sample size of this study (n=90)
may have contributed to the modest number of women (n=26) that had more than one
sexual partner in the last year. However, previous research does indicate that single
Mexican and Mexican-American women tend to have a fewer number of sexual partners
compared to women from other ethnic groups (de Anda, Becerra & Fielder, 1988; Marin,
Tschann et al., 1993; Romero et al., 1998), suggesting that this sample might accurately

represent the sexual experiences of Mexican and Mexican-American women.

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How Does Acculturation Level Lead to These Different Risfl Sexg Practices?

Mediating Relationships

Two cultural factors were examined as mediators between acculturation level and
risky sexual behaviors: religion and sexual gender norms. The findings from the current
study indicate that a woman’s sexual gender norms, but not religion, partially explain
how acculturation level leads to unsafe sex. Interestingly, the complexity of the
relationship between acculturation level and condom use emerged in the examination of
this relationship.

Religion. Religiosity and fate orientation did not mediate the relationship
between acculturation level and risky sexual behaviors. Acculturation level was also not
found to be related to religiosity. This finding contradicts prior research which suggests
that less acculturated Latinas were more likely to attend religious services (N yamathi et
al., 1993), and observe religious practices, compared to highly acculturated Latinas
(Marin & Gamba, 1990). Comments made by some of the recently immigrated women
may shed some light on this discrepancy. Several of the women commented that in
Mexico they frequently attended church services, and participated in different activities
in their church, but barriers such as having to depend on others for transportation, and
having to work on Sundays has interfered with their ability to be active ‘church members
in the United States. Other immigrant women discussed the harsh realities of this
country as undocumented immigrants, and commented on being disillusioned.
Specifically, they talked about feelings of abandonment by God, and commented that

they no longer had faith in God due to these experiences. These remarks suggest these

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women may have been highly religious in Mexico, but due to their experiences as
immigrants in the US. they may no longer have access to a church or care to be involved
with religion. Consequently, immigrant women who would have been expected to be
less acculturated (e.g., Mikawa et al., 1992), and therefore highly religious, might have
been less religious in this sample due to their immigrant experiences. This may explain
why the predicted relationship between acculturation level and religiosity did not
emerge. Future research should address the potential role immigration may have on this
relationship. In particular, length of residency, documentation status and employment
should be considered.

Another factor that may account for this finding is the growing number of
Latinos converting to fundamentalist Protestant religions (Amaro, 1991; Cadena, 1995;
Marin & Gamba, 1990). Ninety-four percent of the women that identified as Protestant
in this sample (n=16) were likely to be moderately or highly acculturated Mexican and
Mexican-American women. Further, many of these women commented on recently
becoming born again Christians. Therefore, women that were anticipated to be less
religious due to their acculturation level (e.g., Marin & Gamba, 1990), might have been
more religious in this sample due to their recent conversion. This may be another factor
that contributed to the hypothesized relationship not being confirmed.

In addition, this study did not find a significant relationship between
acculturation level and fate orientation. There is some empirical evidence that highly
acculturated Latinas compared to less acculturated Latinas are more likely to believe

they can prevent the transmission of the AIDS virus (Marin, Tschann, et al., 1993;

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Mikawa et al., 1992). Yet, this study did not find support for this relationship. Several
methodological differences between previous studies and the current study may explain
this discrepancy. First, the study conducted by Marin et al. (1993) did not directly
measure acculturation level. Instead, the language in which the interview was conducted
determined a participant’s level of acculturation. In other words, language was used as a
proxy for acculturation. In contrast, the present study utilized Cuellar et al’s (1995)
acculturation scale, which was extensive and included several dimensions of
acculturation. This suggests that language as a sole determinant of acculturation level
may not predict fate orientation among single women of Mexican descent. Second, the
sample in Mikawa et al.’s (1992) study was comprised of both men (62%) and women
(38%) who had recently immigrated to the US. from Mexico and Central America.
Further, from Mikawa et al.’s (1992) description, it is difficult to determine whether or
not the participants in their sample were married, single or both. In comparison, the
present study consisted of only single, Mexican and Mexican-American women, with the
majority of women being born in the United States (73%). Generalizations from the
previous study may not apply to the current sample. This suggests that acculturation
level may not be related to fate orientation among unmarried women of Mexican
descent. Additional research with this subgroup may provide further support for this
finding.

Moreover, the present study did not find evidence that religiosity was related to
the use of condoms, anal sex or number of sexual partners. Although the literature on

Latinos had speculated that being religious would influence sexual behaviors (e.g., Land,

139

1994; Worth, 1989; Worth, 1990), the present study does not provide empirical support
for this relationship among women of Mexican descent. However, similar results have
been found with recent research on HIV/AIDS and Mexican and Mexican-Americans
(Organista et al., 1996; Organista et al., 1997; Romero et al., 1997). For example,
Romero et al. (1997) found that among single and married women of Mexican descent
religiosity was not related to risky sexual behavior such as vaginal intercourse without a
condom, anal intercourse and number of sexual partners. Similar, research conducted
with Mexican migrant workers discovered that the use of condoms was not related to the
importance of religion nor being Catholic (Organista et al., 1996; 1997). This finding
suggests that for Mexican and Mexican-American women being religious may not be
related to risky sexual behaviors. Future research should examine whether this is also
true for other Latino subgroups.

There are several possible explanations as to why religiosity was not related to
risky sexual practices. Given that the women in the present sample had already made the
decision to have premarital sex, it is possible that they no longer felt obligated to follow
additional religious precepts on sexual behavior. This would suggest then that religiosity
would not be related to any of the outcomes of this study. Another possible explanation
put forth by Mikawa et al. (1992) suggests that Latinos may apply their religious beliefs
to certain aspects of their lives and not to others. In particular, they argue that religious
beliefs may be separated fiom everyday behaviors such as sexual intercourse. This
explanation may be applicable to the current sample given that many indicated they

received some guidance in their life from their religious beliefs (73%), and yet reported

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that they did not practice their church’s teaching on either premarital sex (67%) or birth
control (73%). Further, several of the women commented that although they did not
engage in anal sex, their church’s edict on anal sex was not a contributing factor in this
decision. They made reference to other factors such as discomfort/pain, and disinterest in
that particular sexual act.

Additionally, this study provides empirical support for a common, yet previously
untested hypothesis, that Latinas with a strong fate orientation were less likely to be in
relationships where condoms were used (Forrest et al., 1993; Worth, 1990b). In the
current study, Mexican and Mexican-American women who believed that God
controlled their destiny, and believed they could not prevent the transmission of HIV,
were more likely to be in relationships where unsafe sex was practiced. This finding
suggests that some women of Mexican descent may believe preventive measures such as
the use of condoms are not useful in avoiding the AIDS virus. In other words, if God has
fated them to have this disease, there is nothing they can do to prevent its transmission.
How this information can assist with HIV prevention efforts can be found in the section
titled “Implications for the Development of Culturally Appropriate HIV/AIDS
Prevention Interventions.”

Woman’s Sexual Gender Norms. Contradictory findings emerged when
examining the mediating effect of a woman’s sexual gender norms on the relationship
between acculturation level and the use of condoms. The results indicate that
acculturation level was related to condom use in two very different and paradoxical

ways. Highly acculturated Mexican and Mexican-American women were less likely to

141

be in sexual relationships where condoms were used and were more likely to have liberal
sexual gender norms. Yet, Mexican and Mexican-American women with liberal sexual
gender norms were more likely to be in sexual relationships where condoms were used.
These paradoxical findings highlight the complexity of the acculturation process, and are
indicative of a statistical condition known as cooperative suppression (Cohen & Cohen,
1975). Evidently, in the present study, acculturation level and a woman’s sexual gender
norms shared variance that was not related to the use of condoms. This resulted with the
remaining variance for a woman’s sexual gender norms being positively related to the
use of condoms, and the remaining variance for acculturation level being negatively
related to the use of condoms.

One possible explanation for this contradictory finding is citizenship status.
Specifically, citizenship status may be an aspect of acculturation level (Romero et al.,
1997) that is not related to sexual gender norms, but is negatively related to the use of
condoms. Simply put, less acculturated Mexican and Mexican-American women may be
more likely to be in relationships where condoms are used because of their citizenship
status, and not because of their sexual gender norms. California is currently experiencing
a significant number of political and social upheavals with regard to undocumented
Latino immigrants (Romero et al., 1998). Several propositions have been passed to
restrict services available to these individuals (e.g., Proposition 187), and a greater
number of deportations are occurring due to a more stringent boarder patrol, and raids by
the INS. Therefore, citizenship status may be affecting the types of birth control that

Mexican woman have access to. For example, Mexican women may experience

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economic barriers regarding the type of contraception they can access due to the low
paying jobs available to immigrant women. In addition, fears of deportation may
discourage some undocumented Mexican women from using public health clinics to
obtain affordable contraception. Future research may want to compare women of
Mexican descent across different states to better examine understand the role of
citizenship on this relationship.

Furthermore, this contradictory finding may be indicative of the multifaceted
nature of acculturation. Ford and Norris (1993a) point out that in certain parts of the
country (e. g., Detroit, New York, Los Angeles) the new culture values and behaviors
being adopted by minorities and immigrants may not reflect mainstream culture (i.e.,
Anglo culture) given the multiethnic composition of these cities. In fact, these groups
may be adopting a culture that is specific to that location and this may or may not
include mainstream values and beliefs. Future research may want to expand the
conceptualization of acculturation and develop other indicators to assess acculturation
level.

Regarding other risky sexual practices, the current study did not find support that
a woman’s sexual gender norms mediates the relationship between acculturation level
and multiple sexual partners. Contrary to prior research (Marin, Tschann, Gomez et al.,
1993; Sabogal et a1, 1993; Sabogal et al., 1995), acculturation level was not found to be
significantly related to the number of sexual partners a woman had in the last year. As
previously mentioned, the small sample size of this study may have contributed to this

insignificant finding. The results also indicate that a woman’s sexual gender norms did

143

not impact the number of sexual partners a woman had in the last year. Although the
literature had surmised that a positive relationship existed between these two factors
(e.g., Gomez & Marin, 1996), this study does not provide empirical support for this
speculation. Perhaps other factors such as sexual confidence and previous sexual
experience would be better predictors of whether or not a woman had more than one
sexual partner.

F urtherrnore, the present study did not find evidence that a woman’s sexual
gender norms mediates the relationship between acculturation level and anal sex. While
the findings of this study did support previous research that acculturation level is

positively related to anal sex (Flaskerud et al., 1996; Ford & Norris, 1993a), the results

do not indicate the a woman’s sexual gender norms explains how this relationship
occurs. Thus, the findings from this study do not provide empirical support for the
assertion in the literature that a woman’s sexual gender norms mediates the relationship

between acculturation level and engaging in anal sex (F laskerud et al., 1996; Ford &
Norris, 1993a). However, a methodological discrepancy may explain why mediation did

not occur. When describing this potential relationship, the literature makes reference to
women who regularly participate in anal sex. In contrast, in the present study women
who had engaged in anal sex at least once in their life were included in the analysis. As
noted in the methods section, this was done due to the small number of women that
engaged in anal sex on a regular basis. Additional research with a larger sample may be

better able to test this potential mediating relationship.

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Moderating Relationships

Two moderators were also examined: the use of alcohol and a partner’s sexual
gender norms. The findings from the current study indicate that neither the use of
alcohol or a partner’s sexual gender moderates the relationship between a woman’s
sexual gender norms and risky sexual behaviors. Interestingly, the use of alcohol was
found to directly influence whether or not a woman had multiple sexual partners.

Use of Alcohol. In addition to religion and sexual gender norms, use of alcohol
prior to sexual activity was examined. This study suggested that women who were
struggling with traditional sexual gender norms would use alcohol to alleviate this
tension. However, gender norm incongruency was not found to be related to the use of
alcohol prior to sexual intercourse. This finding contradicts focus group data which
indicated that women struggling with adherence to traditional sexual gender norms, were
more likely to drink before sex to avoid responsibility for their sexual conduct (F lores-
Ortiz, 1994). The results from this study suggest that women grappling with this conflict
are not any more likely to drink before sex, than women who are not experiencing this
fi'iction. Perhaps women who experience gender norm incongruency resolve these
conflicting feelings through other means, and therefore, do not need to drink before
sexual intercourse. For example, one woman commented that while she still had mixed
feelings about having premarital sex, she had decided to become sexually active because
it seemed like the most natural thing to do in the context of her relationship. In
particular, she made note of the love she shared with her partner, and how those feelings

justified her decision to engage in premarital sex. Instead of resolving feelings of

145

incongruency by using alcohol, she resolved the conflict by focusing on the love she felt
for her boyfriend.

Additionally, alcohol use was not found to moderate the relationship between a
woman’s sexual gender norms, and condom use or multiple sexual partners. While focus
group data had suggested that when under the influence of alcohol traditional Latinas
were more likely to engage in unsafe sex practices (F lores-Ortiz, 1994), the results of
this study do not support this supposition. A possible explanation for this finding is that
the overall use of alcohol prior to sexual intercourse was limited in this study, so it may
have reduced the likelihood that an interaction effect would be detected. Additional
research is necessary to test this hypothesis.

While this study did not find evidence for the use of alcohol as a moderator, it
did support prior research which found that the use of alcohol before sex was positively
related to the number of sexual partners a woman had (Marin & Flores, 1994). In the
current study, women who drank before sexual intercourse were more likely to have had
several sexual partners in the last year. Given that multiple sexual partners increases the
likelihood of coming into contact with a partner that is HIV positive (Nevid et al., 1995),
additional research examining how or when alcohol influences this high risk sexual
behavior is essential. Several remarks made by the women in this study may provide a
starting point for future research. Some of the women that tended to drink before sexual
intercourse commented that they tended to drink in settings such as bars or parties,
which was also the setting where they tended to find sexual partners. These statements

suggest that the use of alcohol and the context in which alcohol is being used may

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precipitate risky sexual behaviors such as multiple sexual partners. Future research
should clarify whether it is the environment, the actual use of alcohol or a combination
of both that result in Mexican and Mexican-American women having more than one

sexual partner.
Partner’s Sexupl Gender Norms. In the present study, a partner’s sexual gender

norms did not moderate the relationship between a woman’s sexual gender norms and
the use of condoms. Focus group data had suggested that even if a woman wanted
condoms to be used in a sexual relationship (i.e., a liberal sexual gender norm), this was
less likely to occur when her partner had traditional sexual gender norms (Forrest et al.,
1993). Yet, this study did not find evidence to support this premise. Perhaps this
moderating relationship did not emerge because most of the women in this sample were
in relationships with men that had similar sexual gender norms. Or perhaps the small
sample size of this study contributed to the interaction term not being significant. Given
that sexual decision making for heterosexual couples involves both men and women
(Amaro, 1995; Campbell, 1995) and that previous research has found that a partner’s
negative reaction to safer sex leads to condoms not being used (Gomez & Marin, 1996;
Moore et al., 1995), additional research exploring this relationship should be considered.
Implications for the Development of Culturally Appropriate
HIV/AIDS Prevention Interventions
Overall, the findings from this study suggest that among women of Mexican
descent some cultural factors have more influence than others on risky sexual behaviors.

The results also indicate that different HIV /AIDS prevention strategies targeting

147

different acculturation groups may be most successful. Mexican and Mexican-American
women varied in their risky sexual practices, and in the factors that predicted these
behaviors. This implies that a general message of HIV/AIDS prevention may be
unsuccessful with women of Mexican descent (e.g., Marin, 1993; Romero et al., 1997).
Acculturation

The results from this study highlight the importance of considering acculturation
level when developing HIV/AIDS prevention interventions for women of Mexican
descent. Specific acculturation levels were found to be associated with specific risky
sexual practices. Highly acculturated Mexican and Mexican-American women were less
likely to be in sexual relationships where condoms were used. The use of alternative
forms of contraception appear to impact this relationship, with highly acculturated
Mexican and Mexican-American women being more likely to use birth control pills and
Depro Provera. The implications of this finding are critical when viewed in the context
of HIV reduction. It indicates that interventions directed toward highly acculturated
Mexican and Mexican-American women need to address both family planning and
disease prevention in their efforts to reduce the sexual transmission of the AIDS virus
(Gomez & Marin, 1996). Prevention strategies should emphasize not only the use of
effective forms of birth control to prevent pregnancy (e. g., birth control pills), but should
also highlight the need for women and their partners to use condoms to reduce the
transmission of HIV and other STDs.

Further, highly acculturated Mexican and Mexican-American were more likely to

have engaged in anal sex at least once, and many of these women engaged in

148

unprotected anal sex. Prevention messages directed toward highly acculturated Mexican
and Mexican-American women need to address the high risk involved with engaging in
unprotected anal intercourse. Clinics and doctors that provide contraception should be
sure to discuss the need for condoms when engaging in this high risk sexual behavior.
Additionally, given that men are ultimately the ones to wear condoms, prevention
messages should be geared to men about the high risk involved with unprotected anal
intercourse.

Highly acculturated Mexican and Mexican-American women were also more
likely to drink alcohol before sexual intercourse. Unfortunately, in the current study,
Mexican and Mexican-American women who drank alcohol before sexual intercourse,
were more likely to have multiple sexual partners, and were less likely to be in sexual
relationships where condoms were used. Obviously, this increases their risk for the
heterosexual transmission of the AIDS virus (e.g., Flaskerud et al., 1996). A potential
strategy to address this risk might include a forum where highly acculturated Latinas are
likely to be found (e. g., clubs, support groups), and where the inhibitory effects of
alcohol can be informally discussed. In particular, these campaigns should stress the
potential risk involved with having sex with many sexual partners, and how the risk for
HIV increases when condoms are not used with each sexual partner.

mm

Findings demonstrate that the relationship between religion and sexual behaviors

is complex. Different elements of religion are differentially related to risky sexual

behaviors. This study did not find evidence that religiosity was related to the use of

149

condoms among women of Mexican descent, although many of the women were
Catholic (82%). This implies that religiosity may not be an impediment in HIV/AIDS
prevention efforts with less acculturated Mexican and Mexican-American women. In
particular, for women of Mexican descent, regardless of acculturation level, strategies
promoting the use of condoms may not conflict with their application of Catholic dogma
regarding birth control (Mikwawa et al., 1992; Organista et al., 1996; 1997).

Yet, this study did find that Mexican and Mexican-American women with a
strong fate orientation were less likely to be in sexual relationships where condoms were
used. In other words, women who felt powerless over the transmission of the AIDS
virus, and their destiny, were less likely to be in sexual relationships where condoms
were used. Several different educational strategies may be necessary to address this
cultural barrier. Comments made by some of the women may provide some insight as to
what should be included in these prevention efforts. For example, when responding to
statements about fate orientation, several of the women made reference to HIV modes of
transmission such as mother to child and blood transfusions, which they argued were
unavoidable means by which people get infected with the AIDS virus. Their comments
indicate that they may not understand that these modes of transmission are less likely to
occur now because of technological advances in medicine (The AIDS Knowledge Base,
1997). Further, it suggests they may not understand that these are not the primary modes
of transmission among Mexican and Mexican-American women in the United States. In
fact, by focusing on these other modes of transmission, they may exacerbate sentiments

that they have no control over the transmission of the AIDS virus.

150

Therefore, one prevention strategy might involve education about the primary
modes of HIV transmission within the Mexican and Mexican-American community.
This prevention strategy should include two factors. First, it should highlight that sexual
intercourse is the primary means by which HIV is transmitted within the Mexican and
Mexican-American community. Second, it should emphasize that since sexual contact is
the primary mode of HIV transmission among this population, AIDS does not have to be
a disease that one leaves up to fate; steps such as the use of condoms can reduce the
likelihood of becoming infected with HIV.

Another strategy may focus primarily on promoting AIDS as a preventable
disease. For example, this strategy might want to emphasize that AIDS, unlike cancer
and other similar diseases which one may be fated to acquire and die from, is
preventable. If people follow precautionary steps such as the use of condoms, one can
avoid becoming infected with HIV.

Sexual Gender Norms

Mexican and Mexican-American women endorsing cultural sexual gender norms
were less likely to be in sexual relationships where condoms were used. This finding
highlights why conventional HIV/AIDS education programs may not be successful with
Latinas who maintain traditional sexual gender norms (e. g., Nyamathi et al., 1993;
Worth, 1989). Simply put, attempts to empower Latinas to negotiate the use of a condom
with their partner, within this traditional framework of sexuality, may be impossible.
Therefore, prevention efforts aimed at Latinas, adhering to these beliefs, must work

within this cultural framework of sexuality.

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Accordingly, strategies that may have a better chance of success with traditional
Mexican and Mexican-Americans are HIV/AIDS prevention interventions directed
toward “couples as a unit” (Nyamathi et al., 1993). These prevention efforts should
emphasize cultural values that will make the use of condoms more acceptable. For
example, familialism is an important cultural value that might assist with this process.
Prevention messages using this specific cultural value should stress that the couple’s
families will be highly effected, emotionally and financially, if one of them become
infected with HIV. Further, they should stress the possibility of conceiving a child that
is HIV positive.

Limitations of the Present Study

Limitations of this study should be acknowledged. First, given that it was a
purposive rather than a random sample, the results of this study cannot be generalized to
all women of Mexican descent. The methods used to recruit women for this study
contribute to this limitation. Churches, social organizations, service providers, and
schools within the researcher’s personal network in southern California were utilized to
recruit women for this study. Participants also assisted in recruiting additional women
from their own personal networks (i.e., snow-balling). Consequently, the findings from
this study may be biased toward women of Mexican descent who live in Los Angeles
and Orange counties, who belong to a Latino social network, who are involved in and/or
participate in Latino events, and feel comfortable discussing their sexual practices.
Although these findings may not represent the experiences of all Mexican and Mexican-

American women in the United States, they do provide some baseline data on how

152

acculturation leads to risky sexual behaviors among Mexican and Mexican-American
women in southern California.

Another limitation of this study is self-report of sexual behaviors by respondents.
Of particular concern with self-report of sexual behaviors is the ability of women to
accurately recall their prior sexual experiences (Erickson et al., 1995). In order to
address this issue, when scheduling an interview all research assistants were trained to
ask participants to bring their personal organizer to the interview, and interviewers also
took along a calendar as part of their interview supplies. Many times women’s personal
organizers were a great source for recall because participants had documented
information in their calendars that would allow them to remember their last four sexual
encounters. For example, many women had documented dates with their boyfriend, kept
records of their menstrual cycle in order to use the rhythm or withdrawal method, and a
few women had even made a notation in their personal calendars as to when they had
sex. For those women that did not have personal organizers, interviewers presented a
calendar to participants, and asked them to use the calendar to assist in their recall of
their last four sexual. encounters.

An additional drawback of self-report of sexual behaviors is that women may
want to portray themselves as being sexually conservative due to concerns that the
interviewer may think they are promiscuous (Marin, Gomez et al., 1993). The current
study took several steps to minimize this potential problem. First, the introduction of the
interview protocol clearly states that the study understands that women have different

types of sexual experiences and that the primary goal of the study is to better understand

153

how Mexican culture influences their individual sexual decision making. Second, only
women with friendly dispositions and previous interviewing experience were brought on
to the research project as interviewers. Third, all interviewers participated in an intensive
training session that provided them with skills to develop rapport with the women they
interviewed. These different strategies were utilized to create a safe forum in which
participants would feel free to discuss their sexual behavior without fear of being judged.
At the conclusion of the interview, women were asked how comfortable they felt talking
about their sexual behavior during the interview; ninety percent stated that they felt some
level of comfort, suggesting that our strategies were effective.

Another drawback of this study is that a distinction was not made as to why
condoms were used in the women’s sexual relationships. Participants were only asked to
identify the type of contraception they were using at the time of the interview.
Consequently, it is unclear from the current study whether condoms were used
exclusively for birth control or for both STD prevention and contraception.
Unfortunately, this limits the conclusions that can be drawn fi'om this study.

Sample size is another limitation of this study. A small sample size (n=90) may
have contributed to the limited variance on the following variables: anal sex, multiple
sexual partners and the use of alcohol prior to intercourse. However, given that previous
research has found that Mexican and Mexican-American women are less likely to

engage in these behaviors, compared to women from other ethnic groups (Ford &
Norris, 1993; Erickson et al., 1995; Choi et al., 1994; Marin, Gomez et al., 1993; Marin

& Posner, 1995; Marin, Tschann et al., 1993; Nyamathi et al., 1993), this sample may

154

accurately represent the experiences of this population.

Finally, the monetary reimbursement of $15 for participation in this research may
have biased the findings of this study. Participants may have agreed to participate in
study simply for the money. However, given that several women did not accept the $15
reimbursement, and many others had to be convinced to accept the reimbursement, this

bias seems minimal.

Conclusion

It is well acknowledged that AIDS is a “preventable disease” (e.g., Gomez &
Marin, 1996). Yet, efforts at preventing the sexual transmission of the AIDS virus have
had limited success with the Latino community (e.g., Amaro, 1995). The findings fiom
this study suggest that the inclusion of cultural variables may facilitate in the
development of effective HIV/AIDS preventions for Mexican and Mexican-American
women. Further, it highlights the complex, and influential role acculturation level has in
determining the types of risky sexual behaviors that Mexican and Mexican-American
engage in. While this study offers an initial examination of the cultural factors that
influence risky sexual practices among Mexican and Mexican-American women,
additional research is needed to better understand the factors that place Latinas at sexual

risk for HIV.

155

APPENDIX A

Figures 1 - 5

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161

APPENDIX B

Flyer (English Version)

162

APPENDIX B

FLYER (ENGLISH VERSION)

 

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163

APPENDIX C

Flyer (Spanish Version)

164

APPENDIX C

FLYER (SPANISH VERSION)

 

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165

APPENDIX D

Phone Protocol (English Version)

166

APPENDIX D
PHONE PROTOCOL (ENGLISH VERSION)

Hello. Thank you for showing an interest in this study. My name is Christina
Rodriguez and I am a doctoral student at Michigan State University in Ecological-
Community Psychology. I am working on my dissertation which is a study that examines
the influence of culture on sexual practices of Mexican and Mexican-American women. If
you are willing, I would like to schedule an interview with you about the cultural factors
that influence your sexual decision making. In this interview, you will be asked about
your cultural background and your beliefs and your partner’s beliefs about how men and
woman should act. You will also be asked about your religious background, your use of
alcohol and your sexual practices with your current sexual partner. This interview will be
conducted face to face and will take approximately thirty minutes to an hour. The
interview will be conducted at your home or at a location convenient for you. You will be
paid $15 for your participation. The interview is completely confidential. Nothing you
say will be attributed to you directly. No identifying information will be included in any
reports or presentations resulting from this study. You may discontinue your participation
at any time before, during or after the interview. Do you have any questions? Given this
information, would you be interested in accepting my invitation to participate in this
study?

If, no: I would like to restate that your participation will be confidential and nothing you
say will be attributed to you directly in the findings. Thank you for taking the
time to speak to me. If you were to change your mind about participating, please
feel free to call my office at (800) 662-0445. Thank you.

If yes: Thank you for agreeing to participate in this study. Before I set up a time to
conduct an interview with you, I would like to ask you a few questions.

1. What is your ethnic background?
If respondent does not identify as a woman of Mexican descent: Thank you for
showing an interest in my study, but I am seeking participants that are of Mexican
descent only. If you are interested in the results of my study, I would be more than
willing to mail you a copy of my results when I have completed my dissertation.
Once again, thank you for calling.

2. What is your date of birth?
If respondent is born after today’s date 1976, she does not meet the age
requirement for this study: Thank you for showing an interest in my study, but I am
seeking participants that are between the ages of 21 and 30. If you are interested in
the results of my study, I would be more than willing to mail you a copy of my
results when I have completed my dissertation. Once again, thank you for calling.

 

167

3. Are you currently married?

0 No - Go to question #4.

CI Yes - Thank you for showing an interest in my study, but I am seeking
participants that are single. If you are interested in the results of my study, I
would be more than willing to mail you a copy of my results when I have
completed my dissertation. Once again, thank you for calling.

4. Are you currently in a romantic relationship with a man?
CI No - Go to question #5.
D Yes - Go to question #6.

5. Are you currently in a sexual relationship with a man?

Cl No - Thank you for showing an interest in my study, but I am seeking
participants that are currently in a romantic relationship with a man or
currently in a sexual relationship with a man. At the present time you do not
qualify for my study. However, if you are interested in the results of my study,
I would be more than willing to mail you a copy of my results when I have
completed my dissertation. Once again, thank you for calling.

D Yes

Spanish English

Only more than Both more than Only
Spanish English equally Spanish English

6. In general, what language do you 1 2 3 4 5
read and speak? Would you say:

7. What was the language(s) you used 1 2 3 4 5
as a child? Would you say:

8. What language do you usually 1 2 3 4 5
speak at home? Would you say:

9. In which language do you usually 1 2 3 4 5
think? Would you say:

10. What language do you usually 1 2 3 4 5
speak with your fiiends? Would
you say:

11. Average acculturation score:

12. Level of acculturation:
Cl Low (1-2.33) 0 Moderate (2.34-3.66) C] High (3.67-5)

13. I would like to know what would be a convenient time and place for you to be
interviewed.

168

Date: Time: Location:

Name: Address: Phone number:

14. Would you prefer to be interviewed in English or Spanish?
15. How did you hear about this study?

 

 

Thank you very much for your cooperation. I or one of my research assistants will be
interviewing you on at . Prior to the interview, we will call you
to confirm the appointment. If you need to contact me for any reason, please feel free to
call me at (800) 662-0445.

 

 

169

APPENDIX E

Phone Protocol (Spanish Version)

170

APPENDIX E
PHONE PROTOCOL (SPANISH VERSION)

Hola. Gracias por el interés en este estudio. Me llamo Christina Rodriguez y estoy
haciendo un doctorado en la Universidad Estatal de Michigan en Sicologia Ecologica
Comunitaria. Estoy trabaj ando en mi tesis la cual se basa en un estudio que exarnina
como influye la cultura alas practicas sexuales de mujeres mexicanas o mexico-
americanas. Si desea participar, quisiera fijar una cita para entrevistarla sobre como sus
decisiones sexuales son influidas por factores culturales. En dicha entrevista se le haran
preguntas sobre su formacion cultural y sobre las creencias de usted y de su pareja en
cuanto a1 comportamiento apropriado de hombres y mujeres. También se la haran
preguntas sobre su formacion religiosa, el uso de alcohol y sus compartamientos sexuales
en los que ha participado con su pareja. Esta entrevista sera condicida cara a cara y
tomara aproximadamente de 30 rninutos a una hora. La entrevista se llevara acabo en su
hogar 0 en otro lugar conveniente para usted. Se le pagaran $15 por su participacién. La
entrevista sera completamente confidencial. Nada de lo que usted diga sera atribuido a
usted directamente. Ninguna informacién que pudiera identificarla sera incluida en
reportes o presentaciénes a resultado de este estudio. Podra discontinuar su participacion
en cualquier momento ya sea antes durante o despues de la entrevista. g'l‘iene alguna
pregunta? Tomando esta infonnacion en cuento, 5acepta mi invitacion para participar en
este estudio?

Si, no: Quisiera repetir que su participacion sera confidencial y que nada de lo que diga
sera atribuido a usted en las conclusiones. Le doy las gracias por haber tomado
el tiempo para hablar conmigo. Si cambia su decisién de participar, favor de
llarnar a mi oficina al (800) 662-0445. Gracias.

Si: Gracias por aceptar participar en este estudio. Antes de que fijemos una cita para
conducir la entrevista con uted, quisiera hacerle unas cuantas preguntas.

1. éCual es su origen étnico?
Si Ia participante no se identifica como mujer de ascendencia mexicana: Gracias
por haber tomado interes en mi estudio, pero busco participantes que son de
ascendencia mexicana solamente. Si le interesa saber los resultados del estudio, le
podria mandar una copia de los resultados cuando haya completado mi tesis. De
nuevo le doy las gracias por haber llamado.

 

171

 

4.

10.

5Cual es su fecha de nacimiento?
Si Ia participante es nacida después de Iafecha de hoy de 1976, no cumple con las
requisitos para este estudio. Gracias po haber tornado interes en mi estudio. Busco
participantes que cuya edad es entre 21 a 30 anos. Si 1e interesa saber los resultados
del estudio, 1e podria mandar una copia de los resultados cuando haya completado
mi tesis. De nuevo le doy las gracias por haber llarnado

 

(3E5 actualmente casada?

Cl No - Sign a la pregunta # 4

C] Si - Gracias por haber tornado interes en este estudio, pero busco participantes
que sean solteras. Si 1e interesa saber los resultados del estudio, le podria
mandar una copia de los resultados cuando haya completado mi tesis. De
nuevo le doy las gracias por haber llamado.

Actualmente, (esta en una relacion romantica con un hombre?
D No - Pase a la pregunta #5
O Si - Pase a la pregunta #6

Actualmente, (esta en una relacion intima con un hombre?

C] No - Gracias por haber tomado interes en este estudio, pero busco
participantes que actualmente esten en una relacion romantica con un hombre.
No obstante, Si le interesa saber los resultados del estudio, le podria mandar
una copia de los resultados cuando haya completado mi tesis. De nuevo le
doy las gracias por haber llamado.

Cl Si
Solo Espanol lngles mas
Espanol mas que Ambos que ingles Solo
ingles iguales ingles

[,POI' 10 general, en que idioma 1 2 3 4 5
habla y lee? Usted diria que:
gCual idioma uso en su ninez? l 2 3 4 5

Usted diria que:
éCual idioma usa en su hogar? 1 2 3 4 5

Usted diria que:
gNormalmente en cual idioma l 2 3 4 5
piensa? Usted diria que:
LNormalmente en cual idioma se 1 2 3 4 5
comunica con sus amistades?
Usted diria que:

172

 

11. Promedio de aculturacion:

l2. Nivel de aculturacion:
CI Bajo (1-2) Cl Moderado (3) Cl Alto (4-5)

13. Quisuiera saber donde y cuando le seria conveniente para conducir la entrevista.

Fecha: Hora: Lugar:
Nombre: Domicilio: Numero de
teléfono:

14. Prefiere 1a entrevista en ingles 0 en espafiol
15. Como supo de este estudio?

 

 

Gracias por su colaboarcion. Su entrevista se llevara acabo en a

las Sera conducida por mi 0 por uno de mis asistentes de la investigacion.
Antes de la entrevista, se le llamara para confirmar la cita. Si por cualquier razon tiene
que comunicarse conmigo, favor de llamar al (800) 662-0445.

 

173

APPENDIX F

Training Manual

174

APPENDIX F

TRAINING MANUAL

TRAINING MANUAL

Structured Interview on
Acculturation, Mexican Culture and HIV

Fall 1997 - Michigan State University

175

BEFORE THE INTERVIEW

Once a participant has contacted me and has consented to participate in
the study, I will be contacting you and giving you the necessary
information (i.e., participant name, ID number and phone number) to
conduct the interview.

Once you have this information you should call the participant and
schedule an interview at a time and place that is convient for the
participant.

Make sure to call the participant the day before to confirm that the
interview is still on and ask them to bring their day calendar or organizer if
they use one.

Items needed for an interview:

a. An envelope with the $15 reimbursement for participant

b. A survey in the language in which the interview is to be conducted
c. Response book

d. Calendar

e. Two consent forms - one for me and one for the participant

f. Receipt for reimbursement

g. Plenty of pens

Dress casual. You want to make the respondent feel comfortable with
you. If you are dressed up, she may feel that she needs to be formal with
you and this may affect the manner in which she responds to the
questions.

Allow yourself plenty of time to arrive at your location and make sure you
have the respondent’s phone number with you just in case you get lost.

IN TERVIEWING

When you arrive, please introduce yourself to the respondent and try to
arrange to have the interview conducted in an area where you will have
some privacy. This will allow for the respondent to feel more comfortable
answering personal questions.

176

Questions should be read as they are written. Please do not rephrase the
question or statement. If you do this it will lower the reliability of the
responses.

Responses to question or statements:

a.

Most of the questions or statements have responses which
have been printed out and can be found in the Reponse Book.
Make sure you are on the correct page and that it is in front of the
respondent. There are directions throughout the survey telling you
which card to show in the Response Book. For the first few
questions or statements in each section go ahead and read the
possible responses. Hopefully, the participant will read off from the
response card placed in front of them and you will no longer need
to read each response out loud. However, some respondents may
not be able to read because they don’t have their glasses or
because they are illiterate. If this is the case, please continue to
read the responses out loud.

Whenever there is a colon (:) at the end of a statement, please
read the responses to the right. For example, in Section E,
question 19 the question reads as follows “To what extent do you
practice your religion’s teaching on premarital sex? Would you
say:” At that point you would read the responses to the right which
are: “not at all, rarely, sometimes, often, or always.”

Other (Specify) - Whenever the participant responds with a
response other than those listed and there is an “other" option,
please make sure to specify what their response is to that question.

Mistakes in coding responses - There will be times when a
respondent will change her response or you miscode an answer.
This is not a problem. Simply cross out the incorrect response and
circle the correct response. Please make a note of these changes
on the last page of the interview.

Probing

a.

This is particulary important when trying to ascertain the last four
times the participant had sex. If they are unable to remember, ask
them to think about special events or occassions which may have
resulted in a sexual encounter. Ask if they have a night or day
when they routinely have sex.

177

4.

Atmosphere of Interview

a. Relaxed
b. Smile
c. Reassure participant of confidentiality
THE SURVEY
INTRODUCTION
1. Once you are settled and ready to start, fill out the front page of the
survey. Make sure you provide all the necessary information.
2. Once you have done this, please read the introduction to the study
located on the first page.
CONSENT FORM
3. After answering any questions the respondent may have, please read the

consent form to the participant. While the consent form is almost a
complete duplicate of the introduction, it is important that you read the
consent form because we do not know the literacy level of the participants
and I want to make sure that they know what they are signing.

DEMOGRAPHIC INFORMATION

4.

Question #2 - Probe if the respondent is vague about their schooling. For
example, they may say that they have some high school or college.
Follow-up by asking them, what was the last grade they attended in high
school or the number of years they completed in college.

Question #4 - Some respondents do not really listen to this question and
give their yearly income instead of their monthly income. If the amount of
money they quoted seems high make sure to verify that it is their monthly
income. Some respondents live with their parents and do not know their
parent’s income. If this is the case, simply obtain the respondent’s
monthly income and make a note of this in the margin.

Question #5 - Make sure that the respondent was born after October
1976.

Question #9 - Check all answers that apply. Do not assume that just
because a woman is on birth control pills that she does not use another
method. For example, some women are on the pill, but do not tell their
partner because they want to use condoms as a form of protection
against STDs and HIV.

178

ACCULTURATION

8. Questions #12 - #15 - This set of questions ends in “e.g.,” statements.
Please include them when you read each question. For example, question
#12 is “I enjoy reading (e.g., books in Spanish.” It should be read as “I
enjoy reading books, for example in Spanish.”

9. Questions #18 and #19 - The responses for these statements are a bit
awkward. Unfortunately, this is how the author of this measure worded
these statements. If the participant seems confused you may want to
reread the statement and read the possible options to these statements.

10. Questions #27-#30 - Sometimes people change their mind about how
they want to identify themselves once they hear all four options. Be
prepared to go back and make changes. If the respondent would like to
change their original answer, simply place an “X” over the original
response and “circle” the new response.

SEXUAL GENDER NORMS

11. Some participants may want you to explain or clarify what some of the
statements mean. Tell them that you are unable to do so. Tell them to
interpret the statement just the way they believe it is meant to be
understood.

GENDER NORMS CONGRUENCY

12. Some of these statements are lengthy and the respondent may not
understand. Once again, simply reread the item at a slower pace and ask
the respondent to interpret it to the best of their ability.

RELIGIOUS BACKGROUND

13. Questions 1b - 1f - Do not read the responses for these questions. Ask
the question and than ask the participant, if one of the listed responses
matches her reponse. You would read the question, for example #1 “What
is your religion’s teach on premarital sex, that is sex before marriage?”
The participant might say “Against it." You would verify what they said by
saying “In other words, they believe in “Abstinence until marriage” and
than you would check that response in the questionnaire.

14. Questions 19 - 1k - Some respondents struggle with these questions. I
have found that the best way to address these problems is to simply go
back to their original responses in Questions 1b-1f and ask whether or not
they practice that teaching. For example, Question lg asks: “To what
extent do you practice your religion’s teaching on premarital sex?”. I would
than remind the respondent that in Question 1b she noted that her religion
promotes the concept of abstinence until marriage, therefore, I would like
to know whether or not she practices this specific teaching.

15. Fate orientation - In the Spanish version of these questions, some of the
questions use the word “toca” meaning it “was meant to be”. However, a

179

few of the respondents thought this meant “to touch” which gives a very
different meaning to the question. If you feel that the respondent has
misinterpreted this question, please feel free to clarify the meaning of this
particular term.

PARTNER’S SEXUAL GENDER NORMS

16.

Make sure the respondent understands that you are not asking about her
opinion, but what she believes her partner believes. Some of the women
may feel that they do not know how to respond to some of the items. Ask
them to simply choose the response that they feel is the most appropriate
for him.

FOUR DATES

17.

18.

19.

If a respondent answers that she does not use condoms or did not use
condoms consistently within one date make sure that the follow-up
question about penetration is “yes". Some respondents are tired by this
point and are not listening or do not understand that we are asking about
penetration “without” the use of a condom. If there is an inconsistency with
the use of condoms and penetration without the use of a condom, please
follow up and clarify this point with the respondent.

Some women do not know what the word ejaculation means. This is
particulary true in Spanish. Please explain that it is the semen that comes
out of a man’s penis when he has an orgasm. If she still does not
understand, I have found that describing what semen looks like seems to
clarify the concept (i.e., white substance that comes out of a man’s penis).
Please follow the instructions given to you throughout this section. This
will allow you to ask the right series of questions. Some women may only
have one partner so you do not need to obtain the demographic
information and their sexual gender norms beliefs for each encounter, just
the first one. However, if the respondent has had different partners you
will fill out a new section for each new partner. This should become clear
to you as you go through the survey and read the directions I have
provided for you.

LEVEL OF COMFORT

20.

Please do not forget to fill out the last section of the interview protocol.
Please do this in your car after the interview. I would like to obtain an
assessment of how reliable you feel the data is.

180

APPENDIX G

Consent Form (English Version)

181

APPENDIX G
PARTICIPANT CONSENT FORM (ENGLISH VERSION)

Michigan State University is currently conducting a study to examine the

influence of culture on the sexual practices of Mexican and Mexican-American
women.

1.

l have been asked to participate in this study because I am a single woman
of Mexican descent between the ages of 21 and 30.

My participation in this study will consist of a face to face interview. I will be
asked about my cultural background, my beliefs about how men and
women should act and my partner’s beliefs about how men and women
should act. I will also be asked about my religious beliefs, my use of alcohol
and my sexual practices with my partner. This interview will take
approximately 30 to 60 minutes and will be conducted at my home or at
another convenient location.

My involvement in this study has been fully explained to me and I freely
consent to participate. I realize that I may discontinue my participation at
any time before, during or after the interview.

I can refuse to answer any question(s) asked of me before, during or after
the interview. I may also ask questions at any time before, during or after
the interview.

I will be paid $15 for participating in this interview. Even if I decide to
discontinue my participation during or after the interview, I will still be paid
$15 for my time.

With my permission, this interview will be audio taped to verify that my
responses were correctly recorded on the survey. The tapes will be kept by
Christina Rodriguez and will be destroyed upon completion of this project. I
also understand that I have the right to ask that my interview not be
recorded and to ask that the tape recorder be turned off at any time.

Any information I provide will be held in the strictest of confidence. Any
information that may identify me will be kept under lock and key in a room
separate from the actual data. Only Christina Rodriguez and her research
assistants will have access to the data provided in this interview.

182

8. Nothing that I say will be attributed to me directly. I further understand that
my participation in this study will remain confidential in any report of
research findings.

9. Any questions about this study may be asked at any time by contacting:

Christina Rodriguez, M.A. Pennie Foster-Fishman, Ph.D.
Michigan State University Michigan State University
Psychology Department Psychology Department

135 Snyder Hall 129 Psychology Research Building
East Lansing, MI 48824-1 1 17 East Lansing, MI 48824-1 1 17
(517) 353-5015l (800) 662-0445 (517) 353-5015/ (517) 355-3825

David E. Wright, Ph.D.

Michigan State University

University Committee on Research Involving Human Subjects
232 Administration Building

East Lansing, MI 49924-1046

(517) 355-2180

My signature below indicates that I have read the above 9 items, that any
questions I have raised have been answered to my satisfaction, and that I agree to
participate in the interview.

Name ' Date

 

D Please mail me a copy of the results of this study at the following address:

183

APPENDIX H

Consent Form (Spanish Version)

184

APPENDIX H

PARTICIPANT CONSENT FORM (SPANISH VERSION)

La Universidad Estatal de Michigan esta conduciendo un estudio para examinar
como infiuye la cultura en los habitos sexuales de mujeres mexicanas y mexico-
americanas.

1.

Se me ha pedido participar en este estudio porque soy una mujer soltera de
ascendencia mexicana entre 21 y 30 aflos de edad.

Mi participacién en este estudio consistira de una entrevista cara a cara. Se
me haran preguntas sobre mi formacién cultural, mis creencias y las de mi
pareja en como deben actuar (comportarse) los hombres y las mujeres.
También se me haran preguntas sobre mi formacién religiosa, mi uso de
alcohol y mis compartamientos sexuales en los que ha participado con mi
pareja. Esta entrevista tomara entre 30 a 60 minutos aproximados y tomara
lugar en mi casa 0 en otro lugar conveniente.

Mi participacion en este estudio ha sido explicada en detalle y doy mi
consentimiento voluntariamente. Comprendo que puedo terrninar mi
participacion en cualquier momento, sea antes, durante o después de la
entrevista.

Puedo negarrne a contestar cualquier pregunta(s) antes, durante o después
de la entrevista. También puedo haoer preguntas en cualquier momento
antes, durante o después de la entrevista.

Se me pagara $15 por participar en esta entrevista. lncluso si decido
discontinuar mi participacién durante o después de la entrevista, se me
pagaran los $15 por mi tiempo.

Con mi perrniso, esta entrevista sera grabada para verificar que mis
respuestas fueron registradas corectamente en el cuestionario. Las cintas
seran guardadas por Christina Rodiguez y seran destruidas a la conclusion
de este estudio. También entiendo que tengo el derecho de pedir que mi
entrevista no sea grabada y que se apague le grabadora de cinta a
cualquier momento.

Cualquiera informacién que provee se guardara con suma confidencia.
Tambien comprendo que cualqier informacién que pueda identificarme sera
guardara bajo llave en un cuarto aparte de los datos actuales. Solamente
Christina Rodriguez y sus asistentes de investigacién tendran aceso a la
informacién procurada en esta entrevista.

185

Nada de lo que diga sera atribuido a mi directamente. Ademas mi
participacion en este estudio pennanecera confidencial en cualquier reporte
de Ios resultados.

Cualquier preguntas sobre este estudio pueden dirigirse:

Christina Rodriguez, M.A. Pennie Foster-Fishman, Ph.D.

La Universidad Estatal de Michigan La Universidad Estatal de Michigan
Departamento de Psciologia Departamento de Psciologia

135 Snyder Hall 129 Psychology Research Building
East Lansing, MI 48824-1 1 17 East Lansing, MI 48824-11 17

(517) 353-5015/ (800) 662-0445 (517) 353-5015/ (517) 355-3825

David E. Wright, Ph.D.

La Universidad Estatal de Michigan

University Committee on Research Involving Human Subjects
232 Administration Building

East Lansing, MI 49924-1046

(517) 355-2180

Al firrnar esta forma de consentimiento, yo estoy de acuerdo de participar
en esta entrevista.

Nombre Fecha

c1 Favor de enviarrne una copia de los resultados de este estudio al
siguiente domicilio:

186

APPENDIX I

Demographics (English Version)

187

APPENDIX I

DEMOGRAPHIC QUESTIONS (ENGLISH VERSION)

 

SECTION A: DEMOGRAPHIC INFORMATION
I would like to start the interview by asking you some general questions.

 

1. Are you currently married, divorced, separated, widowed or never been
married?
01. Married Cl 3. Separated Cl 5. Never been married
Cl 2. Divorced D 4. Vlfidowed

 

2. What is the highest grade you completed in school?
[1 2 3 4 5 sun] [9 1o 11 12] [13 14 15 16][17 18mg 20 21]

Elementary Jr. High High School College Graduate School
Vocational/Technical

 

3. Are you currently:
El 1. Working full-time Cl 4. Keeping house
D 2. Working part-time D 5. In school
D 3. Unemployed Cl 6. Other (Specify):

 

 

4. What is the total monthly income for your household?

 

 

5. What is your religious denomination?

 

D1. Anglican CI 6. Evangelical CI 10. Pentecostal
Cl 2. Baptist Cl 7. Lutheran Cl 11. Scientology
El 3. Brethren D 8. Methodist CI 12. Other:
El 4. Catholic El 9. Mormon D 13. None

CI 5. Church of God

 

6. What year were you born?

 

7. Where were you born?
Cl 1. Mexico
Cl 2. USA
D 3. Other (Specify):

 

 

 

8. Where was your father born?
CI 1. Mexico
CI 2. USA
Cl 3. Other (Specify):

9. Where was your mother born?
El 1. Mexico
Cl 2. USA
CI 3. Other (Specify):

 

 

 

188

 

 

10.

Are you currently using any of the following forms of birth control?
CI 6

 

 

 

 

 

 

 

 

D 1. Birth control pills . IUD/Intrauterine Device 011. Depro Provera
CI 2. Condoms Cl 7. Rhythm method I] 12. Norplant
CI 3. Diaphragm Cl 8. Female sterilization CI 13. No Method
0 4. Douching after intercourse Cl 9. Male sterilization Cl 14. Other.
CI 5. SpermicidelCreams/Jellies CI 10. Withdrawal method
11. Have you ever been pregnant?
CI 0. No
CI 1. Yes
12. Have you ever been tested for the AIDS virus?
CI 0. No - Go to question 13
Cl 1. Yes - Go to question 12
Cl 2. Doesn’t know - Go to question 13
Cl 3. Not sure - Go to question 13
13. Did the test show that you were HIV positive?
Cl 0. No
CI 1. Yes
Cl 2. Doesn’t know
CI 3. Not sure
14. Have you ever been tested for STDs (i.e., sexually transmitted diseases)?
CI 0. No - Go to question 15
El 1. Yes - Go to question 14
Cl 2. Doesn’t know - Go to question 15
CI 3. Not sure - Go to question 15
15. Did any of the tests show that you were infected with an STD?
Cl 0. No
Cl 1. Yes
Cl 2. Doesn’t know
Cl 3. Not sure
16. Did you receive a blood transfusion between 1977 and 1985?
El 0. No
Cl 1. Yes
El 2. Doesn’t know
Cl 3. Not sure
17. Have you ever injected drugs into yourself with a needle that were not

prescribed by a doctor?
Cl 0. No

CI 1. Yes _

Cl 2. Doesn’t know

CI 3. Not sure

 

189

 

APPENDIX J

Demographics (Spanish Version)

190

APPENDIX J

DEMOGRAPHICS (SPANISH VERSION)

 

SECCION A: INFORMACION DEMOGRAFICA
Quisiera empezar la entrevista con unas preguntas generales.

 

1. (Actualmente es usted casada, divorciada, separada, viuda o nunca se ha casado?
CI 1. Casada CI 3. Separada D 5. Nunca he sido casada
CI 2. Divorciada CI 4. Viuda

 

2. gCuél es el ultimo nivel de educacion que complete? (Entrevistadora- Circule el
numero que aplica)
I 2 3 4 5 6 7 8 9 IO 11 12 I3 14 15 I6 17 18 I9 20 2|

Priman'a Secundaria Preparatoria Universidad Escuda de posgrado
Politecnica/Vocacional

 

3. Actualmente usted:

CI 1. Trabaja tiempo completo CI 4. Es ama de casa

CI 2. Trabaja tiempo parcial CI 5. Es estudiante

CI 3. Es desempleada Cl 6. Otro
(Especifique)

 

 

4. LCual es el ingreso mensual de su hogar?

 

 

5. [En que afio nacio?

 

6. LDonde nacio?
CI 1. México CI 2. EEUU D 3. Otro (Especifique)

 

7. 5D6nde nacio su padre?
CI 1. México CI 2. EEUU CI 3. Otro (Especifique)

 

 

 

8. gDonde nacio su madre?
CI 1. México D 2. EEUU D 3. Otro (Especifique)

 

191

 

 

9. [Actualmente utiliza alguno de los siguientes métodos del control de la natilidad/
anticonceptivos? (Entrevistadora- Muestre tarjeta A y lea las respuestas.
Marque todas las que aplican.)

CI 1. Pildoras anticonceptivas CI 9. Esterilizacion masculina/
vasectomia

D 2 Condones/preservativos CI 10. Coitus interuptus/sacar oretirar cl
CI 3 Diafragma miembro/salirse/terminar afuera
CI 4 Ducha vaginal/Iavarse después de la relacion CI 1 1. Inyecciones (Depro Provera)
CI 5 Espuma/jalea/crema espermicida/ CI 12. Norplant, e1 implante

tableta espumante CI 13. Ningt’m método
D 6. Dispositivo/aparato intrauterino/ D 14. Otro:

T de cobre/espiraI/lazo
CI 7. Ritrno o periodo a salvo
CI 8. Esterilizacion femenina/ligarse Ios tubos

 

10. (Ha estado alguna vez embarazada/encinta?
CI 0. No
CI 1. Si

 

1 1. {Se ha hecho la pruba del virus del SIDA?
CI 0. No - Pase a la pregunta 13
CI 1. Si - Pase a la pregunta 12
CI 2. No sé - Pass a la pregunta 13
CI 3. No estoy segura - Pase a la pregunta 13

 

12. gFué positivo su analisis de VIH/SIDA?

CI 0. No '
Cl 1. Si
CI 2. No sé

CI 3. No estoy segura

 

13. (Se ha examinado para ver si tiene enferrnedadas transmitidas sexualmente?
C] 0. No - Pase a la pregunta 15
CI 1. Si - Pase a la pregunta 14
CI 2. No sé - Pass a la pregunta 15
CI 3. No estoy segura - Pase a la pregunta 15

 

 

14. (Cualquiera de estas examinaciones indicaron que usted estaba infectada?

CI 0. No
CI 1. Si
CI 2. No sé

CI 3. No estoy segura

 

192

 

 

15. gRecibio una tranfusién de sangre entre los aflos de 1977 al 1985?

C] O. No
C] 1. Si
CI 2. No sé

CI 3. No estoy segura

 

 

16. (Se ha inyectado drogas que no han cido prescritas por un doctor?

CI 0. No

CI 1. Si

CI 2. No sé

CI 3. No estoy segura

 

193

 

APPENDIX K

Acculturation Measures (English Version)

194

APPENDIX K

ACCULTURATION MEASURES (ENGLISH VERSION)

 

SECTION B: ACCULTURATION
Now I would like to ask you a few questions about your cultural background.

For each statement, please choose one of the following responses: Not at all,
very little or not very often, moderately, much or very often, or extremely often
or almost always. Please choose the response that would be most correct for

you under most conditions or normal circumstances.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extremely
Notvery Very often!
Notet often! Some! often! Almoet
all Very mu. Moderately much Always
1. I speak Spanish. 1 2 3 4 5
2. I speak English 1 2 3 4 5
3. I enjoy speaking Spanish. 1 2 3 4 5
4. I associate with Anglos. 1 2 3 4 5
5. l associate with Mexicans 1 2 3 4 5
and/or Mexican Americans.
6. I enjoy listening to Spanish 1 2 3 4 5
language music.
7. I enjoy listening to English 1 2 3 4 5
language music.
8. I enjoy Spanish language TV. 1 2 3 5
9. I enjoy English language TV. 1 3 5
10. I enjoy English language 1 2 3 5
movies.
11. I enjoy Spanish language 1 2 3 4 5
movies.
12. I enjoy reading (e.g., books in 1 2 3 4 5
Spanish).
13. I enjoy reading (e.g., books in 1 2 3 4 5

English).

 

 

 

 

 

 

195

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notvery Extremely
often! Very often!
Notet Very little Some! omen! Almost
all Moderately much Always
14. I write (e.g., letters in 1 2 3 4 5
Spanish).
15. I write (e.g., letters in English). 1 2 3 5
16. My thinking is done in the 1 2 3 5
English language.
17. My thinking is done in the 1 2 3 4 5
Spanish language.
18. My contact with Mexico has 1 2 3 4 5
been”.
19. My contact with the USA has 1 2 3 4 5
been".
20. My father identifies or 1 2 3 4 5
identified himself as
“Mexicano”.
21. My mother identifies or 1 2 3 4 5
identified herself as
“Mexicana”.
22. My friends, while I was 1 2 3 4 5
growing up, were of Mexican
origin.
23. My friends, while I was 1 2 3 4 5
growing up, were of Anglo
origin.
24. My family cooks Mexican 1 2 3 4 5
foods.
25. My friends now are of Anglo 1 2 3 4 5
origin.
26. My friends now are of Mexican 1 2 3 4 5
origin.
27. I like to identify myself as a 1 2 3 4 5

Mexican American.

 

 

 

 

 

 

196

 

 

 

 

 

 

 

 

 

 

 

 

 

Notvery Extremely
often! Very often!
Notat Very little Some! often! Almoet
all Moderatety much Always
28. I like to identify myself as a 1 2 3 4 5
Mexican.
29. I like to identify myself as an 1 2 3 4 5
American.
30. I like to identify myself as l 2 3 4 5
Anglo-American.
Section 82: Time Specific Acculturation
Now I would like to ask you a few more questions about your cultural
background.
More More
Spanleh Englleh
Only than Both than Only
Spanlsh English Equally Spanleh Englleh
1. In the last 30 days, what was the 1 2 3 4 5

primary language(s) you spoke at
home? Would you say:

 

2. In the last 30 days, what was the 1 2 3 4 5
primary language spoken in the
movies and T.V. programs you
watched?

 

3. In the last 30 days, what 1 2 3 4 5
language were the radio
programs you usually listened?

 

 

 

 

 

 

 

Inten'iewer " All $.13. About magnum
Show Card 82 with Responses mm! than mu 5 than All
Hlepanlc Americana Half Latlnoe Americana
8
4. In the last 30 days, the 1 2 3 4 5

people who have visited you
or who you have visited were
primarily:

 

 

5. In the last 30 days, the social 1 2 3 4 5
gatherings! parties which you
have attended have primarily
been:

 

 

 

 

 

 

197

 

APPENDIX L

Acculturation Measures (Spanish Version)

198

APPENDIX L

ACCULTURATION MEASURES (SPANISH VERSION)

 

SECCION B: ACULTURACION

Ahora quisiera hacerle algunas preguntas sobre su experiencia cultural. Por cada frase
por favor escoja una de las siguientes respuestas: nada, un poco/a veces,
algo/moderado, mucho/muy frecuente o muchisimo/casi todo el tiempo. Escoje la
respuesta que seria la mas correcta en su caso en la mayoria de las situaciones 0 en
condiciones norrnales.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entrevistadora ' Un poco! AI 0/ Mucho/ 24:12:13:
Muwtre La Tarjeta B Con Nada A vecee Modfrado Muy tiempo
Respuestas frecuente

1. Yo hablo Espanol. l 2 3 4 5

2. Yo hablo Ingle's. l 2 3 4 5

3. Me gusta hablar en Espanol. 1 2 3 4 5

4. Me asocio con Anglos. l 2 3 4 5

5. Yo me asocio con Mexicanos 1 2 3 4 5
0 con Mexico-Americanos.

6. Me gusta escuchar la musica 1 2 3 4 5
Mexicana.

7. Me gusta escuchar musica en 1 2 3 4 5
Inglés.

8. Me gusta ver programas en la 1 2 3 4 5
television que sean en
Espanol.

9. Me gusta ver programas en la 1 2 3 4 5
televisién que sean en Inglés.

10. Me gusta ver peliculas en 1 2 3 4 5
Inglés.

11. Me gusta ver peliculas en 1 2 3 4 5
Espanol.

12. Me gusta leer (p.ej., libros en 1 2 3 4 5
Espanol).

 

 

 

 

 

 

199

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mucho/ Muchisimo/
Un poeo/ Algo/ Muy Casi todo el
Nada A veccs Moderado frecuente tiempo

13. Me gusta leer (p.ej., libros en 1 2 3 4 5
Inglés).

14. Escribo (p.ej., cartas en 1 2 3 4 5
Espafiol).

15. Escribo (p.ej., cartas en 1 2 3 4 5
Inglés).

16. Mis pensamientos ocurren en 1 2 3 4 5
el idioma Inglés.

17. Mis pensamientos occuren en 1 2 3 4 5
el idioma Espafiol.

18. Mi contacto con Mexico ha 1 2 3 4 5
sido...

19. Mi contacto con los Estados 1 2 3 4 5
Unidos ha sido...

20. Mi padre se identifica 0 se 1 2 3 4 5
identificaba como
“Mexicano”.

21. Mi madre se identifica 0 se 1 2 3 4 5
identificaba como
“Mexicana”.

22. Mis amigos(as) de mi niflez l 2 3 4 5
eran de origen Mexicano.

23. Mis amigos(as) de mi nifiez 1 2 3 4 5
eran Anglos Americanos.

24. Mi familia cocina comida 1 2 3 4 5
Mexicana.

25. Mis amigos recientes son 1 2 3 4 5
Anglo Americanos.

26. Mis amigos recientes son 1 2 3 4 5

Mexicanos 0 Mexico-
Americanos.

 

 

 

 

 

 

200

 

 

Muchisimo/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Un poco/ Algo/ Muello/ Casi todo cl
Nada A vecu Moderado Muy tiempo
frecuente
27. Me gusta identificarme como 1 2 3 4 5
Mexico-Americana.
28. Me gusta identificarme como 1 2 3 4 5
Mexicana.
29. Me gusta identificarme como 1 2 3 4 5
Americana.
30. Me gusta identificarme como 1 2 3 4 5
Anglo-Americana.
SECCION B2: TIEMPO ESPECIFICO DE ACULTURACION
Ahora, me gustaria hacerle unas preguntas mas acerca de su cultura.
Entrevistadora - E3130] 1:“;
Muestre La Tarjeta B2 Con Solo :ue Los dos In:
Respuestas Espanol Inglés idiomas Espanol Solo Ingles
1. En los ultimos 30 dias, en 1 2 3 4 5
general cual idioma hablo en su
casa? Usted diria que:
2. En Ios ultimos 30 dias, cual fué 1 2 3 4 5
el idioma hablado en las
peliculas y programas de
television que usted vio?
3. En los ultimos 30 dias, cual fué l 2 3 4 5
el idioma de los programas de
radio que usted escuché?
4. En los ultimos 30 dias, las 1 2 3 4 5
personas que usted visito o que
le han visitado fueron:
5. En los ultimos 30 dias, las 1 2 3 4 5

reuniones sociales/flestas en las
que usted estuvo fueron:

 

 

 

 

 

 

201

 

APPENDIX M

Religion Measures (English Version)

202

APPENDIX M

RELIGION MEASURES

 

Section E2: Religiosity
Now I would like to ask you about your religious life. Please respond to the
following statements by responding never, rarely, sometimes, often or always.

 

Some-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never Rarely tlrnes Often Always
1. I attend religious crusades, revival 1 2 3 4 5
meetings or missions.
2. I attend religious services. 1 3
3. I watch religious services on 1 2 3 5
television.
4. I pray privately. 1 2 3 4 5
5. I pray with my family. 1 2 3 4 5
6. I listen to religious music. 1 2 3 4 5
7. My religious beliefs have helped me 1 2 3 4 5
understand my life.
I contribute money to my church. 1 2 3 5
I take part in various activities 1
offered at my church.
10. My life is guided by the religious 1 2 3 4 5
beliefs I learned when I was young.
11. I feel that religion has helped my 1 2 3 4 5
relationship with my partner.
12. I feel that religion has helped me get 1 2 3 4 5
ahead in life.
13. My religious beliefs help guide my 1 2 3 4 5

everyday behavior.

 

 

 

 

 

 

203

 

 

Section E3: Time Specific Religious Activities
At this time I would like to ask you about the religious activities you have

engaged in during the last 30 days.

 

 

 

 

 

 

 

 

 

 

 

1 to 3
tlmes In Several
the last Oncea times a
Never month week week Dally
1. In the last 30 days, how often did 1 2 3 4 5
you attend religious services (e.g.,
mass, bible class)? Would you
say:
2. In the last 30 days, how often did 1 2 3 4 5
you pray with your family? Would
you say:
3. In the last 30 days, how often did 1 2 3 4 5
you listen to religious music?
Would you say:
4. In the last 30 days, how often did 1 2 3 4 5
you contribute money to your
church? Would you say:
5. In the last 30 days, how often did 1 2 3 4 5
your religious beliefs help you
understand your life? Would you
say:

 

Section E4: Fate Orientation

Now I would like to read to you some statements that people have made
about their destiny and HIV/AIDS. I would like you to tell me whether you
strongly disagree, disagree, somewhat disagree, somewhat agree, agree, or
strongly agree with each statement.

 

 

 

 

 

 

 

 

 

 

 

Strongly Dlsagree Somewhat Somewhat Agree Strongly
Dlsagree Dlsagree Agree Agree
1. I am responsible for 1 2 3 4 5 6
what occurs in my life.
2. I have no control over 1 2 3 4 5 6
my life because God
controls my destiny.
3. I control my destiny, not 1 2 3 4 5 6
God.

 

204

 

 

Somewhat
Dlsagree

Somewhat
Agree

 

Good things occur in
my life because God
wills it.

3

4

 

It is a matter of
chance, if good things
happen in my life.

 

It is God’s will if bad
things happen in my
life.

 

If I take the right
actions, I can prevent
bad things from
occurring in my life.

 

l have the ability to
make good things
happen in my life.

 

I am to blame if I
become infected with
the AIDS virus.

 

10.

People become
infected with HIV
because they do not
take care of
themselves.

 

11.

It is a matter of
chance if you become
infected with the AIDS
virus.

 

. I am responsible for

not becoming infected
with HIV.

 

 

13.

People can control
whether or not they
become infected with
HIV.

 

 

 

 

 

 

 

 

 

 

 

 

 

Strongly Dlsagree Somewhat Somewhat Agree Strongly
Dlsagree Dlsagree Agree Agree
14. If I take the right 1 2 3 4 5 6
actions, I can avoid
becoming infected
with the AIDS virus.
15. If it’s meant to be, I 1 2 3 4 5 6
will become infected
with HIV.
16. People get infected 1 2 3 4 5 6

with HIV because God
wills it.

 

 

 

 

 

 

 

206

 

APPENDIX N

Religion Measures (Spanish Version)

207

APPENDIX N

RELIGION MEASURES (SPANISH VERSION)

 

SECCION E1: FORMACION RELIGIOSA
La siguiente serie de preguntas seran sobre su religion y su iglesia.

 

1a. aCuaI es su denominacién religiosa?
C11. Anglicana Cl 6. Evangelista CI 11. Cientologia

 

CI 2. Bautista CI 7. Luterana CI 12. Otra
Cl 3. Brethren CI 8. Metodista (Especifique)
CI 4. Catélica CI 9. Mormona CI 13. Ninguna

Cl 5. Iglesia de Dios Cl 10. Pentecostal
(Entrevistadora - Si la respuesta es “ninguna”, pase a la Seccion E2.)

 

Seccion E2: Religiosidad
Ahora me gustaria preguntarle sobre su vida religiosa. Favor de responder alas

siguientes frases con nunca, rara vez, a veces, seguido o siempre.

 

 

 

 

 

 

 

 

 

 

 

 

Entrevistadora -
. Rare A
Muestre la tarjeta E2 con respuestas. mm. m me. Seguido Sicmprc
2a. Yo asisto alas crusadas religiosas, juntas 1 2 3 4 5
de renacirniento espiritual o misiones.
2b. Asisto a servicios religiosos. l 2 3 4 5
2c. Miro los servicios religiosos a través de 1 2 3 4 5
1a television.
2d. Rezo en privado/sola. 1 2 3 4 5
2e. Rezo con mi familia. 1 2 3 4 5
2f. Escucho musica religiosa. 1 2 3 4 5
2g. Mis creencias religiosas me han ayudado 1 2 3 4 5
a comprender mi vida.
2h. Doy dinero a mi iglesia. 1 2 3 4 5
2i. Participo en varias actividades que se 1 2 3 4 5
ofrecen en mi iglesia.
2j. Las creencias religiosas que aprendi de 1 2 3 4 5
joven son guias en mi vida actualmente.

 

 

 

 

 

 

208

 

 

2k. Creo que mi religién me ha ayudado en 1 2 3 4 5
mi relacion con mi pareja.

 

21. Siento que mi religion me ha ayudado a 1 2 3 4 5
avanzar en mi vida.

 

2m. Mis creencias religiosas son guias para 1 2 3 4 5
mi comportamiento diario.

 

 

 

 

 

 

SECCION E3: TIEMPO ESPECIFICO DE ACTIVIDADES RELIGIOSAS
Ahora me gustaria preguntarle sobre sus actividades religiosas.

 

 

Entrevistadora - ‘ ‘ 3
. veces en Una vez Varies
Muestre la tarjeta E3 con respuestas. .l ammo . l. mu .1.
Nunca IIICS semana semana Diario
33. (En los ultimos 30 dias, con qué 1 2 3 4 5

frecuencia participo usted en
servicios religiosos (p.ej., misa, clase
de biblia)? Usted diria qu:

 

3b. LEn los ultimos 3O dias, con qué 1 2 3 4 5
frecuencia oro/rezo usted con su
familia?

 

3c. gEn los ultimos 3O dias, con qué l 2 3 4 5
frecuencia escucho usted musica
religiosa?

 

3d. LEn los ultimos 30 dias, con qué 1 2 3 4 5
frecuencia contribuyo usted dinero a
su iglesia?

 

3e. LEn los ultimos 3O dias, con qué l 2 3 4 5
frecuencia 1e ayudaron sus creencias
religiosas a entender su vida?

 

 

 

 

 

 

SECCION E4: FATALISMO

Ahora me gustaria leerle algunas declaraciones que han hecho personas en cuanto a su
destino y VIH/SIDA. Quiero que me diga si esta profundamente en desacuerdo, en
desacuerdo, poco en desacuerdo, poco de acuerdo, de acuerdo, o profundamente

de acuerdo.

 

 

Entrevistadora - Muestre Mm...“ E. Mm I,” u D. m
la tarjeta E4 con ”W W M m M «M

respuestas.

 

 

 

 

 

 

 

209

 

 

4a.

Yo soy responsable
por lo que ocurre en
mi vida.

 

4b.

Yo no tengo control
sobre mi vida, porque
mi destino esta en las
manos de Dios.

 

4c.

Las cosas buenas que
pasan en mi vida, son
porque asi lo quiere
Dios.

 

4d.

Yo tengo control
sobre mi destino, no
Dios.

 

4e.

Es cuestion del azar,
si suceden cosas
buenas en mi vida.

 

4f.

Si pasan cosas malas
en mi vida, es porque
asi lo quiere Dios.

 

Puedo prevenir que
me sucedan cosas
malas con medidas
practicas.

 

4h.

Tengo la habilidad de
hacer que cosas

buenas sucedan en mi
vida.

 

4i.

Si me infecto con el
virus de SIDA es por
mi propia culpa.

 

 

Quienes contraen

VIH es porque no se
cuidan.

 

 

 

210

 

 

 

 

 

 

4k.

Es cuestion del azar
si uno es infectado
con el virus del
SIDA.

 

41.

Soy yo la responsable
de no contraer
VIH/SIDA.

 

4m.

Las personas pueden
controlar si se
infectan o no con
VIH.

 

4n.

Si tomo las medidas
necesarias, puedo
prevenir e1 ser
infectada con VIH.

 

40.

Si es porque me toca,
seré infectada con
VIH.

 

 

Quienes son
infectados con VIH es
porque asi lo quiso
Dios.

 

 

 

211

 

 

 

 

 

APPENDIX 0

Sexual Gender Norms Measures (English Version)

212

APPENDIX 0

SEXUAL GENDER NORMS MEASURES (ENGLISH VERSION)

 

SECTION C: SEXUAL GENDER NORMS

Now I would like to ask you about your beliefs about how men and women should
act. Please tell me which statements best describe what you believe by responding
with strongly disagree, disagree, somewhat disagree, somewhat agree, agree or
strongly agree.

 

My
Dlsagree Disease Diaauee Agree Agree Agree

 

1. Women should be 1 2 3 4 5 6
virgins until they get
married.

 

2. A woman should ask 1 2 3 4 5 6
her partner to use a
condom.

 

3. A woman should know 1 2 3 4 5 6
very little about sex until
marriage.

 

4. It is acceptable if a 1 2 3 4 5 6
woman does not want
to have children.

 

5. A “good” woman would 1 2 3 4 5 6
not have anal sex.

 

6. A man should 1 2 3 4 5 6
determine whether or
not birth control is used.

 

7. A woman that carries 1 2 3 4 5 6
condoms in her purse is
“loose.”

 

8. It is acceptable for a 1 2 3 4 5 6
man to have many
sexual partners.

 

 

9. It is a woman’s 1 2 3 4 5 6
responsibility to buy
condoms.

 

 

 

 

 

 

 

213

 

 

Strongly Somewhat Somewhat Strongly
Agree

 

 

Dlsagree Dlsagree Disagree Agree Agree
. It is important for a 1 2 3 4 5 6
woman to have
children.
. A man should 1 2 3 4 5 6

determine how often a
couple has sex.

 

. It is acceptable for a 1 2 3 4 5 6
woman to have many
sexual partners.

 

. Only "loose” women 1 2 3 4 5 6
have oral sex.

 

. Birth control should not 1 2 3 4 5 6
be used so that a
woman can bear her
partner many children.

 

. A “good" man always 1 2 3 4 5 6
uses a condom.

 

 

. It is appropriate for a 1 2 3 4 5 6
man to ask his partner
for anal sex.

. A woman should 1 2 3 4 5 6

comply with her
partner's wishes to
have sex.

 

oo

 

. It is disrespectful for a 1 2 3 4 5 6
man to talk about sex
with a woman.

 

 

 

 

 

 

 

214

 

 

Section G: Condom Self-Efficacy
Now I would like to ask you some questions about using condoms. For each

statement, please tell me which one best describes you by responding never,
rarely, sometimes, often or always.

 

 

 

 

 

 

 

 

 

 

 

 

Interviewer - Show Card G With R“, m M,
Responses

1. I feel comfortable asking a new 2 3 5
partner to use a condom.

2. It is difficult for me to ask my boyfriend 2 3 5
to use a condom.

3. Even ifl had been drinking I would 2 3 5
ask a new partner to use a condom.

4. I would be able to refuse to have sex 2 3 5
with my boyfriend if he would not use
a condom.

5. If I was about to have sex with 2 3 5
someone, I would suggest using a
condom to protect us both.

6. I feel comfortable telling a new partner 2 3 5
that I will not have sex unless we use
a condom.

7. Even ifl had been drinking, I would 2 3 5
ask my boyfriend to use a condom.

8. I would go to a store, ask a clerk for 2 3 5
help, if needed, and buy condoms.

9. If someone I loved complained that he 2 3 5
did not like to use a condom, I would
be persuaded not to use one.

10. If I were going on a date and I thought 2 3 5

that we might have sex, I would bring
a condom with me.

 

 

 

 

 

 

215

 

APPENDIX P

Sexual Gender Norms Measures (Spanish Version)

216

SEXUAL GENDER NORMS MEASURES (SPANISH VERSION)

APPENDIX P

 

SECCION C: NORMAS DE IDENTIDAD SEXUAL
Ahora me gustaria hacerle unas preguntas en cuanto a sus creencias sobre como
deben actuar los hombres y las mujeres. Favor dc decirme cuales de las respuestas
mejor define como se siente: profundamente en desacuerdo, en desacuerdo, poco en

desacuerdo, poco de acuerdo, de acuerdo o profundamente de acuerdo.

 

Entrevistadora - Muestre
tarjeta C con las
respuestas

Profs-damask
ea deaaceerde

Ea
deaaeeu'de

Pace ea
deasceerde

Pace dc
steer-do

 

1.

Las mujeres deben
permanecer virgenes
hasta casarse.

 

La mujer debe pedirle a
su pareja que use un
condon.

 

La muj er debe saber
poco del sexo hasta el
matrimonio.

 

Es aceptable que una
muj er no quiera tener
hijos.

 

Una muj er “decente”
no perrnitiria sexo anal.

 

Un hombre debe
decidir si se usa control
de natalidad.

 

Una muj er que carga
condones en su bolsa es
“facil”.

 

Es aceptable que un
hombre tenga muchas
parejas sexuales.

 

 

Es irnportante que una
mujer tenga hijos.

 

 

 

 

 

 

 

217

 

 

Prelude-este
ea deeaeea'da

deaaceerde

Paces-

facade

I

 

10.

Es la responsabilidad
de la muj er de comprar
los condones.

 

11.

El hombre detennina
qué frecuente la pareja
debe de tener
relaciones sexuales.

 

12.

Es aceptable que una
muj er tenga muchas
parejas sexuales.

 

13.

Solamente las mujeres
“faciles” tienen sexo
oral.

 

14.

No se deben usar
metodos
anticonceptivos para
que la mujer le de
muchos hijos a su
parej a.

 

15.

Un hombre “decente”
siempre usa un
condon.

 

16.

ES apropiado que un
hombre Ie pida a su
pareja que tenga sexo
anal.

 

17.

Una muj er deberia
cumplir con los deseos
sexuales de su pareja.

 

 

18.

Es falta de respeto
cuando un hombre
habla sobre sexo con
una muj er.

 

 

 

 

 

 

 

218

 

 

Seccion G: Condom Self-Efficagy
Ahora me gustaria cambiar el tema y preguntarle del uso de condones. Por cada frase

por favor escoja una de las siguientes respuestas: nunca, casi nunca, a veces, seguido

 

 

 

 

 

 

 

 

 

 

 

 

o siempre.
Entrevistadora - C”, A

Muestre Ia tarjeta G con respuestas. Nunca Nuc- me- See-Ho Ste-1m

1. Me sentiria cémoda preguntarle a mi 1 2 3 4 5
nueva pareja que use un condén.

2. Tengo dificultad preguntarle a mi novio 1 2 3 4 5
que use un condon.

3. Aunque estuviera tomando bebidas 1 2 3 4 5
alcohélicas, yo le diria a mi nueva pareja
que usara un condon.

4. Yo seria capaz de negarle a mi novio 1 2 3 4 5
relaciones sexuales si e1 no usara condon.

5. Si fuera a tener relaciones sexuales con 1 2 3 4 5
alguien, yo le sugeriria usar un condon
para protegemos.

6. Me Siento c6moda diciendole a mi nueva l 2 3 4 5
pareja que no vamos a tener relaciones
sexuales a menos que usemos un condén.

7. Aunque estuviera tomando bebidas 1 2 3 4 5
alcoholicas, yo 1e diria a mi novio que
usara un condén.

8. Yo iria a la tienda, pediria ayuda si fuera 1 2 3 4 5
necesario, y compraria condénes.

9. Si alguien que yo amo se queja de que no 1 2 3 4 5
1e gusta usar condon, yo no usaria condon.

10. Si fuera a salir con un hombre y pensara 1 2 3 4 5

que fueramos a tener relaciones sexuales,
yo me llevaria un condon.

 

 

 

 

 

 

219

 

APPENDIX Q

Gender Norms Incongruency Measure (English Version)

220

APPENDIX Q
GENDER NORMS INCONGRUENCY MEASURE (ENGLISH VERSION)

 

SECTION D: GENDER NORMS INCONGRUENCY

Now I would like to ask you a few questions about struggles you may
experience as a Mexican or Mexican-American woman. For each statement,
please choose one of the following responses: strongly disagree, disagree,
somewhat disagree, somewhat agree, agree or strongly agree.

 

 

Strongly Dlsagree Somewhat Somewhat Agree Strongly
Disagree Disagree Agree Agree
1. l have a difficult time 1 2 3 4 5 6

accepting Mexican
values about what is
appropriate sexual
conduct for a woman.

 

2. I want to be a “good" 1 2 3 4 5 6
Mexican woman, but
sometimes I feel
constrained by
Mexican culture.

 

3. I struggle trying to 1 2 3 4 5 6
follow Mexican beliefs
about how women
should act.

 

4. Sometimes my desire 1 2 3 4 5 6
to be a “good” Mexican
woman conflicts with
what I want to do
sexually.

 

5. I find my views about 1 2 3 4 5 6
the role of women to
be in conflict with my
cultural background.

 

 

6. Sometimes I feel 1 2 3 4 5 6
obligated to follow
Mexican customs
about how women
should act even
though I disagree with
them.

 

 

 

 

 

 

 

221

 

 

 

 

 

W W Somewhat
Dissen- Die-em
Mexican culture limits 1 2 3
my ability to do things
in my life because I am
a woman.
Sometimes I feel like 1 2 3

experimenting
sexually, but my
cultural values make it
difficult for me to do
this.

 

 

 

 

222

 

 

 

 

APPENDIX R

Gender Norms Incongruency Measure (Spanish Version)

223

APPENDIX R

GENDER NORMS INCONGRUENCY MEASURE (SPANISH VERSION)

 

SECCION D: GENDER NORM CONGRUENCY

Ahora me gustaria hacerle unas preguntas acerca de su experiencia como una mujer
Mexicana o Mexico-Americana. Por cada frase por favor escoja una de las siguientes
respuestas: profundamente en desacuerdo, en desacuerdo, poco en desacuerdo, poco
de acuerdo, de acuerdo y profundamente de acuerdo.

 

EntrCViStadora' MuCStre Prelude-eats lie fees as Pace dc De Pref-ada-eate
tarj eta D con las en deaaeeerdo deeaeaerde lie-acuerdo acuerdo acuerdo de snarde

respuestas

 

1. Es dificil para mi 1 2 3 4 5 6
aceptar la conducta
sexual apropiada para
una mujer segun los
valores Mexicanos.

 

2. Yo quiero ser una I 2 3 4 5 6
Mexicana “decente”,
pero a veces me siento
limitada por la cultura
Mexicana.

 

3. Es una lucha para mi 1 2 3 4 5 6
seguir creencias
Mexicanas de como una
mujer debe de actuar.

 

4. A veces e1 deseo de ser 1 2 3 4 5 6
una Mexicana “decente”
conflicta con lo que
quiero ser sexualmente.

 

5. Mis opiniones de cémo 1 2 3 4 5 6
una muj er debe de
actuar estan en contra de
la cultura Mexicana.

 

 

6. La cultura Mexicana me 1 2 3 4 5 6
lirnita hacer cosas en la
vida por ser mujer.

 

 

 

 

 

 

 

224

 

 

Entrevistadora- Muestre
tarjeta D con las
respuestas

Mada-este
deaceerda

 

7. A veces me siento
obligada a seguir
costumbres Mexicanas
de como una muj er debe
de actuar aunque estoy
en desacuerdo.

 

 

8. A veces me gustaria
experimentar
sexualmente pero mis
valores Mexicanos me
lo hacen dificil.

 

 

 

 

 

 

 

 

APPENDIX S

Sexual Inventory (English Version)

226

APPENDIX S
SEUXAL INVENTORY (ENGLISH VERSION)

 

SECTION F1: RELATIONSHIPS IN THE LAST YEAR
Now I would like to ask you about your romantic relationships.

 

 

 

1a. Are you currently in a steady relationship with a man?
0 0. No (If “no”, go to question 1d.)
Cl 1. Yes
1b. Are you dating or living with this person?
CI 1. Dating
Cl 2. Living
1c. How long have you been in this relationship? (Go to

 

question 1e)

 

1d.

Are you currently dating?
Cl 0. No
Cl 1. Yes

 

1e.

Have you ever had vaginal sex or vaginal intercourse?
Cl 0. No
D 1. Yes

 

1f.

Have you ever had anal sex or anal intercourse - that is when your

partner inserts his penis into your bottom, behind or rectum?

Cl 0. No (Interviewer - If respondent has had vaginal intercourse,
continue to question 1g.

If respondent has a boyfriend and has not had ANY form
of intercourse, go to question 31:, page 15.

If respondent does not have a boyfriend and has never
had ANY form of intercourse, go to Section G, page 33.)
CI 1. Yes

 

 

19.

Have you had vaginal sex or vaginal intercourse in the last 12 months?
CI 0. No (Interviewer - If no, go to question 1i)
Cl 1. Yes

 

227

 

 

1h. In

the last 12 months, how often have you used a condom during vaginal

intercourse? Would you say:

C1
C1
CI
0
D

1. Never - 0% of the time

2. Rarely - 25% of the time

3. Sometimes - 50% of the time

4. Most of the time - 75% of the time
5. Always - 100% of the time

 

1i. Have you had anal sex or anal intercourse in the last 12 months - that is
when your partner inserts his penis into your bottom, behind or rectum?

Cl

Cl

0. No (Interviewer - If respondent has had vaginal
intercourse in the last 12 months, continue to question
1k.

If respondent has a boyfriend and has not had ANY
form of intercourse in the last 12 months, go to
question 3c, page 15.)

1. Yes

 

1j. In the last 12 months, when you have had anal sex, how often did you use
a condom? Would you say:

DECIDE]

1. Never - 0% of the time

2. Rarely - 25% of the time

3. Sometimes - 50% of the time

4. Most of the time - 75% of the time
5. Always - 100% of the time

 

1k. In the last 12 months, how many male sexual partners have you had?

 

(Interviewer - If participant has had no male partners, go to Section

G

, page 33.)

 

1|. Are you currently having sex with more than one person?

E]
El

0. No (Interviewer - If “no”, go to question 1n.)
1. Yes

 

 

1m.

How many sexual partners do you currently have including your
primary partner (i.e., your boyfriend or a current sexual partner with
whom you feel the closest).

 

 

228

 

 

1n.

Now I would like you to think about the last 12 months and the times that
you have had an alcoholic beverage. How often did you drink an
alcoholic beverage such as beer, wine or liquor (e.g., mixed drinks,
shots) before having sex? Would you say:

Cl 1. Never (If “never”, go to question F2, page 15)

Cl 2. Rarely

Cl 3. Sometimes

CI 4. Almost half of the time or

Cl 5. Almost always

 

 

 

 

 

 

 

 

10. On average during the last 12 months, how many drinks would you say
you had before having sex? Would you say:
CI 1. 1-2 drinks
Cl 2. 3—4 drinks
Cl 3. 5-6 drinks
CI 4. More than 6 drinks

1p. Think about those times that you drank before having sex, how many
times were you drunk enough so that you were unable to drive a car or
walk straight? Would you say:
Cl 1. Never
Cl 2. Rarely
El 3. Sometimes
Cl 4. Almost half of the time or
Cl 5. Almost always

F2. TRACKING ACROSS THE FOUR DATES

2. Now I would like to ask you about the last 4 times you had sex. I know it
may be difficult to remember, but the use of this calendar may help you
recall these events. In order for me to keep track, I would like you to tell
me the date of each encounter. If you’re not sure about the date, give me
an estimate of when it occurred. What are the four dates?
Interviewer - If respondent cannot remember the last 4 times she
had sex, document the ones that she does remember and for the
encounters she cannot recall write down “Cannot remember.”

1. 2. 3. 4.

2a. How many sexual partners does this represent?

 

 

 

229

 

 

F3. PARTNER SEXUAL HISTORY
33. Now let’s take a minute to remember when you had sex on (insert DATE
ifl). Think about when and where it occurred. On this date did you have
sex with :
CI 1. Your boyfriend
D 2. Someone you are (were) dating
Cl 3. A casual sexual partner or
Cl 4. Someone else (Specify)

 

3b. Did you have sex with more than one person on this date?
CI 0. No
Cl 1. Yes (Interviewer - If yes, go to Insert A)

 

3c. Interviewer -
If respondent has not had sex, but has a boyfriend, please ask :
What is your boyfriend’s ethnicity?

If you are asking respondent about the last time she had sex, please
ask: What is the ethnicity of the person you last had sex with?

Cl 1. Asian! Pacific Islander CI 4. Native American
Cl 2. African-American! Black El 5. White! Caucasian
Cl 3. Latino/ Hispanic Cl 6. Other(Specify)

 

 

3d. To the best of your knowledge is (was) the person you last had sex with
having sex with another person?
Cl 0. No - Go to question 3f
Cl 1. Yes - Go to question 3e.
Cl 2. Doesn’t know - Go to question 3f
Cl 3. Not sure - Go to question 3f

 

3e. As far as you know, does (did) he use a condom when he has (had) sex
with these other people?

Cl 0. No

Cl 1. Yes-

Cl 2. Doesn’t know
Cl 3. Not sure

 

 

3f. To the best of your knowledge has he been tested for the AIDS virus?
Cl 0. No- - Go to question 3h
Cl 1. Yes - Go to question 39
Cl 2. Doesn’t know - Go to question 3h
CI 3. Not sure - Go to question 3h

 

230

 

 

39.

Did the test show that he was HIV positive?
Cl 0. No

C] 1. Yes

Cl 2. Doesn't know

El 3. Not sure

 

 

 

 

 

3h. To the best of your knowledge has he been tested for STDs (i.e.,
sexually transmitted diseases)?
CI 0. No - Go to question 3j
Cl 1. Yes - Go to question 3i
Cl 2. Doesn’t know - Go to question 3j
Cl 3. Not sure - Go to question 3j
3i. Did any of the tests show that he was infected with an STD?
Cl 0. No
Cl 1. Yes
D 2. Doesn’t know
0 3. Not sure
3]. To the best of your knowledge has he injected drugs with a needle that
were
not prescribed by a doctor?
CI 0. No
El 1. Yes
Cl 2. Doesn’t know
El 3. Not sure
3k. To the best of your knowledge has he had a blood transfusion between
the years 1977 and 1985?
El 0. No
C] 1. Yes
El 2. Doesn’t know
El 3. Not sure
3|. To the best of your knowledge does he have sex with other men?

El 0. No

El 1. Yes

Cl 2. Doesn’t know
El 3. Not sure

 

 

3m. To the best of your knowledge has he been in jail?

No
1. Yes
2. Doesn’t know
3. Not sure

DDDD

 

231

 

 

F4. PARTNER’S SEXUAL GENDER NORMS

Now for each of the following statements, I would like you to tell me which
answer best describes what this partner believes about men and women.
Please use the following responses: strongly disagree, disagree, somewhat
disagree, somewhat agree, agree or strongly agree.

 

Strongly
Disagree

Disagree

Somewhat
Dlaawea

Auea

Mel!
Agree

 

Women should be
virgins until they get
married.

1

2

3

5

6

 

A woman should ask
her partner to use a
condom.

 

A woman should know
very little about sex until
marriage.

 

It is acceptable if a
woman does not want
to have children.

 

A “good” woman would
not have anal sex.

 

A man should
determine whether or
not birth control is used.

 

A woman that carries
condoms in her purse is
“loose.”

 

It is acceptable for a
man to have many
sexual partners.

 

It is a woman’s
responsibility to buy
condoms.

 

 

10.

It is important for a
woman to have
children.

 

 

 

 

 

 

 

232

 

 

11.

A man should 1 2 3 4 5 6
determine how often a
couple has sex.

 

12.

It is acceptable for a 1 2 3 4 5 6
woman to have many
sexual partners.

 

 

13. Only “loose” women 1 2 3 4 5 6
have oral sex.
14. Birth control should not 1 2 3 4 5 6

be used so that a
woman can bear her
partner many children.

 

 

 

15. A “good” man always 1 2 3 4 5 6
uses a condom.

16. It is appropriate for a 1 2 3 4 5 6
man to ask his partner
for anal sex.“

17. A woman should 1 2 3 4 5 6

comply with her
partner’s wishes to
have sex.

 

18.

It is disrespectful for a 1 2 3 4 5 6
man to talk about sex
with a woman.

 

 

 

 

 

 

 

F5

. USE OF CONDOMS

5a.

Interviewer - If respondent has not had ANY form of sex, go to
Section G, pg. 33. If respondent has had sex, continue with this line
of questioning.

Now I would like to ask you some specific questions about your sexual
encounter on this date. How many times did you have vaginal
intercourse during this sexual encounter?

 

5b

Of those times, how many times did you use a condom?

 

 

 

5c.

Were there any times during this encounter when there was penetration
(i.e., penis entering the vagina) without the use of a condom?

D 0. No - Go to question 5f.

El 1. Yes

 

233

 

 

5d. Did he ejaculate inside of your vagina?
D 0. No - Go to question 5f.
D 1. Yes

 

5e. How many times did this occur?

 

 

5f. How many times did you have anal sex during this sexual encounter?

(Interviewer - If participant did not have anal sex, go to question 6a.)

 

59. Of those times, how many times did you use a condom?

 

 

5h. Were there any times during this encounter when there was penetration
(i.e., penis entering the anus/rectum) without the use of a condom?
D 0. No - Go to question 6a.
D 1. Yes

 

5i. Did he ejaculate inside of your anus/rectum?
D 0. No - Go to question 6a.
D 1. Yes

 

5j. How many times did this occur?

 

 

F6. USE OF ALCOHOL
Ga. On this date did you drink an alcoholic beverage such as beer, wine or
liquor (e.g., mixed drinks, shots) before having sex?
D 0. No Interviewer - If respondent answered “no”, go to bottom of
the page to D INTERVIEWER
D 1. Yes

 

6b. How many drinks did you have? Would you say:
D 1. 1-2 drinks
D 2. 3-4 drinks
D 3. 5-6 drinks
D 4. More than 6 drinks

 

 

6c. Were you drunk enough so that you were unable to drive a car or walk
straight?
D 0. No
D 1. Yes

 

234

 

APPENDIX T:

Sexual Inventory (Spanish Version)

235

APPENDIX T

SEUXAL INVENTORY (SPANISH VERSION)

 

SECCION F1: RELACIONES EN EL ULTIMO ANO
Ahora me gustaria preguntarle sobre sus relaciones amorosas / romanticas.

 

1a. (Actualmente esta en una relacion amorosa con alguien?
Cl 0. No (Entrevistadora - Si la participante dice “no” pase a la pregunta
1d.)
Cl 1. Si

 

1b. gEsta saliendo o viviendo con esta persona?
CI 1. Saliendo
D 2. Viviendo

 

lc. 5Cuanto tiempo tiene en esta relacion? (Pase a la pregunta 1e)

 

 

1d. LActualmante estas noviando?

 

E] O. No
CI 1. Si
1e. [,Alguna vez ha tenido relacién sexual?
E] O. No
CI 1. Si

 

1f. 5Alguna vez ha tenido sexo anal o coito anal - es decir cuando su pareja introduce
su pene en tu ano, trasero o recto?
CI 0. No (Entrevistadora - Si la entrevistada ha tenido relacion sexual
vaginal, pass a la pregunta 1g.

Si la entrevistada tiene novio y no he tenido NINGUNA clase
de relacion sexual, pase a la pregunta 3c, pagina 16.

Si la entrevistada no tiene novio y NUNCA ha tenido
ninguna clase de relacion sexual, pase a la seccion G, pagina
36.)

CI 1. Si

 

 

1 g. gEn los ultimos 12 meses, ha tenido relacion sexual?

Cl 0. No (Entrevistadora - Si Ia respuesta es “no”, pass a la pregunta 1i)
CI 1. Si

 

236

 

 

1h. gEn los ultimos 12 meses, con qué frecuencia a usado un condon durante sexo
vaginal? Usted diria: (Entrevistadora- Muestre la tarjeta Flh con las
respuestas)
Cl 1. Nunca - 0% de las veces
CI 2. Rara vez- 25% de las veces
CI 3. A veces - 50% de las veces
CI 4. La mayoria del tiempo - 7 5% de las veces
CI 5. Siempre - 100% de las veces

 

1i. LEn los ultimos 12 meses, ha tenido sexo anal o coito anal - es decir cuando su
pareja introduce su pene en tu ano, trasero o recto?
C] O. No (Entrevistadora - Si la entrevistada ha tenido relacion sexual
vaginal en los ultimos 12 meses, pase a la pregunta 1k.
Si la entrevistada tiene novio y no ha tenido NINGUNA clase

de relacion sexual, pass a la pregunta 3c, pagina 16.
CI 1. Si

 

l j. gEn Ios ultimos 12 meses, con qué frecuencia a usado un condon durante sexo
anal? Usted diria que: (Entrevistadora- Muestre la tarjeta Fl j con las
respuestas)

Cl 1. Nunca - 0% de las veces

CI 2. Rara vez- 25% de las veces

Cl 3. Aveces - 50% de las veces

D 4. La mayoria de el tiempo - 75% de las veces
Cl 5. Siempre - 100% de las veces

 

1k. gEn los ultimos 12 meses, aproximadamente cuantas parejas sexuales ha
tenido?
(Entrevistadora - Si la participante dice “ninguno” pase a la seccion G, pagina
36.)

 

11. (gTiene actualmente relaciones sexuales con mas de una persona?

D O. No (Entrevistadora - Si la respuesta es “no”, pase a la pregunta In)
C] 1. Si

 

 

1m. (Actualmente cuantas parejas sexuales tiene incluyendo a su pareja principal
(i.e., tu novio o la pareja actual con quien se sente mas cercas).

 

 

237

 

 

1n. Ahora me gustaria que piense sobre los ultimos 12 meses y las veces que tomo

alcohol antes de tener sexo. 5Con qué fi'ecuencia tomo una bebida alcoholica
(P.ej., cerveza, vino, licor, tragos) antes de tener sexo? (Entrevistadora -
Muestre la tarjeta Fln con las respuestas.) Usted diria que:

1. Nunca (Si la respuesta es “nunca”, pase a la pregunta F2, pagina
16.)

Rara vez

A veces

La mitad de veces

Casi siempre

[313130 13
VIP?!"

 

 

 

10. For 10 normal, durante los ultimos doce meses, (3cuantas bebidas alcoholicas diria
que consumio antes de tener sexo? (Entrevistadora - Muestre Ia tarjeta Flo
con las respuestas.) Usted diria que:

CI 1. 1-2 bebidas
CI 2. 3-4 bebidas
CI 3. 5-6 bebidas
CI 4. Mas de 6 bebidas

1p. Piense en aquellas veces que tomo antes de tener sexo, (cuantas de esas veces
estuvo tan tornada (borracha) que no pudo manejar un carro o caminar derecho?
(Entrevistadora - Muestre la tarjeta Flp con las respuestas) Usted diria que:
C] l. Nunca
CI 2. Rara vez
CI 3. A veces
CI 4. La mitad de veces
D 5. Casi siempre

F2. TRACKING

2. Ahora me gustaria preguntarle acerca de las ultimas 4 veces que usted tuvo
relaciones sexuales. Reconozco que quizés es dificil acordarte, pero el uso de este
calendario puede ayudarle a recordar esos eventos. Para yo poder continuar en
curso, me gustaria que usted me diga la fecha de cada encuentro. Si usted no esta
segura de la fecha, por favor deme un aproximado de cuando ocurn'o. LCuales son
las cuatro citas?

Entrevistadora - Si la entrevistada no puede recordar las ultimas cuatro
veces que tuvo relaciones sexuales, documente las que si se acuerda y por los
encuentros que no recuerda escriba “No recuerdo”

l. 2. 3. 4.

 

 

 

 

 

 

2a. LEsto representa cuantos parejas sexuales?

 

 

238

 

 

F3. INFORMACION BASICA ACERCA DE SU PAREJA

3a.

Ahora vamos a tomar un minuto para recordar cuando tuvo relaciones sexuales
(Insert first date). Piense en cuando y donde ocurrio. En esta fecha usted tuvo
relacion sexual con:

Cl 1. Su novio

Cl 2. Alguien que usted esta (estaba) viendo

D 3. Alguien casual

CI 4. Alguien mas (Especifique)

 

 

3b.

Usted tuvo relaciones sexuales con mas de una persona en esta fecha?
Cl 0. No
D 1. Si (Entrevistadora - Si Ia respuesta es “si”, pase aI encarte A)

 

 

 

 

 

 

3c. Entrevistadora -
Si la entrevistada no ha tenido relaciones sexuales, pero tiene novio por favor
de preguntarle:
gCual es el origen etnico (racial) de su novio?
Si estas preguntando de la ultima vez que tuvo relaciones sexuales, favor de
preguntarle: '
gCual es el origen etnico (racial) de la ultima persona con quien tuvo relacion
sexual?
Cl 1. Asiatico/de las Islas del Pacifico CI 4. Nativo Americano
CI 2. Afro-Americano/ Negro CI 5. Blanco/Anglo-Americano
CI 3. Latino/ Hispano Cl 6. Otro (Especifique)
3d. LQue usted sepa, actualmente tiene relacion sexual su pareja con otra persona?
Cl 0. No - Pase a la pregunta 31'
D 1. Si - Pase a la pregunta 3e
CI 2. No 86 - Pase a la pregunta 31’
CI 3. No estoy segura - Pase a la pregunta 3f
3e. LQue usted sepa, usa condon su pareja con esa persona?
CI 0. No
CI 1. Si
Cl 2. No sé '
CI 3. No estoy segura
3f. LQue usted sepa, ha sido su pareja alguna vez examinado para ver si tiene e1 virus

del SIDA (tambien llamado VIH)?

CI 0. No - Pase a la pregunta 3h

Cl 1. Si - Pase a la pregunta 3g

Cl 2. No 36 - Pase a la pregunta 3h

Cl 3. No estoy segura - Pase a la pregunta 3h

 

239

 

 

LQue usted sepa, fue positivo su analisis de VIH/SIDA?
CI 0. No

CI 1. Si

Cl 2. No sé

CI 3. No estoy segura

 

3h.

gQue usted sepa, ha sido su pareja alguna vez examinado para ver si tiene
enfermedadas transmitidas sexualmente?

CI 0. No - Pase a la pregunta 3j

D 1. Si - Pase a la pregunta 31

CI 2. No sé - Pase a la pregunta 3j

CI 3. No estoy segura - Pase a la pregunta 3j

 

 

 

 

3i. [Cualquiera de estas examinaciones indicaron que el fué infectado?
CI 0. No
CI 1. Si
O 2. No sé
C] 3. No estoy segura
3 j. LQue usted sepa, su pareja se ha inyectado drogas que no han sido prescritas por
un doctor?
CI 0. No
CI 1. Si
CI 2. No sé
CI 3. No estoy segura
3k. LQue usted sepa, ha tenido su pareja una tranfusién de sangre entre los aflos 1977
y 1985?
D 0. No
CI 1. Si
CI 2. No sé
CI 3. No estoy segura
31. (3Que usted sepa, tiene su pareja relaciones sexuales con otros hombres?

Cl 0. No

CI 1. Si

CI 2. No sé

C] 3. No estoy segura

 

 

3m. (3Que usted sepa, su pareja ha estado en la carcel?

CI 0. No
CI 1. Si
CI 2. No sé

CI 3. No estoy segura

 

240

 

 

F4. NORMAS DE IDENTIDAD SEXUAL DE SU PAREJA
Ahora favor de decirme cuales de las respuestas mejor define como se siente su pareja
sobre como deben actuar los hombres y las mujeres. Quiero que me diga si el esta
profundamente en desacuerdo, en desacuerdo, poco en desacuerdo, poco de acuerdo,

de acuerdo, o profundamente de acuerdo.

 

Entrevistadora - mm“...
Muestre tarjeta F4 con
las respuestas

eedeeaceerde deaacearda

face as

face de
acuerda

 

4a. Las mujeres deben 1
permanecer virgenes
hasta casarse.

 

4b. La mujer debe pedirle 1
a su pareja que use un
condon.

 

4c. La mujer debe saber 1
poco del sexo hasta el
matrimonio.

 

4d. Es aceptable que una 1
muj er no quiera tener
hijos.

 

4e. Una mujer “decente” I
no permitiria sexo
anal.

 

4f. E1 hombre debe 1
decidir si se usa
control de natilidad.

 

4g. Una mujer que carga 1
condones en su bolsa
es “facil”.

 

4h. Es aceptable que un 1
hombre tenga muchas
parejas sexuales.

 

 

4i. Es la responsabilidad 1
de la mujer de
comprar los
condones.

 

 

 

 

 

 

 

241

 

 

4j.

Es importante que

una mujer tenga hijos.

 

4k.

Un hombre determina
qué frecuente la
pareja debe dc tener
relaciones sexuales.

 

41.

Es aceptable que una
muj er tenga muchas
parejas sexuales.

 

4m. Solamente las

mujeres “faciles”
tienen sexo oral.

 

4n.

No se debe de usar
ninguin metodo
anticonceptivo para
que la mujer lé de
muchos hijos a su
pareja.

 

4o.

Un hombre
“decente” siempre
usa un condon.

 

Es apropiado que un
hombre Ie pida a su
pareja que tenga
sexo anal.

 

Una mujer deberia
cumplir con los
deseos sexuales de
su parej a.

 

 

4r.

Es falta de respeto
cuando un hombre
habla sobre sexo con
una muj er.

 

 

 

242

 

 

 

 

 

 

F5. Uso DE CONDONES
5a.

Entrevistadora - Si Ia respondiente nunca ha tenido NINGUNA forma de
sexo, siga a la Seccion G, pagina 36.

Si la respondiente ha tenido sexo, continue con esta linea de preguntas.

Ahora quiero preguntarle acerca de su encuentro sexual en esta fecha. gCuantas
veces tuvo relaciones vaginales durante este encuentro sexual?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5b. LDC esas veces, cuantas veces uso un condon?

5c. gAlguna vez durante este encuentro hubo penetracién (es decir cuando e1 pene
entra Ia vagina) sin el uso de un condon?
CI 0. No - Pase a la pregunta 51'
CI 1. Si

5d. éEyaculo el adentro de su vagina?
D 0. No - Pase a la pregunta 51'
CI 1. Si

5e. (3Cuantas veces ocurrio esto?

5f. gCuantas veces tuvo sexo anal durante este encuentro sexual?
(Entrevistadora - Si la participante no tuvo sexo anal, pase a la pregunta
6a.)

5g. (3De estas veces, cuantes veces uso un condon?

5h. gAlguna vez durante este encuentro hubo penetracion (es decir cuando el pene
entra el recto) sin el uso de un condon?
CI 0. No - Pase a la pregunta 6a
CI 1. Si

Si. LEyaculo e1 adentro de su recto?
CI 0. No - Pase a la pregunta 6a
CI 1. Si

5j. LCuantas veces ocurrio esto?

F6. USO DE ALCOHOL

6a. (En este encuentro, tomo alguna bebida alcohélica (p.ej. cerveza, vino, licor,

tragos) antes de tener sexo?

CI 0. No (Entrevistadora - Si la respuesta es “no”, pase a la caja Cl
' Entrevistadora que sigue.)

Cl 1. Si

 

243

 

 

6b.

aCuéntas bebidas tomo? (Entrevistadora - Muestre tarjeta F6b con las
respuestas) Usted diria que:

CI 1. 1-2 bebidas

CI 2. 3-4 bebidas

CI 3. 5-6 bebidas

Cl 4. Mas de 6 bebidas

 

 

 

6c. gEstuvo tan tomada (borracha) que no pudo manejar un carro o caminar
derecho?
Cl 0. No
CI 1. Si

O ENTREVISTADORA - Si la respondiente solo pudo acordarse de un

encuentro sexual, marque la caja a la izquierda y sigue a la Seccion G en la
pagina 36. Si esto no le pertenece, siga a la pregunta 7a.

 

244

 

APPENDIX U

Multiple Partners Insert (English Version)

245

APPENDIX U

MUTLIPLE PARTNERS INSERT (ENGLISH VERSION)

Subject ID#:
Date of sexual encounter:
Partner #:

 

1.

Insert A

How many sexual partners did you have on this date?
Interviewer - If this is the first sexual encounter discussed go to
question 3.

 

Are any of these individuals, someone you had sex with on the previous
occassion(s) you cited?

D 0. No

D 1. Yes

 

Interviewer - Ask respondent this series of questions for each partner
she identified for this particular encounter. Do not document this
information for a partner she previously had sex with. Use a new Insert
A for each partner she identifies for this particular encounter and
answer questions 3b-8r.

 

3.

If only one additional partner: Now I would like to ask you a few
questions about this additional partner. What is the ethnicity of this

person?

D 1. Asianl Pacific Islander D 4. Native American
D 2. African-American/ Black D 5. White! Caucasian
D 3. Latino! Hispanic D 6. Other(Specify)

 

Interviewer - Go to question 4.

 

 

3a.

If more than one additional partner: Now I would like to ask you a few
questions about these additional partners. In order for me to keep track,
each time we talk about a new partner from this encounter, I would like
you to tell me the age of that specific partner. If you’re not sure about their
age, give me an estimate.

Ages: 1. 2. 3. 4.

 

 

246

 

 

3b. What is the ethnicity of the partner who is (insert age)?

 

 

D 1. Asian! Pacific Islander D 4. Native American
D 2. African-American! Black D 5. White!
Caucasian
D 3. Latino! Hispanic D 6. Other(Specify)
4. To the best of your knowledge is (was) he having sex with another
person?

D 0. No - Go to question 6

D 1. Yes - Go to question 5

D 2. Doesn’t know - Go to question 6
D 3. Not sure - Go to question 6

 

5. As far as you know, does (did) he use a condom when he has (had) sex
with these other people?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure

 

6. To the best of your knowledge has he been tested for the AIDS virus?
D 0. No - Go to question 8
D 1. Yes - Go to question 7
D 2. Doesn’t know - Go to question 8
D 3. Not sure - Go to question 8

 

7. Did the test show that he was HIV positive?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure

 

8. To the best of your knowledge has he been tested for STDs (i.e.,
sexually transmitted diseases)?
D 0. No - Go to question 10
D 1. Yes - Go to question 9
D 2. Doesn’t know - Go to question 10
D 3. Not sure - Go to question 10

 

 

9. Did any of the tests show that he was infected with an STD?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure

 

247

 

 

10.

To the best of your knowledge has he injected drugs with a needle that
were not prescribed by a doctor?

 

 

 

 

D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure
11. To the best of your knowledge has he had a blood transfusion between
the years 1977 and 1985?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure
12. To the best of your knowledge does he have sex with other men?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure
13. To the best of your knowledge has he been in jail?
D 0. No
D 1. Yes
D 2. Doesn’t know
D 3. Not sure
14. PARTNER’S SEXUAL GENDER NORMS

 

Now for each of the following statements, I would like you to tell me which
answer best describes what this partner believes about men and women.
Please use the following responses: strongly disagree, disagree, somewhat
disagree, somewhat agree, agree or strongly agree.

 

 

 

 

 

Interviewer - Show Card 5%,”: °"""‘ W ”m“ m '22..”

14A with responses

a. Women should be 1 2 3 4 5 6
virgins until they get
married.

b A woman should ask 1 2 3 4 5 6
her partner to use a
condom.

c. A woman should know 1 2 3 4 5 6
very little about sex until
marriage.

 

 

 

 

 

 

 

248

 

 

It is acceptable if a
woman does not want
to have children.

 

A “good” woman would
not have anal sex.

 

A man should
determine whether or
not birth control is used.

 

A woman that carries
condoms in her purse is
“loose.”

 

It is acceptable for a
man to have many
sexual partners.

 

It is a woman’s
responsibility to buy
condoms.

 

It is important for a
woman to have
children.

 

A man should
determine how often a
couple has sex.

 

It is acceptable for a
woman to have many
sexual partners.

 

Only “loose” women
have oral sex.

 

Birth control should not
be used so that a
woman can bear her
partner many children.

 

 

A “good” man always
uses a condom.

 

 

 

249

 

 

 

 

 

 

p. It is appropriate for a 1 2 3 4 5 6
man to ask his partner
for anal sex.

 

q. A woman should 1 2 3 4 5 6
comply with her
partner’s wishes to
have sex.

 

r. It is disrespectful for a 1 2 3 4 5 6
man to talk about sex
with a woman.

 

 

 

 

 

 

 

 

 

When you are done obtaining information about her partners for this particular

sexual encounter, return to the main questionnaire.

If you are discussing: sexual encounter #1, return to page 18, Section F5.
sexual encounter #2, return to page 23, Section F9.
sexual encounter #3, return to page 27, Section F13.
sexual encounter #4, return to page 32, Section F17.

250

 

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