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LEARNING FROM MEXICAN AMERICAN YOUNG WOMEN:
UNDERSTANDING PERCEPTION AND MANAGEMENT OF
HIV RISK

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LEARNING FROM MEXICAN AMERICAN YOUNG WOMEN: UNDERSTANDING
PERCEPTION AND MANAGEMENT OF HIV RISK

By

Mercedes M. Morales

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

MASTERS IN ARTS

Department of Psychology

2006

ABSTRACT

LEARNING FROM MEXICAN AMERICAN YOUNG WOMEN: UNDERSTANDING
PERCEPTION AND MANAGEMENT OF HIV RISK

By
Mercedes M. Morales

This study explored the perception and management of HIV risk in an
understudied group: Mexican American college women from traditional Mexican
families. Given that sexual expression is very closely related to culture, (Handelsman,
Cabral, & Weisfeld, 1987), the study sought to understand the parental and cultural
messages that the young women received in relation to relationships, sexuality, and
sexual protective behaviors. It also explored the relationship between these messages and
their protective behavior around HIV/AIDS.

Ten semi-structured in-depth interviews were conducted with college women ages
18-23, who had been in a relationship within the past 6 months. They were recruited
from a special program for Latinos/as in a Midwestern university. Interviews were
audio-recorded, transcribed verbatim and analyzed cross-case and within-case.

Participants varied in their level of HIV-related risk, however, most did not
perceive themselves to be at risk for HIV. In relation to familial messages about
sexuality, all participants reported having received very traditional cultural messages
about sex and relationships from their parents while growing up (e. g. don’t have sex until
marriage,). Interestingly, some also received speciﬁc protective messages, primarily from
a female family member (e. g, use condoms). Those young women who described most
effectively protecting themselves from HIV had both traditional and protective messages

from their families.

C0pyright by
MERCEDES M. MORALES RODRIGUEZ
2006

TABLE OF CONTENTS

LIST OF TABLES ................................................................................... vi
LITERATURE REVIEW
Introduction ...................................................................................... 1
Prevention Offers Hope ..................................................................... 2
History of Preventive Interventions ....................................................... 3
Traditional Individual-Level Change Approaches to HIV Prevention ............... 4
Hearing Women’s Voices ................................................................. 10
Research Focused on Understanding Women’s Risk ................................... 11
Hispanic Cultural Values .................................................................. 21
Latino/a Parents and Communication about Sexuality ................................ 24
Learning from One Group ................................................................ 29
METHODS
Study Design and Use of Qualitative Methods, ....................................... 34
Setting Description .......................................................................... 34
Sample ....................................................................................... 35
Procedures ................................................................................... 35
Recruitment ......................................................................... 35
Semi-Structured In Depth Intemews37
Interpretation and Analysis Methods ............................................ 38
RESULTS
Background and Culture of Study Participants ......................................... 41
What messages, in relation to sex did these young women receive?. . . . . . ...42
Traditional Messages ............................................................. 43
Protective Messages in Relation to Sex ........................................ 49
Breaking with Traditional Gender Norms ..................................... 52
Relationship Landscape ................................................................... 53
Sexual Communication .................................................................... 54
HIV Knowledge ............................................................................ 57
Sexual Risk Behaviors ........................................................................ 60
Sexual Risk Perception .................................................................... 63
Familial Messages and Sexual Risk ...................................................... 67
Discrepant Cases ........................................................................... 67
Authenticating Data ........................................................................ 69
DISCUSSION
Cultural and Parental Messages in Relation to Sexual Risk .......................... 72
Predictors of Sexual Risk Behaviors ..................................................... 74
Limitations .................................................................................. 78
Implications, Future Studies and Interventions ........................................ 79

iv

Appendices ........................................................................................... 83

Appendix A — Interview Protocol ................................................................. 84
Appendix B — F lyers ................................................................................ 99
Appendix C — Consent Forms .................................................................... 101
Appendix D - Coding Frameworks ............................................................. 104

LIST OF TABLES

Table 1 — Familial Messages in Relation to Sexuality ........................................ 129
Table 2 — Sexual Risk ............................................................................. 130
Table 3 — Familial Messages and Sexual Risk ................................................. 131
Table 4 — Sexual Communication with Partner and Sexual Risk ........................... 133

LITERATURE REVIEW
Introduction

As the acquired immunodeﬁciency syndrome epidemic enters its third decade it
continues to affect millions. Approximately 40 million people are currently living with
HIV or AIDS (World Health Organization, 2004). In 2003 alone, it is estimated that 5
million people were infected with the virus (CDC, 2004). In the United States, 886,575
people had been diagnosed with AIDS through 2002 (CDC, 2004) and it is estimated that
281,931 individuals are currently living with HIV/AIDS.

In the United States, Hispanics are disproportionately affected. Hispanics
accounted for 19% of the total number of new US. AIDS cases (including residents of
Puerto Rico) reported in 2000, despite the fact that the group made up only 13% of the
population at that time (CDC, 2004). The AIDS incidence rate per 100,000 population
among Hispanics (in the year 2000) was 3 times the rate for Whites (22.5) (CDC, 2004).
Latina women are at very high risk, accounting for approximately 20% of the reported
cases among women (CDC, 2002). While Latinos (Latino men) make up 6% of AIDS
cases due to heterosexual contact in the United States, Latinas (Latina women) make up
47% of the AIDS cases in this exposure category. Latinas have the highest rate of
heterosexual exposure (47%), when compared to African American (39%) and White

(40%) women (CDC, 2002).

Prevention Offers Hope

As of today, despite tireless work from the medical community, no cure has been
found for acquired immunodeﬁciency syndrome. A vaccine is yet to be discovered.
Thus, in light of the fact that Latina women are being infected and affected by this
terminal illness every day, we need to turn to the one area where we can hope to ﬁnd the
answer. This is the area of prevention. HIV is not airborne or in our water supply. This
illness is a preventable disease and prevention, at the moment, constitutes the only way of
reducing the number of people being infected and affected by this illness. What
constitutes effective prevention is different for different groups and there is undoubtedly
a necessity to develop, implement, and evaluate population speciﬁc preventive
interventions for HIV infection (Hobfoll, 1998; Lauby, Smith, & Stark, 2000; & O’Leary,
2000)

As is apparent from the literature on HIV preventive interventions directed at
women, the development of population speciﬁc interventions is talked about more often
than it is carried out. The prevention of HIV/AIDS is inherently difﬁcult due to the
sensitive areas that it concerns, especially when dealing with sexual transmission.
Achieving change in sexual practices of individuals is an innately difﬁcult task. Not only
is sex considered a private matter, there are other obstacles such as power imbalances
(O’Leary, 2000), racial and cultural issues (Tross, 2001), and ooncems about trust (Bird,
Harvey, Beckman, & Johnson, 2001) that need to be taken into account. These and other
challenges abound in the relatively young ﬁeld of HIV prevention.

As one reviews the literature it becomes apparent that the way HIV prevention

has been conducted and the way its many challenges have been managed (by scientists,

social scientists, and interventionists) has evolved quite a bit in the past two decades.
Understanding this progression is crucial to beginning to understand how to best move
forward.

History of Preventive Interventions

Prevention of HIV/AIDS has taken many forms in the past. HIV prevention
interventions have been implemented, in their majority, through government ﬁmded
projects (Fisher and Fisher, 2001). Often, neither behavior scientists nor well-tested
theories of behavior change have been incorporated into the intervention design process
(Fisher and Fisher, 2001). In fact, for a long time most interventions focused only on
providing information about HIV; a type of effort that empirical data has shown to be
notoriously ineffective in promoting safe sex behaviors (Fisher & Fisher, 2001; O’Leary,
2000; & Wulfert and Wan, 1993). Over time, preventive interventions took on a new
face with the development of theory-driven, individualistic approaches.

The behavior that most individualistic interventions aimed at women (including
Latinas) have tried to change has been the consistent use of the male condom. The
condoms’ high level of effectiveness in reducing the transmission of HIV (Van Devanter,
Gonzalez, & Merzel, 2002) and low cost have made consistent condom use the goal of
choice of most individual-level change interventions. Furthermore, when we take into
consideration that, since the 1990’s, the most frequent mode of transmission for women
has been heterosexual contact, it becomes clear why this strategy has been adopted.
These approaches that seek individual level change in people’s HIV risk behaviors
(namely condom use in this case) emphasize changing characteristics of the individual

believed to be associated with safe sex behaviors. Some characteristics typically focused

on include self-efﬁcacy, motivation, risk perception, skill building, and intentions. A
brief discussion on some of the most popular individualistic models and some of the
theories that they are based on is provided below.
Traditional Individual-Level Change Approaches to HIV Prevention

Perhaps one of the most used models in the design and implementation of HIV
interventions has been one based on Albert Bandura’s theory of social cognition
(Bandura, 2000). According to Bandura, the biggest problem with respect to behavior
change is not instructing people in what they need to do, it is imparting to them the social
and self-regulatory skills and the self-beliefs necessary to practice safe behaviors.
According to this approach, an effective behavior change intervention must involve four
components. One of these is self efficacy (i.e., the sense that one can control his or her
motivation and environment, especially his or her behavior). The other 3 components
are: 1) an informational component to increase awareness and knowledge of health risks
and to convince people that they have the ability to change behavior; 2) a component
about outcome expectations to develop the self-regulatory and risk reduction skills
needed to translate risk knowledge into goals around and plans of preventive behavior;
and 3) a component that develops or changes social supports for the individual who is
making the change, in order facilitate the change process and promote maintenance
(Bandura, 2004). Social cognitive theory has been used to design and implement small-
group or workshop programs that provide participants with risk reduction information,
use exercises to encourage change, plan and problem solve behavior change, teach
behavior and self management risk reduction skills, and reinforce clients’ behavior

change efforts (Kelly, Somlai, & DiFranceisco, 2000).

Another individualistic model that is often found in the literature of HIV
prevention interventions is the Transtheoretical Model of Behavior (Prochaska & Velicer,
1997). The Transtheoretical Model of Behavior describes behavior change as a process
of movement through a series of stages. These stages are: precontemplation,
contemplation, preparation, action, and maintenance. According to the model,
interventions need to be adjusted to the person’s readiness to change. Doing this makes it
more likely that the intervention will be effective (Cabral, Galavotti, & Gargiullo, 1996).

Different factors are important at different levels. For example, in the ﬁrst stages
(precontemplation and contemplation) cognitive and emotional factors are the most
important. Given that people are not thinking or just beginning to think about changing
their behavior, elements such as awareness of risky behavior and understanding pros and
cons are crucial at this point. Action and maintenance are important in later stages.
Support for behavior change becomes important even later to prevent relapse (Cabral,
Galavotti, Garguillo & Paul, 1996).

A third model that has been widely used in the design and implementation of
prevention interventions is the Information-Motivation-Behavioral Skills Model. This
model integrates some formerly isolated constructs (information, motivation, and
behavior) that have to do with HIV prevention interventions (Fisher & Fisher, 2001 ).

The model assumes that there are several determinants of HIV preventive behavior. If
individuals are well informed, motivated to act, and possess the behavioral skills to act
effectively, they will be likely to initiate and maintain patterns of HIV preventive
behavior. Thus, interventions that utilize this model will attempt to inform, motivate, and

provide skill building activities to participants.

Other widely used theoretical approaches to individual level change in HIV risk
behavior include the following: (1) the Health Belief Model, which asserts that people
will engage in preventive behavior if they feel susceptible to a health condition, believe
the condition is characterized by level of severity, and feel that the costs of engaging in
the preventive behavior are outweighed by the beneﬁts (Hochbaum, 1958), (2) the AIDS
Risk Reduction Model, which assumes that change is a process that individuals must go
through and that different factors effect movement through different states in the process
(Catania, Cotes, & Kegeles, 1994), (3) the Theory of Reasoned Action, which asserts that
an individual’s HIV preventive behavior is a function of his or her intention to perform a
given preventive act (Azjen & Fishbein, 1980), and (4) the Theory of Planned Behavior,
which is an extension of the previous model that adds the construct of perceived
behavioral control (Azjen, 1991).

Limitations of Individual-Level Change Models

Although some of the interventions that have been developed based on individual
level change models have produced desired results with some populations (CDC, 1999),
the fact that these approaches focus primarily on individual level change, presents some
limitations. The individualistic approach of these models focuses on behavioral change
and often does not take social, cultural, or community elements into account.
Emphasizing behavioral change alone can result in ignoring the overall ecological system
people live in (Hobfoll, 1998,). When only the individual is targeted and expected to be
able to change those behaviors that put her at risk, one assumes that this is something
completely within her range of control. This approach often does not consider the fact

that individuals are never isolated in making those decisions that relate to sexual risk.

There are issues relating to power and cultural norms that come into play in the context

that these behaviors take place in (Amaro & Raj, 2000; & O’Leary, 2000). In fact, recent

research on the sexual risk of minority populations in the United States has found

increasing evidence that sexual risk is embedded in gender and cultural contexts (Amaro,

2003). Hortencia Amaro speaks of the inﬂuence of gender on sexual decision making:
“Norms about sexual behavior are culturally prescribed and differ for men and women
across cultures- what is acceptable for men vs. women regarding initiation of sex and
when and with whom to have sex etc. The ability to negotiate successfully is related
to the power and resources that each individual has. The unequal status of men and
women typically means that women have less power to negotiate. Safer sex is two
different things for women and men...” (p. 30).

Amaro’s comments point to a need to achieve a clearer understanding of the
cultural and gender issues that go into women’s perception of risk, power, and safe sex
negotiation.

Wingood and DiClemente are among the few researchers that have begun to take
on this task (1998). In their work, on barriers to condom use among African American
women, they argue that the prevention literature has been limited by focusing mainly on
psychological models to explain behavior (W ingood & DiClemente, 2000). Instead, they
advocate for the importance of reaching an understanding of the cultural, relationship,
and gender-speciﬁc factors that inﬂuence the sexual decision-making process.

Wingood and DiClemente (2000) utilize the Theory of Gender and Power as a
framework to talk in a more holistic manner about issues related to sexual risk, such as

partner-related factors and gender issues (Wingood and DiClemente, 1998). This theory

describes three major (overlapping but distinct) components in the relationships between
men and women. The three structures are the division of labor, structure of power, and
structure of cathexis. The ﬁrst of these, division of labor, is described by the authors as
an allocation of particular types of work based on an individual’s sex. According to
Wingood and DiClemente this might manifest itself in areas such as the segregation of
unpaid work and inequalities in wages and educational attainment between men and
women. Women are at a power disadvantage in relationships given that there is an
economic disparity between men and women which favors men. The sexual division of
power has to do with issues of control and authority within the relationship. Women’s
ability to impose and deﬁne a situation or assert hegemony (which might be reﬂected in a
difficulty negotiating safer sex) is an example where this might manifest itself (W ingood
and DiClemente, 1998). Finally, the third component is the structure of cathexis. This
component speaks to social norms. It includes what a culture dictates men and women
should and shouldn’t do within a sexual relationship. Values (such as the importance of
motherhood, the belief that you are “loose” if you carry condoms, and the belief that
using condoms reﬂects a lack of trust) manifest themselves in this structure. The
utilization of frameworks such as this one, that allow us to begin viewing a more
complete picture of risk behaviors within a cultural context, is crucial to overcoming
some of the limitations of individual level change models. They add to our ability to
facilitate preventive behaviors. Unfortunately, work such as this is not the norm. More
often we see the implementation of “cookie-cutter” interventions which inevitably means

that efforts will often be less appropriate and less effective.

Over the past several years the need for a broader perspective that starts by
understanding the sexual risk context of a group, has been noted by numerous social
scientists. A call for the comprehension of these elements has emerged from the
prevention literature given the increasing realization that often sexual behavior appears to
be a lot more related to factors that have to do with a person’s surroundings than with
speciﬁc cognitive and behavioral factors of the individual (Hobfoll, 1998). In fact, wide
agreement can be found in the prevention literature about the necessity to “tailor”
programs to speciﬁc populations. A tailoring approach, of course, assumes that studying
and understanding the at-risk group is the crucial ﬁrst step toward effective intervention.
It is very common to read in this literature about the importance of “tailoring” programs
to ﬁt the needs of different groups (O’Leary & Wingood, 2000; & Lauby, Smith, &
Stark., 2000). Lauby et al. (2000) argue: “To be successful. .. interventions need to
address social, economic, and cultural issues that affect the target population’s access to
information and its ability to focus on health-related behaviors” (p. 221). Reppucci et
al.(1999) explain: “ Programs designed to alleviate large scale problems must become
multilevel in nature, e. g. focusing on individuals, families, community setting and
societal norms” (p. 441). These are just a few of the authors who argue how important it
is to understand cultural context and world view when attempting to carry out an
intervention. Some authors go as far as telling us that consistently individualistic
approaches that aim at providing generic interventions are “destined for failure”
(Reppucci et a1. 1999) and that an ecological perspective is the crucial next step toward

ﬁnding interventions that work.

With such wide agreement for the need of a more ecologically focused efforts it is
surprising and disappointing that prevention efforts aimed at different risk groups,
including Hispanic women, continue to utilize in their majority generic individualistic
approaches that often don’t reﬂect understanding of those things outside of the person
that might be affecting her or his behavior.

Hearing Women’s Voices

It is crucial that we begin to understand those ecological variables that come into
play when it comes to the sexual risk (Castaneda, 2000). One of the ways we can begin
achieving this is by hearing the voices of those we are hoping to understand and aid.
Comprehending women’s experiences, hearing their points of reference and what their
world means to them in their own voices is a crucial ﬁrst step to the development of
effective prevention efforts. This process of understanding people’s realities and risks
from their perspectives, as opposed to those established by social science or the dominant
culture, is a necessary process. This is evident in a piece of research by VanOss Marin,
Tschann and Gomez (1998). They conducted an intervention aimed at Hispanic adults
that had the objective of increasing condom use. The research focused on self-efﬁcacy as
a marker for Hispanic individuals’ sense of empowerment over their bodies and social
interactions. Lower self-efﬁcacy for condom use characterized those individuals who
reported ﬁnding it more difﬁcult to discuss condoms and control their sexual impulses.
However, as Hobfoll (1998) points out in his discussion of this study, self-efﬁcacy is a
decidedly Northern European and European American ideal. In fact, within the Latino
culture not only is self-efﬁcacy not a value, being controlled by one’s passions and not to

control those passions is thought of as healthy behavior. This individualistic construct,

10

which is very prominent in the HIV prevention literature, changes meanings in many
ways when working with Latino populations. Hobfoll (1998) explains, “to be in control
over condom use implies then to be more Anglo and less Latino unless some personal
cultural rapprochement is found between these two conﬂicting needs to be healthy and to
be passionate” (p. 135) This work illuminates the point that issues central HIV
prevention, such as empowerment, differ across cultures. Thus, attempting to understand
those factors that effect people’s perception of risk and desire and ability to change from
their own point of view becomes the challenging, but key, task in the development of
effective prevention efforts (Hobfoll, 1998).

Although not widely used, there are some exceptions to the rule of generic
implementation of individual-level change models. In the following section, prevention
efforts are described that take on the challenge of working with participants to let
solutions emerge through achieving a deeper understanding of Hispanic women’s
perception of risk and collecting their ideas as to how to best cope with risk.

Research Focused on Understanding Women’s Risk

One excellent example of an intervention rising out of a community through the
researchers’ efforts to achieve a deeper understanding of women’s perception of risk is an
intervention that arose out of a failed attempt at health promotion with Latinas (O’Leary,
2000). This intervention, based on the theory of social cognition, focused on providing
information and skill building around HIV preventive behaviors. The seven session
intervention was conducted over the course of several weeks with 46 Latina women. No
differences were found between the control group and the group that received the

intervention (Suarez-Al-Adam, Rafaelli, & O’Leary, 2000).

11

Data collection efforts were undertaken to try to discover why the intervention
had not been effective. Individual interviews were conducted with the goal of exploring
the possible effects of partner abuse on women’s ability to respond to the intervention.
Data was collected quantitatively, as well as qualitatively, on machismo (i.e.,
hyperrnasculinity), condom conversations with partners, and instances of sexual abuse.
Subsequently, focus groups were conducted. The major ﬁnding of the data collection
was that women reported being motivated by the initial intervention, but that their male
partners “won’t listen to us” (Suarez-Al-Adam & O’Leary, 2000).

Focus group discussions brought up the issue of extramarital sex among the
women’s partners. They agreed that if men used condoms with secondary partners,
disease would be prevented. Thus, ﬁom these discussions with the women an innovative
intervention emerged. The informal intervention used take-home videos to be watched
with their partners. Also, women would request the utilization of condoms, by their
partners, with secondary partners. Only 48% of the women were certain that they could
request that their partners use condoms with them, whereas 70% of the women were
certain they could request that they use condoms with other partners. Meetings of the
focus groups would continue to be held to report fwdback and to develop social networks
between the women through sharing their experiences (O’Leary, 2000).

All participants, except one, reported positive reactions from their partners after
seeing the video together. Researchers also found that 70% of women reported some
level of conﬁdence, “perceived efﬁcacy to persuade”, that after speaking with them their

partners would use condoms with other partners.

12

Another excellent example of an approach that took the perspectives of its
participants into consideration is an HIV prevention effort currently underway for inner-
city women at high risk for HIV heterosexual transmission (Tross, 2000). The piece of
research reviewed constitutes a team’s ﬁrst phase in the development of a preventive
intervention program for at risk women in New York City. The author, as a member of a
team of HIV and substance abuse researchers in New York City, joined the CDC’s
network of AIDS Community Demonstration Projects. Efforts were concentrated on
outreaching, observing, and interviewing inner-city women. The goal of this data
collection was to develop a program for and with them. Before taking on that task, the
researchers characterized salient features of their lives that directly inﬂuenced their HIV
preventive behavior. Among these were: HIV transmission and prevention awareness,
life experience with HIV, perceived risk, HIV sexual risk behavior, perceived barriers to
HIV safer sexual behavior, and substance abuse. They also identiﬁed which messages
and methods of HIV prevention intervention would be most likely to appeal to them
(Tross, 2000).

Individual interviews, focus groups, and ethno graphically informed street
observation was utilized to collect data. Important data was gathered as to normative
values, relationship contexts, and daily pressures in participants’ own terms. They found
that these women tended to be Latinas, mothers, and in unstable relationships. Their
partners were likely to be involved in drug use and they were likely to have a history of
alcohol and drug use. Experience with people with HIV was very common, but a sense
of personal risk was rare. Experience with condoms or other safe sex was also rare. It

was also found that women felt that the male norm of “machismo” was constraining, and

13

that they experienced intense fears of relationship conﬂict, abandonment, or even
violence (Tross, 2000).

Unfortunately, the process toward building these sort of interventions is a lengthy
one, Tross has been working on this effort with this community since the early 1990’s.
Consequently, we yet do not have an intervention with outcomes to assess the effects of
this approach. However this, and other work such as this provide the building blocks to
begin understanding what types of factors, relating to women’s experiences around
cultural norms and gender issues, come into play in Latina women’s perception of risk
and safe sex negotiation and behaviors .

Several other studies found in the literature have begun to take on the task of
shedding some light on these factors from a cultural and gender focused perspective.
Villarruel (1998) conducted focus group interviews with Puerto Rican and Mexican-
American adolescents and their mothers. Villarruel chose to study both mothers and
daughters, because parental communication is one of the ways that cultural attitudes,
including those associated with sexual behaviors, are passed on. The goal of the research
was to describe the inﬂuence of familialism (i.e. valuing of family), gender-role
expectations, and religion on the sexual attitudes, beliefs and norms of young Latina
women. Villarruel chose this focus because these factors have been linked to sexual
behaviors and attitudes toward sex. For example, familialism has been linked to
decreased inﬂuence by peers on risk taking behaviors (Padilla & Baird, 1991).
Religiosity (e. g., religious practice and belief, church attendance, and valuing religion)
has been associated with less permissive attitudes about sex and limited sexual

experience (Durant, Pendegrast, & Seyrnore, 1990.). Other gender role components that

14

have been associated with sexual behaviors and attitudes include the cultural imperative
to be a mother and the value of machismo, which includes power to decide sexual and
contraceptive behavior (Villarruel, 1998). Adhering to the belief of the importance of
motherhood has been associated with positive views of pregnancy and childbearing and
low contraceptive use (Smith & Weinman, 1995), while adherence to machismo has been
associated with unprotected behavior (Padilla & Baird, 1991).

Villarruel (1998) asked the young women to speak about the messages relating to
sex and expected sexual attitudes and conduct that they received from their families,
teachers, church etc. The interviews were analyzed utilizing thematic content analysis.
She found that both daughters and mothers talked about valuing virginity. This was
linked to self-respect, but not religiosity. Religion, in fact, was not found to be associated
to sexual behaviors. Villarruel (1998) reports that virginity and high self-respect were
often viewed as things that made them different from their non-Latina peers. The
protection of their future and their desire to achieve their dreams as reasons to delay
sexual activity were two themes that emerged from the interviews. From the parents’
interviews, it emerged that mothers showed concern for STDs and HIV, but were far
more concerned about unintended pregnancy. Something else that emerged from parents
was the pattern of “protecting their children”. Many had rules about boys and would give
advice about avoiding being alone with them. Villarruel (1998) reports that many Latina
adolescents interpreted the protective behavior of their parents as a Sign that their parents
cared for them. These young women also recognized that rules of their families, the
strictness with which they were being raised, and the obligations to their family, as

different from that experienced by their Anglo peers (V illarruel, 1998).

15

Overall, Villarruel (1998) found that the link between cultural values, speciﬁcally
familialism and gender roles, and norms and expressions of sexual behavior was
supported in this study. She concludes that health care professionals can utilize
information learned about cultural norms to promote the delaying of sexual activity in
Latina adolescents. Speciﬁcally, Villarruel (1998) suggests that health care professionals
such as nurses can support protective behaviors of family members, while assisting
adolescents to develop skills necessary to support safer sex behaviors. She also suggests
framing information about birth control, including condom use, within the context of
protecting one’s family and utilizing the rite of passage of the “Quinceanera” as a way to

promote delay of sexual activity (Villarruel, 1998).

A second study that sheds some light on the experiences and understandings of
sexuality that young Latina women have was conducted by Faulkner (2003). In this
study 31 Latina women participated in in-depth interviews. She utilized grounded theory
analysis to explore these young women’s deﬁnitions of sex and sexual relationships. The
purpose of the research was to improve the understanding of young adult Latinas’
sexuality by exploring the meanings that they attribute to sex, safer sex, and their ideal
relationships. Women deﬁned sex as various things. These included sex as virtually
anything (i.e., vaginal intercourse, oral sex, massaging, handholding, kissing, ﬂirting, and
caressing constituted sexual activity for about one third of the participants), as well as
making distinctions between sex and making love. Safer sex was conceptualized by the
women as “smart sex”. This meant that pregnancy and disease were being prevented and
that their emotional well-being was being protected by choosing trustworthy partners.

Only one woman (an AIDS educator) viewed erotic potential in the use of barrier

16

methods (i.e., condoms, dental dams etc.). However, other women did express their view
that barrier protection was a way that partners show care and respect for one another.
Most of them possessed a good idea as to how to properly protect themselves against
disease and pregnancy.

Ideal relationships were conceptualized by women as reciprocal, monogamous,
and both physically and emotionally safe. They talked about ideal sexual relationships
as ones arising from relationships that were “going somewhere” (Faulkner, 2003).

Several things emerged on the women’s attitudes and perceptions about men.
Faulkner (2003) explains that traditional attitudes construed men as “players”. Like in
Villarruel’s (1998) study, women reported being warned by family, as well as male
friends and older women, about avoiding these kinds of men. Some of the participants
expressed a preference in dating Latino men, while others expressed a preference in
dating non-Latino men. Those that preferred dating non-Latinos explained that Latinos
“had no clue” about women and considered them “not to have sexuality”.

Faulkner (2003) also found that the participants’ viewed men’s sexuality as
uncontrollable, leading them to devise plans for avoiding “players” and avoiding being a
“ﬂirt girl” because of the desire to be seen as moral and culturally competent. F aulker
explains that Latinas made sense of their sexuality by either rejecting, accepting, or
altering messages they received about sexuality. Those who rejected messages (Faulkner
calls them less traditional) thought that women’s roles encompassed more than
motherhood and relational partner. They tended to express beliefs in women’s rights to
sexual experience. They also tended to express anger at sexism, lack of sexuality

information, being labeled a certain kind of sexual person (e. g. lesbians or feminists), and

17

being called derogatory names. Those women that altered messages to ﬁt with their own
emerging beliefs about appropriate sexual behavior tended to adopt some parts of the
messages and discard others. For example, some women made distinctions between sex
for society (i.e., intercourse) and sex for church (i.e., any sexual activity). One woman
explained that although having sex with her partner was wrong according to the church,
she felt it was okay because they loved each other. Those women that fell into the third
group accepted the messages. They avoided sexual activity and attempted to stay in
control of their partners’ and their own sexual desires. These women, who endorsed
traditional values tended to assume that men orchestrated sex, led the way in sexual
activities, and were supposed to teach their partners once they got married. They also
expressed valuing “saving yourself” until marriage as honorable.

Faulkner (2003) also found that participants sorted women into two classes: Bad
women or “ﬂirt girls” and “good girls’. The ﬁrst of these, “ﬂirt girls”, talk about sex and
recognize sexual desire, while the second of these, “good girls”, do not discuss sexual
issues. It is crucial to note that these beliefs may constitute a barrier in the promotion of
HIV preventive behaviors. It is difﬁcult to “empower” young women to protect
themselves if they feel that even talking about sex will result in negative labeling.

Faulkner explains that while all women wanted equal relationships, they talked
about the difﬁculty of negotiating sexuality because of identity issues. Although women
were clear about what constituted safer behavior; they were not as conﬁdent about how to
always accomplish it. In fact, the women’s knowledge about safer sex contrasted with
actual practice. They reported different reasons for not utilizing condoms. These

included her or her partner’s attitudes toward condoms (e. g., feeling embarrassed at

18

buying them, feeling a reduction in closeness between herself and her partner, a partner’s
negative views toward them), the use of other forms of contraception, wanting to be
“spontaneous”, trusting a partner, and knowing a partner’s sexual history (sometimes this
included getting tested for sexually transmitted diseases and HIV). Gender role
expectations could also be seen as providing difﬁculty in the practice of safe sex when
one takes into consideration that individuals who hold traditional gender role
expectations will be likely to think that women who talk about sex, act like they enjoy
sex, and initiate condom use are promiscuous or “ﬂirt girls” (Faulkner, 2003).

It is important to note that women who adhere to traditional gender norms, those
that alter them, and those that do not adhere would be likely to respond differently to
preventive interventions because they have processed the cultural messages they have
received differently. This points to the importance of comprehending speciﬁc groups of
young women’s understanding of cultural messages around gender and sexuality in the
design and implementation of preventive interventions. It becomes clear that the same
interventions would not apply to all young Hispanic women. What cultural messages
they have received and whether those have been accepted, rejected, or altered would need
to be taken into account to produce effective interventions.

These studies provide some of the building blocks needed to begin untangling and
understanding how certain groups of Hispanic women view themselves and their sexual
relationships in relation to the gender and culture-related messages that they have
received across their lifetimes. These researchers have begun the important task of
distilling those contextual issues that come into play in the complex dynamics of

perception of risk, sexual risk behaviors, and safe sex negotiation. These include

19

farnilism, motherhood as a value, respect for family and self, protection of children, and
traditional gender role expectations (Faulkner, 2003; O’Leary, 2000; Villarruel, 1998).

Speciﬁcally, Villarruel (1998) tells us about these values within the context of
young Latina women who have not yet become sexually active. She puts forth the ﬁrst
steps of incorporating cultural beliefs around gender into an intervention with this
population through the suggestion of having health care professionals advocate the
(traditional Latino) value of virginity. This abstinence based approach is one way that
sexually transmitted diseases such as HIV (as well as unintended pregnancy) could be
prevented in a population of young Hispanic women who have not chosen to become
sexually active. It is also important to consider that although this could prove to be an
effective approach for a subset of the population, other women will enter sexual
relationships. Faulkner (2003) talked to some women who had were in sexual
relationships; she begins setting the ground for understanding how those women that she
spoke to perceive sex in relation to cultural norms and gender.

The work of these researchers has been groundbreaking in its ability to begin
approaching the problem of HIV prevention in subsections of Hispanic populations
through achieving a deeper understanding of different groups and those cultural norms
that affect risk perception and risk taking behaviors. Villarruel (1998) and Faulkner
(2003) have touched on some of the Hispanic cultural values that permeate young
women’s risk taking behaviors. The following section provides a brief overview of some

of these and other cultural values that have been identiﬁed in the literature.

20

Hispanic Cultural Values

There are several values attached to Latino culture that have been identiﬁed in the
literature as important in relation to many behaviors, including sexual risk taking
behaviors. These include: marianismo and machismo (Denner & Dunbar, 2004; Gil &
Vasquez, 1996; & Villarruel, 1998), farnilismo (Marin & Marin, 1991; Rafaelli & Ontai,
2004; Villarruel, 1998), and simpatia (Castaneda, 2000; Marin & Marin, 1991).

Marianismo and machismo are traditional gender roles associated with Latino culture.
Gil and Vasquez (1996) describe marianismo and machismo as prescribing appropriate
traditional gender roles of feminine and masculine behavior, including sexual behavior.
Marianismo includes the valuing of modesty, faithfulness, and virginity as feminine
ideals. Machismo, on the other hand dictates that men should be strong, in control, and
providers for their families (Marin & Marin, 1991). In relation to sexual behaviors, it
involves being in charge of sexual activity, having multiple sex partners, and not
communicating about sex with women (Marin, Gomez & Hearst, 1993). We would
expect these values to be important in connection to sexual risk taking, given that they
speak to the attitudes and behaviors that are expected of Hispanic women and men in
sexual situations.

Farnilism is another value that has been identiﬁed as important in relation to
sexual behavior (Villarruel, 1998; Padilla & Baird, 1991). This value involves
individuals’ strong identiﬁcation with and attachment to nuclear and extended families,
and strong feelings of loyalty, reciprocity, and solidarity among members of the same
family (Marin & Marin, 1991). Villarruel (1998) found that patterns of familism (i.e.,

respect for self and family, protection of self, child, and family) served as mediators of

21

stressors for young women who were experiencing pressure to have sex. This value has
been found to be important in relation to other behaviors as well. For example, Marin,
Marin, Perez-Stable, Otero-Sabogal, & Sabogal (1990) found that family-related reasons
for smoking cessation (e. g., bad example on children and family’s health) were far more
important for Hispanic than non-Hispanic White smokers. It is important to note that this
emphasis on the importance of family might make a difference in how young women act
in relation to HIV risk taking behaviors, given that one would expect that the values held
by ones’ family would weigh heavily on how she acted in relation to sexual risk taking
behaviors. For example, a young woman who grew up in a family that held virginity as
an important value, might be more likely to delay sexual activity.

Simpatia is a Hispanic cultural script that emphasizes the need for behaviors that
promote smooth and pleasant social relationships (Marin & Marin, 1991). Simpatia
includes a tendency to show conformity and empathy for feelings of other people and to
behave with dignity and respect toward others (Marin & Marin, 1991). Marin and Marin
(1991) explain that simpatia may be in play in that Latinos are more likely to give
socially desirable responses as research participants. When it comes to sexual behaviors,
reluctance to discuss HIV reduction behaviors with partners may be experienced, given
that cultural prescriptions to maintain harmonious relations may weigh heavily if it is
believed that discussion will result in conﬂict (Castaneda, 2000).

Finally, some researchers have hypothesized a link between religious beliefs and
sexual behaviors (Fierros-Gonzélez & Brown, 2002; Scott, Shifman, Orr, Owen, &
Fawcett, 1988; Urrea-Rodriguez, 1998; & Villarruel, 1998). Research has shown mixed

results in relation to this link. Although some ﬁndings point to a relationship between

22

religiosity (e.g., religious practice and belief and church attendance) and sexuality (e. g.,
less permissive attitudes about sex and limited sexual experience) (Scott et a1., 1988),
other research has found these to not be related. For example, in qualitative interviews
with young Latina women, Villarruel (1998) found that religion did not appear to have an
inﬂuence on decisions about sexual behavior. Fierros-Gonzélez and Brown (2002) had
similar ﬁndings. In their study of Mexican American college students, those who
considered themselves highly religious were still practicing risky behaviors. Religion
seemed to have no association with practice of risky sex..

Understanding cultural values in relation to sexuality is important because these may
serve as barriers, as well as facilitators, to preventive behaviors. For example, traditional
gender norms around sexuality may make Latinas reluctant to engage in risk reduction
behaviors with a partner, however values around protecting one another and protecting
family may facilitate them (Castaneda, 2000; & Villarruel, 1998).

It is crucial to point out that although many of the people of Latino/a origin in the
United States share some common values, subgroups are quite different from one
another. There is no such thing as one homogeneous group of Hispanics (Marin &
Marin, 1991). Although we speak of Hispanic and Latino values, it is important to point
out that the people of Latino/a origin who live in the United States will often differ
dramatically ﬁ'om one another. Issues such as the person’s country of origin, level of
acculturation and how long they have been in the United States all play a part in how a
person identiﬁes themselves, as well as what values and perceptions they hold (including

those related to culture, gender and sexuality). This does not mean that cultural values are

23

not important in relation to sexual behaviors, simply that we must be aware of exactly
what group we are trying to understand.
Latina/o Parents and Communication about Sexuality

When we speak about the importance of cultural messages, in regards to sexuality
that young Latinas receive, we must also speak about parents. Parents are some of the
most important conveyers of cultural norms to their children. Sexual expression is very
closely related to culture, in particular to what is considered proper, and parents’ attitudes
and experiences have a signiﬁcant inﬂuence on the transmission of prescribed cultural
norms. (Handelsman, Cabral, & Weisfeld, 1987). Given this, the next section reviews
the literature on how Latina/o parents handle communication about sexuality with their
children. Unfortunately, there is a relative dearth of literature on this topic. Seven
articles found did describe sexuality communication between parents and youth of
Latina/o descent.

Overall, studies that explored the content of the discussions that occur between
Latina/o parents and youth found that while Latino/a parents do sometimes communicate
with their daughters about sexuality they were often vague in their communication and
are more likely to talk about relationships, give warnings, and convey values than to talk
speciﬁcally about sexual behavior (Marin & Gémez, 1997; O’Sullivan, Meyer-Balhburg,
& Watkins, 2001; & Rafaelli & Green, 2003). For example, Marin and Gomez (1997)
found that discussions about sex sometimes are often vague, giving messages such as “Be
Careful”.They suggest that parents may be reluctant to talk to their girls about sex

because of the emphasis on their innocence.

24

Interestingly, Rafaelli & Green (2003) found that daughters reported higher levels of
communication than sons (mostly from their mothers), despite traditional cultural
reticence regarding female sexuality in Hispanic cultures. However, relationships and
values were more frequently discussed than protection and facts. O’Sullivan et al. (2001)
found that those Latina mothers who talked to their daughters about sexuality
“emphasized extreme, detrimental aspects of sexual and romantic involvement with boys
and men, including pain, shame, and humiliation” (p. 281). They concluded that while
African American mothers aimed to prevent STDs and pregnancy, Latina mothers aimed
to prevent the formation of relationships at all.

When Latina/o parents’ conversations turned to more speciﬁc topics, they tended to
emphasize biological aspects of sexuality, instead of protective behaviors (Rafaelli &
Ontai, 2001). Rafaelli and Ontai (2001) found that communication was limited to
biological topics and warnings of the dangers of sexual activity. In 22 qualitative in-
depth interviews with Hispanic young women, about the role of cultural beliefs and
values in sexual socialization, they found that only six had discussed physical
development and eight intercourse and pregnancy.

The ﬁndings of these studies suggest that it may be the case that Hispanic culture
does not necessarily dictate that young women can’t be talked to about sex, just that the
communications should be vague, and concentrated on relationships, values, warnings
about sex, and biology instead of discussion of protective behaviors. Some authors
propose that this lack of communication about protection, coupled with many rules and
restrictions about dating and sex put Latinas at risk for sexually transmitted diseases due

to the lack of agency that results (Rafaelli & Green, 2003; & O’Sullivan et a1., 2001) .

25

In one study participants reported that their mothers’ reticence about stepping past the
realm of reproduction and hygiene when talking about sexuality resulted in their turning
to others for information about sexual matters (e.g., aunts, sisters, ﬁiends of the family or
other friends’ mothers). In some instances mothers willingly let others answer these
questions (O’Sullivan, 2001)

A few studies went a step further and explored whether communication about
sexuality had any effect on the onset of sexual activity of young Latina women. Both
studies ﬁndings suggest that it does. Pick & Andrade (1995) in a survey of 1,257
adolescent girls of Mexican descent found that the girls with the lowest probability of
having begun sexual relations by 16-19 were those who had spoken frequently with their
mothers about sex. Unfortunately, the study did not examine the content of the
conversations between the mothers and daughters.

Romo, Leﬂcowitz, Signamn and Au (2002) did explore the content of
communications and, like Rafaeli and Green (2003), found that the Latina mothers talked
about beliefs and values and gave cautionary advice about sex and relationships. This
was related to adolescents’ abstaining from or delaying sexual involvement. This was
consistent with what Liebowitz, Castellano, and Cuellar’s (1999) ﬁnding that for
Mexican American adolescents the strongest predictor of sexual onset was the child’s
perception of parent-child congruity of sexual values.

These ﬁndings point to the fact that parental communication about values related to
abstinence can delay sexual activity. However, not all young women will remain
abstinent until marriage. In fact the CDC (2004) estimates that about half of Latina

young women are sexually active by the time they’re in high school. Two studies

26

provide some insight as to how sexual communication with parents might be related to
sexual risk behaviors in young women who are sexually active.

The Family and Adolescent Risk and Communication Study (F ARCS) which
surveyed 907 Latina/o and Aﬁican American participants (41% of which were sexually
active), explored the interactions between parental communication and peer
communication in these African American and Latina/o teens (Whitaker & Miller, 2000).
They found that the relationship between perceived peer norms and sexual behavior was
stronger among teens who had not discussed sex with a parent than among teens who
had. The same held true for condom use. They found that when parent teen discussions
of speciﬁc sexual topics “were associated with less risky sexual behavior, less conformity
to peer norms, and a greater belief that parents provide the most useful information about
sex” (p. 266).

Whitaker, Miller, David, and Levin (1999) found that parent-teenager discussions
about sexuality and sexual risk were related to the teens talking to their sexual partners
about sex and using condoms. However, whether this relationship was present or not had
to do with what parents said as well as how they said it. Skilled, comfortable, and open
parents were best able to provide messages that lead to protective behaviors.

The ﬁndings from these two studies suggest that speciﬁc messages about protection
from well-informed sources may be related to safer sexual behaviors in young women.
This may be true because parent-teen discussions about speciﬁc sexual issues provide
information, reinforce parent values, and buffer teens from pressure (Whitaker & Miller,

2000)

27

Overall, these articles on parental communication about sexuality highlight
several important points. First of all, it has been found that some Latino/a parents are
indeed reluctant to talk to their children about sexuality, and that this could be related to
cultural norms relating to sexual silence (Marin & Marin, 1991; & Diaz, 1998). Those
parents who do talk to their children about sexuality are often vague and prefer providing
information about values and relationships instead of speciﬁc sexual topics and
protection (Marin & Gomez, 1997; & Rafaelli & Green, 2003). This communication
about values and relationships seem to be related to later onset of sexual activity in young
Latinas. Also, those girls who were talking to their partners about sexuality and
protecting themselves were those who had received clear and speciﬁc information on
sexuality from parents or other adults who were willing and able to provide it (Whitaker
et a1, 1999, & Whitaker & Miller, 2000). Therefore, it appears that in relation to
preventive interventions, it’s important that young women who decide to become
sexually active have an adult in their lives that can be supportive and provide protective
messages.

Unfortunately, the literature is limited. The number of studies is quite small and
most lack depth in the description of parent-child communication about sexuality. Only
three of the studies found, two of which belonged to the same research initiative,
described the content of parent-child communications about sexuality and how that
related to sexual behaviors

In addition, some of these studies did not concentrate on a speciﬁc group.
Instead, they used general categories such as “Hispanics” or “Latinos” to describe their

samples. This may not be appropriate given that, as mentioned above, there is great

28

diversity between different groups of Latina/cs. Similarly, some researchers grouped
entirely different groups such as Puerto Ricans with other Latina/os (who live in the
United States) or Hispanics with Aﬁican Americans. Given that on some occasions
results were not described by group, it is impossible to determine what trends occur in
each and what role culture plays, if any. The exploration of how parent-child
communication plays out in speciﬁc subgroups is crucial to the construction of effective
preventive interventions.

Finally, within this literature, there seems to be the assumption that young women
who are Latina will either adhere to their parents values and beliefs about not having sex
before marriage and beneﬁt from that (Pick & Andrade, 1995; Rafaelli & Ontai, 2000) or
will not adhere and be more at risk because of it (Rafaelli & Green, 2003; Romo et a1.,
2002). The literature would beneﬁt ﬁom studies that look at those young women who
grew up with traditional messages about sexuality, chose to have sex before marriage and
are currently protecting themselves from HIV and STDs. Considering the large number
of Latinas that are sexually active by the time they reach high school, it is important to
understand who is protecting themselves and what factors had to do with that.

Learning from One Group

Hispanics in the United States make up 13.3 % of the population (Ramirez &
Cruz, 2003), making up the largest minority group in the United States; with Mexican
Americans constituting the largest group (66.9 % of the total Hispanic population,
Ramirez & Cruz, 2003). They are disproportionately affected by HIV (CDC, 2004).

Within the Hispanic population, a group of importance when it comes to the study

of HIV preventive behaviors is college students. Currently, people under the age of 22

29

are at highest risk of contracting HIV; therefore, most college students are in the age
range most at risk for HIV infection (Prince & Bernard, 1998). College is considered a
period of increased sexual experimentation for many college students (Fielstein, Fielstein
& Hazelwood, 1992), especially for those who are living away from home for the ﬁrst
time (F ierros-Gonzalez & Brown, 2002). Furthermore, the sexual activity of many
students is characterized by short-term monogamous relationships or multiple partners
and inconsistent use of condoms (Critelli & Suire, 1998; & Reinisch, Sanders, & Liemba-
Davis, 1993). The study of effective preventive strategies for this population is
especially important given that university settings may be more accessible than others for
interventions, thus allowing prevention efforts to reach this at risk group.

Considering the heightened risk of Hispanics in the United States, the fact that
Mexican Americans constitute the largest group of Hispanics in the United States, and
that college students are clearly at risk for HIV infection, Mexican American college
students emerges as an important group of study in relation to HIV risk. The importance
of this group is highlighted by the inconsistent condom use that has been reported in
studies within this population. In one study, 66.5% of Mexican American college
students surveyed responded that they had engaged in risky sexual practices without
using a condom (Fierros-Gonzalez & Brown, 2002). A study with unmarried young
Mexican American women, only 19% reported always utilizing condoms during vaginal
intercourse (Urrea-Rodriguez, 1998).

Few studies have looked at sexual risk in single Latina women (Urrea-Rodriguez,
1998). Entering a university setting may present a vulnerable time, in terms of sexually

risky behaviors, for Latina young women that are, for the ﬁrst time, stepping out of the

30

protective environment of their family life. This may be an especially risky time for
Latinas who are ﬁnding that they must make sense of a mainstream Anglo and traditional
Latino/a messages regarding appropriate sexual behavior that are often contradictory
(Faulkner, 2003). Given that for those who choose to engage in sexual relationships,
condom use is the most effective way to prevent way HIV transmission, it is imperative
to understand what factors inﬂuence young Mexican American women’s ability to
negotiate it’s use (Urrea-Rodriguez, 1998).
Learning from Mexican American Youth

There are only a few studies that shed some light on some of the factors that
inﬂuence the sexual risk and condom use of young Mexican American men and women.
In relation to sexual risk behaviors, research has demonstrated that condom use is related
to relationship characteristics. As would be expected, individuals in monogamous
relationships or who are married are less likely to use condoms than those involved in
casual relationships (Fierros-Gonzalez, 2002; Castaneda, 2000). A higher level of
commitment has also been associated with a lower level of condom use (Castaneda,
2000). In other words, if you feel that you are in a committed and monogamous
relationship, you are less likely to utilize condoms. HIV -related communication also
seems to be related to condom use. In one study it was the strongest correlate of condom
use with a partner in the last three months. In the same study, a high association was
found between intimacy and HIV-related communication (Castaneda, 2000).

In terms of perception of sexual risk, one study found that higher levels of
relationship commitment were related to lower levels of perception of risk (Castaneda,

2000). In other words, the more committed individuals felt to their relationships, the less

31

likely they were to perceive sexual risk. This can probably be attributed to higher levels
of perceived mono gamy in more committed relationships.

While researchers are beginning to examine the characteristics of relationships
that are related to safe sex behaviors, there has been almost no research on predictors of
risk behavior. Castaneda (2000) did explore the role of acculturation in protective
behaviors. She found that low acculturated Mexican American women and men viewed
female condom introducers (i.e., women who introduce the use of a condom) as
signiﬁcantly more promiscuous than male condom introducers. This supports the view
that there is a double stanndard regarding communication about condom use, where
women are not supposed to bring up condoms (Castaneda, 2000; & Marin & Marin,
1991 ).

Building on What We Know

The work of these researchers allows us to begin understanding some of the
factors that may be at play in sexual risk behaviors. Some of the aspects that emerge
from the literature are related to more general interpersonal issues, such as relationship
status. Others are related to culture,, such as “sexual silence” for women around
condoms (Diaz, 1998). These researchers have taken on the important task of beginning
to study these elements that are related to sexual risk. There is still a lot to be done
however, in order to construct effective interventions for different groups of Latina
women. Although these four studies give us an idea of where to start, there’s still a need

to build a deeper understanding of those issues that are related to sexual risk for different

groups.

32

An important group to focus on is Mexican American college women, these
young women are in a complex cultural environment where they receive messages that
are often in conﬂict with one another. The literature reviewed above tells us that
individual level factors (such as perception of risk), interpersonal factors (such as risk
behavior), and contextual factors (such as culture) matter in understanding sexual risk.
Therefore, in order to build effective interventions for this group it is crucial that we
understand more about their perceptions HIV risk, their how they protect themselves,
and what cultural and familial messages they are receiving about sexuality.

Research Questions

The study addressed the following research questions in order to further our
understanding of this group of Mexican American college women’s perception of risk
and protection from HIV.

1. What are the cultural messages, in relation to sex, that they have
received growing up?
2. What do they do to protect themselves from HIV?
3. How do these Mexican American College women perceive their risk
of HIV infection?
la. Do they view themselves to be at risk?
lb. Do they know about safe sex and prevention?
4. How are these messages that they received from their families in

relation to sexuality, related to their sexual risk behavior?

33

METHODS
Study Design and Use of Qualitative Methods

These research questions were explored through qualitative methodology.
Inductive qualitative research methods are useful in the exploration of questions that seek
to uncover insider views, perceptions, and beliefs around a process or experience (Denzin
& Lincoln, 1994). Given this study’s goal of exploring these in relation to perception of
sexual risk and management of risk, this method was well suited to meet the goals. The
approach that was utilized to get at these was in depth interviewing. This approach was
ideal for these purposes because it seeks to understand the meaning of people’s personal
experiences (Rubin & Rubin, 2005). Individual interviews were utilized given that they
are particularly useful for understanding individuals’ perspectives and gathering their
stories (Patton, 2001).

Setting Description

The setting of this study was a state University in the Mid-west. In this Univesity,
about 54% of the population is made up of women and 46% men. Out of the total
population, about 2.8% is Chicano/Other Hispanic (about 1,250 persons).

There are more than 500 registered student organizations including honoraries,
professional organizations, fraternities and sororities, racial/ethnic groups etc. About 15
are speciﬁcally devoted to Latino/a and Chicano/a people and issues. All participants for
this study were recruited from a program designed to assist the children of migrant
workers to get into and succeed at college. This site was chosen for recruitment for two
main reasons. First of all, this provided a site where all young women were ﬁrst

generation migrants to the United States and therefore more likely to self-identify as

34

Mexican, Mexican-American, or Chicana/Xicana . Secondly, the program
administration and staff expressed the importance of conducting such a study with their
students.

Sample

A total of 12 female students of Mexican American descent, ﬁrst generation, and
currently enrolled in the University participated in the study. They were eligible to
participate if they had been involved in a sexual relationship in the past 6 months, had
been in college for at least a semester, were between the ages of 18 and 23, and self
identiﬁed as Mexican or Mexican American. Out of the 12 interviews conducted, 10
were used for analyses. Two were eliminated due to recordings that were too poor to be
transcribed.

Procedures
Recruitment

Possible participants were contacted in several ways. First of all, personal contact
was made by the investigator at an organization meeting. On this occasion, the
researcher explained the purpose and content of the interview and invited the 11 potential
participants present to take part in it. A total of 4 participants were recruited at this
meeting.

Second, study ﬂyers (describing the study and selection criteria) were distributed
to potential participants by program staff by hand and email. A contact number and
email was provided on the ﬂiers so that potential participants could contact the
investigator if they were interested in participating. Only one participant was recruited

through hand delivered ﬂyers. Finally, a snowball recruitment technique was utilized,

35

whenever a participant would leave the interview she would be asked if she knew of any
other potential participants that could be interested. If so, she was asked to share the
study’s ﬂier with them. A total of 5 participants were recruited in this manner.

When potential participants contacted the researcher, she explained the purpose of
the study and told them that it involved participation in a 90 minute recorded interview.
If interested, they were screened for eligibility (e. g., age, ethnicity, student status, etc.).
Once the screening took place, if they were eligible and willing to participate, a meeting
time for the interview was set up. (A total of three persons contacted the investigator,
but upon screening, were not eligible to participate.)

Follow up reminder messages were sent one week prior to the interview and a
conﬁrmatory call or email message was placed the day before each interview took place.
All of the interviews were conducted in the investigator’s private ofﬁce.

On two occasions potential participants were scheduled for interviews, conﬁrmed
that they would be available during the reminder phone call but did not show up at the
scheduled time.

It’s important to note that, it is not possible to determine the proportion of
potentially eligible women who could have participated in the study. There is no way of
knowing how many women who heard about the study met the eligibility criteria. The
decision was made to stop interviewing because saturation was reached with regard to the
women’s traditional cultural upbringing and the sexual messages they received. In
addition, a range of possible sexual protective behavior was represented, ranging from no

condom use to consistent condom use.

36

Semi-Structured In Depth Interviews

When participants arrived for their interviews I (the interviewer) had a recorder
and an interview protocol ready. The participant was given a brief explanation as to what
to expect and told that she could choose to discontinue her participation in the study at
any time. She was also assured of the complete conﬁdentiality of the interview and asked
if she could be audio-taped.

Once permission was granted, a consent form was signed by the participant and
the interview began. Interviews ranged in length from 36 minutes to 2 hours and 12
minutes. As is common practice in research on HIV prevention, each participant was
paid for her participation in the interview. An amount of $15 was deemed appropriate as
an incentive but not so much that it would be coercive, as outlined in section 8.06 of the
APA Ethical Principles of Psychologists Code of Conduct (2003).

The interviews conducted were semi-structured in nature. Their purpose was to
uncover women’s perceptions, beliefs and experiences in relation to HIV risk, risk
management, and cultural messages around gender roles and sex. The interview protocol
consisted of four main sections. These were 1) Demographics and Background, 2) The
participant’s perception of risk and safe sex, 3) Management of risk (i.e., negotiating
safe sex and barriers to safe sex), and 4) Cultural messages around sex and the
processing and management of these. Participants who described their sexual
relationships to have taken place with one main partner within the last 6 months and
participants who had sexual encounters but did not identify one main partner were asked
different sets of questions. This was important given that perception of risk, risk

management, and safe sex negotiation can differ signiﬁcantly if a participant is referring

37

to a main partner or not. The investigator utilized the set of questions that referred to
main partners if the participant identiﬁed a partner that she has or had sex with, or had
been with for over a four week period, and with whom she had a mono garnous
relationship. Otherwise, the investigator utilized the second set of questions.

After interviews were conducted, they were transcribed verbatim. These
transcriptions were then checked for accuracy by reviewing them against the original
tapes. All identifying information was removed from the transcript during this process to
ensure conﬁdentiality.

Finally, the electronic documents containing the transcripts were imported into
qualitative analysis software to aid in the analysis of the data. Speciﬁcally, the
qualitative analysis software ATLASti 4.2 was utilized in the organization and coding of
the transcripts.

Interpretation and Analysis Methods

The goal of the analysis of the data was to achieve a deeper understanding of
these young women’s perception of risk, risk management, and processing of cultural
messages received. In order to address these distinct research questions, two methods of
analysis were utilized, cross case analysis and within case analysis.

Cross-Case Analysis

A cross-case analysis strategy was used to explore themes that came up across
individual cases. In other words, answers from different people to common questions or
different perspectives on a particular issue were grouped and analyzed. (Patton, 2002).
This process helped me, in collaboration with the chair of this study, determine what

common themes emerged in relation to the research questions. This process included

38

several steps. First, I read all of the transcribed and cleaned interviews and coded data by
the research question that it corresponded to. Thematic content analysis followed.
Recurring regularities in the data were looked for to reveal patterns that could be sorted
into categories (Patton, 2001). The criteria of internal homogeneity and external
heterogeneity were used to judge if the categories were meaningful. Speciﬁcally,
emergent themes were identiﬁed through a comparative method (Lincoln and Guba,
1985). This involved grouping units of information that were similar in content. To
ensure thoroughness of the process an iterative approach of moving back and forth
between the transcripts and the coding framework was used. This process resulted in
forming an initial list of codes as the investigator read through the interviews.
Throughout, the investigator was in very close communication with the chair of this
research. Codes and descriptions were reviewed and discussed at each phase of the
coding process to be sure that there was agreement on deﬁnitions and examples of each
code. .Codes were changed and revised several times (see Appendix D). After all
interviews were read and coded the ﬁrst time, the coding framework that resulted was
revised and all of the interviews were recoded utilizing the resulting framework. This
data analysis strategy was utilized to address all questions.
Within-Case Analysis

In addition to cross-case analysis, a within-case analysis was conducted for all
research questions. This helped illustrate how each individual’s experiences with cultural
messages received inﬂuenced management of sexual risk. This process included several
steps. First, the themes that were identiﬁed throughout the cross-case analysis were

organized and inserted into tables that allowed an examination of which themes came up

39

in each individual’s story. These summary tables addressed the following themes:
traditional messages received by the young women about sexuality (see Table 1),
protective messages received by the young women about sexuality (see Table l), and
sexual risk (see Table 2). Then, a within-case table was created that broke the
participants up by risk group. It also included what familial messages in relation to
sexuality each participant had received (see Table 3). By organizing the data in this way,
patterns within the stories were identiﬁed. The chair of this study and I worked closely
together to identify themes and patterns across the stories that addressed cultural
messages and their relation to protective sexual behaviors. In the following paragraphs I

will be discussing which patterns emerged.

40

RESULTS

In order to begin building a knowledge base that would allow the construction of
culturally appropriate sexual risk interventions, it was important to explore some of the
potential links between culture and sexual behavior. A ﬁrst step was to explore and
describe these young women’s cultural background. This will be described in the
following section. Then, the messages that the participants received from their families
in relation to sex and relationships are described. This will be followed by a description
and discussion of their relationships, communication about sexuality in those
relationships, HIV knowledge, sexual risk behaviors, and perception of risk. Finally a
within case analysis will be used to explore how these aspects are related.

Background and Culture of Study Participants

All of the participants came from migrant farm-working families. While they
reported having been born in a variety of places (Texas=4, Mexico=3, Michigan=2, and
Florida=1) all reported migrating ﬁ'om Texas or Florida to Michigan each year for their
parents (and in some cases themselves) to work in the ﬁelds.

Throughout this migration process, all participants described having grown up
immersed in Mexican culture, both while living in Michigan as well as Texas (or
Florida). Half reported growing up in predominantly Mexican communities, 3 reported
growing up in ethnically mixed communities, and 2 reported growing up in
predominantly White communities. All described strong ties with their Mexican origins.
In terms of self-identiﬁcation a majority of participants (n=9) identiﬁed as Mexican, with
four also identifying as Mexican American. One young woman, through her work as an

activist within the university, had recently come to identify herself as Xicana.

41

All participants described growing up very immersed in Mexican culture. There
were several things that they described as contributing to this immersion. These
included: speaking Spanish at home when were growing up (n=10), eating Mexican
foods (n=6), and practicing Mexican traditions (n=5) such as Quinceaneras (traditional
coming of age party when girls turn 15), Bautismos (Christenings), and Mexican
Holidays. Some also mentioned cultural norms such as machismo (n=4).

I speak Spanish as far as before I speak English... like it is a thinking process I’ll
speak Spanish, but then I’ll like try to convert it into English, but yeah, the food, the
attitude, the machismo, the religion, I mean the celebrations. I think I was very into a
Mexican family (P004, 2972308)

We had like the bautizos [Christenings] and the Quinceaneras, and killing the cow,
you know the whole pig thing, the whole roasting the pig so it was all real Mexican...
I went to Church on Sunday, Mexican Church and mass was in Espanol.

(P003, 1452151)

Overall, all of the young women in the sample felt that they had grown up in
traditionally Mexican households.

What messages, in relation to sex, did these
young women receive growing up?

As mentioned above, all of the young women in the sample felt that they had
come from traditional Mexican families. Therefore, it was not surprising to ﬁnd out that
all of the participants received traditional Mexican messages from their parents as well as
other family members in relation to sex and relationships. Throughout the analysis
process, a cultural or familial message was considered “traditional” if it reﬂected the
traditional Mexican values described in the literature. These included marianismo, which
includes valuing virginity and the importance of not having sex before marriage (Marin
& Marin, 1991); machismo, which dictates that women should be submissive and men

dominant; and farnilismo, which is described as a strong identiﬁcation with and

42

attachment to nuclear and extended families, and strong feelings of loyalty, reciprocity,
and solidarity among members of the same family (Marin & Marin, 1991). Some
examples of speciﬁc messages, in relation to sex and relationships, that reﬂected these
traditional values included don ’t have sex until marriage and you can ’t go out with boys.

However, these traditional messages were not the complete story, in addition to
these, many of the young women (n = 7) also reported receiving non-traditional
protective messages in relation to sex from at least one member of her family (e. g.,
protect yourself and use condoms). In addition, some of the young women (n=6)
reported that someone in their family was open to talking to her about sexuality. Finally,
some (n=4) of the participants received the message that it was okay to break with
traditional gender norms such as the need to marry if they got pregnant.

Traditional Messages

All of the participants in the sample described having received at least one of a set
of traditional messages from their families in relation to sex and relationships. While
some only received one such message, others received as many as six different types (see
Table 1). These included a) We don ’t talk about sex, b)Don ’t have sex til’ marriage c)
You can ’t go out with boys, (I) It 's desirable to be a virgin, and 6) You become a woman
atI5.
We don 't talk about sex (n=4)

Several participants described We don ’t talk about sex messages. Given that
parents strongly disapproved of sexual activity in their daughters, even talking about it
was out of the question.

I: Were issues of sexuality ever talked about in your home at all?
P: Oh Lord Jesus, no! Um, if you would have sex and then they would have found

43

out like you had to marry him. . .That was a given. . .No, I could never tell my mom,
I’m having sex. [laughter] Or what if I want to have sex like, you know, not even to
my sisters... My mom thinks that I don’t, you know... ‘no I raised her with some like
good advice like, you know, I don’t think she’ll be doing something like that.’ (P010,
1238: 1262)

In my family you don’t really talk about that kind of stuff, you don’t. Like you can’t
just go and tell your mom you know and ask her the questions about protection. She’ll
be like well why do you want to know about that you know? Even dating, dating is
just, they’re all like you’re not gonna date until you’re this age... (P002, 365:370)

Some of the young women that I talked to related this sexual silence directly
to their culture and one expressed a desire to change this with her children.

I: Do you feel like women your age then are vulnerable to, to HIV?

P: Yeah, I think mostly in Mexican American because they’re not really open to those
kinds of subjects, you don’t talk... with your mom. .. about that.

I: You don’t do that?

P: No, it’s a lack of respect. (P002, 4342443)

I just felt like our culture is so tabooed. .. around wanting to talk about sex and like I
said earlier we just need to talk about it. When I have children I’m gonna like

try to be different, the way my mom taught me. I’m gonna try to like be different or
whatever but that’s about it. I don’t think it should be tabooed or girls shouldn’t have
satisfaction. They don’t know. Girls should only have one partner and stuff like that,
they shouldn’t go out and explore. (P003, 1005:1014)

The following quote from one participant succinctly expresses why she feels sex is
not talked about in her home. Basically, if you are not supposed to be having sex then
there should be no need to talk about it.

I: You were mentioning that what you learned ﬁ'om your family made you feel...

shyer about bringing that stuff [sexuality] up. What speciﬁcally that you learned from

your parents do you think made it harder?

P: I think that you’re not supposed to talk about it, that you’re not... even supposed to

be asking those questions... It’s something that you’re not supposed to know about

until you’re married. (P 002, 730:736)

Don ’t have sex before marriage (n=9)

Almost all of the participants described having received the message Don 't have

sex before marriage from their parents as they were growing up. While in some

instances young women were told that they should not engage in any sexual interactions
with boys, in others, parents speciﬁed that behaviors such as kissing and holding hands
were allowed.
Like with my dad, I couldn’t have a boyfriend... I couldn’t bring a man home so that
was out of the question but my mom was more like, ‘Don’t have sex’. You can kiss
or hold hands or whatever but you cannot have sex and she’s really strict... (P003,
935:942)
...well, my mom has always been like, don’t have sex until you get married. I never
really talked to my dad about what he thinks [giggles] but my mom’s always been
that kind of person, (P 006, 8092816)

Overall, this was one of the most prevalent and salient messages received by this
group of young women.

Most of the participants who received the Don ’t have sex message when they
were growing up, also described being told that they could not got out with boys.

Can ’t go out with boys (n=7)

Many participants described being told that they were not allowed to go out with
boys as they were growing up. While some were allowed to begin dating at 15 (the
traditional coming of age time), this was not the case for all.

I: Were there like any ages that you could start doing stuff at or not really?

P: Well, you, it’s actually considered that once you turn 15 that okay, you’re
becoming a woman therefore you can start having male friends at least... but
whenever I would tell my mom oh you know I have a guy ﬁiend [she would say]
“who is he?, why do you have a guy friend you shouldn’t”, they still have that attitude
so but I guess in my family they’re just extra strict... (P005, 298:308)

It is weird like you can see my sister which is 14, you remember that was just starting
like joking around oh she has got a boyfriend or oh he has got a girlfriend. My dad
will be like yeah, that’s my boy or whatever, ‘but how many girlﬁiends you got?’ Or

whatever and like making fun... But whenever it comes to my sister he just looks at
her saying, oh you can’t have a boyfriend. (P009, 805:815)

45

On some occasions, participants described this You can ’t go out with boys
message as being one of the many things that they were restricted from doing by their
parents.

It’s disappointing... I wanted to hang out with my ﬁiends as well. . .um going to the
movies, there was no going to the movies with girlfriends or just going shopping,
hang out with the friends and no boy phone calls, no dating... stuff like that. (P 005,
282:296)

P: ...I started wanting to do things outside of high school with ﬁiends and she [my
mom] didn’t understand that and they [my parents] were very like close-minded about
certain subjects.

I: Like what?

P: Like the fact of going out with boys... a group of boys and girls and they didn’t
really understand why... why can’t you... go with the girls and guys can’t pick
you up and stuff like that. (P003, 431 :445)

This traditional message reinforced the idea that young men should not be around
young women, given that this could lead to sexual activity.
Don ’t bring boyfriends home(n= 7)

Don ’t bring boyfriends home was another message that most of the women had
received growing up. Through this message, their parents were communicating that,
given that they did not approve of going out with boys, if they were going to have
boyﬁiends, they did not want the young women to bring them home. The only time
when parents expressed an interest in meeting their daughter’s boyfriends was if they
planned to get married.

I: .. .when you were growing up, how did your parents feel about... your relationships
with boys?

P: [laughs]... they knew about my boyfriend, my ﬁrst boyfriend in high school. I
never brought him home ‘cause... if you bring your man home, you are going to
marry him. That’s the way it is set... the rules. So... I’m not going to marry him... so
I’m not going to bring you home... my dad would just say, you are going out
tonight and I don’t want to hear anything about your novio [boyfriend]or whatever...

So I was like, yes dad I’m not going to go out with him, I’m just going to go out with
my ﬁiends... But, he knew... (P010, 120421219)

46

Rarely some parents did let their boyfriends come over and see the girls but it wasn’t
a lot. . ..I think it’s basically like that, like you don’t want to introduce your man until
you get engaged. He comes into the family... Having too many men, it’s seen as being
wrong, bringing too many men in the house like the main worry, que van a decir los
vecinos [What are the neighbors going to say?]. He and then you bring another one
next week and stuff like that. (P003, 975:983)

Desirable to be a virgin(n=4)

A cultural message in relation to sex that is often cited in the literature on
Mexican and Mexican American populations is valuing virginity. In fact, marianismo,
which includes the valuing of modesty and faithfulness as feminine ideals, also puts a
great value on virginity (Marin and Marin, 1991). Several participants described having
received this message from their parents. Most described how they had decided to reject
this valuing virginity message.

I: And what kinds of things did you learn about how, about how women should act in
relationships?

P: Oh my God, I don’t think I’ve learned anything, like I’ve seen it but I don’t take it
in. My mom, like I said she lost her virginity to my dad and she was like 27 so she’s
all into like give yourself to one man and that man only you know?

I: So it sounds like you feel like those things that you learned didn’t really impact
how you decided to be?

P: Not at all. I embrace like the whole music and the foods but a lot of the old ways of
thinking, the traditional ways, I don’t believe in that at all. It’s like I go back

and it’s like with my cousins. They were asking if I had a pad. I’m like, I don’t use
them, I haven’t used them since I can’t remember, I use tampons right. And my aunt
was like, “You’re not using that!” She was telling my cousin that she’s not using that.
“Are you crazy! Blah, blah, blah.” Like they think, they really think that you can lose
your virginity with. .. I don’t know what they think you know, you’re having
satisfaction from wearing a tampon? [laughing] I don’t know what they think. But it
was crazy because they just thought I was too wild like I’m using a tampon, Oh my
God! You know. So it’s just little things like that they kinda made me like, Oh my
God, are you serious!? They’re really taboo about stuff like that. They need to be
educated. (P003, 1016:1033)

I really don’t agree... you should not have anything in your vagina until you’re
married. That includes sex, check-ups, pap smears, um tampons, I don’t think that
means that you lose your virginity. I think... when you make issues like that.

47

taboo... you’re like eliminating a topic... to communicate to your children about and
when you don’t have communication then it just causes a lot of problems, or... it can
cause a lot of problems so I think that’s. . . one major thing that I don’t agree with.
(P005, 7872795)

You become a woman at 15 (n=4)

Another traditional message that was received by some of these young women
was You become a woman at 15. This highlights the Mexican upbringing that these
young women received. In Mexican culture, 15 is the traditional age at which a girl
“turns into” a young woman. At this time, she is often allowed to begin wearing make-up
and talking to young men. This does not mean that they can have sex at this time.
Turning 15 is often marked by a large coming of age birthday party called a Quinceanera.

P: . . .we all have .. .. Quinceanera when we turn 15. Like a traditional sweet 16. Like,
we become ladies.

I: Did you have one?

P: Yes. We all had one.

I: All your sisters?

P: ...All four of us had a, Quinceanera. . ..Quinceanera is like the big wedding without
the groom. It is a kind of girl party. ..our dresses Quinceanera dresses are big and
puffy and you get the whole thing... the band, you get the big ballroom, you get the
ornaments, everybody and it’s a big thing, to us back home, it’s a very big thing... It
is just celebrating that they are a lady... leaving the childhood and becoming a
woman type of thing. (P008, 408:432)

1: Another thing that you mentioned brieﬂy was the culture and the machismo, and
can you tell me a little bit more about that?

P: Yeah. Well... I didn’t live with my real dad, I lived with my step-dad. .. he plays
the machismo as the dad. . .you know, you can’t wear makeup, you can’t wear lipstick
until you are 15, until you have... cumples los 15, la Quinceanera [you turn 15, your
“Quinceanera”] But I didn’t have a Quiceanera I still follow to the 15 years... until I
was 15 and then you could... use the makeup, plug out your eyebrows, te razuras
[you shave] you know... the whole girly stuff. And... you can’t go out until... you
are 15. Never bring a boyfriend to the house... that whole stereotype, that machismo.
(P004, 3332344)

48

Protective Messages in Relation to Sex:
Recognizing the Possibility of Sexual Activity

For some of the participants the traditional messages, in relation to sex, that they
received did not represent the whole story. Although they were being told that they
should not be talking about sex, going out with boys, or having sex, on some occasions
there was either an explicit or implicit recognition on part of parents or other family
members (usually aunts or older sisters) that this would not always be the path that the
young women would choose. Speciﬁcally, out of the young women who received these
protective messages, one young woman spoke about receiving them from her parents
while the others (n=6) received them from another female family member. This
subgroup of the sample received speciﬁc protective messages in relation to sex from their
relatives. The messages included under this category are those that urge them to protect
themselves if they choose to have sex and let them know that they have someone to talk
to about sex (see Table 1). Below are some examples of how the participants described
these messages. It’s important to note that although we make a distinction between
traditional messages and protective messages, that it is likely that some of the traditional
messages relayed by family members are meant to be protective as well.

Protect yourself sexually (n =5)

Some of the young women in the sample reported receiving protect yourself
messages. These messages encouraged them to protect themselves sexually. They
ranged from more general to more speciﬁc. Below are some examples of young women
who were told protect yourself.

my dad has always said no te, no te dejes que te pendejeen no seas pendeja mija, no

seas pendeja [don’t let them fool you, don’t be a fool daughter, don’t be a fool]
basically what he said and... my mom basically tells me... if you feel that’s right do

49

what you do... but if you think you’re gonna be... doing sex whatever... [she] just
tells me use protection, be careful, I mean we know you’re smart enough and you
know what you’re doing so it’s, I’m just telling you just use protection y ta bueno
[and that’ll be good] (P001, 1011:1020)

1: ...how are your... ideas around sexuality and relationships different from your
parents, if at all?

P: Um well, my mom has always been like, don’t have sex until you get married. I
never really talked to my dad about what he thinks [giggles] but my mom’s always
been that kind of person, and then after a while like after me talking to her and stuff,
“I think I do want to have sex before I get married,” well now it’s just mostly, “be
safe when you do have sex.” She’s like, “well I guess if you can’t wait until you’re
married, just be safe, be smart about it, that’s what she tells me now.” (P006,
8092816)

Implicit in some of these messages is the idea that these parents would have
strongly preferred that their daughters remain virgins until marriage. However, when the
possibility that this may not be the case was presented, they were willing to provide
protective messages in conjunction with the traditional ones.

On some occasions, protect yourself messages were even more speciﬁc and direct
such as Use a Condom and There 's always birth control pills.

I: . . .do you feel like since you didn’t talk about it then that made it harder or easier to
protect yourself? How do you think. . . that affected?

P: I think it was easier to protect myself ‘cause I got put all these things in my brain.
Use a condom, you know my aunts were always telling me and stuff like that. . .(003,
754:760)

1: What type of things did your mom tell you?

P: ...She is a very blunt person and you could be watching TV and you know, sex
thing comes up and I wasn’t covered from not seeing it. I was able to see it... a lot of
sexual scenes that came on TV or like movies and we could talk ‘bout like having
sex, I guess amongst ourselves in the family. [My parents said], so cuidate [take care
of yourself] take care of yourself if you ever have sex, you know. You use
protection... there is always birth control pills... there is so many things you can use
for sex and don’t use... bad judgment and. . .and believe that, whatever the guy tells
you it is okay and it is not. . . protect yourself... (P004, 7172730)

You can talk to me about sex(n=6)

50

Although some of the young women interviewed felt that they had received the
family message Talking about sex is not acceptable, six of them also felt like at least one
family member (usually an older female) was open to talking to them about sex. In some
instances, they spoke about how that made it easier for them to protect themselves.

I: Do you think of those things that you learned made it easier, harder to protect
yourself in your sexual relationship?

P: I think a lot easier, ‘cause like I know what I want and then they’ve talked to me
like the sex talk, the period talk, the whole birth control talk, the whole getting
pregnant, so like it makes it easier for me knowing what is acceptable in my
household and what’s acceptable for me and what they’ve taught me. (P004,
1189:1196)

In some cases, the young women who were being told that they could not talk
about sex in their households (by their parents) described how they found conﬁdants in
other older female family members such as sisters and aunts.

I: was ever a time when you kind of wanted to talk about protection but weren’t able
to?

P: Yeah... I wasn’t really, really asking about it you know. I was just under a lot of
stuff and mostly just asked my ﬁiends about protection and stuff or ask sometimes
you know my sisters about that since they’re, they’re really open to anything that I
would want to talk about. . .Um, mostly it was just what I would see in observations
and my sisters talk about their relationships, mostly we wouldn’t really talk about,
about relationships you know with your parents or, or anybody else. It was mostly
people that I trusted or that we were together, we were close... mostly my sisters...
1: And what kinds of things would you talk about?

P: About, we’d talk about sex, we would talk about... we would just talk about ways
that he [your boyfriend] should treat you, you know. If anybody was having a
problem we’d talk about it you know. Oh don’t let him do that to you, this and that.
(P006, 6282639)

, I didn’t really talk to my mom about it [sex]. I talked more to my aunts, um, like I
told you my mom is not very old. One of my aunts is like 30, um, one of my aunts is
like 33, so they are more in closer to age to me... I grew up around them... so my
youngest aunt was the one that. .. she would just be like, don’t be having sex right
away and blah, blah, blah and you know, you don’t need to be... ﬂashy and letting
boys know that, you are easy or whatever. (P008, 942:951)

51

Through these alternative messages, these young women felt that they had a

family member that was understanding of their situation and wanted to offer advice.
Breaking with traditional gender norms and Personal Choice (n =4)

Although these young women were receiving traditional messages in relation to
gender roles and sexuality, some also talked about how they felt that their families, either
directly or indirectly, communicated that it was okay to break with traditional gender
norms and behaviors. Breaking with these would not necessarily mean the complete
withdrawal of family support. Below are two examples ﬁom young women that
described how they felt their families communicated that it was okay for women to work
outside the home.

I think even though my parents were very old fashioned, they’ve always

believed that the woman can do it, like we don’t have to stay home and cook and
clean and you know, now we are expected to do that, yes. But, we are also like to
where we can work. (P008, 1802:1804)

Below, this participant explains how seeing her mom work outside the home
made her realize that “women can do something”, they don’t need to stay home.

[Before] mostly that my mom would just stay home and we would also help out my
dad, we come work in the ﬁelds here in Michigan but mostly we would go back home
in Texas to just stay home, my daddy would go out to work. But ever sense that
happened [mom started working outside the home] you know the roles kind of
changed a little bit. You know, not a little bit, totally, totally different, they totally
changed and they’re different now. Yeah now that that happened I was see that and
know it’s not just, the man could go out of work you know. Also, the woman can also
do something you know. (002, 6692675)

Traditionally, if a young woman gets pregnant out of wedlock, it is required that
she marry the father of the child. Some of these young women described how their
mothers told them that they did not necessarily need to get married if this happened.

I’ve even been telling her recently um: don’t expect me to get married because,
‘cause I remember I told her ma’ I think I’m gonna get pregnant and she’s like estas

52

mensa o que? [are you acting dumb or what?] and then she was like, well at least if
you really wanna do it... when you ﬁnish your [University] and then if you want to
get pregnant and not get married it’s okay (P001 , 977:996)

. . .me and my mom pretty much think the same way. ‘Cause one of her ﬁiend’s
daughters went to school with me. They married her to this guy ‘cause she had gotten
pregnant. And I remember at the wedding me and my mom were talking and I told
her, like ma if I ever get pregnant are you going to make me marry him? She said no.
Not unless you want to, because they were forcing her to marry. And like, okay, ...
because I wouldn’t want you to marry me with someone just because I did whatever it
was that I did, you know. If that’s not who I want to be with, then yes I probably did a
mistake, you know, whatever, but I don’t feel I have to spend with the rest of my life
with him because I did that one mistake. So, we kind of agree on that. (P008,

1 823 : 1 83 7)

Similarly, one participant described how her parents, although they adhere to
“machismo”, would not want her to stay in a bad relationship. Although it goes against
traditional norms, it would be okay for her to get a divorce if he “did not value her”. Her
parents also encourage her to study so that she is able to support herself if she leaves her
husband.

I think they all believe in the whole machismo of the men in the house. Like the men
work and the female stays at home. Like they’ve always told me... go to college,
ﬁnish your college education and do whatever you want to do so one day you’ll get
married... if your husband doesn’t value... hits you or etc., well you can always leave
him and always depend on you have a college education. But they’ve never told me,
if you are married by charge, you have to stay with them no matter what... (P004,
1085: 1091)

Through these messages, these older women seem to be communicating that
traditions can be broken. Although they clearly adhere to traditional values and norms,
more importance is being put on the personal happiness of the young woman than on
adhering to the traditional norm.

Relationship Landscape
The types of sexual partners the participants had had in the pat 6 months ﬁt into

one of the following categories: long-term partner (including ex-boyfriend and current

53

boyfriend), casual partner, and one night stand. As mentioned before, a partner was
considered to be long-term if they had been dating exclusively for over a four week
period (although all participants who described being in long term relationships, had been
with their partners for at least 3 months). Casual partners, was deﬁned as having sex with
a partner that they are not dating exclusively, or for fewer than 4 weeks. One night stand
was deﬁned as a one-time sexual encounter with someone they had just met.

Half (n=5) of the participants had had two or more sexual partners. Out of those,
2 talked about an ex-boyfriend and a current boyﬁ'iend and 3 talked about current or ex-
boyﬁiend and a casual partner. Out of the other 5 girls who had 1 sexual partner within
the past 6 months, 4 talked about their current boyfriend and one talked about a casual
dating relationship. Therefore, most of the descriptions provided were of long term
relationships. These ranged from six months to three years.

Sexual Communication

All participants reported that they had at some point communicated with their
partners about sexual topics. The content and quality of these interactions varied
however. Speciﬁcally, three types of communications seemed to emerge. These
included conversations about sexual history, conversations meant to lead to protective
behaviors, and conversations about general sexual topics.

Sexual History

Some of the participants described asking about their partners’ sexual past as a

way to assess potential risk.
P: It was just like probably like within the ﬁrst week of having those long talks, it
came about. Because I wanted to know... how many people he’s been with made me

know what type of person he was as well. . .Gave me a little insight of his personal,
what he believed if you are the mad sex alcoholic or if he actually cared.

54

I: ...can you tell me a little bit more about that? Like what types of things did he say
and what conclusions did you get from that?

P: Well, he had told me that he had only been with one other person. So him losing
his virginity at an older age was a shocker and was but then after trim talking and
what he wanted and how he grew up in his household also like made me believe
that... he did do that at an older age... (P006, 8052821)

I: So did you ever talk about issues like related to intimacy or anything like that with
him?

P: Um, yeah, yeah. We would talk about you know... I would ask him stuff about sex
and all that stuff.

I: Is there any example that you can think of or any time that?

P: I would ask him like how long ago he had lost his virginity and if he still hadn’t
you know... if he could count how many girls he had been with, how many. I would
tell him, come on be honest... (P002, 3132325)

Prelude to Protective Behaviors
Some participants described having conversations with their partners about
sexuality that were meant to lead to protective behaviors. The following two quotes
illustrate how two participants talked with their partners about going to get tested for
STD’s.

1: Yeah, how about STDs? Is that something that crosses your mind at all?

P: Yeah, that’s something, and I’ve talked to him about that just because I know that
like he has slept with more people than I have so... I asked him to go get checked and
I’ve gotten checked just because so we’ve both done that.

I: So. . . you’ve both gotten checked?

P2 Yeah, yeah.

I: ...the decision to use protection does that have to do at all with STDs also or is it
mostly pregnancy?

P: Yeah, it’s mostly pregnancy... (P006, 5372545)

I: ...can you tell me about how you think or talk about... protection if it ever comes
up?

P: Uh-huh. .. we talked about that like right away, ‘cause I mean that’s really
important to me, you know, like there is a lot of like dirty people out there, you
know. . .you have to really be careﬁrl. So, we talked about it and then like um, we
went to go get checked and all that kind of stuff and so like then I was on birth
control... (P007, 6012615)

55

Several participants described feeling that they did not need to talk about
protection with their sexual partners because they were not going to have sex unless a
condom was used; safe sex was assumed.

I: ...did you mostly have safe sex or was it mixed or

P: Yes. No, we had no mix. [laughter] No, it was safe sex. But I guess I had in my
mind that if this person didn’t want to have sex, that I was not going to have sex.

I: Oh really?

P: Yeah, so I knew what, but I knew how I wanted it too like safe sex

I: And how do you think he knew that?

P: I guess that I mentioned that I didn’t want to have a family like anytime soon. I
was very scared, not scared but like consciously reading about, you know, diseases
and getting updated that I probably gave him the character of... safe sex, I

don’t know. I’m just assuming here, I don’t know.

I: But you didn’t have to bring it up, it just kind of then happened then that way?
P: Yeah, then I was so informed that I just assumed he was informed of it too.

I: I see.

P: So, it was like at that moment that if it was not going to be safe, it was not going to
happen, period.

1: Okay.

P: I mean there was no discussion about that. (P004, 8492878)

General Sexual Topics
Another theme that emerged was that participants felt very comfortable talking
with their long-term partners about general sexual topics. In the following quotes,
several participants describe how talking about sexuality is not a source of discomfort in
their relationships.

I:. . .you were saying, how comfortable is it to like bring up anything [relating to sex]
P: It’s comfortable, like he is really open to anything and it is just like I can talk to
him about like [if I] feel uncomfortable or like whatever.

I: ...are there any things that you wish you could talk about in relation to sexuality
that you can’t?

P2 With him?

I: Uh-uh.

P: I think we can talk about anything we want, I know that for sure. So that is just
how close I feel to him and like how comfortable I feel with him. (P011, 6342647)

I: And then in terms of like STDs, did that ever concern you at all?
P: No.

56

1: Okay. And what was it that made you feel safe?
P2: Um, I guess he was just, I knew he was being honest like that. Or I don’t know,
like we would just, I don’t know we were just really open like we still are. You know,
we don’t have shame to talk about our history or whatever, you know... (P010,
1 01 7: 1 03 4)
It’s important to note that, for the most part, participants were not having
“negotiation conversations” as was expected.

HIV Knowledge: Do they know about safe sex and
prevention in relation to HIV?

In relation to HIV, 1 was interested in ﬁnding out how much the participants knew
about transmission, detection, and prevention given that this could play a role in their
sexual risk perception and behaviors. Most relayed only correct knowledge about how
HIV was transmitted and how it could be prevented. However, some misconceptions did
emerge as well. Three participants mentioned one incorrect piece of knowledge about
HIV. Below are some quotes that illustrate the correct and incorrect knowledge that
these young women had about the detection, transmission, and prevention.

Correct Knowledge

Participants were aware that HIV was transmitted through bodily ﬂuids like blood
and semen. They mentioned that you could get HIV ﬁom blood transfusions (in the
past), sharing needles, and unprotected sex (or if a condom broke). In addition, most also
had correct knowledge about prevention methods. Abstinence, condoms, testing, and
avoiding contact with used needles were mentioned.

I: what do you know about how people like get it and how to prevent it [HIV]?

P: How to prevent it, well number 1 abstinence and 2 using protection, like condoms,
female condoms... that’s the only way I know of, of how to prevent it. Um, how
people get it? Through... obviously sex but I think blood transfusions, probably not

anymore but back then yeah, and... sharing needles, unprotected sex. (P005,
559:570)

57

I: what are some of the things that you’ve learned about that?

P: Like ways to prevent it?

1: Yeah.

P: Like condoms, don’t have sex at all. Um, know who you are having sex with. Go
get checked... like through blood, bodily ﬂuids and like semen, blood... you can still
get HIV with condoms like if it breaks or whatever and stuff comes out. But. . .you
don’t get HIV from kissing. (P007, 7142726)

Some participants mentioned the sources of their HIV knowledge. Below, one
participant mentions how she learned new information about HIV from the Latino/a
students program she was in, another describes how her sister, who worked in a
prevention program, taught her about HIV.

1: ...in terms of preventing it, what are some things that you’ve heard about that?
About ways to prevent it.

P: Well I had the whole idea that you could transmit it through saliva. And which I
came to ﬁnd out it wasn’t. . .. [the program] gives you a health class. . .But, you know,
through like blood transfusion as well and people get cut you have open wounds...

1: And what are some good ways to not get it? That maybe they taught you at [the
program] or that you heard somewhere else?

P: Um, I don’t use needles that other people have been using. You know, there is
safer ways to have sex. And use like a condom at all times. . .(P004, 9812988)

Well, it’s just like you know blood and stuff like that and of course like sex, just
things like that. My sister used to talk to me about that all the time, she used to be in a
program where they would go around and talk to the teenagers about um sexual
diseases and drugs and stuff like that... (POO6, 5512559)

In addition, half of the participants were aware that minorities and speciﬁcally
Latina/o groups were at higher risk than others. They offered several explanations as to
why this might be the case including lack of prevention education in low-income
communities, lack of awareness of medical services (such as testing and free condoms),
and the cultural reticence toward visiting physicians.

1: ..how about... ethnicity, do you feel that any particular group is more at risk or?

P: I think minorities are more at risk just because usually because in Pontiac like it’s a

low income city so I think whenever you have not enough money towards

education... and programs like to teach you know,about stuff like that you have
people who are less knowledged, knowledgeable about issues like that and also like if

58

there’s money for health care then they can’t really afford to you know go to the
Clinic and get checked and stuff... so I think that’s why minorities are more at risk.
(P005, 5722580)

I: ...you were mentioning that... that people are getting infected... do you feel like
people your age are at risk?

P: Yeah. Deﬁnitely, especially... Latinos because a lot of people don’t go to the
doctor and they are scared of the doctor... many of our people are uneducated and
don’t know that there is like prevention methods. They don’t know that there is places
that will help them, that will test for free... and I think that’s one of the reasons that...
our population has been increasing in the number of. . .HIV cases urn so much,
because people just aren’t aware of what’s out there and even the help that they can
get and... you can go get free condoms anywhere, you know. You just have to go ask.
But people don’t know that... that is something that we as a community need to go
back and... work within our... respective communities and make sure that people
know that there is... resources available for them. (P007, 7392754)

Incorrect Knowledge

Although most had a good handle on HIV transmission and prevention, several
participants did display some incorrect knowledge in relation to HIV. Speciﬁcally, each
one of these participants mentioned one incorrect piece of knowledge about the virus.
All of the misconceptions were in relation to detection and transmission of HIV.

For example, one participant was under the wrong impression HIV could not be
detected in someone’s blood test for 10 years after they got infected, when in fact it can
be detected within two to three weeks of infection.

I: ...have you ever personally felt at risk?

P: Anybody to me who has unprotected sex has been at risk so I’ve had unprotected
sex other than with my current boyﬁiend now so you know, well he did get checked
out, but I was told... you gotta wait ten years like to take into account the past 10
years or whatever and um so I plan on doing it again.

I: A test? You got tested?

P: He got tested.

12 Oh he got tested?

P: I’ve done it when I was in high school but I wasn’t even sexually active at that
time, I think I was, I forgot. But it was a long time ago and I had it done then and I
think I should have it done again but I want to wait some years before I take it. (P005,
5822596)

59

This misconception may put her at higher risk. As seen above, she decided to not
get tested because she believed that it will take years before the virus can be detected.
Unlike the misconception above, the next two are less likely to interfere with
protective behaviors. These young women were under the impression that HIV is more
transmissible than it actually is. For example, one participant believed that donating
blood could put her at risk while another believed that gloves were needed for casual
contact with a person who has HIV.
P: It is a fast growing in the Latino population, HIV. . .It is like developing. It is
number one within like Latinas I think, right isn’t it?
I: Uh-huh.
P: I don’t know if those are Latino men as well, but I’m not sure. But, yeah, like
sometimes you can get scared of just donating blood or being with one person,
so I have that in my mind all the time. (P004, 9302944)
I: What are some of the things that you’ve heard about how not to get HIV?
P: I don’t know, just, I mean like condoms of course but then like whenever you’re
with a person that has that you wear gloves stuff like that... (P006, 5602565)
Despite these misconceptions, most of the young women that I talked to

understood what HIV transmission, detection, and prevention consisted of.

Sexual Risk Behaviors and HIV Protection:
What do they do to protect themselves from HIV?

In terms of sexual risk in relation to HIV, the young women ﬁt along a continuum
of sexual risk behaviors. While some described protecting themselves very effectively
against HIV, others were not (see Table 2). Participants described safe sex behaviors that
we categorized as either low risk or moderate risk. These categoriesare based on
scientiﬁc knowledge of HIV transmission and modes of protection. HIV can be
transmitted through bodily ﬂuids, with unprotected sexual activity with male partners

being the most common mode of transmission amongst Latinas (CDC, 2004). Therefore,

60

moderate risk was deﬁned as engaging in protected sex with casual partners and
unprotected sex only with monogamous, long-term partners, but without testing for HIV.
Low risk was deﬁned as engaging in protected sex with all partners or engaging in
unprotected sex only with monogamous partners with testing for HIV.

In addition, there were two participants who were engaging in a higher level of
risk, unprotected sex with non-monogamous partners. Given that there were only two
cases of this sort, these don’t constitute adequate representation for an “at risk” group.
However, several things were learned from these discrepant cases and these are described
at the end of the following section.

Low Risk Group

Several of the young women ﬁt into the low risk group. These young women
described protecting themselves with condoms and/or monogamy and HIV testing. Most
of the participants in this group described always using condoms with their current sexual
partners. Below are some quotes from those young women that described that they
would not have sex unless their sexual partner had a condom.

I: .. .did you mostly have safe sex or was it mixed or. . .?
P: Yes. No, we had no mix. [laughter]. No, it was safe sex. But I guess I had in my
mind that if this person didn’t want to have safe sex, that I was not going to have
sex. .. so I knew what I wanted, but I knew how I wanted it; to be like safe sex (P004,
8492878)
Well it was like a person I knew and we were just at a party and then we just laughed
and we were just hanging out and it just came up and then it was like, you know, they
are like oh, well I don’t have one [a condom] and I’m like, oh urn neither do I, so it
just, yeah, it just didn’t happen. . . It wasn’t a very difﬁcult decision, I was just like,
no. You know, there is so much risk. (P007, 7742800)

One participant described protecting herself through monogamy and HIV testing.

However, this was only the case with her current monogamous partner. In the past, she

61

had used condoms with casual partners and described how she reﬁised to have sex with a
casual partner one time because he didn’t have a condom. In relation to her current
relationship, she described how they had used condoms in the beginning, however, as
they “got more serious” and the relationship became monogamous, they got tested for
HIV and moved into only using birth control to prevent pregnancy. In this case HIV and
STDs were not seen as an issue to be concerned about because she and her partner had
been tested and she felt they were in a monogamous relationship.

Moderate Risk Group

Some participants fell into a “Moderate Risk Group”. These participants were
protecting themselves from SIDS and HIV with monogamy (but without HIV testing)
with their long-term partners, and condoms with their casual partners (if they had them).
While they were using some level of protection, the fact that they were having
unprotected sex with people they didn’t know to be HIV negative may have put them at
risk.

Participants described how they had used condoms with their current long-term
partners at ﬁrst and were now in monogamous relationships where their main concern
was pregnancy.

I take birth control. I’ve been taking it for like about a year... And um, that’s about it.
We used to like use condoms before, but I’m taking birth control and I don’t know,
that’s about it. . .I’m not, I don’t even want the risk of getting pregnant ‘cause I’m not
even ready to be a mom. (P009, 587:607)

P: ...I am on birth control. . ..we are not ready to have a kid.

I: So, and was that a decision that you made or that you made together?

P: Well, oh I made that one quick. I was like... I know you are

going to be like the only one... so I was like, I’m not going to, you know, take that

risk. So he was like, oh yeah, you know, go to a doctor or let’s go check ourselves...
I: And before then... had you been using some other type of protection?

62

P: ...Oh, well yeah. (P010, 939:971)

Most of the participants in this group said that they had always used condoms
with their casual partners, or at the beginning of their long-term relationships. One
participant described only using condoms intermittently at the beginning of her current
long-term relationship because she believed the relationship was monogamous.

Sexual Risk Perception: How do these Mexican American College women perceive their
risk of HIV infection? Do they view themselves to be at risk?

Although some of the these young women were protecting themselves more
effectively and more often than others, all but one reported not feeling at risk for HIV.
They offered several explanations for why this was the case. Some of the explanations
referred to actual protective behaviors, these included: I 've protected myself I 've been
tested for HIV/My partner has been tested for HIV. Others were based on judgments
about the number or quality of partners they or their partners had been with: My partner
has only been with one person, I have not had many partners, and I ’ve been smart about
who I sleep with.

All of the participants in the low risk group felt they were not at risk for HIV.
Given that those participants protected themselves with condoms or monogamy and HIV
testing it can be assumed that, for the most part, their perception that they were not at risk
was accurate. Speciﬁcally, three of the participants from this group said that they felt
they were not at risk because they had protected themselves from HIV through the use of
protection and/or testing.

I: And did you personally feel like you were at risk for HIV at any time or?
P: Hmm? Really, not really.
I: ...what were the things that made you feel safe?

P: I would just have to say the fact that we would use protection...
I: ...was that like most of the time, or some of the time, or all of the time?

63

P: All of the time. (P002, 445:455)

I: Have you ever felt like maybe you were at risk for HIV

or not personally. . .?

P: Um, no, well no I mean even with my last boyfriends like I’ve always been like,
you know, go get checked, do whatever, you know, like and just always using
condoms and stuff...

I : So it sounds like the reason why you haven’t felt at risk is because you’ve
been doing certain things to make sure that you are not, like getting tested and so I’m

right, okay?
P: Yeah. (P007, 760:769)

The last participant in this low risk group, who was protecting herself by using
condoms every time that she had sex, also mentioned the fact that her partner’s sexual
history contributed to her low sense of risk because he had only been with one other
person.

1: Okay, I just wanted to make sure so, you were explaining that mostly you didn’t
feel so much at risk for HIV as much as pregnancy and other stuff. Is that right?

P: Yeah. I don’t know, I guess I had that consciously like, I don’t know.

I: What do you think made you feel that you were not at risk?

P: I guess the fact that he was with one other person, but I mean that was not an
excuse. Wasn’t as much terrifying of someone else, if he had told me he’d been
with. .. 40 you know. But then one person can always change, transmit it. (P004,
997: 1007)

In the moderate risk group, none of the participants felt that they were at risk for
HIV either. Like the low risk group, three of the participants in this group mentioned not
feeling at risk because they protected themselves from HIV. Given that these young
women reported protecting themselves with condoms (with casual partners and at the
beginning of relationships) and monogamy but were not aware of their own or their
partners’ HIV status, it can be assumed that they may not have been in as low a risk at
they believed. In the following example, this young woman explains that she believes

she’s protected herself when she’s had intercourse, and therefore has not felt at risk.

I: ...And have you ever personally felt like you were at risk at all?

P: No.

I: What kinds of things have made you feel safe?

P: I don’t know, the fact that I’ve always like protected myself [through condoms at
the beginning of relationships and monogamy once relationships were established]
when I have been sexually, like in intercourse. . .(P009, 742:753)

Other reasons offered by these participants were less based on their assessment of
efﬁcacy of their protective behaviors, instead they were more based on their judgment of
the degree of risk (e. g., number of partners, likelihood of infection or the quality of their
partners as people). These included I ’ve been smart about who I sleep with and HIV is
the extreme.

1: ...since you got to college was there ever a time that you felt you were exposed to
HIV and didn’t protect yourself, and if so what do you think like prevented that?

P: No, I’ve never felt like I’ve been exposed to HIV just because my, the partners that
I’ve chose to be with I just, I considered them smart and intelligent... they’re not one
of those people to have sex with just anybody and everybody so in that sense I didn’t
consider them... possible candidates or nothing like that... I don’t think I’ve been
exposed to HIV.

(P005, 620:627)

1: .. .were you also worried about HIV or was it mostly STDs?

P: No, HIV no.

I: What made you not worry about HIV

do you think?

P: I just feel like it’s like to the extreme, HIV, you would really need to be with
someone that... [did not ﬁnish this thought] (P003, 672:691)

It is important to point out that despite the fact that participants had accurate
knowledge of how HIV is transmitted and how to protect oneself, they did not feel like
they were themselves at risk, despite of their risky behaviors.

Although most of the young women that I talked to speciﬁcally said that they did
not feel at risk for HIV there was more concern about other STDs and pregnancy. Most

described being concerned about STDs. Within this group, several felt at risk because

they had engaged in risky behavior while the rest described that they either perceived risk

65

and therefore protected themselves or protected themselves and therefore did not perceive
risk.

In the following quotes one participant (who expressed not feeling at risk for
HIV) described her concern that she might have contracted an STD from a one-time
partner while another describes how she was more concerned about STDs than HIV.

1: Were you worried about STD’s or HIV or anything like that?
P: I was worried about STDs. I was because it was like this guy I barely met and I’m
like, I don’t know? (P001, 8322848)

I: Uh-huh. So did that ever cross your mind [HIV]. . .?
P: I think it was mostly other things. It fell under like the STDs for me, like I felt like

it was something I was going to get. It fell under that. Well I guess you could say it
was a priority. (POO4, 9462956)

Similar to the descriptions of HIV protection, those participants that described
protecting themselves from STDs, deﬁned “protection” in different ways. These
included using condoms, testing, and monogamy.

I: . . .with the partners that you’ve had more recently, have you ever been concerned
about STDs with them at all?

P: Not really.

I: And what has made you feel safe?

P: I think it is because I just, I mean at least we are using something

[condom]. . .(P008, 1559:1568)

1: ...how about STDs? Is that something that crosses your mind at all?

P: Yeah, that’s something, and I’ve talked to him about that just because I know that
like he has slept with more people than I have so I told him like, I asked him to go get
checked and I’ve gotten checked just because so we’ve both done that (P006,
537:545)

Well one thing I really like about having a boyfriend is that I can do whatever I want
with him sexually and not have to worry about STDs considering you know if he’s
not messing around, which I feel like he isn’t. (P005, 435:449)

In relation to pregnancy, most participants reported feeling concerned about it.

Similar to STDs, several felt at risk because they had engaged in risky behavior while the

66

rest described that they either perceived risk and therefore protected themselves or
protected themselves and therefore did not perceive risk.
Ay, a lot of girls in my family... my sister, didn’t get any help, with teen pregnancy
you know and becoming mothers at a very, very young age you know and I didn’t
want that to happen to me and the way to avoid it was protection you know and that’s
why I thought that it was important. ‘Cause I didn’t, I didn’t really want no kids, I
don’t want no kids. (P002, 380:400)
1: Did you ever get concerned that you’d become pregnant or anything?
P: Yes. [laughs] ...Yes I did, I was like, oh my gosh, we didn’t use a condom, you
know, like what if like you know something happened or whatever... but actually it
was always right around before my period. . .when we wouldn’t use any type of
protection. So, I’d be like, okay I’m going to give it like two weeks or something...
and like oh wow I get my period. So I was like well I did get my period... I was a
little bit concerned sometimes, but you know, but no I did not get pregnant. (P001,
990: 1009)
Familial Messages and Sexual Risk

As mentioned above, all of the young women in the sample had received
traditional messages in relation to sex (such as Don 't have sex before you are married
and You can’t go out with boys).

In addition, some had also received speciﬁc protective messages in relation to sex.
Interestingly, the participants who belonged in the moderate risk group had only received
the traditional messages, while the participants who belonged in the low risk group had
all received the traditional messages and the protective messages (see Table 3).

Discrepant Cases

It’s important to point out that, as mentioned above, there were two cases in the
sample that did not ﬁt into either the Low Risk Group or the Moderate Risk Group.
There were several things that distinguished them from the rest of the sample. First of

all, these two participants described a higher level of sexual risk behaviors than the other

67

young women in the sample. Speciﬁcally, they both described having unprotected sex
with their partners and being long-term relationships with men who, at the time, were
involved with other women. In relation to casual partners, one described using condoms
whenever she would have sex with someone. The other, who had had two sexual
partners (her boyfriend and a one night stand) described not using condoms with either
one.

Secondly, in relation to familial messages about sex and relationships, these two
participants had received fewer traditional messages than the rest of the participants.
Like, the low risk group, they had also received some protective messages.

Finally, both participants described extenuating circumstances that could have
contributed to their sexual risk. One of them did not care if she got pregnant, and
therefore was not protecting herself. The other young woman was a survivor of sexual
assault, which could have compromised her ability to protect herself.

In relation to perception of risk, one of the young women felt that she was not at risk
for HIV while the other did. While one felt like she had not been at risk because she’d
only had unprotected sex with two people, the other felt that she had been at risk because
she had unprotected sex with a boyfriend who had cheated on her. However, this second
participant described how she could not talk to her boyfriend about this because he might
think she had been with other people.

I: So and in terms of HIV, is that something then that has ever worried you?

P: It has, but I’ve never talked about it with, I go with my boyﬁiend, I’ve never talked
about it with him. I don’t know, we just, the conversation just never has really come
up.

1: Okay and why do you think that is?

P: I think I’m scared.

I: Really, what are you scared of?

68

P: I don’t know, I think I’m just scared of him thinking that either I’ve been with
other people, well I have, but that’s not the point, or if him thinking that I’m saying
that he has something or yeah. . .There was this one time when um, I had boughten
different underwear and didn’t know I was allergic to that type of material, I got a
really irritated, really itchy and I didn’t want to tell him... At the beginning I didn’t
know what it was and I’m like oh my God what am I going to tell him, what am I
going to do? . . . I still didn’t tell him. ..(P008, 1570:1603)

Authenticating Data

As a qualitative study, trustworthiness takes the place of validity in ensuring good
quality of the data (Guba & Lincoln, 1989). According to Guba and Lincoln (1989),
credibility, transferability, and conﬁrrnability are all included in ensuring trustworthiness
of the data. Credibility was ensured in three ways. The ﬁrst two involved review of the
coding and theme analysis by independent, outside reviewers. This was accomplished:
(1) through engaging in debrieﬁng with the chair of this research and (2) through the
coding of a portion of data by a second coder. This included extended discussions of
ﬁndings, conclusions and tentative analyses. The second coder independently coded
portions of data. Then, the independent coder and I carefully reviewed the coding of
these portions, discussed differences, and achieved consensus.

Negative case analysis or revising working hypotheses in the light of hindsight,
with an eye toward developing and reﬁning a given hypothesis (or set of them) until it
accounts for all known cases (Guba and Lincoln, 1989) was also utilized to ensure
credibility. Throughout the negative case analysis process, the two discrepant cases
described above jumped out as contradicting my working hypothesis. Unlike other

participants who received protective messages ﬁom their family members, these young

women were engaging in unprotected sexual contact with their partners. As mentioned

69

above, a closer study of their stories revealed confounding factors that may have played
into this decision making.

Third, in order to assure that conclusions were consistent with participants
understandings, member checks were conducted. This process is, according to Guba and
Lincoln (1989), the single most crucial technique for establishing credibility. It includes
taking ﬁndings back to respondents and verifying that they are accurate thus ensuring that
their constructed reality has been captured throughout the analysis and interpretation
process. Speciﬁcally, at the end of each interview, the participants were asked if they
could be contacted in the future to verify ﬁndings with them. All said they could be
contacted for this purpose. Individual meetings were set up with a subsample to conduct
the member checks. Speciﬁcally, one participant belonging to the Low Risk Group and
one participant belonging to the Moderate Risk group met with the investigator to verify
the ﬁndings. An outline summary of the results corresponding to each of the participants
groups was provided to each participant. Then, I talked with the participant in about the
results and asked if this spoke to her personal experience. In both cases, participants felt
like the results found in the study accurately reﬂected her experience.

Trustworthiness is also ensured through transferability, which usually takes the
place of generalizability. It was ensured by providing in depth descriptions of the time,
place, context and culture of salient ﬁndings (Guba & Lincoln, 1989). Conﬁrmability,
which ooncems tracing data back to its original sources, was ensured by keeping a

detailed record of all data collection and analysis decisions made .

70

DISCUSSION

The stories of the young women in the Learning from Mexican American Young
Women Project open a small window through which we can begin to unfold how they
understand cultural messages about sex, their own sexuality, their sexual risk, and their
HIV protective behaviors. Many of the participants expressed their desire to help others
by talking about their experiences and it is my hope that this analysis does their stories
justice and adds to the knowledge base that will lead to effective interventions for these
populations.

The participants in this study were all sexually active college women from
traditional Mexican backgrounds who were attending a predominantly white university.
Although this group represents a speciﬁc sub-sample of Mexican American women, it
was an excellent place to start building an understanding of how cultural messages are
related to sexual behaviors for young Latinas. First of all, they are a group who is likely
to be faced with decisions about engaging in sexual risk behaviors (F ielstein, Feilstein, &
Hazelwood, 1992). These college students were experiencing an important transition.
They had moved out of their parents’ home and into a new environment where they were
less likely to receive traditional Latino cultural messages about sexuality and more likely
to be exposed to peer and mainstream messages and pressures to engage in sexual
activity. Second, they are a group who is likely to be accessible for and open to
intervention. Their willingness to participate in the study demonstrated that they were
open to discussion about their sexual relationships. In addition, college students are a

relatively easy-to-reach population who are often in a period of increased sexual

71

experimentation (Fielstein, Fielstein & Hazelwood, 1992). Finally, issues related to
perception of sexual risk, sexual risk behaviors, and protective behaviors are
understudied in Latino populations. Mexican American college women represent an
important subpopulation.
Cultural and Familial Messages in Relation to Sexual Risk

Given that family is an important conveyer of culture and that sexual expression
is very closely related to culture, (Handelman, Cabral, & Weisfeld, 1987) this study
explored the familial messages that participants received in relation to sexuality.
All participants reported receiving at least one type of parental message that reﬂected the
traditional Mexican values in relation to sexuality described in the literature. The
messages included We don ’t talk about sex, Don ’t have sex (before marriage), and You
can ’t go out with boys.. These ﬁndings were consistent with other studies which have
also found that speciﬁcs about sexuality are seldom talked about in traditional Mexican
homes and that often parental messages aim to restrict contact with boys in order to
prevent sexual behaviors. (Marin & Gomez, 1997; O’Sullivan et a1. 2001; & Rafaelli &
Green, 2003). Other studies, which have looked at parent-child communication about
sexuality have found that Latino/a parents will sometimes focus on relaying warnings and
values, instead of speciﬁc messages about sexuality (O’Sullivan et a1., 2001; Rafaelli &
Green, 2003; Rafaelli & Ontai, 2001; & Romo et a1., 2002). This was also reﬂected in
the study ﬁndings, with the relaying of messages such as It ’s desirable to be a virgin and
Don ’t have sex until marriage.

These traditional messages about sexuality, however, did not represent the entire

story. Some of the participants also received protective messages from family members

72

as well. These included Protect yourself sexually and You can talk to me about sex.
Unlike most other studies about sex communication in Latino/a families, this study
looked at family communication in an open-ended manner, which lead to the participants
talking about other providers of protective sexual messages. Speciﬁcally, the study found
that some participants were receiving protective messages from other female family
members (although one participant described a Protect yourself sexually message from
her parents). In other cases other female family members, such as aunts and sisters, were
the ones conveying the protective messages. This ﬁnding was consistent with O’Sullivan
et a1., (2001) ﬁnding that young Latina women sometimes turned to close family
members other than their mothers for information about sexuality when it was not
provided by their mothers. O’Sullivan et a1. (2001) also found that the girl’s mothers
were aware of and comfortable with this arrangement.

To date, most of the literature on parent-child communication about sexuality
between in Latino families only goes as far as asking if communication takes place at all
and has not explored the content. This work went a step further by exploring the topics
of conversation between the young women and their family members. This brought to
light that the less traditional protective messages are occurring within traditional families.
What seems to be communicated in some families is: We want you to not have sex, but if
you choose to, don ’t make a consequence out of it. This acceptance of the possibility of
sexual activity and desire that they be efﬁcacious (if they do choose to have sex) is new

to the literature of communication in Latino/a families and should be explored further.

73

Predictors of Sexual Risk Behavior

Despite similarities in the young women’s traditional backgrounds and the
traditional messages that they received about sexuality, they did vary along other
dimensions. For example, they were engaging in different levels of sexual risk.
Participants that belonged in the “low risk” group were protecting themselves with
condoms and/or monogamy and HIV testing while those that belonged in the “moderate
risk” group were protecting themselves with monogamy (without HIV testing) with their
long-term partners, and condoms with their casual partners.

There was much less variation, in the level of HIV knowledge that these women
had than there was in their risk behavior. Most had a clear idea of what prevention and
transmission entailed. However, despite similar levels of HIV knowledge, there seemed
to be little or no connection between level of HIV knowledge and level of HIV risk the
participant was undertaking. This ﬁnding is also echoed in the HIV literature. Level of
knowledge (by itself) tends to not be related to perception of HIV risk or protective
behavior (Fisher & Fisher, 2001; O’Leary, 2000; & Wulfert & Wan, 1993). This is why
information-only interventions have been notoriously ineffective and why social
scientists have moved toward the study of other contextual variables, like culture, in
order to understand what other factors may be at play.

It is important to point out, however, that in this study there was one individual-
level factor that can perhaps help explain the discrepancy between HIV knowledge and
HIV risk. This factor was perception of risk. Despite a range of sexual risk behaviors,
most participants did not feel at risk for HIV. All participants but one reported feeling

like they were not at risk for HIV infection. Therefore, it is not surprising that many were

74

not using barrier methods to protect themselves from it. In fact, even those who were
protecting themselves effectively from HIV (the low risk group), were not doing so with
the express purpose of avoiding the virus. Instead, condoms were being used with the
purpose of avoiding STDs and/or pregnancy, which they did feel at risk for.

This leads to the question: What can this lack of perception of risk be attributed
to? When we look at the interviews through this lens it would seem that they felt that
they had “done enough” to protect themselves. Out of those that had casual partners,
most protected themselves with condoms with casual partners.

Although they knew the facts about HIV transmission, it appears that in some
cases they were not translating this knowledge into accurate risk perception. Some of
the young women talked about how they wouldn’t sleep with “just anyone”. Some also
mentioned that at the beginning of the sexual relationships they had asked their partners
questions about their sexual histories in order to assess their level of risk. It would seem
that after these assessments of the person the young women felt that they were not putting
themselves at risk for HIV. In other words, it would seem that they had found a way to
understand their risk that was not necessarily accurate, based on their initial judgment of
the person, rather than on an ongoing assessment of their exposure to potentially risky
behavior.

Of course, it is impossible to know if in reality they were experiencing cognitive
dissonance about their situations. Although they understood their risk, they may not have
felt empowered to utilize condoms with longer-term partners and, therefore, resorted to
this kind of “justiﬁcation” of the risky behaviors. They may have felt that they could not

bring up condoms due to issues of trust. Bringing up the use of condoms in relationships

75

that should be monogamous implies that they either don’t trust their partner or that
they’ve been doing something they shouldn’t have. This undermines the monogamous
relationship and contradicts how they’ve been taught to behave. Interestingly, in these
cases this might mean that longer-term relationships may put young women more at risk
instead of less. This is very concerning given that most women who become infected
with HIV, are infected by their primary partners (boyfriends and husbands) (O’Leary,
2001)

Most notably, the young women who engaged in more protective behaviors, had
received both traditional and protective messages ﬁ'om a family member. It is possible
that this combination of traditional and protective messages contributed to these
participants’ ability to protect themselves. It may be the case that when family members
are up front about their values, but also provide speciﬁc advice about protection, that
these messages are more likely to have an effect on young women’s protective behavior.
One reason why this may be the case is that this recognition of the existence of restrictive
values around sexuality may open a dialogue between family-mernbers about sex. This,
in itself, may make young women more likely to feel comfortable talking about sexual
topics and this could, in turn, be related to protective behaviors. In addition, the relaying
of protective messages on top of that may let the young women know that, beyond the
importance of traditional values, their health and future should not be compromised if
they decide to have sex. In other words, these speciﬁc messages may be protective
because they relay speciﬁc information about sexual protection, despite the recognition

that this behavior would go against cultural values around sexuality.

76

The ﬁnding that speciﬁc messages about sexuality can be protective is consistent
with what was found in the Family and Adolescent Risk and Communication Study
(FARCS) (Whitaker & Miller, 2000; & Whitaker et al., 1999). Whitaker and Miller
(2000) and Whitaker et al. (1999) found that parental discussions about speciﬁc sexual
topics were associated with less risky sexual behavior. This was the only study found
that explored both the content of the conversations between the parents and adolescents
and how these may inﬂuence sexual risk in Latino/a teens. However, it is important to
point out that the participants in this study were not all Latinas. All data was analyzed in
aggregate despite the fact that some participants were Hispanic and others Aﬁican
American. Given this, it becomes impossible to tease out what messages occurred in
what populations. Furthermore, interview data was collected from teens in Alabama,
New York and Puerto Rico, which differ greatly along many dimensions (i.e. language
and culture). The cultural diversity of the group makes it difﬁcult to make any
conclusions about cultural inﬂuences. This is unfortunate given that we would expect
these to be very important, as illustrated in O’Sullivan et al. (2001). In a study with 72
Aﬁican American and Latina mother-daughter dyads they found that while African
American mothers aimed to prevent STDs and pregnancy, Latina mothers aimed to
prevent the formation of relationships.

To date, researchers have not explored the relationship between the cultural
messages that are being relayed to young Latinas about sexuality and their protective
sexual behaviors from a cultural perspective. The current study adds to the literature by
identifying cultural messages that are being related to these young women in relation to

sexuality, within this particular group. Furthermore, we are able to begin to form an

77

understanding of how this might be related to their ability to protect themselves. In
addition this study looked at these topics in a slightly older population than has been
studied in the past, that may be at more risk. Finally, as mentioned above, other studies
have been limited to communication ﬁ'om mothers and fathers. My ﬁndings suggest that
other family members may in fact be very involved in relaying protective messages and
that these messages may be important for effective prevention. The topic of how these
familial messages may help prevent risk behaviors should be further explored. It is
possible that discussions about sexuality lead to young women feeling comfortable with
sexuality in general (instead of guilty) and in “negotiating” safe sex with their partners.
Limitations

It is important to note that who these young women are could be related to how
they perceive and manage their sexual risk. There are some ways in which they may
have been different from other girls that also grew up with traditional upbringings. First
of all, they had chosen to move away ﬁom home to go to college. Some of them even
mentioned resistance from their parents to doing this, with one participant having to “run
away from home” in order to go to school. Furthermore, they were sexually active and
willing to talk with an investigator about their sexual relationships and protective
behaviors. These two things may have played into their perception of risk and sexual risk
behaviors. For example, moving away from home, especially against their parents’
wishes demonstrates a level of independence that could also be related to their sexual
agency within their relationships and sexual encounters. In addition, their willingness to

talk openly about their sexuality could be related to their ability to negotiate risk. A

78

young woman who felt sexually silenced might not feel comfortable in this situation and
may have chosen not to participate.

The ﬁndings of this study are not expected to generalize to all Mexican American
women, or even Mexican American college women. However, as is often the case with
qualitative work, this was not the purpose of this work. Instead, I sought to explore what
familial and cultural messages were being received by these young women in relation to
sexuality and how they related, if at all, to sexual risk. Through this process the study
achieved its goal of building a deeper understanding of these mechanisms in this
subpopulation. Exploration of the generalizability of these ﬁndings to other subgroups is
an important next steps.

Implications, Future Studies and Interventions

Scholars have long recognized the importance of culture in sexual risk and,
therefore, the importance of tailoring interventions to speciﬁc cultural groups (O’Leary &
Wingood, 2000; Lauby, & Smith, & Stark, 2000). Unfortunately, very little work has
explored whether culture actually does play a role and if so through what mechanisms.
The inﬂuence of familial communication about sexuality on sexual risk is also a very
understudied in these populations. This study represents a small step toward a deeper
understanding of some of these contextual variables that seem to be at play in the sexual
risk behavior of young Latinas and, ultimately, the creation of tailored interventions for
Latino/ a subgroups.

Past studies on Latino/a populations have found that parental messages that relay
traditional cultural values can delay the onset of sexual activity (Rafaelli & Green, 2003;

& Liebowitz et al., 1999). Thus, researchers have suggested the use of these messages

79

by interventionists to prevent young people from engaging in sexual activity at all

(V illarruel, 1998). However, the CDC (2002) estimates that up to 44% of young Latina

women become sexually active before the age 18. Therefore, other types of intervention
efforts need to be taking place as well, for those young women who do become sexually
active.

Given that the current state of the literature suggests that messages received from
family members (value-oriented, traditional and protective) matter in the prevention of
sexual risk behaviors, further research should explore the mechanisms through which
familial messages about sexuality are processed by young Latinas and how this translates
into decreased sexual risk behaviors. Finding out why these messages matter, what
elements of the messages are essential to them being preventive, and through what
mechanisms they are perceived, understood, and assimilated by young women are
important next steps. Furthermore, it is important to study what elements a relationship
must have in order for these preventive messages to be effective. This information will
lead to an understanding of who could be an effective interventionist.

Given that family inﬂuence seems to be important in these matters, this may mean
programming targeted at encouraging parents and/or other people in these women’s lives
(aunts or older sisters for example) who are open to the topics of sexuality to be
informed, supportive, and effective providers of information about sexual protection.

Clearly, some families may be resistant to this. Many parents may feel that
talking to their daughters about sexuality encourages the onset of sexual activity.
However, longitudinal research suggests that exposure to knowledge about sexuality does

not increase onset of sexual activity (Guttrnacher, 1994). Exposing parents and others to

80

this kind of information may be the ﬁrst step in making them effective interventionists.
Furthermore, increasing general awareness of rates of sexual activity, STD’s, and HIV
may make parents and other family members less reticent to talking teens about sexual
topics. If parents are informed about the effectiveness of mixed messages that relay
Don ’t have sex, but if you do protect yourself they may be more likely to use them.
Given that not all families may be open to these kinds of intervention, other adults
that may take the place of parental ﬁgures could be trained to provide these kinds of
accurate and supportive messages. For example, in the case of the subpopulation in this
study, all of the young women were involved in a college advancement program where
other young women (who are Latina graduate students) become their mentors. They
build very strong bonds with these women and often come to them for advice and help.
In their case, this close mentor-student relationship may be a good point of intervention.
Finally, the ﬁndings of this study have implications for how to work with young
Latinas. As mentioned before, it is concerning that most did not perceive HIV risk
despite the fact that they were being well-informed about what constitutes risk were and
engaging in some level of risk. They felt like they had “done enough” by assessing the
character and past behaviors of their partners, asking about their sexual history, or only
having unprotected sex with a few individuals. This suggests that interventionists should
focus on debunking the notions that ”safe sex” can be judged, based on personality
characteristics. Emphasis should be placed on the fact that, regardless how good a
person is, you can’t know their status unless they’ve been tested. Also, these young
women described that once they were in a long-term relationship, they stopped assessing

their sexual risk. There should be an emphasis on assessing risky behavior as a non-

81

static factor that may change over time. Making ongoing assessments of risk within
relationships in a way that doesn’t compromise trust is, of course, an important topic that
should be explored further. In addition, researchers and interventionists need to think
about framing the use of condoms within the context of monogamy.

In summary, this study illuminated several important points. First of all, young
Mexican American women are receiving traditional messages about sexuality from their
families, but some are also receiving protective messages. Secondly, these messages
don’t always come for parents. Finally, traditional as well as well as protective messages
may play an important role in the protective behaviors of these young women. This work
will hopefully become one more piece of the HIV prevention puzzle. It illuminates some
new ways of thinking about this subgroup and new paths to explore. It is my hope to
have done these young women’s stories justice and our obligation as researchers to
continue to build on this knowledge in search for solutions that will work in HIV

prevention.

82

APPENDICES

83

APPENDIX A

Interview protocol

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APPENDIX B

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100

APPENDIX C

Consent Form

101

LEARNING FROM MEXICAN AMERICAN YOUNG WOMEN: ASSESSING
PERCEPTION AND MANAGEMENT OF HIV RISK
CONSENT FORM

Purpose of the Study: You have been invited to participate in a study designed to learn
about how young women understand and cope with sexual risk in their relationships.

Procedures: If you decide to participate in this study you will be asked to participate in
an interview that will last approximately 90 minutes. The interview will be audio taped.
You will be asked about your background, culture, relationships, sexual relationships and
management of sexual risk.

Compensation: You will be given $15 in cash at the completion of the interview.

Benefits: This study will increase our understanding of health practices of Latina
women, help identify sexual risk management behaviors and possibly assist in the
development of interventions to decrease the number of new HIV infections in this
population. By participating you will be contributing to the understanding of women,
relationships and healthy behaviors.

Risks: Known risks of this study are minimal. It is possible that you might feel a little
uncomfortable discussing sex or other related subjects. If this happens, you or the
interviewer may stop the interview at any time.

Conﬁdentiality: All responses will be kept strictly conﬁdential. Only members of the
research team will have access to the data. Information obtained from you will not be
shared with other family members or participants. Interview data, in the form of tapes and
transcripts, will not have your name on them. They will be identiﬁed only with a

numeric code. The master list of codes and the consent forms will be stored in a separate
locked cabinet from the tapes and transcripts. Audiotapes and the master list will only

be used by the research team and will be destroyed when the research study has ended. If
ﬁndings are published, you will not be identiﬁed in any way. Your privacy will be
protected to the maximum extent allowable by law.

Withdrawal: You do not have to take part in this study if you don’t want to. If you
don’t want to answer any of the questions, you don’t have to. If you want to stop the
interview, all you have to say is “I want to stop.” You may withdraw from the study at
any time. There are no penalties to you if you choose not to participate in this study or if
you choose to withdraw or discontinue your participation.

If you have any questions about this study, please contact the investigator, Mercedes M.
Morales by phone: (517) 214-6819, by email: morale33@msu.edu or by regular mail at:
Psychology Department, East Lansing, MI 48824. You may also contact the Principal
Investigator on this project, Dr. Deborah Salem, by phone (517) 432-3672, by email:
salem@msu.edu or by regular mail at: 127 Psychology Building, East Lansing, MI
48824.

102

If you would like to receive a copy of the results of the study, please contact Mercedes
M. Morales and she will send you a summary of the results when the study is completed.

If you have questions or concerns regarding your rights as a study participant, or are
dissatisﬁed at any time with any aspect of this study, you may contact - anonymously, if
you wish, Peter Vasilenko, PhD, Chair of the University Committee on Research
Involving Human Subjects (UCRIHS) by phone: (517) 355-2180, fax: (517) 432-4503,
email: ucrihs@msu.edu, or regular mail: 202 Olds Hall, East Lansing, MI 48824.

CONSENT

By signing this consent form I am indicating my voluntary agreement to participate in
this study. I wish to receive a signed copy of this consent form.

 

Printed name of participant Signature of participant

 

Date Signature of principal investigator

By signing below I am indicating my voluntary agreement to have my interview audio
taped.

 

Printed name of participant Signature of participant

103

APPENDIX D

Coding Frameworks

104

DEVELOPING CODING SCHEME FOR BACKGROUND, CULTURAL
AND FAMILIAL MESSAGES
07-27-05, Version 111

(DOCUMENT NOTES: This document should reﬂect the codes that emerged from
transcripts 001 and 005 after coding for cultural and family messages re: sex.)

A. BACKGROUND
B. QUESTIONS:

Bl. What type of cultural upbringing did you have with regard to Mexican culture?
B2. What is the family culture?

B3. What are the messages that you have received growing up?

First Level Codes-Open Coding
BACKGROUND:

Parents migrants
Raised between Texas and Michigan

Ethnicity/ Identiﬁcation
Mexican American Identiﬁed
Hispanic Identiﬁed
Latino/a identiﬁed(NOTE: neutral connotation)
Not identiﬁed as Hispanic (NOTE: negative connotation)
Ethnic identity shifts by context

Grew up with
Nuclear family
Extended family
Stepfather

Neighborhood

Predominantly Mexican
Mixed

School
Predominantly Mexican
Mixed

Home

 

Texas=Home
Home=family
Home=same house every year

105

Social Circle

All Mexican/Mexican American friends
Mexican American boyfriends

Everyone is Mexican in Texas
FAMILY:

Relationship with Family
Close to family
Close to parents
Close to father/father ﬁgure
Close to mother
Close to siblings
Improving relationship with parents

Communication with Parents
Open Communication
Re: boys
Re: sex

Description of F ather/F ather Figure:

Traditional but not machista

Machista

Authoritarian
Dad sets and enforces curfews
Dad knows everything she does in Texas
Dad’s authority respected

Parental Messages/Views

Parents desire for daughter to stay close to home
Parents understand “things are changing”

Expectations
Different expectations for girls and boys/men and women in
relationships
Girls expected to bring only their future husband home
Boys can bring whoever they want home
Man works
Woman stays home
Divorce is okay

Re: sex (Note: some are implicit)
Don’t sleep around

106

Don’t have sex until married
Don’t have sex until in a long-term relationship
Don’t have sex early

Re: responsibilities
Do good in school
Do chores
Go to church

Different treatment for boys and girls

Different standards for material things for boys and girls
Girls need to work hard for their material things
Curfews/Going out

Father’s Messagg

Re: daughter’s behavior in relation to her “Mexicanidad” — perceived
incongruence
“Mexican girls don’t act like that”

Re: Relationships
Parents should only meet future husband/don’t bring boyfriend
home

Re: Gender
Women should be in the kitchen
Sisters don’t order brothers around

Re: Sex
“Don’t get pregnant”

“Don’t grow up”

Mother messages

Re: Relationships
Okay to get pregnant if not married if she’s done with school
Should marry a Mexican
College education is backup to marriage (supported by husband)

Re: Sex
Protect Yourself

107

Protect yourself no matter what boys say
You know what you’re doing

Be careful

Don’t get pregnant

Use birth control

Other Family Messages
Pressure to get married ﬁ'om extended family members

Reactions to Family Views
Deﬁant
Confrontational
Disagreement
Assimilation
Negotiating
Coming up with personal views
“They are closed minded”
Open communication around sexual topics as protective factor

PARTICIPANT VIEWS
Participant ideas re: sex aad @tionships
Desire to remain single for now

Desire to get pregnant before married
Does not want her own family now

In relation to her parents
Does not want to let father down

Getting pregnant=letting father down
What parents don’t know can’t hurt them

CULTURE

Immersion in Mexican Culture:

Langaage
Spanish spoken at home
English spoken at home
“Spanglish” spoken

No formal education in Spanish

108

Media

Media in Spyish
Soap operas in Spanish
Magazines in Spanish
Newspapers in Spanish
Movies in Spanish

Medlaﬁin English
English TV

Food
Mexican food

Religious Afﬁliation
Catholic Church

Mexican mditions
“posadas”
Three Kings Day

Miscellaneous
Positive cross-cultural experiences
Desire for independence
Without open parental communication people replicate parents views.
Life around family

 

Demographic Information
Age
Year in College

109

CODING SCHEME FOR BACKGROUND, CULTURAL
AND FAMILIAL MESSAGES
9-13-05, Version XII

A. BACKGROUND
B. QUESTIONS:

Bl. What type of cultural upbringing did you have with regard to Mexican culture?
B2. What is the family culture?

B3. What are the messages that you have received growing up?

CODES

Background
Born in
California
Mexico
Texas
Ethnicity/Identiﬁcation
Hispanic Identiﬁed
Mexican American Identiﬁed
Mexican Identiﬁed
Not identiﬁed as Hispanic
Grew up with
extended family
nuclear family
stepdad
Home
Texas=Home
Home=Family
Home=Same house every year
Neighborhood
mixed
predominantly Mexican
Parents migrants
Raised between TX/CA and MI
School
Mixed
segregated
predominantly Mexican

110

Culture
Immersion in Mexican Culture

Language
English spoken at home
Spanglish spoken at home
Spanish spoken at home

Media in Spanish

Mexican food

Music in Spanish

Religious Afﬁliation-Catholic

Traditional Ways

Traditions

Family
Description
Family
Parents Machista
Father Figure
He sets rules
Machista
Traditional but not Machista
Traditional/Strict
Violent
Messages
Aunts told her "protect yourself"
Women stay home
Re: sex-Don't talk about it
Relationship with Family
Close to
brother
family
father
mother
sister
Improving Relationship with
Mother
Parents
Not close to
family
father
mother
parents
sister

111

Openess with Female Relatives
Mom knew about boyf. but not dad
My mom was always like on my side.
Talks openly with mother about sex
Talks openly with sisters about sex

Strained relationship with
Parents
Sister
Friends
Ethnicity
Mixed

Predominantly Mexican

General Cultural Messages
Mexican American women don't talk about sex
Only spoke when spoken to out & don't ask why of respect
Respect for Tradition

Interesting Quote

Miscellaneous
Negative multiracial experience-there was a lot of racism like when I was younger
Positive multi-racial experience

Parent Messages/Views
Re: ﬁiends and going out-not allowed
Expectations
have respect for your family,
Re: boys
Don't bring boyfriend home"
Can't go out with boys
Re: Gender Roles
more lenient with male sibilings
women don't need to stay at home
Re: maturity-you become a woman at 15
Re: relationships
marry after done with school
take on domestic role in mar.
Re: sex
Don't get pregnant

112

Don't have sex early/before marriage
Don't sleep around

What they can't see won't hurt them

Father's Messages

re: daughter's behavior in relation to her "Mexicanidad"-perceived
incongruence
re: relationships
be married before living together
re: sex
"Don't let them fool you"
Modeling
Dad
okay for men to cheat/be with lots of women
Mom
Give yourself to one man
Mother messages
re: relationships
divorce is okay
college is backup to marriage
it should be equal
man should be a gentleman
woman should respect herself & make herself respected
re: sex
it's bad
Use birth control
Don't get pregnant
don't have sex til' marriage
Don't need to marry if pregnant
Girls should not have satisfaction
Okay to get pregnant if done with school
Protect yourself
We don't talk about it
parents held traditional gender roles although mother worked
Re: relationships
Ideal partner
career oriented
family oriented
inspires "conﬁanza"
Mexican man

Participant Disagreement with Parental Messages
General
My parents and I are from dif. worlds
Speciﬁc
desire to get pregnant before married

113

don't want to marry a Mexican

Need for young people to break tradition and talk about sex
Traditional views

Desire for Independence

Participant views re: sex and rel-Parents
Don't want to let parents down by getting pregnant

ATLAS File Description:

|HU: Learning from Latinas Project-072905

File: [C:\Documents and Settings\Meche\My Documents\Thesis Stuff\DATA\ATLAS
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114

CODING SCHEME FOR BACKGROUND, CULTURE, & CULTURAL
AND FAMILIAL MESSAGES

11-21-05, Version IVX
BACKGROUND AND CULTURE:

Background
Born in California
Born in Mexico
Born in Texas

Ethnicity/ Identiﬁcation
Hispanic Identiﬁed
Mexican American Identiﬁed
Mexican Identiﬁed
Not identiﬁed as Hispanic
Xicana Identiﬁed

Grew up with
extended family
mom and aunts
nuclear family
stepdad

Home
Texas=Home
Home=Family
Home=Same house every year

Multiracial Experience
Negative-
there was a lot of racism like when I was younger
Positive-

Neighborhood
Close knit
mixed
predominantly Mexican
predominantly White

Parents migrants
Raised between TX/CA and MI

School
Mixed

115

CAMP

segregated

Political Activism
predominantly Mexican

Culture
Immersion in Mexican Culture
General Cultural Messages
Culture is so tabooed about around wanting to talk about sex
Only spoke when spoken to out & don't ask why of respect
Respect for Tradition

Language
English spoken at home
Spanglish spoken at home
Spanish spoken at home

Media in Spanish
Mexican food
Music in Spanish
Religious Afﬁliation-Catholic
Traditional Ways
Family oriented
Latino parents not open minded re: sex
Mexican parents don't want daughters to be independent
Traditions

Family
Description

Mother-would take care of family and work

Parents
Machista
Old F ashioned/T raditional

F ather/F ather Figure
Protective
He sets rules
Machista
Traditional but not Machista
Traditional/ Strict
Violent

Relationship with Family
Close to brother
Close to family

Family very important in any decisions she makes

Close to father

116

Close to grandmother
Close to mother
Close to sister

Improving Relationship with Brother
Improving Relationship with Mother
Improving Relationship with Parents

my parents were never there

Need to respect elders

Not close to family
Not close to father
Not Close to mother
Not close to parents
Not Close to sister

Strained relationship with Parents
Strained relationship with sister

F ﬁends-Ethnicity

Mixed

Predominantly Mexican

PARENTAL/FAMILY AND CULTURAL MESSAGES

*Note: 1) Reﬂects table with data, dated 112005. 2) Codes that were exactly the
same (example: “Don’t talk about it) are collapsed.

*Legend: italics = code
Bold = meta-code/family
BOLD UNDERLINED AND ALL CAPS = Themes

 

 

 

1. Young women should follow traditional gender roles in relation to sex and
relationships (MESSAGE l):

RULES and NORMS:

0 Girls should not have or want to have sex
0 Don't talk about it- it’s bad

Don 't talk about it (2)

it's bad

Girls should not have satisfaction

culture is so tabooed about around wanting to talk about sex

117

 

0

don't have sex til' marriage (2)

I don 't have sex til ' marriage

I Desirable to be a virgin

I be married before living together

0 Can't go out with boys (NOTE: in some cases they specify that this is
the message until the age of 15)

I Can 't go out with boys
I friends and going out-not allowed

0 You become a woman at 15 (Quinceanera)

I you become a woman at 15
I can have boyfriend at 15
I you can wear makeup at 15

IN RELATIONSHIPS:
0 Value traditional relationship/marriage

Women stay home

take on domestic role in mar.
relationships-monogamous
yourself to one man

don 't believe in divorce

Don ’t go out or you ’ll lose your man (CODED AS “showed her
how to keep her man ”)

0 Your Relationship with your Partner should be equal and respectful

cheating should not be accepted

it should be equal

man should be a gentleman

woman should respect herself & make herself respected

0 Find Partner that follows traditional values

career oriented
family oriented
inspires "conﬁanza"
Mexican man

0 HOW YOUNG MEN SHOULD BEHAVE:

Men should have more freedom than women

118

More lenient with male siblings

Can bring girlfriends home

men should have more ﬁ'eedom

more lenient with male siblings

okay for men to cheat/be with lots of women
girls have more to loose than guys.

 

11. But if you do not follow these traditional gender roles, Be careful (MESSAGE 2)

 

0 Protect Yourself -Sexua11y-Don’t get pregnant
I Don 't get pregnant (2)
I Use birth control/Protect yourself (2)
I Don 't sleep around

0 Protect Yourself-Emotionally/In the Eyes of Others (?)
I Don 't sleep around

I "Don't let them fool you"/Be Careful
I Be careful
I “Don 't let them fool you "
I sex-it’s all boys want

1

 

III. I don’t want to hear about it. (MESSAGE 3)

o What they can 't see won 't hurt them.

0 “Don't bring boyﬁiend home"-unless you’re marrying him/Don’t want to

hear about them (boys)
I Don 't bring boyfriend home
I Don 't want to hear about them

 

I IV. You can tell me about it. (MESSAGE 4)

o Openness with female relatives about sex and relationships.
I Mom knew about boyf but not dad
I My mom was always like on my side.

Talks openly with aunts about sex

Talks openly with mother about sex

Talks openly with sisters about sex/relationships
Don 't be having sex right away

I Don't let boys think you're easy/appearance

119

0 It’s okay to break with traditional gender norms and rules

I Don't need to many if pregnant
I okay go get pregnant if done with school
I divorce is okay

I women don 't need to stay at home
I parents held traditional gender roles although mother worked

OTHER CODES IN SUMMARY TABLE:
0 School, Relationships, and Sex
0 School important-in relation to sex

0 Valuing Education and Traditional Values-Marriage
I marry after done with school
I college is back up to marriage

0 Respect
I Only spoke when spoken to out & don 't ask why of respect
I have respect for your family,
I Respect for Tradition

0 Independence
I Background will not necessarily inﬂuence your decisions in
relationships

I Desire for Independence
I I just learned a lot of it by myself

OTHER CODES:

I Participant views/Disagreements

0 Participant views re: sex and relationships
0 Don't want to let parents down by getting pregnant
0 Don't want to let parents down by telling them she's living with boyf.

0 Participant Disagreement with Parental Messages

0 My parents and I are from dif. worlds
0 Desire to get pregnant before married

120

OOOOOOOO

Desire to have sex before marriage
Desire to have sex before marriage, cautious because of par. mess.
Don't want to marry a Mexican

Is living with boyfriend

Need for young people to break tradition and talk about sex
(My parents have) Traditional views

Should be equal treatment between genders

Desire for Independence

0 Miscellaneous-

0

O
O
O

Negative sexual experience

Had a Mexican dad, so horrible and um,
Religion important to me

Interesting Quote

121

CODING SCHEME FOR SEXUAL COMMUNICATION, HIV KNOWLEDGE,
PERCEPTION OF RISK, AND SEX BEHAVIORS
Version 111

NOTE: Numbers correspond to ATLAS Ti codes.
Sexual Communication:
0 Talked

0a1. asked partner about sexual history

Oal a. asked partner about sexual history/assessed if he cared
0a2. asked partner about STDs

0a3. talked about HIV risk

0a4. talked about pregnancy

0a5. talked about sex

0a6. talked about protection

0a6l. talked about protection/felt comfortable

0a61. talked about protection/talking about protection got easier

000000000

0 Did NOT Talk
0 0b]. we did not talk about sex
0 0b2. we did not talk about protection
I 0b2a. Assumed it would be safe sex
I 0b2b. we did not talk about protection unless something happened
I 0b20. Barrier/we didn't talk about that in my family
0 Negotiation
0 Del a. No Barriers

o Barrier

o 0c1b. partner did not want to use condom
o 0c1c. spur of the moment

0 0c2. Want a better future
0 003. Power/asked him to wear a condom, 1 was playing with his head
o 004. Asked if he had a condom

Knowledge:

0 Prevention

122

O
O
0

la]. Condoms/condoms protect
1a2. Condoms/prevention with condoms
1a3. prevention with abstinence

0 Detection and Transmission

00000

0 Risk

0
O
O

1b1. transmission thru bodily ﬂuids

lb2. it takes 10 years before you can detect HIV
1b3. incorrect know

lb4. you might be at risk even if with prot

lb5. HIV growing in Latino populations

1c1. women and men at same risk
1c2. minorities are at higher risk
1c3. everyone is at risk for HIV

Perception of Risk

0 General

2a1. did not feel at risk because I protected myself
2a2. if it happens it happens

2b1. did not feel at risk for HIV

2b1a. did not feel at risk for partner had not slept with many other people
2b1b. did not feel at risk for have not felt exposed to HIV because I chose
smart partners who don't have sex with everybody

2b2. perceived risk of HIV

2b2a. perceived risk for Felt less at risk for HIV than other things

2b3. Thought about HIV and effects

2c1 . did not feel at risk for S'TDs
2c] a. did not feel at risk for STDs/partner monogamous
2c2. perceived risk of STD

0 Pregnancy

0
O
0

2d]. Pregnancy/did not perceive risk of pregnancy
2d2. Pregnancy/perceived risk of pregnancy
2d3. Pregnancy/Don't want to have kids now

123

o 2d4. Pregnancy/not afraid of getting pregnant/might not be able to
o 2d4. Pregnancy/not afraid of getting pregnant/wants to be a mother

Sexual Behaviors
0 General

0 3a]. casual sex
0 3a2. sex with condom is not pleasurable

0 Protective

3b1a. Condoms/always used a condom

3b1b. Condom/I would not have sex unless he had a condom
3b1c. Condom/used condom with casual partner

3b2. did not rush into sex

3b3. don't mess around with anyone here.

3b4. I don't have sex with just anybody

3b5. lost virginity to long-term boyfriend

0000000

0 Not Protective

o 301 a. Condoms/did not use condom
o 302. don't use birth control
o 363. had unprotected sex because I thought I was in love

0 he’s willing to comply with anything I wish

0 breaking with traditional gender rules about sex

0 Everyone was having sex at MSU

0 Personal History/ I was a virgin

0 Sexual Comm/'ve become more open-minded about sex
0 tries to help friends make safe sex decisions

|HU: Learning from Latinas Project-072905

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Code-Filter: All

 

124

CODING SCHEME FOR SEXUAL COMMUNICATION, HIV KNOWLEDGE,
PERCEPTION OF RISK, AND SEX BEHAVIORS

Version V

NOTE: Numbers correspond to ATLAS Ti codes.

0 Sexual Communication

0 Talked

Oal. asked partner about sexual history

Oala. asked partner about sexual history/assessed if he cared
0a2. asked partner about STDs

0a3. talked about HIV risk

0a4. talked about pregnancy

0a41. talked about pregnancy/don't want to get pregnant again
0a5. talked about sex

0a5a. talked about sex/felt comfortable

0a6. talked about protection

0a61. talked about protection/felt comfortable

0a61. talked about protection/talking about protection got easier
0a71. Asked partner to get tested

Oa71. talked about need to get tested

0a8l. talked about STDs

0 Did Not Talk

0b1. we did not talk about sex

0b2. we did not talk about protection

0b2a. we did not talk about protection/Assumed it would be safe
sex

0b2al . we did not talk about protection/Assumed it would be safe
sex/we're not ready to get pregnant

0b2b. we did not talk about protection/we did not talk about
protection unless something happened

0b2c. we did not talk about protection/Barrier/we didn't talk about
that in my family

0b2d. we did not talk about protection/it never came up

0b3a. we did not talk about HIV/I was scared

0b3b. we did not talk about HIV

I Negotiation

Go] a. No Barriers

Oclb. Barrier/partner did not want to use condom

Oclc. Barrier/spur of the moment

Ocld. Barrier/did not have a condom

0c2. Want a better future

003. Power/asked him to wear a condom, I was playing with his
head

125

004. Asked if he had a condom

0 HIV Knowledge
Prevention

O

0000

lal. condoms protect

1a2. prevention with condoms
1a3. prevention with abstinence
1a4. rubber gloves

1a5. don't share needles

Detection and Transmission

0

00000

Risk

O

0000

lbl. transmission thru bodily ﬂuids

lb2. it takes 10 years before you can detect HIV
1b3. incorrect know

lb4. you might be at risk even if with prot

1b5. HIV growing in Latino populations

1b6. you can get it using condoms

1c1. women and men at same risk
lc2. minorities are at higher risk
1c3. everyone is at risk for HIV
1c4. young people at higher risk
105. all women at same risk

I Perception of Risk
General

0
0

HIV
0

2a]. did not feel at risk because I protected myself
2a2. if it happens it happens

2b1. did not feel at risk for HIV
2b1a. partner had not slept with many other people
I 2b1b. have not felt exposed to HIV because I chose smart
partners who don't have sex with everybody
I 2b1c. only slept with one person and had him checked
I 2bld. protected myself
2b2. perceived risk of HIV
I 2b2a. But felt less at risk for HIV than other things
I 2b2b.perceived risk of HIV/scared to bring it up

2b3 a. Thought about HIV and effects

2b3b. Thought about HIV and effects/makes me nervous so I try
not to think about it

126

0 STDS

o 201. did not feel at risk for STDS
I 201 a. partner monogamous
I 201b. felt more at risk for pregnancy
I 2010. was protecting myself
I 201d. we were open about our past

0 202. perceived risk of STD

0 Pregnancy
0 2d]. did not perceive risk of pregnancy/protecting herself

OOOOO

2d2. perceived risk of pregnancy

2d3. Don't want to have kids now

2d4. not aﬁ'aid of getting pregnant/might not be able to
2d4. not afraid of getting pregnant/wants to be a mother
2d5. mixed feelings about getting pregnant

0 Sexual Behaviors
0 3a]. casual sex
- 3a2. sex with condom is not pleasurable
0 Protective Behaviors (Note: These are behaviors the participants
considered protective.)

0

00000000

Condoms
I 3b1a. always used a condom
3b1a1. always used a broke once
3b1b. I would not have sex unless he had a condom
3b10. used condom with casual partner
3b1d. used condoms at ﬁrst
3b1c. used condoms sometimes
3b2. did not rush into sex
3b3. don't mess around with anyone here.
3b4. I don't have sex with just anybody
3b5. lost virginity to long-term boyfriend
3b6. we decided to have safe sex to prev another preg
3b7. Uses birth control
3b8. withdrawal
3b9. got tested for STDs

o Non-protective Behaviors

O

O
O
O

301 a. did not use condom

301 a1. did not use were drunk

301 a2. did not use assumed I'd take care of myself
302. don't use birth control

127

o 303. had unprotected sex because I thought I was in love

0 Other

Have not gotten tested

he’s willing to comply with anything I wish

50-50 relationship philosophy

Afraid to get tested

Both got tested

breaking with traditional gender rules about sex
decided to start using bc instead of condoms

Everyone was having sex at MSU

I think he was trying to get me pregnant

Personal History/I was a virgin

Respect for boyﬁiends' family-not sleeping in the same room
Sexual Comm/'ve become more open-minded about sex
tries to help friends make safe sex decisions

whatever happens happens

OOOOOOOOOOOOOO

Atlas File Info.

|HU: Learning ﬁom Latinas Project-072905

File:
[C:\DOCUME~1\Margie\Desktop\WORKIN~1\Thesis\HUs\Learning_from_Latinas_Pro
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Date/Time: 08/27/06 05:01 :59

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REFERENCES
Alan Guttrnacher Institute (1994). Sex and America ’s Teenagers. New York: Author.

Amaro, H. (2003). Innovations in HIV Prevention with Latina and Aﬁican American
Women at HIV Risk. 9’” Annual Summer Public Health Videoconference on Minority
Research.

Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction
strategies. Sex Roles, 42 (7/8), 723-749.

Azjen, 1., & Fishebein, M. (1980). Understanding Attitudes and Predicting Social
Behavior. Englewood Cliffs, NJ: Prentice Hall.

Azjen, I. (1991). The theory of planned behavior. Organizational Behavior and Human
Decision Processes, 50, 179-211.

Bandura, A., (2004). Health promotion by social cognitive means. Health Education and
Behavior, 31(2), 143-164.

Bandura, A. (2000). Social cognitive theory and exercise control of HIV infection. In
R. DiClemente & R.J. Peterson, (Eds.) Preventing AIDS: Theories and Methods of
Behavioral Interventions. New York: Plenum Press.

Bird, S.T., Harvey, S.M., Beckrnan, L., Johnson, C. (2001). Getting your partner to use
condoms: Interviews with men and women at risk of HIV/STDS. Journal of Sex
Research, 38(3), 233.

Cabral, R. J ., Galavotti, C. g. Paul, M. (1996). Paraprofessional delivery of a theory based
HIV prevention counseling intervention for women. Public Health Reports, 111(1).

Castaneda, D. (2000). The close relationship context and HIV /AIDS risk reduction
among Mexican Americans, Sex Roles, 7/8 (42), 551-580.

Catania, J .A., Coates,J., & Kegeles, S. (1994). A test of the AIDS risk reduction model:
Psychological correlates of condom use in AMEN cohort survey. Health Psychology,
13(6), 548-555.

Center for Disease Control and Prevention. (2004). Basic statistics. Retrieved January 28,
2004 from http://www.ch.gov/hiv/stats.htm.

Center for Disease Control and Prevention. (2004). HIV/AIDS among Hispanics in the
United States. Retrieved January 28, 2004 from
http://www.cdc.gov/hiv/pubs/facts/hispanic.htrn.

Center for Disease Control and Prevention. (2004). HIV/AIDS surveillance report, cases

134

of HI V infection and AIDS in the United States 2002. Retrieved January 18, 2004
from http://www.cdcgov/hiv/stats/h_asr1402.htm.

Centers for Disease Control and Prevention. (November 1999). Prevention Research
Synthesis Project. with Evidence of Prevention; Revised, HIV/AIDS Compendium of
HIV Prevention Interventions. Atlanta, GA.

Center for Disease Control and Prevention. (2004). Table 6. Estimated numbers of
diagnoses of AIDS in adult or adolescent Hispanics, by diagnosis during 2002,
exposure category, and place of birth—United States. Retrieved January 29, 2004
from http://www.cdgov/hiv/stats/h_asrl 402/table6.htm.

Center for Disease Control. (2002). Update. Acquired Immunodeﬁciency Syndrome
Report, United States, 2001. Survey Report 12 (2). Retrived January 29, 2004 from
hgrzllwwwcdcgov/hiv/stats.

Critelli, J ., & Suire, D. (1998). Obstacles to condom use: The combination of other

forms of birth control and short-term monogamy. Journal of American College
Health, 46, 215-219.

Denner, J ., & Dunbar, N. (2004). Negotiating femininity: Power and strategies of
Mexican American girls. Sex Roles, 50 (5/6).

Denzin, N. K., Lincoln, Y. S. (1994) Handbook of Qualitative Research. Sage
Publications. Thousand Oaks, London.

Diaz, M. R. (1998) Latino gay men and HIV: Culture, sexuality and risk behavior. New
York: Routledge.

Durant, R., Pendergrast, R., & Seyrnore, C. (1990). Sexual behavior among Hispanic
female adolescents in the United States. Pediatrics, 85, 1051-1058.

Ethical Principles of Psychologists and Code of Conduct (2003). American Psychological
Association. Retrieved on October 4, 2004 from
http://www.apa.org/ethics/00de2002.html#8_06.

Faulkner, S.L. (2003). Good girl or ﬂirt girl: Latinas deﬁnitions of sex and sexual
relationships. Hispanic Journal of Behavioral Sciences, 25 (2). 174-200.

Fielsten, E.M., Fielstein, L. L., & Hazelwood, M. G. (1992). AIDS knowledge among
college freshmen students: Need for education? Journal of Sexual Education and
Therapy, 52.

Fierros-Gonzalez, & Brown, J. M. (2002). High risk behaviors in a sample of Mexican-
American collage students. Psychological Reports, 90, 117-130.

135

Fisher, J. D., and Fisher, W. A. (2001). Theoretical approaches to individual-level change
in HIV risk behavior. In J. L. Peterson & R. J. DiClemente (Eds.), Handbook of
HIV Prevention (pp. 3-48). Kluwer Academic/Plenum Publishers, NY.

Gil, R. M., & Vazquez, C. I. (1996). The maria paradox: How Latinas can merge old
world traditions with new world self-esteem. New York: Peri gee.

Guba, E. G., & Lincoln, Y. S. (1989). Fourth Generation Evaluation. Newbury Park,CA:
Sage.

Handelsman, C. D., Cabral, R. J ., & Weisfeld, GE. (1987). Sources of information and
adolescent sexual knowledge and behavior. Journal of Adolescent Research, 2(4),
455-463. ‘

Hobfoll, S. E. (1998). Ecology, community and AIDS prevention. American Journal of
Community Psychology, 26 (1), 133-144.

Hochbaum, G. M. (1958). Public participation in medical screening programs. A
sociopsychological study, Public Health Service, PHS PUB. 5 72. Washington DC, US
Government Printing Ofﬁce, 1958.

Kelley, J. A., Somlai, A. M., & Di Franceisco, W. J .(2000). Bridging the gap between the
science and service of HIV prevention: Transferring effective research-based

prevention interventions to community AIDS service providers. American Journal of
Public Health, 90 (7).

Lauby, J. L., Smith, P. J ., & Stark, M. (2000). A community-level HIV prevention
intervention for inner-city women: Results of the women and infants demonstration
projects. American Journal of Public Health, 90 (2), 216-222.

Liebowitz, S., Castellano, D. C., Cuellar, I. (1999). Factors that predict sexual behaviors
among young Mexican American adolescents: An Exploratory Study. Hispanic
Journal of Behavior Sciences, 21(4), 470-479.

Lincoln, Y. S. & Guba, E. G. (1985). Naturalistic Inquiry. Sage Publications. Beverly
Hills. California.

Lincoln, Y. S. & Guba, E. G. (1989). Fourth Generation Evaluation. Sage Publications.
Newbury Park. London.

Marin, B. & Gomez, C. A. (1997). Latino culture and sex: Implications for HIV
prevention. In J. Garcia & Maria Cecilia Zea (Eds.), Psychological Interventions
and Research with Latino Populations (pp. 73-93). Boston, MA: Allyn & Bacon.

Marin, B., Gomez, C. & Hearst, N. (1993). Multiple heterosexual partners and condom

136

use among Hispanics and non-Hispanic whites. Family Planning Perspectives, 25,
1 70-1 74.

Marin, G., Marin, B. V., Perez-Stable, E. J ., Sabogal, F ., & Otero-Sabogal, R. (1990).
Changes in information as a function of culturally appropriate smoking cessation

community intervention for Hispanics. American Journal of Community Psychology,
1 7.

Marin, G., & Marin, B. V. (1991). Research with Hispanic Populations. Sage
Publications. Newbury Park.

Marin, B. V., Tschann, M., Gomez, C. A., & Gregorich, S. (1998). Self efﬁcacy to use
condoms in unmarried Latino adults. American Journal of Community Psychology,
26(1), 53-71.

O’Leary, A., & Wingood, G. M. (2000). Interventions for sexually active women. . In J.
L. Peterson & R. J. DiClemente (Eds), Handbook of H1 VPrevention (pp. 3-48).
Kluwer Academic/Plenum Publishers, NY.

O’Leary, A. (2000). Women at risk for HIV from a primary partner: Balancing risk and
intimacy. Annual Review of Sex Research, 11 (2000). 191 -234.

O’Sullivan, L., Meyer-Bahlburg, H. F. L., Watkins, B. X., (2001). Mother-daughter
communication about sex among urban African American and Latino families.
Journal of Adolescent Research, 16 (3), 292-292.

Padilla, A., & Baird, T. (1991). Mexican American sexuality and sexual knowledge: An
exploratory study. Hispanic Journal of Behavioral Sciences, 13, 95-104.

Patton, M. Q. (2001). Qualitative Research and Evaluation Methods. (3rd ed.). Sage
Publications. Thousand Oaks. London.

Pick, S., & Andrade, P. (1995). Impact of family on the sex lives of adolescents.
Adolescence, 30 (119).

Prince, A., Bernard, A. L. (1998). Sexual behaviors and safe sex of college students in a
commuter campus. Journal of American College Health, 4 7, 1 1-21.

Prochaska, J. 0., & Velicer, W. F. (1997). The transtheoretical model of health behavior
change. American Journal of Health Promotion, 12, 38-48.

Rafaelli, M., & Green, S. (2003) Parent-adolescent communication about sex:

Retrospective reports by Latino college students. Journal of Marriage and
Family, 65 (2). 474-481.

137

Rafaelli, M., & Ontai, L. L. (2004). Gender socialization in Latino/a families: Results
from two retrospective studies. Sex Roles, 50 (5/6), 287-299.

Rafaelli, M., & Ontai, L. L. (2001). She’s only 16 years old and there’s boys calling over
to the house: an exploratory study of sexual socialization in Latino families. Culture,
Health, and Sexuality, 3 (3), 295-310.

Ramirez, R. R., & Cruz, G. P. (2003). The Hispanic population in the United States.
Population Characteristics, June 2003, US Department of Commerce. Economics
and Statistics Administration. US Census Bureau. Washington DC.

Reinisch, J. M., Sanders, ,S. A., Hill, C. A., & Liemba-Davis, M. (1993). High-risk
sexual behavior among heterosexual undergraduates at a mid-westem university.
Family Planning Perspectives, 24. 1 16-121.

Reppucci, N. D., Woolard, J. L. &, Fried, C. S. (1999). Social, community and preventive
interventions. Annual Review of Psychology, 50.

Romo, L. F., Leﬂrowitz, E. S., Sigrnan, M., Au, T. K. (2002). A longitudinal study of
maternal messages about dating and sexuality and their inﬂuence on Latino
adolescents. Journal of Adolescent Health, 2002(31), 59-69.

Rubin, H. J ., & Rubin, I. S. (2005). Qualitative Interviewing: The art of hearing data.
(2“d edition). Sage Publications.

Scott, C., Shifrnan, L., Orr, L., Owen, R., & Fawcett, N. (1988). Hispanic and Black
American adolescents’ beliefs relating to sexuality and contraception. Adolescence,
23. 667-687.

Smith, P. B. & Weinman, M. L. (1995). Cultural implications for public health policy for
pregnant Hispanic adolescents. Health Values, 19(1), 3-9.

Suarez-Al-Adarn, M., Raffaelli, M. & O’Leary, A. (2000). Inﬂuence of abuse and partner
hypermasculinity on the sexual behavior of Latinas: Results from an HIV preventive
intervention study. AIDS Education and Prevention, 12, 263-274.

Tross, S. (2001). Women at heterosexual risk for HIV in inner-city New York: Reaching
the hard to reach. AIDS and Behavior, 5 (2), 131-139.

Urrea-Rodriguez, C. (1998). Acculturation and Mexican culture: Implications for
culturally appropriate HIV/AIDS prevention interventions. Dissertation. Michigan
State University.

Van Devanter, N., Gonzalez, V. & Merzel, C. (2002). Effect of an STD/HIV behavioral

intervention on women’s use of the female condom. American Journal of Public
Health, 92(1), 109-115.

138

VanOss-Marin, B., Tschann, M. & Gomez, C. A. (1998). Self-efﬁcacy to use condoms
in unmarried Latino adults. American Journal of Community Psychology, 26 (1).

Villarruel, A. (1998). Cultural inﬂuences on the sexual attitudes, beliefs and norms of
young Latina adolescents. Journal of the Society of Pediatric Nurses, April-June, 3.

Whitaker, D. J ., Miller, K. S., David, M., & Levin, M. L. (1999). Teenage partners’
communication about sexual risk and condom use: The importance of
parent-teenager discussions. Family Planning Perspectives, 31 (3), 117-121.

Whitaker, D. J ., & Miller, K. S. (2000). Parent-adolescent discussions about sex and
condoms: Impact on peer inﬂuences of sexual behavior. Journal of Adolescent
Research, 15 (2), 251-273.

Wilson, B. D. M., & Miller, R. L., (2003) Examining strategies for culturally grounded
HIV prevention: A review. AIDS Education and Prevention, 15 (2).

Wingood, G. M., & DiClemente, R. J. (2000). Application of the Theory of Gender and
Power to examine HIV related exposures, risk factors and effective interventions
for women. Health Education and Behavior, 27(5).

Wingood, G. M., & DiClemente, R. J. (1998). Partner inﬂuences and gender-related
factors associated with noncondom use among young adult Aﬁican American women.
American Journal of Community Psychology, 26 (1).

World Health Organization (2004). Global AIDS epidemic shows no sign of abating;
highest number of H1 V infections and deaths ever. Retrieved January 19, 2004
from http://www.who.int/hiv/en/.

Wulfert, E., & Wan, C. K. (1993). Condom use: A self—efﬁcacy model. Health
Psychology, 5, 346-353.

139

   

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