[ATTITUDES TOWARDS SEXUAL COMMUNICATION BETWEEN PARENTS AND ADOLESCENTS IN PUERTO RICO]. / ACTITUDES HACIA LA COMUNICACIÓN SEXUAL ENTRE PADRES/MADRES Y ADOLESCENTES EN PUERTO RICO.

Communication between parents and adolescents about sexuality faces challenges due in part to sociocultural factors. This study aimed to document the attitudes of parents and adolescents about communication regarding sexuality. The results emanate from the baseline measurement of the Cuídalos Project. The presented data is part of a larger study that aimed to evaluate a web-based module to foster communications between parents and adolescents (13-17 years of age) on health-related issues. In this article, we present the baseline data in which participants answered questions on their comfort when talking about sexual health issues. The sample was composed of 458 parent/adolescent dyads (n=916). We carried out a frequency and central tendency analysis of the gathered data. The average age for adolescents was 15 years of age, and 15% were sexually active. Adolescents reported better attitudes towards sexual communication than parents. Still, parents understood that they shared sufficient information on sexuality related topics. Parents and adolescents reported some level of difficulty and lack of comfort when talking about specific prevention methods. Results highlight the need to incorporate parents into interventions geared for adolescents and their sexual health. In Puerto Rico, it is necessary to develop programs that aim to reduce high-risk sexual activity among adolescents.

[EXPERIENCES RELATED TO AN INTERVENTION TO REDUCE STIGMA RELATED TO HIV / AIDS AMONG MEDICAL STUDENTS IN PUERTO RICO]. / EXPERIENCIAS RELACIONADAS A UNA INTERVENCIÓN PARA REDUCIR EL ESTIGMA RELACIONADO AL VIH/SIDA ENTRE ESTUDIANTES DE MEDICINA EN PUERTO RICO.

HIV-related stigma exists. People with HIV/AIDS have their rights violated and mental/ physical wellbeing hindered. Health professionals (HP) are a primary source of support, however these can also be sources of stigma. Therefore, it is useful to train HP on the consequences of social stigma. We implemented an intervention to reduce stigma related towards HIV/AIDS with 507 medical students. It proved to be an efficacious intervention with reduction in the levels of stigma in our intervention group and significant differences with the control group (p <.05). Creating opportunities for training to address the stigma associated with HIV / AIDS is relevant to community psychology because we collaborate in changing attitudes that can adversely affect the prevention of new infection, adherence to antiretroviral treatment and quality of life.

Religion and HIV/AIDS stigma in Puerto Rico: a cultural challenge for training future physicians.

HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population.

Religion and HIV/AIDS stigma in Puerto Rico: a cultural challenge for training future physicians.

HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population.

Testing the efficacy of an HIV stigma reduction intervention with medical students in Puerto Rico: the SPACES project.

INTRODUCTION: Stigma associated with HIV has been documented as a barrier for accessing quality health-related services. When the stigma manifests in the health care setting, people living with HIV receive substandard services or even be denied care altogether. Although the consequences of HIV stigma have been documented extensively, efforts to reduce these negative attitudes have been scarce. Interventions to reduce HIV stigma should be implemented as part of the formal training of future health care professionals. The interventions that have been tested with health care professionals and published have several limitations that must be surpassed (i.e. lack of comparison groups in research designs and longitudinal follow-up data). Furthermore, Latino health care professionals have been absent from these intervention efforts even though the epidemic has affected this population disproportionately. METHODS: In this article, we describe an intervention developed to reduce HIV stigma among medical students in Puerto Rico. A total of 507 medical students were randomly introduced into our intervention and control conditions. RESULTS: The results show statistically significant differences between the intervention and control groups; intervention group participants had lower HIV stigma levels than control participants after the intervention. In addition, differences in HIV stigma levels between the groups were sustained for a 12-month period. CONCLUSION: The results of our study demonstrate the efficacy of the modes of intervention developed by us and serve as a new training tool for future health care professionals with regard to stigma reduction.

A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis.

INTRODUCTION: Within healthcare settings, HIV-related stigma is a recognized barrier to access of HIV prevention and treatment services and yet, few efforts have been made to scale-up stigma reduction programs in service delivery. This is in part due to the lack of a brief, simple, standardized tool for measuring stigma among all levels of health facility staff that works across diverse HIV prevalence, language and healthcare settings. In response, an international consortium led by the Health Policy Project, has developed and field tested a stigma measurement tool for use with health facility staff. METHODS: Experts participated in a content-development workshop to review an item pool of existing measures, identify gaps and prioritize questions. The resulting questionnaire was field tested in six diverse sites (China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis). Respondents included clinical and non-clinical staff. Questionnaires were self- or interviewer-administered. Analysis of item performance across sites examined both psychometric properties and contextual issues. RESULTS: The key outcome of the process was a substantially reduced questionnaire. Eighteen core questions measure three programmatically actionable drivers of stigma within health facilities (worry about HIV transmission, attitudes towards people living with HIV (PLHIV), and health facility environment, including policies), and enacted stigma. The questionnaire also includes one short scale for attitudes towards PLHIV (5-item scale, α=0.78). CONCLUSIONS: Stigma-reduction programmes in healthcare facilities are urgently needed to improve the quality of care provided, uphold the human right to healthcare, increase access to health services, and maximize investments in HIV prevention and treatment. This brief, standardized tool will facilitate inclusion of stigma measurement in research studies and in routine facility data collection, allowing for the monitoring of stigma within healthcare facilities and evaluation of stigma-reduction programmes. There is potential for wide use of the tool either as a stand-alone survey or integrated within other studies of health facility staff.

Más que una responsabilidad individual: factores socio-estructurales y el estigma relacionado al VIH/SIDA / More than individual responsibility: socio-structural factors and hiv/aids stigma

La estigmatización del VIH/SIDA es de interés para la Psicología Comunitaria (PC) y organizaciones nacionales/internacionales. La enfermedad es ampliamente conocida, sin embargo su significado social es un reto para la empresa salubrista. Es altamente estigmatizada y se le atribuye la contaminación de la sociedad saludable. Desarrollar adiestramientos para profesionales de la salud (PS) y estudiantes de profesiones de la salud (EPS), incluyendo a psicólogos/as en esta área, es importante para lograr un mayor alcance a programas preventivos y de tratamiento. Un reto para reducir el estigma, es lograr que PS comprendan cómo las condiciones sociales fomentan la enfermedad, en lugar de concentrarse en las acciones individuales de las personas afectadas. Para esto es necesario considerar aquellos factores socio-estructurales que fomentan la estigmatización de las personas con VIH/SIDA (PCVS) como la pobreza y el género, entre otros. Los objetivos fueron explorar: 1) manifestaciones de estigma hacia el VIH/SIDA de PS y EPS y 2) su percepción de los factores socio-estructurales e individuales en estas manifestaciones, utilizando un diseño exploratorio de corte cualitativo. A partir del análisis de discurso de 80 entrevistas semiestructuradas a profundidad (40 PS y 40 EPS), se identificaron tres patrones temáticos que fomentan la enfermedad sociedad/cultura, género y responsabilidad individual.

Stigmatization of illicit drug use among Puerto Rican health professionals in training.

Social stigma continues to be a barrier for health promotion in our society. One of the most stigmatized health conditions in our time continues to be addiction to illicit drug use. Although it has been widely recognized as a health concern, criminalizing approaches continue to be common in Puerto Rico. Health professionals need to engage in challenging the stigma of illicit drug use in order to foster policies and government efforts with health-oriented approaches. Still, personal stigmatizing attitudes among them continue to be a barrier for the implementation of this agenda. Therefore, the main objectives of this study were to document stigma towards illicit drug use among a sample of health professionals in training, and explore differences in such attitudes among participants from different areas of training. In order to achieve this objective we carried out a sequential mixed method approach with a sample of 501 health professionals in training or practice from the disciplines of medicine, nursing, psychology and social work. Results evidence the continued existence of stigmatizing attitudes among this population. We discuss some of the implications for public health and potential strategies for action.

Cambios: ¿cómo influyen en los y las adolescentes de familias reconstituidas? / Changes: how do they influence on adolescents in reconstituted family?

En Puerto Rico, al igual que en países de América Latina, el Caribe y Estados Unidos, existe una alta tasa de divorcios. Muchas personas divorciadas vuelven a casarse, estableciendo una familia reconstituida. En esta nueva relación, la madre o el padre biológico comparte con su pareja (madrastra o padrastro) e hijo/s e hija/s de la relación anterior. Nuestro objetivo fue estudiar cómo se ajustan los hijos e hijas adolescentes de padre y madre divorciados, que ahora integran una familia reconstituida, a los cambios que surgen como resultado de pertenecer a la misma. Seleccionamos personas adolescentes ya que ésta es una etapa de transición importante en su desarrollo. Además, en estudios previos se señala que el divorcio afecta a los y las adolescentes más que a otros miembros del núcleo familiar. Realizamos entrevistas semi-estructuradas con integrantes adultos/as y adolescentes de ocho familias reconstituidas. Los y las adolescentes informaron que al formar parte de la familia reconstituida se enfrentaron a cambios negativos y positivos, entre ellos: cambio de escuela, alejamiento de familiares, compartir con familiares de la nueva pareja de su madre o padre, mejoría en los procesos de comunicación y en el estatus económico. Recomendamos investigaciones e intervenciones futuras dirigidas a esta población.

A high rate of divorce exists in Puerto Rico, however, many divorced people decide to remarry, establishing a reconstituted family. In this new relation the biological mother or father shares with their new relationship (mother and father in law) and also with their children of their first relation. They can come into this relationship with their children or they can have children of their own. Our objective was to study how adolescent children of mothers and fathers who are divorced adjust to a newly reconstituted family and the changes that come as a result of being a part of this family. We selected adolescents because this is an important stage in a child's development. Furthermore, in previous studies authors report that divorce affects adolescents more than other members of the family. We carried out semi-structured interviews with adults and adolescents of eight reconstituted families. The adolescents informed us of how negative and positive changes had affected them when the reconstituted family was formed. The adolescents reported that when forming part of a reconstituted family, they faced both negative and positive changes, such as change of school, distancing from relatives, spending time with relatives of their father or mother's new spouse, improvement in the communication processes and the economical status. We recommend research and future interventions directed at this population.

Cambios: ¿cómo influyen en los y las adolescentes de familias reconstituidas? / Changes... How do they influence on adolescents in reconstituted family?

En Puerto Rico, al igual que en países de América Latina, el Caribe y Estados Unidos, existe una alta tasa de divorcios. Muchas personas divorciadas vuelven a casarse, estableciendo una familia reconstituida. En esta nueva relación, la madre o el padre biológico comparte con su pareja (madrastra o padrastro) e hijo/s e hija/s de la relación anterior. Nuestro objetivo fue estudiar cómo se ajustan los hijos e hijas adolescentes de padre y madre divorciados, que ahora integran una familia reconstituida, a los cambios que surgen como resultado de pertenecer a la misma. Seleccionamos personas adolescentes ya que ésta es una etapa de transición importante en su desarrollo. Además, en estudios previos se señala que el divorcio afecta a los y las adolescentes más que a otros miembros del núcleo familiar. Realizamos entrevistas semi-estructuradas con integrantes adultos/as y adolescentes de ocho familias reconstituidas. Los y las adolescentes informaron que al formar parte de la familia reconstituida se enfrentaron a cambios negativos y positivos, entre ellos: cambio de escuela, alejamiento de familiares, compartir con familiares de la nueva pareja de su madre o padre, mejoría en los procesos de comunicación y en el estatus económico. Recomendamos investigaciones e intervenciones futuras dirigidas a esta población.(AU)

A high rate of divorce exists in Puerto Rico, however, many divorced people decide to remarry, establishing a reconstituted family. In this new relation the biological mother or father shares with their new relationship (mother and father in law) and also with their children of their first relation. They can come into this relationship with their children or they can have children of their own. Our objective was to study how adolescent children of mothers and fathers who are divorced adjust to a newly reconstituted family and the changes that come as a result of being a part of this family. We selected adolescents because this is an important stage in a child's development. Furthermore, in previous studies authors report that divorce affects adolescents more than other members of the family. We carried out semi-structured interviews with adults and adolescents of eight reconstituted families. The adolescents informed us of how negative and positive changes had affected them when the reconstituted family was formed. The adolescents reported that when forming part of a reconstituted family, they faced both negative and positive changes, such as change of school, distancing from relatives, spending time with relatives of their father or mother's new spouse, improvement in the communication processes and the economical status. We recommend research and future interventions directed at this population.(AU)

Desarrollo de la Escala sobre el Estigma Relacionado con el VIH/SIDA para Profesionales de la Salud mediante el uso de métodos mixtos.

HIV/AIDS stigma continues to be an obstacle for primary and secondary HIV prevention. Its consequences for the lives of people living with the disease have been well documented and continue to be of great concern for health care providers and researchers in the field. These consequences are worsened when such stigma emanates from health professionals, as this can limit access to services. One of the main obstacles for HIV/AIDS Stigma research in Puerto Rico is the absence of quantitative measures to assess HIV/AIDS stigma manifestations among health professionals. The main objective of this study was to develop and test the psychometric properties of a culturally appropriate HIV/AIDS stigma scale for Puerto Rican health care providers and to develop a reduced form of the scale suitable for use in time-limited clinical settings. The developed measure was based on qualitative evidence gathered from Puerto Rican health professionals (n=80) and administered to a sample of 421 health professionals in training. The scale addresses 12 HIV/AIDS stigma dimensions. In quantitative analyses 11 of these dimensions demonstrated satisfactory validity and reliability. These dimensions in turn were subcomponents of a higher-order general stigma factor.

AIDS-related stigma and health professionals in Puerto Rico / El estigma relacionado al SIDA y los profesionales de la salud en Puerto Rico

This study addresses an important issue in the AIDS epidemic in Puerto Rico: AIDS stigma among health professionals and health profession students. AIDS stigma has been documented among health services providers such as doctors, nurses, psychologists, and social workers. It has detrimental effects of the services provided and the lives of people living with HIV/AIDS (PLWHA). The main objective of this study was to explore AIDS stigma manifestations among a sample composed of eighty health professionals and health profession students who participated in in-depth qualitative interviews. Four thematic categories stemmed from the data analysis process. These addressed the following subjects: social manifestations of stigma, stigma manifestations in the workplace, use of sensitive information to control PLWHA, and surveillance of PLWHA. Participants manifested instances of stigmatization they had witnessed in their work and training scenarios. Furthermore, they elaborated on the need to place effective surveillance mechanism on PLWHA in order to control the epidemic.

Este estudio aborda un tema de importancia en la epidemia del VIH/SIDA en Puerto Rico: el estigma que emana de profesionales de la salud y estudiantes de dichas profesiones. El estigma relacionado al VIH/SIDA se ha documentado entre profesionales de la salud de la medicina, enfermería, psicología y trabajo social. El mismo tiene efectos detrimentales en los servicios provistos y las vidas de las personas que viven con VIH/SIDA (PVVS). El objetivo principal de este estudio fue explorar las manifestaciones del estigma relacionado al VIH/SIDA en una muestra de ochenta profesionales de la salud y estudiantes de profesiones de la salud que participaron en entrevistas cualitativas a profundidad. Cuatro ejes temáticos emanaron del análisis de las entrevistas. Estos abordaron los siguientes temas: manifestaciones sociales de estigma, manifestaciones de estigma en sus escenarios de trabajo, uso de información sensitiva para controlar a las PVVS, y la vigilancia de las PVVS. Las personas participantes describieron manifestaciones de estigma que habían presenciado en sus escenarios de trabajo y adiestramiento. Además, proveyeron descripciones elaboradas sobre la necesidad de implantar sistemas efectivos de vigilancia sobre las PVVS para controlar la epidemia.

AIDS-Related Stigma and Health Professionals in Puerto Rico.

This study addresses an important issue in the AIDS epidemic in Puerto Rico: AIDS stigma among health professionals and health profession students. AIDS stigma has been documented among health services providers such as doctors, nurses, psychologists, and social workers. It has detrimental effects of the services provided and the lives of people living with HIV/AIDS (PLWHA). The main objective of this study was to explore AIDS stigma manifestations among a sample composed of eighty health professionals and health profession students who participated in in-depth qualitative interviews. Four thematic categories stemmed from the data analysis process. These addressed the following subjects: social manifestations of stigma, stigma manifestations in the workplace, use of sensitive information to control PLWHA, and surveillance of PLWHA. Participants manifested instances of stigmatization they had witnessed in their work and training scenarios. Furthermore, they elaborated on the need to place effective surveillance mechanism on PLWHA in order to control the epidemic.