Tamara R. Buckley, Ph.D., Principal Investigator

HIV Prevention among college-going women in a minority serving institution

Specific Aims

Although the literature suggests that Black women report higher levels of self-esteemthan do women from other racial groups (Ziegler-Hill, 2007), and thus may have more favorable attitudes toward themselves (Rosenberg, 1965, p. 15), that self-esteem advantage has not translated into lower rates of HIV/AIDS, even though self-esteem has been identified as protective of HIV risk in other US racial groups(Hollar & Snizek, 1996; Keeling, 1991).

US Black women ages 18 to 29 are infected with HIV in numbers disproportionate to their percentage of the national population (DiClemente et al., 2008; Hall, Song Rhodes, et al, 2008; Jarama, Belgrave, Bradford, Young, & Honnold, 2007; O’Leary, Jemmott & Jemmott III, 2008; Wyatt, Williams, Myers, 2008); the Centers for Disease Control and Prevention (CDC) reports that they account for 66% of new HIV infectionsamong women while comprising 12% of the female population (CDC Morbidity and Mortality Weekly Report, 2007) and that their rates of diagnosis are 20 times those of white women (CDC and Prevention, 2005). Researchers (see exceptions, Jarama, Belgrave, Bradford, Young, & Honnold, 2007) have remained largely silent about self and group identity as an explanation for racial disparities in HIV-related attitudes and behaviors(Williams, Spencer, & Jackson, 1999), although a growing number of largely ethnic minority researchers assert that the heterogeneity of race and gender continue to be missing factors in HIV research that may impact women’s HIV risks (Amaro & Raj 2000; Bowleg, Belgrave, & Reisen, 2000; Wingood & DiClemente, 2006; Wyatt, Williams, Myers, 2008). The goal of the proposed pilot study, therefore, is to take a developmental approach that examines the complexity of young Black women’s racial and gender identity (i.e., attitudes, beliefs, and values). We assert that young Black women’s racial and gender identity may inform their self-esteemand how that is enacted in sexual narratives, and,therefore, their HIV risk related behaviors.

To explore presumptive vs. objectively measured knowledge and social vs. private self-report,the proposed 24-month study will use a mixed method design. Specifically,

  • Two semi-structured 1.5 hour interviews will be conducted within a 10-day period of 15 young Black women ages 18-29, with unidentified HIV status, recruited from an urban, minority-serving college in New York Citythat explore how racial identity, gender roles, and self esteem intersect with their sexual narratives and HIV knowledge and behaviors.

The time lag between interviews allows participants time to reflect on their attitudes and behaviors and possibly deepen their responses in the second interview.

  • After the completion of the second interviewand informed by its results, quantitative measures of racial identity, gender identity, self-esteem, HIV knowledge and behaviors will be administered to the original group of 15 women (group 1) and to a separate larger group of 30 young Black women (group 2).
  • The ultimate goal of the study is to generate knowledge about young Black women’s identity development (i.e., their attitudes, beliefs, and cultural values) regarding race and gender that may influence their self-esteem, sexual narratives and HIV-related behaviors. Results will be used to develop an intervention for HIV prevention among young Black women.

Background and Significance

Black women at risk.Almost 20 years ago, epidemiologic studies identified young Black women’s increased vulnerability to be infected by HIV (Wingood & DiClemente, 2006). Nearly two decades later, approximately 66% of HIV/AIDS cases in US women are among African Americans (CDC Morbidity and Mortality Weekly Report, 2004). Researchers (e.g., Hortensia & Raj, 2000; Reid, 2000; Wingood & DiClemente, 2006; Wyatt, 2005) suggest taking a comprehensive approach to women and HIV prevention by recognizing the diversity of Black women’s race and gender. Racial identity and gender-role schema both group individuals into distinct categories or statuses and each category has implications for a person’s attitudes, thoughts, and behaviors. Many current approaches do not account for the heterogeneity that exists among young Black womenon both race and gender dimensions, nor have they targeted college populations.

Black college women at risk. The majority of HIV research focuses on prevention for high-risk minority women and men who have sex with men, while largely ignoring young black college women as a risk group although they engage in behaviors that place them at risk for contracting HIV (Alleyne, 2009).A mini HIV epidemic in North Carolina colleges (Hightow et al., 2004) and anecdotal data gathered from the PI’s classroom experiences suggests that college-educated persons may be at high risks for HIV and STIs, although they are often perceived to have the cognitive and affect regulation skills to lower their risks. Other research suggests that African American college women, compared to women from other racial groups, may be at greater risks for STIs and HIV based on their social networks (Randolph, Toress, Gore-Felton, Lloyd, & McGarvey, 2009). It is possible that Black women in college are more likely to view the epidemic as distal rather than proximal (Colleague, personal communication, August 18, 2009), particularly since for many the face of AIDS continues to be associated with gay men.

Rationale for approach. There is an insufficient volume of theory-driven research aimed at HIV prevention among Black college women that utilizes a mixed-method design. In this pilot study we integrate theoretical approaches (i.e., racial identity theory and gender-schema theory) from the psychological literature to address a public health problem, conduct semi-structured interviews, and gather data from validated quantitative measures, to generate in-depth knowledge about this understudied group.

Theoretical Approaches. Racial identity will be examined using Helms’ Black racial identity theory, which deconstructs the usual monolithic treatment of race by examining within racial group differences in attitudes, thoughts, and beliefs. Research has found that Black persons in early stages of racial identity tend to have negative feelings about their group, whereas those in higher stages have higher self-esteem (Buckley & Carter, 2005; Helms & Cook, 1999) and higher elf efficacy that may have implications for negotiating safer sex practices.

Bem’s gender-schema theory (1983) will be used to explore the complexity of gender. The theory proposes that males and females employ a variety of responses to societally prescribed gender norms, with some adopting traditionally defined“feminine” roles (e.g., nurturing) and others choosing traditionally defined “masculine” roles (e.g., instrumental). HIV researchers (e.g., Bowleg, Belgrave, & Reisen) found that both expressive and instrumental gender roles are associated with direct power strategies that may impact sexual practices.

Significance. The college period represents a teachable moment for HIV prevention among black women since approximately75% to 90% of all college students are sexually active (Dalton,Donald, & Ratliff-Crain, 1999; LaBrie, Earleywine, Schiffman, Pedersen,&Marriot, 2005) and recent studies have found college social networks to be a source of increased risks for STIs and HIV among this group (Alleyne, 2009; Hightow et al., 2004; Randolph, Toress, Gore-Felton, Lloyd, & McGarvey, 2009).

Preliminary Studies

Tamara Buckley, Ph.D., Associate Professor, HunterCollege and Doctoral Faculty in Social-Personality Psychology at the GraduateCenter, PI, received the Carolyn Payton Early Career Psychology Award, American Psychological Association, Division 35, Psychology of Black Women, for her research on the impact of racial identity and gender identity on young Black women’s self-esteem (Buckley & Carter, 2005). She has also published work on racial and gender identity among adult biracial women (Buckley & Carter, 2004) and a multiracial sample of men (Carter, Williams, Juby, & Buckley, 2005). Dr. Buckley has received a National Institutes of Health, Health Disparities Research Loan Repayment Program (Award No. L60MD000331-01) and eight grants from the City University of New York Research Foundation for her work onBlack adolescents’identity and mental health, funding which has led to threepeer-reviewed publications (e.g.Buckley & Carter, 2005; Buckley & Carter, 2004) and three national conference presentations. The current pilot study represents a transition for Dr. Buckley in applying her expertise in gender and racial identity to HIV risk.

Dr. Buckley’sresearch also includes work on cultural competency among mental health professionals. She was recently (2007-2008) a Visiting Scholar at the Russell Sage Foundation, where she worked on a conceptual model of cultural competency and a mixed-method empirical study of child welfare workers engagement of race and culture in their practice.

The work cited below demonstrates Dr. Buckley’s ability to recruit for and execute funded projects and her expertise in racial and gender identity.

In 2001, Dr. Buckley designed a quantitative study analyzing the impact of Black adolescent girls’ racial and gender identity on their self-esteem, partially funded by Professional Staff Congress, City University of New York (PSC/CUNY), for which she recruited 200 NYC Black adolescent females and conducted all statistical analyses. In 2000, she designed and conducted a content analysis to understand young biracial women’s identity development(Buckley & Carter, 2004; add other citation). Her current qualitative research focuses on cultural competency in child welfare practice and utilizes Atlas.ti software for data analyses (Foldy & Buckley, 2009). For this and other research, identity development has been significantly associated with psychological and health outcomes (Benkert, Hollie,Nordstrom, Wickson,Bins-Emerick, 2009;Buckley & Carter, 2005; Kessler, 2009). In a sample of Black MSM, an anti-white racial identity and low psychological well-being were associated with unsafe sex practices (Kessler, 2009). Among Black adults, racial identity was associated with mistrust of the health care system but high levels of trust and satisfaction with nurse practitioners(Benkert, Hollie,Nordstrom, Wickson,Bins-Emerick, 2009). Intwo-spirit American Indians/Alaska Natives, a positive integration between self and group identity regarding ethnicity, race, and culture (i.e., Actualization) was protective against physical pain and impairment and poor self-rated health (Chae & Walters, 2009)

In addition, Dr. Buckley works with young Black women through three minority-serving organizations: HunterCollege, CUNY (Associate Professor), Harlem Educational Activities Fund (Advisory Board Member), and Sponsors for Educational Opportunity (Volunteer). Moreover, she has had a research team since joining Hunter and actively trains and mentors graduate students of color in all aspects of research. For this pilot study, Dr. Buckley will hire two research assistants from the doctoral program in Social-Personality Psychology at the GraduateCenter who have conducted qualitative research.

Research Design

Project Description & Timeline

Respondents (n = 45) will be recruited through the Hunter College, CUNY, School of Education (SOE) subject pool, which reaches approximately 600 undergraduate and graduate students who are required to complete up to two research credits in order to graduate. If additional respondents are needed, the PI will draw on established relationships in the Department of Psychology to gain access to the Psychology subject pool. HunterCollege is a minority-serving institution noted for its diversity regarding race, ethnicity, county of origin, and socio-economic status. In the School of Education, the graduate enrollment by race includes: 52% White, 11.1%; Black; 20.6% Hispanic; 11.2% Asian/Pacific Islander; .4% American Indian/Native Alaskan; and 4.3% other. Undergraduate enrollment by race in the SOE includes: 50.2% White; 14.5% Black; 18.1% Hispanic; 13.1% Asian/Pacific Islander; 0.2% American Indian/Native Alaskan; and 3.9% other.

The screening criteria for the study are as follows: Participants must, a) be between the ages of 18-29, b) self identify as female, c) self identify as Black, African American, African, Caribbean American, or biracial (black and another racial group), d) be currently enrolled students in courses at Hunter College, City University of New York, e) be currently sexually active or have been in the last 12 months. Applicants will initially be screened by the computer kiosk. The PI or an RA will verify that each respondent has met the screening criteria when meeting them in person.

Respondents who meet the survey criteria must provide written consent for interview and audio-taping as applicable indicating their agreement to participate before being enrolled in the study. Consented respondents will be randomly assigned to either group 1 or group 2. Group 1 respondents (n = 15) will be asked to complete two 1.5 hour face-to-face semi-structured interviews, conductedwithin a ten day period, and six validated,paper and pencil, self-report measures. Group 2 respondents (n = 30) will be asked to complete six quantitative measures, only. Group 1 respondents who complete both the qualitative and quantitative components of the study (n = 15) will be offered $40 for their participation. Group 2 respondents who complete the quantitative measures (n = 30), alone, will be offered $15 for their participation.

The study will be conducted in the Department of Educational Foundations at HunterCollege in the WestBuilding, Room W1143, an office designated for research. Data collected in this study will be in a locked file cabinet in the PIs office. Only the PI will have access to the collected data and the original protocols of this study.

Data analysis.Will be completed in three distinct stages:

1)Qualitative Data Analysis: First, audio-taped qualitative data will be transcribed into word processing files by a paid professional transcriber to be hired. Two RAs to be hired and trained by the PI will cross-review transcriptions against the tapes to ensure accuracy.The PI will randomly select 20% of the transcripts to review against the audio-tape to ensure accuracy.

Interview 1 and Interview 2 together will be considered the unit of analysis. Analysis will be conducted by the PI and the two RAs using Atlas.ti (cite), a qualitative software package that provides a database for coding respondent characteristics by enabling the coder to assign specific codes to text, track the number of codes, and analyze inter-coder agreement.

•The PI and two RAs (team) will separately read all transcripts without coding to familiarize themselves with the dataset.

•The team will use content analysis, in which key ideas, words, and phrases are grouped based on theirrelation to the purpose of the study (Morgan, 1996) and to identify themes that accurately capture the data. The group will use a consensus coding approach to generate the final codes for the dataset. The goal is to generate themes that accurately capture participants’ culturally informed sexual narratives.

2)Quantitative Data Analysis: The six scales will be measured to test the strength of association among racial identity, gender identity, self-esteem, HIV knowledge, and self-reported HIV behaviors. No predictive or causal statements will be drawn because of the design and small sample size. Data from the self-report measures will be entered into in SPSS and descriptive statistics will be generated.

3)Comparison of Qualitative and Quantitative Data for Group 1: Results from the quantitative analyses will be compared against the qualitative results to explore presumptive vs. objectively measured knowledge and private vs. social self-report. The quantitative data will also be mapped onto the qualitative data to ascertain possible trends in the findings.

Projected Timeline:

Months 1 to 5: Hunter College Institute Review Board (IRB) Approval

Hire Research Assistants

Months 6 to 10: Recruit participantsand collect data

Months 11 to 17: Identify themes and code qualitative data

Code quantitative data and enter data

Months 18 to 24: Prepare Written Report and Disseminate Findings

Months 25 to 36: Prepare External Grant Applications