The University Archives has determined that this item is of continuing value to OSU's history.Wheeler, Darrell P., Ph.D., M.P.H., University of North Carolina, Greensboro - "Enhancing the Social Work Role in HIV/AIDS Education, Intervention and Prevention with Vulnerable Groups"The Ohio State University College of Social Wor

Wheeler, Darrell P.

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Enhancing the social work role in mvIAIDS education,Intervention and prevention with vulnerable groupsDarrell P. Wheeler, Ph.D., M.P.H.University of North Carolina, GreensboroStatement of the Research ProblemHuman Immunodeficiency Virus (HIV) is known to be related to the development ofAcquired Immunodeficiency Syndrome (AIDS), a disease which is affecting and infectingmillions of people world wide. HIVIAIDS disease has reached pandemic proportionsglobally. Presently, there is no cure for AIDS. Prevention is our only known mechanismfor disrupting the rapidly growing number of HIVIAIDS cases in the U.S. and worldwide.Social workers have been. are, and must continue to be prominent in the cadre of HIV/AIDSprevention and intervention specialist.In the field of HIV and AIDS research a substantial literature has emerged detailingintervention campaigns with gay and bi-sexual populations. Early campaigns to reduce theincidence of HIV/AIDS in the United States focused on gay, white male communities whereAIDS was first acknowledged as a U.S. public health concern. Much less empirical researchhas been conducted to investigate the social factors contributing to HIVI AIDS infection inminority communities where the incidence is disproportionately manifested.Today, HIV/AIDSeducation campaigns have emerged in almost every Americancommunity. However, in some communities the messages of HIV/AIDS education andprevention have had limited impact on reversing the incidence of new HIV/AIDS cases.AIDS education and prevention programs must therefore be developed for impacting thesehard to reach communities if the spread of HIV/AIDS is to be reduced. Interventionsfocusing on this, preventable. illness must develop from culturally specific research whichclearly identifies and addresses factors contributing to the proliferation of this epidemic.Ultimately, the success of HIV IAIDS intervention programs addressing suchcommunities, must dispel the myths and rumors shrouding the existence and pervasiveness ofthis illness within these communities. Developing programs which are not just culturallysensitive. but, more vitally, culturally specific and relevant to the social context and contentof these groups is necessary (Mitchell, 1990; Chase. 1990; Kadaba. 1990: Nickens. 1990).Preventive programs must accommodate the particular nuances of the target group.The increasing numbers of Blacks being diagnosed with AIDS annually indicates thatBlack communities, as a whole, are not fully benefiting from current HIV/AIDS preventionefforts. The significance of HIVIAIDS in Black communities co-exists with the deterioratingsocial status of the young Black male (13-21 years of age) in the American landscape. Bothare prominent social issues warranting immediate and goal directed attention.-86-Research background questions/hypothesesThe goal of this investigation was to contribute to the evolving knowledge base foreffectively intervening in the prevention of new HIV/AIDS cases in this vulnerablepopulation. Empirical studies suggest that attribution of personal versus environmentalresponsibility warrants detailed attention for individual as well as community mv/AIDSinterventions (McDonnell, 1993; Rosen, 1993).Two assertions undergird the hypothesis for this work. First, in the absence of a cureor vaccine for HIV/AIDS, social and medical health interventions designed to prevent newtransmissions of the virus must emphasize primary prevention. Second, interventionstrategies for reaching historically hard to reach groups should be designed with knowledgeof and input from the target population. This study was intended to add to the professionalknowledge, and provide for the study community a resource for enhancing their HIV/AIDSeducation, prevention and intervention programs.This work focuses on the identification of psychosocial factors which mediate therelationship between ethnicity, social class and sexual risk behaviors for HIV/AIDS in youngurban Black males. The central argument is that. in economically disadvantaged populationsthe sexual risk taking practices of young men are mediated by (1) marginalization. or onesself perception of societal alienation and discrimination; (2) locus of control; and (3)internalization of learned sexual role processes, here termed gender identification.Furthermore, for young Black males social inconsistencies associated with systematic racismand stereotyping make the impact of these variables more dramatic than for their Whitecounterparts.Defining the mediating variables:Marginalization-- typically reflects an individual's internalization of culturallyoppressive, impersonal and exclusionary forces (Gottlieb. 1969; Gould. 1969 and Myers.1991; & Barker, 1987). The effect of these forces is to render the individual sociallymarginalized from full and equal participation in the legitimate social, political and economicsettings of the dominant culture.Locus of control-- whereas marginalization looks to the significance of goodness offit between aspirations and aspiration attainment. locus of control focuses on the attributedsignificance placed on sources which facilitate or constrain goal attainment.Gender identification-- refers to the individual's mix of masculine and feminine.psychological characteristics and not the biological determinants of gender.Four research questions were generated to guide the study: (1) Does the interactionbetween race/ethnicity and social class/status predict for young Black males their potentialfor risk of sexual exposure to HIY/ AIDS? Does it do so for white males in comparableclass/status groups?; (2) What is the general level of mY/AIDS knowledge and awarenessamong sexually active young Black males?; (3) Are there significant differences inperceptions of locus of control, gender identification. and marginalization between youngWhite and Black males?: and (4) To what extent do locus of control. marginalization andgender identification impact the sexual risk for HIY/AIDS taking behaviors in racial/ethnicgroups of young males?-87-MethodologyThe goal(s) of education and providing risk reduction options targeting the Blackcommunity, through the establishment of ethnically specific operationalized programming, ISto increase the likelihood that Blacks will engage in risk reduction activities. This riskreduction behavior occurs when information is provided in a manner that conforms to thesocial context of the target group's daily environment. One mechanism for establishing thegoals and objectives, and operationalizing these is through the assessment of perceivedcommunity needs. Focus groups have proven effective in obtaining insight not alwaysafforded in quantitative assessments. In order to assess perceived needs related to HIV/AIDSin the target community a focus group was conducted. Information from the focus groupaided in the development and implementation of the quantitative assessment tool.Implementation of this study blended quantitative and qualitative designs. Toinvestigate the four research questions a cross sectional study design was employed. Thedesign, while limited in its ability toestablish causal relationships, provided a conciseperspective exploring probable correlations between the study variables.Drawing upon the significance of the HIV IAIDS problem in the Black community andthe deteriorating social status of the young Black male. the study focuses on young (13-21years of age) males living in an urban environment. In the selected community theprevalence of AIDS cases, at the time of the study, was estimated to be 594 diagnosed caseswith Blacks comprising 22 percent of these cases. The overall percentage of Blacks in thecommunity was, however, less than fifteen percent.Sampling was conducted at the local county health department's centralizedSexually Transmitted Disease (STD) Clinic during a two week period. During the period ofthis study 859 persons were registered at the intake desk of the clinic. This figure includesall persons coming into the clinic during the two week sampling period. It was not possible,by virtue of the confidentiality criterion established for this study design, to differentiatebetween those persons visiting the clinic once from those visiting more than once during thesampling period. However, of the 552 questionnaires obtained. 337 were obtained during thefirst week of sampling. A tally of the daily log counts for the clinic indicates that 438persons were registered during the first week of sampling. The number of questionnairesobtained during the first week of the study represents 76.9 percent of the total number ofpersons registered.Of the 552 questionnaires obtained, 377 (68.3 per cent) were male responders and175 (31.7 per cent) females. In the age group targeted for this study. 13-21 years of age,there were 110 completed questionnaires. The resulting sample consisted of seventy-fiveBlacklAfrican American (Non-Hispanic) and thirty-five. Caucasian/Wh ite (Non-Hispanic)responders.A self-administered questionnaire was given to all patients during the study period.The questionnaire sought data on socio-demographic characteristics, perceptions of locus ofcontrol. gender identification. marginalization, knowledge and awareness of HIV/AIDS andrisk factors for HIV infection including STD diagnoses. Each questionnaire was matched tothe patients STD health exam status. The patient's name was not recorded on thequestionnaire. STD health exam status (past and current) was used as a significant proxy forrisk of HIV/AIDS exposure. Data collected on the sampling instrument and the STD-88-diagnoses were analyzed using One-Way ANaYA, Chi-square, correlation matrices anddiscriminant function analyses.ResultsDuring the two weeks in the field, a total of fivechundred and fifty-two responseswere obtained. In the group of young male respondents (n= 110) significant relationshipswere found to exist between race, marginalization, social class, and risk for sexual exposureto HIY on key components. Discriminant function analyses were applied to determine themodel's ability to predict inclusion on the criterion variable. The model was found tosignificantly predict inclusion on several components of the composite dependent variable.Black males were significantly more likely to have unplanned fathering events (p = .000) thantheir White counterparts and to have past and present histories of sexually transmitteddiseases (p=.024 & p=.OOO respectively). These factors are suggested as proxies for risk ofexposure to HIY/AIDS. HIY/AIDS knowledge among Black males (mean value=33.734)was comparable with that of White males (mean value=33.727). Differences were noted inrelative awareness of HIYIAIDS between Black (mean value =3.507) and White (meanvalue 3.400) male respondents.The data present a mixture of highly significant and statistically weak relationships.Interactions between race/ethnicity, marginalization and at least three of the components ofthe risk factors for HIY are substantiated. Less statistically significant findings were obtainedfor differences between Black and White males on locus of control or gender identificationscales. Further exploration of psychosocial and environmental determinants of risk for HIYexposure through sexual practices appears warranted. The variables selected showsignificance for predicting risk for behavioral factors associated with HlYIAIDS exposure.Utility for Social Work PracticePublic health problems, such as HIY/AIDS take a major toll on a society's resourcesand ability to sustain homeostasis. In light of the growing severity of this epidemic researchcan no longer wait for biomedical technology to create the "cure" for AIDS. Social workpractitioners and researchers must join forces to establish linkages which result in effectiveprevention and early intervention campaigns. Our professional knowledge and skills can, andmust be mobilized, to benefit the consumer groups for whom we advocate. Interventionswhich will be effective must consider the psychological, social-environmental, as well as thebiological components of the disease. The social work profession has much to offer inunderstanding and responding to such complex interactions. This study presented one pathby which social work research can be designed and implemented towards understanding andserving a vulnerable group in their struggle with a major health and social issue. Attendingto the needs of vulnerable client groups through specifically informed interventions wouldappear to be important considerations in program and policy development.-89-Selected ReferencesAral, Sevgi 0., Soskoline, Varda, Joesoef, Fiduan M.,O'Reilly,Kevin R. (1991). SexPartner Recruitment as Risk Factor for STD: Clustering of Risky Modes. SexuallyTransmitted Diseases, l8.(1), 10-17.Barker, Robert L. (1987). The Social Work Dictionary. Silver Spring, MD.: NationalAssociation of Social Workers.Bowser, Benjamin P. (1989). Crack and AIDS: An Ethnographic Impression. Journal ofthe National Medical Association, II (5), 15-17.Chatters, Linda M. (1991). Physical Health. In J.S. Jackson (Ed), Life in Black America,(pp. 199-220). Newbury Park, CA.: SageChirgwin. Keith, DeHovitz, Dillon. Stephen, McCormack, William M. (1991, December ).HIV Infection, Genital Ulcer Disease and crack Cocaine Use among PatientsAttending a Clinic for Sexually Transmitted Diseases. American Journal of PublicHealth, '!u(12), 1576-1579.Chute, Mary Eleanor (1991, April 22). Black Males' declining health focus of conference.The Pittsburgh Press B1, 5.Coleman. Richard P. & Rainwater, Lee with McClelland, Kent A. (1978). Social Standingin America: New Dimensions of Class. New York, NY.: Basic Books. Inc.De La Cancela, Victor (1989). Minority AIDS Prevention: Moving Beyond CulturalPerspectives Towards Sociopolitical Empowerment. AIDS Education and Prevention,1(2), 141-153.Duh. Samuel V. (1991). Black and Aids: Causes and Origins. Newbury Park. CA.: SAGEPublications. Inc.Gold. Robert S., and Kelly, Mim A. (1991). Cultural Sensitivity in AIDS Education: AMisunderstood Concept. Evaluation and Program Planning, 11 221-231.Gould. Laurence J. (1969, November). Conformity and Marginality: Two Faces ofAlienation. Journal of Social Issues 25(2), 39-63.Gottlieb. David (1969. November). Poor youth: A Study in Forced Alienation. Journal ofSocial Issues 25 (2), 91 120.-90-Granovetter, Mark & Tilly, Charles (1988). Inequality and Labor Processes. In N.J.Smelser (Ed.), Handbook of Sociology, (pp. 175 - 221). Newbury Park, CA.: SagePublications.Gurin, Patricia, Gurin. Gerald, Lao, Rosin c., Beattie, Muriel (1969, Summer). Internal-External Control in the Motivational Dynamics of Negro Youth. Journal of SocialIssues, 25 (3) 29-53.McDonnell. James R. (1993). Judgements of Personal Responsibility for my Infection: AnAttributional Analysis. Social Work, 38(4) 403-410.Moss, Philip and Tilly, Chris (1991, January). Why Black Men are Doing Worse in theLabor Market: A Review of Supply-Side and Demand-Side Explanations. Preparedfor the Social Science Research Council Subcommittee on Joblessness and theUnderclass.-91-

Enhancing the Social Work Role in HIV/AIDS Education, Intervention and Prevention with Vulnerable Groups

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Enhancing the Social Work Role in HIV/AIDS Education, Intervention and Prevention with Vulnerable Groups

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