In the United States, HIV/AIDS disproportionately impacts Latinas. Although they comprise 9% of the population, they account for 15% of HIV incidence rates [1
]. The CDC reports that for Latinas rates of HIV infection are 4 times greater than for non-Latina White women and that Latinas constitute a growing proportion of new infections [1
]. Despite these alarming trends, insufficient research has explored how Latinas experience HIV/AIDS. Latinas infected with HIV/AIDS face added obstacles; they cope not only with the disease but also must contend with socioeconomic issues such as linguistic or cultural barriers, gender discrimination/racism, low socioeconomic status, and limited access to health care, all of which contribute to the overall maintenance of the illness [4
]. Few studies have examined cultural factors as they relate to coping styles and health risk behavior in HIV/AIDS infected Latinas.
The present study examines acculturation and its association with health risk behaviors of HIV positive Latinas by positing coping styles as a mediating mechanism between the two. With the exception of one recent study among Latino MSM (men who have sex with men) [7
]; the linkage between acculturation, coping styles and health promoting behaviors has not been examined among HIV positive Latinos. The conceptual model driving this study is an extension of three related areas within the literature: acculturation’s role in health risk behaviors for Latinos, the impact of acculturation on coping styles for Latinos, and the impact of coping styles on health risk behaviors of HIV positive persons.
Previous research with Latino populations has indicated that acculturation is related to health and mental health outcomes [8
]. While acculturation—the psychosocial, behavioral, linguistic and ideological changes to the individual that result from continuous contact between two cultures [11
]—has been found to be an important factor to consider when examining health outcomes for Latino populations, the findings have been mixed and debatable. Some studies indicate that high acculturation has positive outcomes, including higher socioeconomic status, better education, and access to health insurance [13
]. At the same time, other studies have indicated that increased acculturation is associated with worse health outcomes, such as alcohol consumption, smoking, diet, HIV risk, and substance use [14
]. Furthermore, other studies have found that being less acculturated is a protective factor against substance abuse, sexual risk behavior, depression and stress [6
The relationship of acculturation and health risk behaviors also differs for Latinos depending on the country of origin and socioeconomic status prior to immigration. The Hispanic Health Paradox [18
] is the hypothesized phenomenon which contends that despite social, economic, cultural and linguistic disadvantages faced by the newly immigrated, Latinos have fewer negative health outcomes than their US born counterparts, or even non-Latino Whites. As Latino immigrants acculturate to US host culture, they have worse health and mental health outcomes [18
]. The Hispanic Health Paradox has been found to be true mainly for Mexican-origin immigrants but not for Puerto Ricans and Cubans and with little evidence for Central Americans. Researchers believe that the Hispanic Health Paradox is attributable to two main factors. (1) Immigrating to a new country is an arduous and taxing undertaking, therefore only sturdy or healthier persons make the migration. (2) That Latino culture, through its closely knit familial structure and traditional familial standards, is in someway protective and insulates the individual, and that deterioration of that culture by time and influence of US culture results in worse health outcomes [20
Highly acculturated Latinas engage in higher levels of alcohol and drug use, more frequent premarital sex, and have more partners than do less acculturated Latinas [4
], although a greater number of sex partners does not inherently translate to HIV risk. Indeed, other studies have found that while less acculturated Latinas have fewer sex partners, they are vulnerable to HIV infection through their partners. Researchers believe that cultural and religious norms and possible domestic violence prevent Latinas from negotiating condom use in a monogamous relationship [23
Previous research has demonstrated that coping style is associated with the health and risk taking behaviors of HIV positive persons, including HIV positive women [25
]. Coping styles are the cognitive and behavioral strategies used to manage internal or external stressors that strain personal resources [30
]. According to Namir [31
] coping styles are differentiated into three main groups; active-cognitive coping, active-behavioral coping and avoidance coping. Maladaptive coping styles such as avoidant coping styles are associated with sexual risk behavior, drug use and HIV risk behavior, while active coping acts as a protective barrier for HIV risk behavior [26
]. Avoidance and self-blame coping styles are associated with increased anxiety and depression, while positive action coping styles are associated with better health outcomes [31
]. Previous studies have also found that HIV positive African American and Latina women have employed positive action, spirituality and social support coping styles more often than White women [25
]. While the body of knowledge is growing concerning studies that address ethnicity and race when examining coping styles for HIV positive persons [25
], studies that have examined race/ethnicity within the context of coping with HIV illustrate the need for more rigorous and in-depth look at the population shift in HIV infection. These studies highlight the importance of examining acculturation differences in use of coping styles of HIV positive Latinas.
Previous research has also demonstrated an association between acculturation and coping styles [32
]. In the general population of Latinos, studies have found relations between coping and acculturation—more acculturated Latinos use negative coping styles while less acculturated Latinos use more spiritual and social network coping [34
]. In the HIV literature, there have been a handful of studies examining acculturation and coping styles with HIV positive MSM Latinos [7
]. More acculturated HIV positive MSM Latinos endorsed more positive action coping and it was related to health-promoting behaviors. Moreover, positive action coping was found to mediate the relationship between higher acculturation and health-promoting behaviors [7
]. Unfortunately, to our knowledge no comparable study prior to this paper has examined these relationships among HIV positive Latinas.
As Latinas are an ever-increasing proportion of new HIV/AIDS cases in the United States it is critical to understand what motivates health risk behaviors for these women, how they are coping with the disease, and how their acculturative experiences are associated with coping and behaviors. This study proposes to examine the relationship between acculturation and health risk behaviors of HIV positive Latinas, looking specifically at the role of coping styles as a mediator in this process. This paper uses structural equation modeling to test the proposed model.