An instrument developed in the United States by the Centers for Disease Control and Prevention to assess HIV/AIDS knowledge and four attitudinal dimensions (Peer Pressure, Abstinence, Drug Use, and Threat of HIV Infection) and an instrument developed by Basen-Engquist et al. (1999) to measure abstinence and condom use were translated, cross-culturally adapted, and validated for use with Spanish-speaking high school students in El Salvador. A back-translation of the English version was cross-culturally adapted using two different review panels and pilot-tested with Salvadorian students. An expert panel established content validity, and confirmatory factor analysis provided support for construct validity. Results indicated that the methodology was successful in cross-culturally adapting the instrument developed by the Centers for Disease Control and Prevention and the instrument developed by Basen-Engquist et al. The psychometric properties of the knowledge section were acceptable and there was partial support for the four-factor attitudinal model underlying the CDC instrument and the two-factor model underlying the Basen-Engquist et al. instrument. Additional studies with Spanish-speaking populations (either in the United States or Latin America) are needed to evaluate the generalizability of the present results.
HIV risk factors were assessed among 120 persons in treatment for serious mental illness. Although subjects had good general knowledge regarding HIV, many engaged in high risk behaviors. Condom use was infrequent among those who had multiple sexual partners, and sharing needles was common for those who used i.v. drugs. Clearly, factual knowledge about HIV was not sufficient to prevent risky behavior. Nearly half of the sample was categorized as at medium to high risk, and almost half of the participants, especially those at medium risk, underestimated their own level of risk. The results suggest that education and intervention strategies should focus on increasing the accuracy of the individual's risk assessment as well as changing attitudes towards condoms and improving skills in using condoms. Assessing personal risk and adopting risk-reduction strategies are the keys to successful AIDS prevention for persons with serious mental illness.
Mental health and substance abuse treatment staff completed a set of measures assessing their attitudes, knowledge, and beliefs concerning AIDS. Results indicated that while most staff were aware of basic information about the disease, approximately one-third were not aware of the neuropsychological and psycho-behavioural concomitants of the disorder. Those surveyed were aware of the main transmission routes, but overgeneralized their concern to casual contact. Most staff indicated willingness to work with HIV-infected individuals, although 29% stated they would try to avoid working with them. Interestingly, mental health staff expressed greater hesitancy than substance abuse staff. These and other results are interpreted to suggest that some desensitization of concern may have already occurred among those who have worked with HIV-positive clients. Individuals who had worked with an HIV-positive client had greater knowledge, less discomfort, and were less likely to want to avoid those who are HIV-positive. Questions attempting to identify sources of discomfort in working with AIDS or HIV-positive clients suggested that fear of contagion may be the primary concern, followed by discomfort of working with the terminally ill, and then discomfort with IV drug users and homosexuals. The implications of these results for continuing education activities and staff readiness are discussed.
There is a critical need for trained HIV mental health specialists who possess the knowledge and attitudes necessary to meet the challenges of the HIV epidemic. A model for an intensive and experimental continuing education tutorial is briefly described, and evaluative data are presented. Upon completion of the three-day workshop, participants show an increase in HIV-related knowledge and a positive shift in attitudes regarding working with people affected by HIV disease.
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