Urban American Indian Identity, Alcohol Use, and HIV Risk

This project has already completed the first two years of a three year study at Columbia University School of Social Work and is now being transferred to University of Washington on 2/1/01 for the final year (year 3) of the study (2/1/01-1/31/02). The study received human subjects continuation approval at Columbia University on 11/14/00 (HS 495B).

HIV research addressing American Indians and HIV/AIDS is scant: a computerized search for relevant publications locates less than a dozen relevant citations of empirical work. Although considerable heterogeneity exists among the over 500 federally recognized tribes in the United States, overall epidemiological data point to this group as one at potentially high risk for HIV because of high rates of alcohol abuse. Moreover, while reservation-based samples demonstrate decreased levels in problem drinking, urban samples indicate increased levels, thereby potentially placing urban Indians at greater risk for HIV exposure. This project for a FIRST award is a three-year modified prospective longitudinal panel study of 300 adult urban American Indian (AI) men and women living in the New York Metropolitan region. The modified longitudinal panel study will focus on the protective role of cultural factors (i.e., identity and enculturation) in moderating the relationship between stressors (i.e., daily discrimination, historical trauma and other trauma exposure) and alcohol use, abuse, drinking styles, and HIV sexual risk behaviors among adult urban American Indians. Respondents will be randomly selected from an American Indian membership list at a local Indian agency after blocking by sex and borough to ensure approximate representation. Data will be collected in face-to-face structured interviews. To test the feasibility of the longitudinal component, the first 50 respondents will be interviewed at two time points 12 months apart. Focus groups will be run throughout the study to identify pertinent cultural themes and to elicit feedback regarding the cultural equivalence of the measures. This study will be one of the first examining the relationship between alcohol and HIV sexual risk behaviors among urban American Indians. Additionally, this study will provide information as to how identity should be incorporated into the development of primary, secondary, and tertiary alcohol abuse and HIV risk prevention interventions for this population.

Specific Aims. The overall aims of the study are to (1) identify the temporal associations between alcohol use (i.e., quantity, frequency, and variability) and HIV sexual risk behaviors (i.e., condom use, and high risk sexual behaviors); (2) examine the mediating role of alcohol-sex expectancy on the alcohol-HIV sexual risk behavior relationship; (3) identify the temporal relationship between three groups of stressors–antecedent risk factors in the environment (i.e., family and peer AOD use), life stressors (i.e., trauma, daily discrimination), and personal disposition (psychological distress & psychopathology) on alcohol use and HIV sexual risk behaviors; and (4) examine how identity attitudes and enculturation buffer the effect of life stressors on alcohol use and HIV sexual risk behaviors.