The Experiences of Discrimination Measure In a Rural Population: Initial Validation of Measure and Association with HIV-Related Risk-Taking: Poster Presentation

Purpose: A recent analysis found that 90% of counties that experienced the largest increase in incidence rates of AIDS were located in the Southeastern U.S. and some rural regions, including the Mississippi Delta and other parts of the Southeast U.S., are now approaching national HIV prevalence rates (Hall, Li, and McKenna, 2005).  African-Americans and Hispanics in the rural U.S. are disproportionally affected by the HIV epidemic (Williams, Neighbors, Jackson, 2008).   Recent research has shifted in focus from emphasizing the role of access and availability of services towards identifying demographic, environmental, economic, and social factors that may contribute to poorer health outcomes in rural areas (Eberhardt, Ingram, Makuc, 2001).  The aim of this study was to assess the validity of the Experiences of Discrimination measure (EOD) in a sample of African-American residents of rural Southeast Louisiana, and to examine the extent to which types and frequency of experiences of discrimination are associated with HIV-related sexual risk-taking in this population.

Methods:214 respondents (56.07% female) were recruited at alcohol consumption and purchase venues and other public locations.  Demographics, experiences of discrimination, and HIV-related risk-taking were assessed in anonymous interviews, lasting approximately 30 minutes. Univariate, bivariate, and multivariate analyses were performed using SAS version 9.2, including principal components analysis (PCA) and Cronbach’s alpha for internal consistency reliability of EOD.  We conducted a bivariate analysis between EOD (scaled both by frequency of occurrence and situational counts) and socio-demographic characteristics, lifetime history of having a sexual transmitted infection, the sexual risk composite score, perceived risk of HIV and HIV knowledge.  We conducted crude and adjusted linear and logistic regressions to assess associations between the sexual risk composite and having ever had an STI, respectively, and EOD scaled on frequency (regression 1) and situations (regression 2).  All socio-demographic characteristics were entered into each model and included if they had at least a 10% influence on the predictor parameter estimate. 

Results:The EOD measure demonstrated sound psychometric properties, including a factor structure comparable to that observed in the initial validation study and good to excellent internal consistency reliability.  EOD frequency and situations scores significantly predicted sexual risk and lifetime history of a sexually transmitted disease in multiple linear and logistic regression analyses.

Implications:  Findings presented here suggest that the EOD measure is a psychometrically sound tool for use in research on health disparities in rural areas.  Furthermore, results indicate that experiences of discrimination, as captured by the EOD measure, are positively associated with HIV-related risk taking in this population.  Findings emphasize the importance of addressing discrimination across various settings as a way of improving sexual health and halting the rising HIV rate in rural regions of the United States.