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. Author manuscript; available in PMC: 2022 Oct 1.
Published in final edited form as: J Nurs Scholarsh. 2019 Mar 19;51(4):427–437. doi: 10.1111/jnu.12470

HIV Testing Among Heterosexual Hispanic Women in South Florida

Rosina Cianelli 1, Natalia Villegas 2, Lisette Irarrazabal 3, Jose Castro 4, Emmanuela Nneamaka Ojukwu 5, Oluwamuyiwa Winifred Adebayo 6, Lilian Ferrer 7, Nilda Peragallo Montano 8
PMCID: PMC9526396  NIHMSID: NIHMS1831541  PMID: 30888099

Abstract

Purpose:

The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women.

Design:

This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study.

Methods:

Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression.

Findings:

The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it.

Conclusions:

Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women.

Clinical Relevance:

Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

Keywords: Barriers, explanatory variables, facilitators, Hispanic women, HIV testing, nursing, rapid testing

In the United States, Hispanics are disproportionately affected by the human immunodeficiency virus. Although Hispanics represent approximately 17% of the U.S. population, they account for an estimated 21% of people living with HIV and 24% of the newly diagnosed cases (Centers for Disease Control and Prevention [CDC], 2017). In Florida, the estimated HIV rate among Hispanics is 27.7 per 100,000 (Florida Department of Health [FLDOH], 2016a). Of the 29,844 women in Florida living with HIV in 2013, 14% were Hispanic. HIV is the eighth leading cause of death for Hispanic women 25 to 44 years of age in the state (FLDOH, 2016a). Miami-Dade County, where this study was conducted, accounts for 13% of the total population in Florida. However, this county represented 28% of the adult HIV infection cases in Florida during 2015 and leads the United States in the rate of new HIV cases each year (FLDOH, 2016b; Miami-Dade County, Florida, 2016).

Miami-Dade County has the highest number of people living with HIV in Florida, with 26,042 cases in 2015 (Miami-Dade County, Florida, 2016). Of this number, 43% were Hispanic and 26% were Hispanic women (Miami-Dade County, Florida, 2016). Moreover, the HIV diagnosis rate among Hispanic women in 2015 was more than three times that of White women (CDC, 2017).

In combating HIV infection, HIV testing is critical for both prevention and care efforts (CDC, 2015). Such testing is especially critical in Florida, where an underlying factor affecting HIV disparity among Hispanics is late diagnosis of HIV (Trepka et al., 2016). Previous studies on HIV among Hispanics have indicated the following facilitators for testing: availability of rapid HIV testing with immediate results, healthcare professional recommendation (Craig, Beaulaurier, Newman, De La Rosa, & Brennan, 2012; De Jesus, Carrete, Maine, & Nalls, 2015; Lopez-Quintero, Rojas, Dillon, Varga, & De La Rosa, 2016; Montealegre, Risser, Selwyn, McCurdy, & Sabin, 2012; Morales-Aleman & Sutton, 2014), and the use of saliva or oral fluid as opposed to blood (fingerstick or venipuncture; Dietz, Ablah, Reznik, & Robbins, 2008; Gaydos et al., 2011; Merchant et al., 2009; Mullins, Braverman, Dorn, Kollar, & Kahn, 2012; Nunn et al., 2012).

Certain barriers to HIV testing among women have been identified in the literature. These include cultural values, fear of HIV test results, low-risk perception, older age, fewer than 13 years of education, not seeing a healthcare professional within the preceding year, stigma and discrimination, lack of HIV-related knowledge, being in a committed relationship with a partner, and not being pregnant (Akers, Bernstein, Henderson, Doyle, & Corbie-Smith, 2007; Basta, Stambaugh, & Fisher, 2015; Bogart et al., 2015; Cianelli, Ferrer, & McElmurry, 2008; Lopez-Quintero et al., 2016; Messer et al., 2013; Tan et al., 2011; White et al., 2015). As noted by Solorio, Forehand, and Simoni (2013), significant differences in attitudes and beliefs are found when comparing nontesters and testers. Nontesters are more likely to have less knowledge about HIV risks, to perceive their sexual behaviors as less risky, and to deflect HIV-related stigma. The main barrier for HIV testing for both groups, however, was the belief that if they undergo HIV testing and the result is positive, they would face HIV-related stigma and rejection from friends and family members (Solorio et al., 2013).

Purpose

The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with HIV testing among heterosexual Hispanic women.

Determining which of these factors (e.g., receiving recommendations from a healthcare provider to get tested, confidentiality regarding test result, HIV knowledge) most influence HIV testing among heterosexual Hispanic women may help to guide future efforts to stem the spread of infection among these women.

Methods

Study Design

This study is a secondary analysis of baseline data from SEPA III: The Effectiveness Trial (2P60MD00226606 National Institute on Minority Health and Health Disparities NIH/NIMHD). SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates as “Health, Education, Prevention, and Self-Care.” The parent study, SEPA III, is a randomized controlled experimental study that evaluates the effectiveness of the SEPA intervention in increasing HIV prevention behaviors and reducing the incidence of sexually transmitted infections among Hispanic women when delivered in a real-world setting by community agency personnel in South Florida (Cianelli, Villegas, McCabe, De Tantillo, & Peragallo, 2017; De Oliveira, Cianelli, Gattamorta, Kowalski, & Peragallo, 2016; Peragallo et al., 2005; Peragallo, Gonzalez-Guarda, McCabe, & Cianelli, 2012). In SEPA III, after each assessment, all women in the study received HIV testing and counseling. The current analysis is the first that analyzes baseline data related to HIV testing.

This secondary data analysis as well as SEPA intervention are theoretically based on the Social Cognitive Model (SCM) to promote behavioral change and HIV testing and to reduce HIV risk. The SCM is grounded in Social Learning Theory (Bandura, 1977), which presents the performance of a behavior as a function of outcome expectancies (expectation of more positive than negative outcomes) and self-efficacy (confidence in the ability to perform the behavior). The SCM posits a model of triadic reciprocity in which behavioral, cognitive or other personal factors, and environmental influences operate interactively as determinants of each other (Bandura, 1977). Through self-efficacy, people have the confidence and ability they need to adopt a health-protective behavior (e.g., condom use, request an HIV test). People will choose a course of action based on their own ability to perform a given behavior (Bandura, 1977). This model has been effectively used by nurses and interdisciplinary teams in the past when developing interventions for behavioral change in different areas (Ghazi et al., 2018).

Sample and Setting

Three hundred twenty Hispanic women were recruited for the parent study SEPA III. Recruitment occurred at the Florida Department of Health, the Miami Refugee Center, and public places (e.g., churches, clinics, supermarkets) in Miami-Dade County. Eligibility criteria were as follows: self-identifying as Hispanic, between 18 and 50 years old, self-identifying as heterosexual, and reporting sexual activity with a man within the preceding 3 months. Women were excluded from participation if they had participated in a structured HIV program in the previous 6 months. Five hundred forty-seven women were assessed for eligibility; 61 did not meet the inclusion criteria, and 166 could not be contacted by the research team. In total, 320 women were enrolled in SEPA III and responded to the baseline questionnaire. All of them met the inclusion criteria to be included in this secondary analysis constituting the final analytical sample (N = 320).

Power analysis was used to determine whether the sample size was adequate for the proposed secondary analysis. The type I error rate selected for calculating the z critical value was set at α = .05. The sample size estimation was obtained with the program G Power (Faul, Erdfelder, Lang, & Buchner, 2007), using z-test sample estimation (a priori, normal distribution odds ratio procedure, two-tailed test of significance, and a power = .8). Based on the estimation, the sample required to conduct the logistic regression is 208 participants.

Data Collection

Women were interviewed in their preferred language by trained bilingual (Spanish and English) female research staff using a standardized protocol and a structured interview. Interviews were conducted in private offices. Assessments were collected with a secure web-based research management software system (e-Velos, Velos Inc., Fremont, CA, USA) that allowed assessors to ask participants questions and document their responses on the computer. Approval for this study was obtained from the Florida Department of Health Institutional Review Board. All participants signed the consent form.

Study Variables

Selection of the following study variables was guided by the literature and by the triadic reciprocity SCM model, where behavioral, cognitive, and other personal factors and environmental influences operate interactively as determinants of each other (Bandura, 1997).

Demographics

This questionnaire consisted of 18 items that assessed women’s sociodemographic backgrounds and characteristics (e.g., age, education, religion, relationship status, and occupation).

HIV test

This questionnaire was developed based on the work of Haines et al. (2011), Rogers et al. (2006), and Weiser et al. (2006). The 11-item self-report measure assesses history of previous HIV testing, facilitators, barriers, and beliefs about HIV testing. For this questionnaire, some responses were dichotomous (yes or no), some were continuous (Likert scale), and others required the women to select the best response from a list of possible options that represented their reason for testing.

History of previous HIV test

One question focused on history of previous testing. The women were asked whether they had tested prior to participating in the study and needed to respond with “yes” or “no.”

Beliefs about HIV testing

Three questions assessed the participants′ beliefs about HIV testing. The first question asked the participants what would happen if they obtained a positive HIV test result. For this question, the women were provided a list of possible responses, for which they had to select “yes” or “no.” Responses include “if I am HIV positive I would get medical help” or “if I am HIV positive I would kill myself or hurt myself in some way.” The second question focused on the participants’ beliefs about obtaining a negative HIV result and provided a list of possible beliefs, for which they had to select “yes” or “no.” For example, “if I am HIV negative I would be happy” or “people in the community would respect me more.” A “yes” response to either of the questions above was tallied as a belief. The third question asked participants if they were confident about the accuracy of HIV rapid test results. The response to this question was scored on a 5-point Likert scale of “strongly agree” to “strongly disagree.” Women who responded with “strongly agree” or “agree” were considered confident about the accuracy of the rapid test.

Facilitators for testing

Six questions assessed the testing facilitators. Five of these questions focused on physical factors that influence testing such as location, timing, and type of sample (saliva or blood) used for the HIV test. For each question, women were provided a statement about HIV testing, to which they provided responses on a 5-point Likert scale from “strongly agree” to “strongly disagree.” (Examples: “I am more likely to be tested for HIV if a rapid test is available,” “I would be more likely to get an HIV rapid test if were offered to me in compared to requesting it myself,” “I prefer an HIV test where you get the results immediately over one that requires returning another day for the results,” “I would prefer to get HIV tested with blood sample.”) If a participant selected “strongly agree” or “agree,” it was considered a facilitator for HIV testing.

Question 6 assessed the principal reason(s) that facilitate HIV testing. Some of these reasons included “heard of testing via television or radio message,” “knew HIV test result would be confidential,” “encouraged by someone who had been tested for HIV,” “test was recommended by a healthcare provider,” and “tested with preferred sample (blood or saliva),” among others. A “yes” response to any of those reasons was considered a facilitator for HIV testing.

Barriers to testing

Women who had never tested in the past were asked what barriers they encountered that could have possibly deterred testing. The question was phrased as follows: “What was your principal reason for not testing in the past?” A list of possible barriers was provided, and women had to respond to these with “yes” or “no.” Responses included “afraid to know the result,” “no reason to believe was infected,” and “was ashamed to be seen at the HIV testing centers.” A “yes” response was an indicator of a barrier to testing.

HIV knowledge

The Heckman HIV knowledge scale was used for this study. The scale consists of 12 true-false items that address knowledge about HIV transmission, prevention, and consequences (Heckman et al., 1995; Sikkema et al., 1996). The scale has a total of 12 points, with the correct answer to each question weighing 1 point. The total scores for each individual were then converted to percentages. Individuals with higher scores demonstrate greater HIV knowledge. This scale has demonstrated adequate internal consistency (α = .74; Heckman et al., 1995), including one study involving Hispanic women, with an internal consistency of α = .75 (Peragallo et al., 2005).

Data Analysis

Statistical Package for Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA) was used to analyze data, and descriptive statistics and logistic regression were computed.

Bivariate analysis of both dependent and independent variables were examined to explore these relationships and investigate potential issues of multicollinearity among independent variables. Bivariate analyses were performed using SPSS software to run mixed models for each independent variable and each outcome. All independent variables were entered into a multiple regression equation for each dependent variable. Criteria to determine multicollinearity between independent variables were examined by assessing tolerance, the variance inflation factor (VIF), and the condition index. The diagnostics found no multicollinearity among independent variables (tolerance level < 0.1, VIF > 10, and condition index > 30) (Belsley, Kuh, & Welsch, 1980; Norusis, 2000). A final decision regarding which variables to include in the final model was made based on support in the literature regarding a potential relationship and the theoretical framework.

The simultaneous (standard) logistic regression analysis described the relationship between the outcome variable (HIV testing) and eight explanatory variables that were entered simultaneously into the logistic regression model: age, living with the partner, education, HIV knowledge, and the following facilitators for HIV testing—if an HIV rapid test is available, if an HIV test is offered by a healthcare provider instead of women asking for it, getting the results immediately, and if tested with a blood sample. The variables included in the analysis represent the social cognitive triadic model consistent with the SCM.

The decision to select the variables for the predicting model was based on the SCM’s triadic reciprocity: (a) regarding “behavior,” the selected variable was the HIV test; (b) for “cognitive and other personal factors,” variables were selected based on the support of the literature (age, living with the partner, education, and HIV knowledge); (c) and the “environmental influences” variables selected were the facilitators for HIV testing most often mentioned by the women in this study (if the HIV test was offered by a healthcare provider instead women asking for one, if they get the results immediately, and if they were tested with a blood sample).

Results

Demographic Information

Most of the women (96%) were born outside the United States. The majority of the women were from Cuba (54.7%), followed by Nicaragua (9.4%) and Colombia (9.1%). Only 14 (4.4%) were born in the United States. The rest of the women (22.5%) were from other countries in Central and South America (e.g., Honduras and Dominican Republic). The average length of time in the United States for women born outside the country was 8.50 (SD = 8.25) years. The majority (94%) of women said they preferred to communicate in Spanish, with 4% preferring English and 2% preferring both Spanish and English (Table 1).

Table 1.

Demographic Information (N = 320)

Characteristics n % M SD
Age (years)   34.79     9.23
Education (years)   13.73     3.39
Employed   91 28.0
Monthly family income ($) 1,690.84 1,048.52
Has children 237 74.1
Number of children     1.37     1.21
Place of birth
 Cuba 175 54.7
 Nicaragua   30   9.4
 Colombia   29   9.1
 United States   14   4.4
 Other   72 22.5
Language of communication
 Spanish 301 94.0
 English   13   4.0
 Both English and Spanish  6   2.0
Living with spouse/partner 219 68.0
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HIV Testing

Previous HIV testing

Most of the women (n = 280, 87.5%) had tested for HIV prior to their participation in the study, with one third testing during pregnancy. Thirty-nine participants (12.2%) mentioned they had not tested prior to the study, and one woman (0.3%) did not know if she had been tested prior to the study.

Beliefs about HIV testing among all women in the study (N = 320)

The majority of the women believed that if they obtained a positive HIV test result, the following could happen: they would take better care of themselves to try and keep from getting sick (n = 319, 99.7%), they would ask their partners to also get tested for HIV (n = 319, 99.7%), and they would get medical help (n = 317, 99.4%). Fifty-one (15%) said that they would kill or hurt themselves if they tested positive.

A majority of the women also believed that if they obtained a negative HIV test result, the following could happen: (a) happiness because they are not infected (n = 317, 99.1%); (b) their family (n = 310, 97.2%) and their partners (n = 310, 97.2%) will also be happy; (c) they would ask their partners to be tested for HIV (n = 274, 85.6%); and (d) their partners may decide not to get tested for HIV because they would assume that they are negative, too (n = 194, 60.6%). Some believed that the people in the community would respect them more (n = 132, 41.4%), and others believed there was no point in testing (testing was meaningless) because they had no control over whether they get infected with the HIV or not (n = 81, 25.5%).

Facilitators for testing among all women in the study (N = 320)

Women reported that they were more likely to get tested for HIV if (a) an HIV rapid test were available (n = 312, 98.1%); (b) an HIV test was offered by a healthcare provider instead of women asking for one (n = 261, 81.6%); (c) they would get the results immediately (n = 264, 82.5%); and (d) they were tested with a blood sample (n = 229, 72.2%). However, some women (n = 69, 22%) indicated that they would prefer a saliva sample test.

Facilitators for testing among women who had tested in the past, prior to the study (N = 280)

Women who had tested prior to the study (n = 280) reported they did so for the following reasons: they were told that they could test and receive results the same day (n = 87, 31.1%), the test was recommended by a healthcare provider (n = 86, 30.7%), they knew that the HIV test results would be confidential (n = 83, 29.9%), and they were encouraged by someone who had been tested for HIV before (n = 75, 26.8%). The least reported facilitators to get an HIV test were symptoms of illness (n = 3, 1.1%) and blood donation (n = 15, 5.4%).

Barriers to testing among women who had never tested prior to the study (N = 39)

Barriers for testing were measured for women who had not previously been tested for HIV (n = 39, 12% of the total sample). The most reported reasons for not having an HIV test were as follows: they had no reason to believe they were infected (n = 28, 73.7%), they had concerns about lack of social support if the HIV test result was positive (n = 8, 20.5%), they feared testing would force them to stop some sexual practices (n = 7, 17.9%), and they had concerns about the confidentiality of the HIV test results (n = 7, 17.9%). Others reported that they had no HIV testing center close by (n = 6, 15%), they were afraid to know the test result (n = 5, 13%), they had no quality clinics (n = 5, 13%), they were worried about violence from partner following a positive result (n = 5, 13%), and there was no treatment if the HIV test result was positive (n = 4, 10%). On the other hand, some women feared discrimination by health providers (n = 4, 10%) or moved so often that it was difficult to get tested (n = 3, 7.7%), while others were ashamed to be seen at the HIV testing site (n = 2, 5%). None of the women perceived that the HIV test results would give them an inaccurate result, and they were not advised against getting the HIV test.

HIV knowledge

The mean score for HIV knowledge was 76.6 (SD = 14.05, range 25–100), with 69.6% of the participants scoring 83 or higher. At least 80% of the participants correctly responded “no” to the following statements: “Birth control pills protect against the AIDS virus”; “If a man pulls out right before orgasm condoms do not need to be used to protect against the AIDS virus”; and “Most people who have the AIDS virus look sick.” More than half of the participants incorrectly responded “no” to the following two statements: “Vaseline and other oils should not be used to lubricate condoms” and “Most people who carry the AIDS virus look and feel healthy.” Only 15 women (4.7%) answered all questions correctly.

Logistic regression

Potential explanatory variables of HIV testing were entered simultaneously into the logistic regression model: age, living with the partner, education, HIV knowledge, if an HIV rapid test is available, HIV test was offered by a healthcare provider instead of women asking for one, gets the results immediately, and if tested with a blood sample. Table 2 shows the logistic regression results. HIV knowledge (β = 0.30, SE = 0.12, p = .015, odds ratio [OR] = 1.03) and HIV test is offered instead of women asking for one (β = 0.69, SE = 0.27, p = .013, OR = 1.99) were significantly related to HIV testing after controlling for the other variables in the model. This translates into the odds of HIV testing increasing by 1.03 for every one-unit increase in HIV knowledge, and increasing by 1.99 for every one-unit increase when an HIV test is offered instead of a woman having to ask for one. Further, HIV testing was not related to age, living with the partner, education, HIV rapid test available, get the results immediately, and if tested with a blood sample.

Table 2.

Logistic Regression

95% CI for EXP(B)
β p  Odds ratio  Lower  Upper
Age −0.002 .901 0.998 0.959 1.038
Living with partner  0.602 .109 1.826 0.875 3.812
Education  0.067 .270 1.069 0.949 1.204
HIV knowledge  0.030 .015a 1.030 1.006 1.056
HIV rapid test is available −0.500 .170 0.606 0.297 1.239
HIV test is offered to me  0.691 .13a 1.995 1.158 3.438
Get the results immediately −0.060 .747 0.942 0.656 1.353
If tested with a blood sample  0.163 .418 1.177 0.794 1.743
Constant −2.088 .125 0.124
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Note. CI = confidence interval; EXP(B) = Odds ratios for the predictors.

a

Significant at p < .05.

Discussion

This study expands on scientific knowledge related to HIV testing among Hispanic women in South Florida. We examined facilitators of, barriers to, and beliefs about HIV testing. The most common facilitators for HIV testing were receiving recommendations from a healthcare provider to get tested and the test is offered by a healthcare provider rather than women asking for it. These results are consistent with findings from the literature, which demonstrate that a healthcare provider’s endorsement is an important factor to consider for HIV testing among Hispanic, African American, and Caucasian women (Hempling, Zielicka-Hardy, Ellis, Majewska, & Fida, 2016; Lopez-Quintero et al., 2016). Healthcare providers should be aware of such facilitators and intervene accordingly. For example, they can make efforts to offer their clients HIV testing routinely as this has been shown to be a significant explanatory predictor of testing.

Further, in contrast to the literature suggesting that the use of saliva or oral fluid as opposed to blood sample is a facilitator for testing among Hispanic women (Lopez-Quintero et al., 2016), our results showed that Hispanic women preferred blood sample testing. Thus, providers who recommend quick blood sample tests that produce same-day results over an oral swab may have greater success in getting patients to opt in for testing. Confidentiality regarding test results was also indicated as a facilitator for testing, which comes as no surprise since stigma and disclosure have been documented as deterrents to testing among Hispanics and African American communities (Catona, Greene, Magsamen-Conrad, & Carpenter, 2016; Gilbert & Rhodes, 2013).

A majority of the women in our study had been tested for HIV prior to participating in the study. A third of these women stated they tested as part of a prenatal program. Such results are consistent with findings from the literature suggesting that although Hispanics are documented to generally have low testing rates and later entry into care (CDC, 2015), their testing rates during pregnancy are greater when compared to African American and Caucasian women (Fitz-Harris et al., 2014; Lawrence, Liu, & Towner, 2009). The improved testing rate during pregnancy and among refugees comes in response to recommendations by the CDC to test all pregnant women and refugees (CDC, 2012).

The most common barrier reported by the women was “no reason to believe they were infected.” This result may be related to low HIV risk perceptions, a common barrier to testing among Hispanic and African women (Lopez-Quintero et al., 2016; Nunn et al., 2012; Weiser et al., 2006). These low-risk perceptions found among Hispanic women are often a result of their HIV knowledge and their belief that being in a monogamous relationship does not make one susceptible to acquiring the virus (Villegas et al., 2011, 2013).

For Hispanic women, marianismo cultural value represents the submission of women to men. This produces a double standard whereby women are placed either in the category of good mothers and wives or in the category of bad women who are sexually available and knowledgeable (Cianelli et al., 2008). Marianismo represents the near impossibility of discussing safer sex practices with partner(s), increasing Hispanic women susceptibility to acquire HIV. Additionally, the Hispanic culture of familism embodies the belief in strong family ties that emphasize honor, respect, and support to members of the family, prioritizing family needs over the needs of the individual. Familism has been shown to deter HIV testing (Ma & Malcolm, 2016). Therefore, strategies to improve communication among partners and within families may increase testing rates among Hispanics.

Additionally, our study showed that increased HIV-related knowledge was associated with greater odds for testing and was an explanatory variable for HIV testing. This finding is similar to those from the literature that suggest HIV-related knowledge is a major precursor for testing among Hispanic women (Lopez-Quintero et al., 2016). Therefore, to adequately educate Hispanic women, emphasis should be placed on the importance of testing, HIV transmission modes, and dispelling some of the misconceptions surrounding the physical appearances of infected individuals. Such emphasis and clarification on HIV-related knowledge may lead to increased testing. This is also congruent with the SCM, which establishes knowledge as a gateway that must be passed before more complex personal and social behaviors come into play (Bandura, 1977).

Most women in this study believed that a positive result would encourage them to seek medical advice as the next step. This finding is consistent with studies conducted among Arabic women (Al-Jabri et al., 2014). On the other hand, a negative result would lead them to assume their partners are negative and thus do not need to be tested. However, regardless of test results, participants stated that they would encourage their partners to get tested. These findings suggest that the outcomes of an HIV test (whether positive or negative) can influence a woman’s sexual and reproductive behaviors, including her perceptions of her partner’s status (Sennott & Yeatman, 2016). Further, another alarming finding from our study was the proportion (15%) of women who acknowledged they may hurt or kill themselves if they tested positive. Suicidal ideations are often precursors to actual suicides or suicidal attempts found to be prevalent among HIV infected persons (Schlebusch & Govender, 2015). Hence, efforts to increase HIV-related knowledge and education among Hispanics are crucial not only to improve testing but also to prevent loss of life. Therefore, our findings regarding HIV beliefs reveal the importance of providing pre- and post-HIV test counseling to women in order to provide them with emotional and psychological support to prevent them from hurting themselves. In addition, after testing, those who obtain a positive result should immediately be referred for care per the HIV/AIDS treatment cascade recommendations (U.S. Department of Health & Human Services, 2016). These counselors should be properly trained to identify patients at risk for suicide so that immediate interventions are put in place to prevent such occurrences.

Some explanatory variables in the logistic regression were not significant. Age was not a significant explanatory variable of HIV testing, which possibly results from these women having been recruited from the Department of Health and compliant with HIV testing guidelines as part of routine care regardless of their age. Because they were receiving health services, the availability of the HIV test probably was not perceived as a problem for most of them; in addition, the test is offered to them without cost. These women’s familiarity with the system and experience waiting for the results of other laboratory tests can explain why they did not perceive that receiving the result immediately was a critical factor to get an HIV test. Most of these women and their families received other benefits in these centers (e.g., vaccines, medications), so returning to the center is part of their normal healthcare routine. Women may also trust that the healthcare providers offered the best care available, so if the healthcare provider decided to use blood or saliva, the women would likely trust that the result would be accurate.

Living with a partner was not a critical factor to get an HIV test, which can be related to the concept of support networks prevalent in Hispanic culture. Familism values (Ma & Malcolm, 2016) also include extended family, which can provide support to maintain health even for women without a partner. Finally, the level of education in this sample was high (13 years on average, and less than 3% of the sample had 7 or fewer years of education), which could explain why this factor did not register as critical in the decision to obtain an HIV test. Most of the women had the experience of taking an HIV test before the study, and they were informed about HIV testing.

Limitations

A major limitation of this study is that the results were mostly self-reported and, as such, possibly subject to recall bias by the participants. Also, the sample consisted of a geographically secluded portion of this unique population, which may not lend itself to extrapolate to a larger population. Finally, another limitation could be the possibility of overlap between beliefs, barriers, or facilitators.

Conclusion and Implications

Strengthening HIV knowledge and offering HIV tests are significant contributions that healthcare providers make to the health of Hispanic women; this is consistent with the SCM, which can be used as a guideline when promoting HIV testing among Hispanic women. Healthcare workers, especially nurses, are critical actors in HIV prevention programs with Hispanic women, and as such they should expand their practice by embracing the challenge of increasing HIV knowledge and offering HIV tests to increase HIV prevention behaviors.

The endorsement of a healthcare provider has been consistently documented in the literature as a facilitator for testing, and HIV knowledge has also been shown to be a significant explanatory variable for testing. In studies of Hispanic women, similar findings have also been noted. Therefore, for those not mandated to get tested, it is imperative that their healthcare providers offer them testing. It may be beneficial for the providers to educate women and offer them testing during their regularly scheduled wellness visits or yearly physicals.

Also, additional HIV educational efforts should be directed to Hispanic women, with a particular focus on the transmission modes of the virus and the physical appearances of infected individuals. Such knowledge would help to clarify and dispel some of the prior misconceptions these women have about the disease.

Communication and negotiation with the partner should also be encouraged to alleviate the negative consequences that certain cultural values like marianismo may have on these women’s decisions and ability to get tested. Therefore, regardless of test results, healthcare providers should encourage these women to inform their partners so that they are also tested, and more effort should be put into promoting self-care for this vulnerable group of women.

A comprehensive approach to health promotion can be based on the SCM. The SCM provides a suitable foundation to achieve behavioral changes based on an individual’s confidence and self-efficacy to adopt a behavior and maintain it.

Clinical Relevance.

The results of this study can extend to nurses who work in HIV prevention. Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women. The study results showed that healthcare providers play a critical role in HIV testing. To increase HIV testing among women, healthcare providers, especially nurses, could implement and advocate for the following initiatives in practice: actively offer HIV testing, make rapid tests available, and offer different ways of getting tested (e.g., blood and saliva tests). Also, they should provide an environment in which women feel safe and perceive that the results will be confidential. Finally, nurses should promote strategies in the community and healthcare centers to increase awareness, knowledge, and risk perception about HIV transmission among women. Moreover, they should offer information about the progression and treatment of HIV, and about how women can be connected to care if they are HIV positive.

Clinical Resources.

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