Gender Matching, Not Ethnic Matching, Desired For HIV Posttest Counseling

1
Gender Matching, Not Ethnic Matching, Desired For
HIV Post-test Counseling

• Catherine Woodstock Striley, MSW, LCSW, Ph.D.,
• NIMH Postdoctoral Trainee
• Linda B. Cottler, Ph.D., Professor
• Department of Psychiatry

2
Acknowledgements

• Funded by
• NIDA 01-DA08324, L.B. Cottler, PI
• NIMH training grant T32-MH17104, L.B.Cottler,
  Director.

3
Problem

• Very sensitive information is presented in HIV
  pre- and post-test counseling
• Some studies in mental health settings suggest
  that
• Women and men may prefer gender-matched
  counselors
• African-Americans and whites may prefer a
  racially/ethnically matched counselor
• Not everyone returns for their post-test
  counseling session
• This may be due to dissatisfaction with the
  counselor

4
Aims

• To examine whether or not women and/or men, and
  African-Americans and/or whites, prefer a matched
  counselor for HIV pre- and post-test counseling
• To examine whether or not individuals with a
  racially or gender matched counselor express more
  of a preference for a matched counselor

5
Sample

• EachOneTeachOne
• NIDA funded study
• investigated the effectiveness of providing HIV
  education to chronic drug and intravenous drug
  users.

6
Sample

• 1220 drug users recruited
• from St. Louis City high drug abuse, crime and
  prostitution areas
• Store-front satellite health centers
  (HealthStreet) opened in two of these
  neighborhoods
• Community Health Outreach Workers went out onto
  the streets to recruit sample
• All received HIV pre- and post-test counseling
  and were randomized to enhanced HIV prevention
  or standard of care

7
Methods Independent Variables

• Gender of participant (self-reported)
• Race of participant (self-reported white or
  African-American)
• Gender of counselor (agency records)
• Race of counselor (agency records)
• Matched (counselor and participant match on
  gender or race)

8
Methods Dependent Variables

• Prefer an ethnically-matched counselor
• Prefer a gender-matched counselor
• Satisfaction
• "If you were the counselor, what would you do or
  say differently?"

9
Analyses

• Chi-squares in SAS
• Gender by desire for gender-match
• Ethnicity/Race by desire for ethnic-match
• Matched by desire for gender-match
• Matched by desire for ethnic-match

10
Sample Characteristics

• 103 (93) were African-American
• 8 (7) were white
• 77 (69) were men
• 34 (31) were women
• Age ranged from 19 51 with a mean of 36 (sd7)

11
Matching

• 50 (42) had an African-American counselor
• 75 (58) had a white counselor
• 101 (78) had a male counselor
• 29 (22) had a female counselor
• 42 of the session were done by 2 African
  American counselors
• 58 were conducted by white counselors

12
Matched Pairs
13
Satisfaction

• Satisfaction was measured by whether they would
  have done or said anything differently
• Only 2 out of 118 said anything but "No",
  "Nothing", "Not a thing", "Would not change
  anything" or related statement
• 1 suggested offering food
• 1 suggested more AIDS information

14
Aim I Results Only gender affects desire for
match

• Race and gender not significantly associated with
  desire for a racially or gender matched counselor
  except that men (17 of 77 or 22) were more
  likely to desire a match than women (2 out of 32
  or 6)
• Out of those that desired a gender-match, 89
  were men compared to 11 of women, significantly
  more than would be expected
• X24.3, p.04
• N111

15
Aim II Gender Matching Results

• 3 people (6) who did not have a gender matched
  counselor wanted one while 44 (94) did not
• 16 (25) of those who did have a gender matched
  counselor wanted a matched counselor while 48
  (75) did not
• X26.62, plt.01
• N111

16
Gender Matching Results
17
Aim II Race Matching Results

• No one without a race-matched counselor wanted
  one, while 65 (100) of those without a matched
  counselor did not want one
• 9 (20) of those with a race matched counselor
  wanted a matched counselor while 35 (80) did not
  
• X214.28, p.0002
• N108

18
Race Matching Results
19
Conclusions

• In this sample, women did not prefer a gender
  matched counselor
• Other research has found differently
• Interestingly, men did want a gender matched
  counselor
• Counseling was about sexually risky behavior and
  HIV/AIDS
• Race/ethnicity did not predict desire for an
  ethnically matched counselor

20
Conclusions II

• Match predicted desire for a match
• Being matched in this study was random
• Satisfaction, as measured by whether they would
  have done or said anything differently, was high
• Being matched in the context of high
  satisfaction, significantly predicted desire for
  a match

21
Implications

• Being matched and satisfied may produce a "halo
  effect"
• If you measure desire for match after a good
  experience, you are likely to find they desire to
  repeat the good experience and may attribute it
  to the match
• This study unable to measure opposite If
  unsatisfied, is there less desire for a match?

22
Implications II

• It may not be important to match counselors and
  clients by race and gender for HIV counseling
• Except that males did prefer a male counselor
• African-Americans may not expect to have a
  matched counselor
• When their expectations change, and they realize
  it is an option, they may desire a race matched
  provider

23
For more information

• Catherine Woodstock Striley, MSW, LCSW, Ph.D.
• NIMH Postdoctoral Fellow
• Department of Psychiatry
• 40 N. Kingshighway, Suite 4
• St. Louis, Missouri 63108
• Phone [phone]
• Fax [phone]
• StrileyC_at_epi.wustl.edu