Overcoming violence, depression and HIV
by Anne-Kathleen BorushkoA typical April afternoon. The sky is cloudy, and the cool breeze gently bends the tall grasses in the miles of surrounding fields. Brightly colored wildflowers speckle the lush green canvas. The sounds of the city are noticeably absent. In this rural landscape, a sense of peace pervades.
But in this setting, where you would expect to find a century-old ranch home, sits the Cyndi Taylor Krier Juvenile Correctional Treatment Center. And peace is only temporary in the lives of many of the teens here. Violence - both in the home and in the community - is a large part of their everyday lives.
"Half the people are here because of violence," said one young man at the treatment center.
"We were born around violence," another teenager commented.
National statistics reveal the extent - and cost - of this violence. According to the U.S. Centers for Disease Control and Prevention, homicide is the second-leading killer of young people in the United States. The homicide death rate for young Hispanic males is twice as high as that of the general young adult population.
Violence, however, is not an isolated problem. Research shows that adolescent exposure to violence increases risk for depression. Other studies link depression to increased HIV risk. In the adolescent population, HIV is reaching new epidemic proportions. But few intervention studies have been conducted with incarcerated youth, and fewer, if any, have addressed the interrelationship between violence, depression and HIV risk in this population.
That is why Janna Lesser, Ph.D., R.N., assistant professor in the department of family nursing care, and Manuel Oscós-Sánchez, M.D., assistant professor in the department of family and community medicine, are collaborating to study this interrelationship in incarcerated Latino youth.
"I’m a Latino," said Dr. Oscós-Sánchez. "I went to medical school, residency, and did a fellowship and asked, ‘What are the real issues that are facing Latino men?’ That’s what we want to address."
"We’ve learned that these teens are most concerned with violence and depression," said Dr. Lesser, the study’s principal investigator, who has led studies with high-risk youth for more than a decade. "So HIV-prevention programs are only going to be successful if we also address these other concerns."
The Health Science Center’s MESA (Michigan En San Antonio) Center for Health Disparities, funded by the National Institute of Nursing Research, provided a grant for the study’s initial phase, a series of focus groups, field observations and individual interviews with Latinos at the Cyndi Taylor Krier Juvenile Correctional Treatment Center.
The data suggest that violence pervades all areas of these teenagers’ lives. Preliminary findings indicate that these young men engage in a complex cognitive process to determine whether to participate in violent activities. In addition, data revealed a widespread breakdown in relationships, particularly between adolescents and parents.
"While in the treatment center, many of the young men learn to interact positively with treatment officers and counselors," Dr. Oscós-Sánchez said. "This helps them see a different possibility for relationships on the outside."
After presenting the preliminary findings to the treatment center’s medical staff, the Health Science Center team received positive feedback.
"I was impressed with how much the young men opened up to the researchers," said Diana Verastigui, R.N., B.S.N., clinic nurse supervisor at the treatment center. "I look forward to working with the Health Science Center to find new ways of treating and supporting these young people."
After analyzing the data, Drs. Lesser and Oscós-Sánchez will develop an intervention process to facilitate healing, targeting all three concerns: violence, depression and HIV risk. They are seeking funding for the project’s second phase, which will evaluate the feasibility and effectiveness of intervention strategies.
This research not only affects San Antonio youth, it also opens the eyes of Health Science Center students. Chidi Obinani, an undergraduate nursing student, assisted with this project.
"Before I worked with Dr. Lesser, I didn’t know much about research," said Obinani. "But I learned that I can do more, affect more people, and create more change through research."
Following his graduation this spring, Obinani plans to pursue a Ph.D. in nursing research. He credits Drs. Lesser and Oscós-Sánchez with inspiring him through their passion for research and working with at-risk populations.
"It’s really important to open people’s eyes to how other people live, and despite how they live, their strengths," Dr. Lesser said. "That’s what draws me to working with this population - their strengths."
The Health Science Center team is building on these strengths - and utilizing them to facilitate change. Sitting among a circle of teenagers, Dr. Lesser leads an insightful discussion. "What do you think can cause a change?" she asks.
Light brown eyes looking intently into his future, one 16-year-old answers, "We have to change ourselves."
That is just what this research study aims to do - help these teens find peace within themselves.
UT Health Science Center
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