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Looking at AIDS through rose-colored glasses

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Looking at AIDS through rose-colored glasses
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Kee, Phaik Ling
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English
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ix, 157 leaves : form ; 29 cm

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AIDS (Disease) ( lcsh )
Asian American women ( lcsh )
Pacific American women ( lcsh )
Women -- Diseases ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Includes bibliographical references (leaves 146-157).
General Note:
Submitted in partial fulfillment of the requirements for the degree, Doctor of Philosophy, Public Administration.
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School of Public Affairs
Statement of Responsibility:
by Phaik Ling Kee.

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|University of Colorado Denver
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Auraria Library
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36960460 ( OCLC )
ocm36960460
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LD1190.P86 1996d .K44 ( lcc )

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Full Text
LOOKING AT AIDS THROUGH ROSE-COLORED GLASSES
ty
Phaik Ling Kee
B.A., College of Wooster, 1989
M.S.W., Colorado State University, 1991
A dissertation submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Public Administration
1996


1996 by Phaik Ling Kee
All rights reserved.


This Thesis for the Doctor of Philosophy
degree by
Phaik Ling Kee
has been approved
by
7dcif.


Kee, Phaik Ling (Ph.D.), Public Administration
Looking at AIDS through Rose-Colored Glasses
Dissertation directed by Professor Peter deLeon
ABSTRACT
The United States accounts for one of the highest numbers of
reported AIDS cases in the industrialized world, with an estimated 1 out of
every 250 U.S. residents infected with HIV. The AIDS epidemic is
increasingly becoming a complicated and urgent "women's issue," most
especially for women of color.
The purpose of this exploratory research was to study and begin to
understand the relationship between U.S. Asian and Pacific American
women (APA) and AIDS, as well as the issues and barriers that might
potentially increase or decrease their risk of contracting AIDS. This
particular study was based on the overall urgency that has surfaced on
women and AIDS.
This exploratory study is based on the data collected from ten APA
women living in the Denver metropolitan areas. The role of the
community leaders/liaisons is integral to this study. All interviews were
audio-tape recorded, transcribed, and analyzed based on the concepts of
fieldwork research and grounded theory. Two major categories, View of
Sex and Significance of Gender Role in Decision-making and the
properties that emerged from the data, suggest that AIDS was generally an
iii


uncomfortable subject of conversation for the study participants because it
dealt with the issue of sex.
The overall findings suggested that the preliminary theoretical
frameworks possessed many elements from the Asian-American Identity
and Cultural and Structural Assimilation theories, and are relevant to the
analysis and interpretation of this study. Levels of acculturation
apparently had a significant effect on how these women perceived their
risk of contracting AIDS. An integrated bi-cultural identity appeared to
increase these women's ability to better address the issues of sex and AIDS
with their partners because their identities were not completely dependent
on their men.
In conclusion, this study rejects the assumption that APA women
cannot take control over their own sexuality and bodies. Instead, the
findings suggest that APA women choose not to take control over
their own sexuality and bodies, which ultimately leads to a similar
outcome of being at-risk of contracting AIDS.
This abstract accurately represents the content of the candidate's
thesis. I recommend its publication.
Peter deLeon, Ph.D.
1 v


DEDICATION
This dissertation is dedicated to my mother, Dalli Khor, who
willingly made tremendous sacrifices so that I may pursue my dreams.
This dissertation is also dedicated the late Anita Satterly, who inspired and
encouraged me to begin this journey.


ACKNOWLEDGMENTS
I would like to thank all members of my dissertation committee for
their support and patience. To Dr. deLeon, I am grateful for your energy,
guidance, dedication and most of all, your commitment to my learning.
Special thanks to Dr. Lazzari for her encouragement, guidance and support
throughout the process. To my wonderful friends, Felisa Ong, Ramona
Chun and Marcelina Rivera, thank you so very much for your
encouragement, time and support. To all the community leaders/liaisons,
I will always be indebted to your willingness to help make this study
possible.


CONTENTS
CHAPTER
1. INTRODUCTION ............................................1
Problem Statement and Rationale .........................8
Thesis Organization ...............................18
2. THEORETICAL FRAMEWORKS .................................19
Introduction ...........................................19
Cultural and Structural Assimilation Theory ............22
Asian-American Identity Theory .........................26
Power and Powerlessness Theory .........................37
Conclusion .............................................44
3. METHODOLOGY ............................................45
Research Guidelines ....................................47
Design ............................................48
Sampling ..........................................54
Observation Methods ...............................60
Data Analysis .....................................68
Validity, Reliability and Limitations ..................73
4. FINDINGS ...............................................76
Chapter Format .........................................77
Summary of Demographic Information .....................79
Overall Framework of Findings ..........................80
Category View of Sex ............................84
vii


Category Significance of Traditional Gender Roles ....90
in Decision-Making
Summary ................................................94
Specific Themes of Categories by Research Guidelines .........95
Research Guideline # 1 .................................95
Men's Role in Decision-Making ..........................98
Perception of Personal Risk ...........................101
Leadership Role .......................................103
Research Guideline # 2 ......................................105
Research Guideline # 3 ......................................107
Research Guideline # 4 ......................................Ill
Overall Impression of Interview Process .....................114
Researchers Observation ....................................116
Research Setbacks .....................................119
Limitations and Findings Conclusion .........................119
DISCUSSION ..................................................121
Introduction ................................................121
Discussion and Implications .................................124
Decision to Not Exercise Control ......................126
Religious Affiliation .................................128
Personal Attitudes and AIDS ...........................129
Overview of the Research Process ......................131
Theoretical Frameworks ................................133
Asian-American Identity Theory ........................134
viii


Cultural and Structural Assimilation Theory ..........135
Power / Powerlessness Theory .........................136
Policy Implications ........................................137
Overall Summary of Research Implications .............141
Potential Areas for Future Research ..................143
APPENDIX
A. Participant Consent Form ................................145
BIBLIOGRAPHY .....................................................146
IX


CHAPTER ONE
INTRODUCTION
There are several large-scale social issues currently affecting the
world today, such as global wanning and overpopulation. Perhaps most
compelling, though, is the Acquired Immune Deficiency Syndrome
(AIDS) epidemic. According to the World Health Organization (WHO),
this disease has the potential to infect as many as 30 to 40 million people
and most likely kill a large portion of them by the year 2000 [American
Association for World Health (AAWH) Resource Booklet, 1994].
AIDS has become a global menace and one likely to become an even
greater force of destruction in the immediate future. For example, on
January 21, 1996, Colorado's KUSA 10 oclock news reported that the U.S.
has identified at least five new AIDS patients who are carrying Human
Immunodeficiency Virus (HIV) strains, which, up until now, were
predominantly found in Asia and Africa. There seemingly are no
geographic boundaries for this insidious disease. Nor is the short-term
prognosis any more promising, nor are any cures imminent despite the
resources being marshalled to defeat it. According to National Institutes of
Health (NIH) Director Dr. Anthony Foucci, "an AIDS vaccine or cure is at
least 10 years away" (Media Broadcast on March 30,1994).
1


In terms of massive loss of human lives and economic
developments, the global community will pay a very' high price in human
capital for this disease. According to the latest World Health Organization
(AAWH Resource Booklet, 1994, p. 15; researchers emphasis) report:
The largest number of estimated AIDS cases over 2.5
million is in Sub-Saharan Africa, but as the epidemic
takes hold in South and. Southeast Asia there has been an
eight-fold increase in the past year in the number of AIDS
cases in Asia, from more than 30,000 to about 250,000.
AIDS cases are the visible part of the epidemic, but because
there is an average of ten years between HIV infection and
the onset of AIDS, they reflect the HIV situation a decade
ago. Today, an estimated 16 million adults and over 1
million children have been infected with HIV since the
beginning of the pandemic. This is an increase of
approximately 3 million adult infections since July 1, 1993,
of which almost half occurred in women.
It appears that developing Third World countries are currently
experiencing a significant increase in estimated HIV cases, while the
United States and other developed countries have managed to "somewhat
stabilize" the increase in number of AIDS and HIV cases. In other words,
the latter are no longer experiencing high percentages of AIDS increases
within a one-year period. It is estimated that developing countries in the
Sub-Saharan Africa and South /Southeast Asia have more than 13 million
HTV cases compared to the estimated 16.5 million HIV cases in the world.
These two regions comprise more than 79 percent of the estimated
cumulative total HIV cases in 1994 (AAWH Resource Booklet, 1994).
2


According to WHO AIDS experts, more than one-third of all adults
in urban areas (rural cases not accounted for) from Sub-Saharan Africa are
believed to be HIV positive (Shenon, November 8, 1992). This estimate
has a tremendous impact on all the Sub-Saharan nations (Ghana, Kenya,
Zaire, etc.) right now and more so in the year 2000 because research over
the last several years has documented that small villages have literally
been wiped out by AIDS. Only the very old and some children were not
infected because many adults and young children have either died from
AIDS or are currently HIV positive, leaving a tremendous imbalance of
the population in the area (AIDS documentaries aired on Public Broadcast
Station).
When it comes to the AIDS epidemic, South/Southeast Asian
nations seem to be following in the unfortunate footsteps of their African
neighbors. According to WHO, "reliable projections show that at least 10
million Asians will be infected with HIV by the year 2000. The two
countries most affected by this disease are India and Thailand. As stated by
Philip Shenon in The New York T^ir.es on November 8, 1992:
India The WHO estimates that more than 1 million
people in India, out of a population of 860 million, are
infected with the AIDS virus more than in all Europe
and about as many as in the United States. The Indian
Health Organization projects that 20 million to 50 million
Indians will be infected with H.I.V. by the year 2000.
Thailand The Government estimates that 200,000 to
400,000 people of a population of 58 million are infected
with the AIDS virus; experts say that number could reach


2 million to 4 million, or as much as 6 percent of the Thai
population, by the end of the decade (Section I, p. 1).
To place the HIV pandemic in perspective: To date, this disease has
claimed more lives in Thailand than all the political coups in the history
Thailand combined. According to Thai Government officials, "If the
spread of AIDS continues to spread uncontrolled ..., the number of HIV-
infected people could multiply to 2-4 million by year 2000. More than half
will be women (Handley, 1992, p. 29). This report is supported by WHO
in its "The HIV / AIDS Pandemic: 1993 Overview literature:
As of early 1992, estimates from Thai sentinel surveillance
studies indicated that HIV prevalence among pregnant
women attending antenatal clinics was greater than 1.4%
in over 20 provinces. In at least 4 provinces prevalence
was more than 4%, and in one province reached 8.8%. In
early 1990, the government of Thailand estimated that
there were at least 50,000 HIV-infected people in the
country. It is estimated that by the late 1992 this number
had risen to approximately 450,000 (WHO Global
Programme on AIDS, 1993, p. 12).
The most recent world update on AIDS comes from prolific AIDS
journalist Philip Shenon, who has been monitoring the steady invasion of
AIDS in Southeast Asia. His AIDS article in The Denver Post, originally
printed in The New York Times, was published on February 3, 1996; it bore
a poignant and powerful headline that stated, "In Asia, time is running
out. Dying has begun; toll may hit 10 million" (The Denver Post, pp. 18A
and 20A).
4


Even though AIDS did not arrive in Asia until the late 1980s, this
disease has surpassed its predecessors in spreading and infecting Thailand.
Shenon wrote:
Last year, nearly 50,000 people died of AIDS in Thailand
alone. Even as the infection rate has peaked in other parts
of the world, it is still exploding in Asia, with the virus
spreading mostly through heterosexual intercourse.
Epidemiologists working with the World Health
Organization have predicted that the number of infected
Asians will rise from 3.5 million this year to as many as 12
million by the year 2000. Last year, for the first time,
estimates suggest that the number of people infected with
HtV, the virus that causes AIDS, was larger in Asia than
in Africa. By the turn of the century, more people will be
infected each year in Asia than the rest of the world
combined (Shenon, 1996, p. 20A).
While most AIDS observers are pessimistic about the AIDS
epidemic in the world, the situation in the United States today is not
markedly better, despite massive publicity, educational programs, and
research. More than 1.5 million Americans have been diagnosed with
HIV or AIDS. Currently, "AIDS is the fourth leading cause of death
among women aged 25-44" (AAWH, 1994, p. 18). And, the fight against
AIDS continues to be expensive and difficult.
Over the last 10 years, millions of dollars have been spent to fight
the spread of AIDS through education, prevention, treatment, research,
and so forth. At the moment, the only way to control the spread of AIDS,
and ultimately eradicate AIDS, is through public education that leads to
prevention. Unfortunately, this statement is easier said than done as


reflected in Robert Walkers 1994 book entitled AIDS Today, Tomorrow,
(1994, p. 29):
In aggregate, our attempts at public sex reeducation have
been simultaneously impressive and inadequate. We are
rapidly learning how little we know about how to
convince people to change their basic ways or, indeed,
even how to reach them with a message they can
assimilate. I have been involved in local phases of this
effort and I have been humbled by the discovery that I
knew much less about teaching than I thought; the
elaborate plans posters, pamphlets, programs always
sound so good to the middleclass, educated warriors
around the conference table but absolutely bomb when
put into effect. I suspect that one major reason for failure
has been the unwillingness to show' the true face of AIDS
in presentations to the general public.
Based on past reports and numerous world-wide studies about the
effectiveness of education and prevention efforts, it is clear that one of the
most crucial components to winning the fight against AIDS is behavioral
change. There are a w'ealth of statistics from the many AIDS public health
organizations that continue to indicate that more and more people, both
in the U.S. and the world, are being fatally infected through sexual
activities. Fundamentally, given the typical means of transmitting AIDS,
sexual practices are at the core of the behavioral change. Walker (1994, p.
159) wrrote:
"Sex has become an all-or-nothing game, that is EACH
TIME you play you are in a zvin/no-win situation. ... if
you lose playing the AIDS odds, the loss is irreversible and
6


irremediable and your luck has completely run out"
(emphasis in original).
AIDS has pushed both the public and the government into a new
behavioral arena where the issue is highly controversial even taboo
because for the first time in history, AIDS is a disease that is mostly
transmitted through sexual activities- When AIDS first became visible
during the early 1980s, the Judeo-Christian traditions made it quite
uncomfortable for both the public and the government to address this
issue openly and honestly. This discomfort continues to have
tremendous impact on public policies and our ongoing fight against AIDS.
Walker (1994, p. 160 ) highlighted this problem:
This harsh fact of life has many implications for personal
behaviors as well as for government policy. ... Regardless
of one's sex, a personal policy of "Just saying NO!" can, in
fact, save your life. On the public level we must learn to
discuss the "unmentionables." One of the most
extraordinary revelations brought about by AIDS is the
depth of ignorance about the possibilities, functions and
dangers of sex.
Public administration and public policy, as professional fields of
theory and practice, have met one of its most powerful and challenging
foes in AIDS policy because the public is clearly divided between the
conservative and liberal sentiments toward its remedy. Because of its
controversial transmission modes and type of victims, AIDS has become
one of the major social and political debate issues of the 1990s It is not
only costly, in terms of human lives, but it also involves the allocation of
7


scarce resources to treat AIDS patients in today's managed care approach to
health care.
Problem Statement and Rationale
The "relationship" between women and the AIDS epidemic is
unique. The general public normally associates HIV/AIDS susceptibility
with someone who is either a homosexual male, an intravenous drug
user, or a highly promiscuous individual. WHO projects, however, that
by the year 2000, approximately 13 million women worldwide wall be
infected with HIV and "the number of women becoming infected with
HIV is increasing faster than any other population" (AAWH Resource
Booklet, 1994, p. 22).
There are many reasons both biologically and socially, why
women, in general, are more vulnerable than men in contracting AIDS.
Biologically, a woman's reproductive anatomy is more conducive for the
transmission of the virus due to greater surface exposure. "A greater
amount of semen has contact with a woman's genital tract than vaginal
secretions do with a mans genital tract" (AAWH, 1994, p. 22). In addition
to biological vulnerability, women also need to contend with a serious
cultural variable, relative to men, that further increases their risk of
contracting AIDS subordination and the issue of "powerlessness"
(AAWH Resource Booklet, 1994, p. 23):
8


One of the most intractable barriers to the control of AIDS:
the subordination and powerlessness of women
(emphasis in original).
The subordination of some women contributes greatly to
the challenges surrounding the AIDS pandemic. It may
hinder discussion and honest communication between
sex partners. By creating conditions in which women
find it difficult to avoid the risk of infection, sex
discrimination raises the general level of HIV infection
within the community and increases the AIDS threat for
everyone.
In addition to WHO's findings and recommendations, De Bruyn
(1992) also reviewed and analyzed the existing epidemiological trends of
AIDS and its impact on women living in developing countries such as
Brazil, Chile, Haiti, India, Ivory Coast, Kenya, Malawi, Mexico, Thailand,
Trinidad, and many more countries in the African, Asian, and South
American continents. De Bruyn's (1992) conclusions supported WHOs
findings regarding the relationship and impact between AIDS and women
in developing countries.
De Bruyn (1992) concludes that women in developing countries will
continue to be the major group of the world's population to be diagnosed
with HIV and AIDS as well as experience and suffer from this disease in a
much different way than men. The effect of AIDS on these women is
predominantly linked to four major reasons:
(1) Stereotypes related to HIV/ AIDS have meant that
women are either blamed for the spread or not recognized
as a potential patients with the disease. The consequences
can be: delayed diagnosis and treatment, stigmatization,
9


loss of income and violation of human rights. (2)
Women are at increased risk of exposure to HIV infection
for reasons related directly and indirectly to their gender.
(3) The psychological and social burdens are greater for
women than men in similar situations. These include:
problems related to pregnancy and motherhood; rejection
as marital partners, loss of security and income (if they or
their partners are seropositive); greater demands to cope
with the effects of the epidemic, both as lay persons and
professionals. (4) Women's frequently low
socioeconomic status and lack of power make it difficult
for them to undertake prevention measures (De Bruyn,
1992, p.249).
De Bruyn's (1992) findings, after reviewing existing epidemiological
AIDS trends regarding women in developing countries, should not be
surprising. They merely confirm the suspicions of why women, in
general, seem relatively "untouched" by existing prevention and
education efforts as their numbers of HIV infections continue to rise.
Moreover, the apparent ignorance by the medical community that
continues to associate AIDS as a "homosexual/gay or prostitute disease"
has taken a substantial toll on women, in general, because AIDS messages
specifically targeting women are at least ten years behind the reality of the
present situation. In addition, these AIDS educative messages were not
gender sensitive or relevant to the cultural, traditional, social, or
psychological conditions of these developing countries.
Furthermore, factors that contribute to women's vulnerability to
contracting AIDS include lack of access to AIDS information and
preventive practices because women in developing countries generally
10


have lower educational levels and literacy rates. In some developing
countries, women engage in anal sex in order to preserve their "virginity
because of its cultural and traditional values, thereby, increasing womens
risk of contracting AIDS. The one factor that is most detrimental to any
concentrated prevention or educational efforts is that women in these
countries do not have the power to demand or even negotiate condom
use (or, in most cases, any contraceptive use) even though they are aware
of their spouses extra-marital affairs and visits to prostitutes (De Bruyn,
1992).
Asian and Pacific Americans (APAs) represent approximately 3.3
percent (8.5 million) of the total U.S. population today. Between 1970 and
1990, "APAs grew at a rate although admittedly from a low number
more than 10 times that of the total population" (Lin-Fu, 1993). The U.S.
population grew by 11 percent during the 1970s, but the APA population
grew by 141 percent (6.5 million) (Robey, 1989). According to Lin-Fu (1993,
p. 21):
Despite its recent dramatic increase, and the projected
escalation in growth, APAs have remained one of the
most poorly understood, invisible and neglected minority
groups, receiving little attention from the health care
system and policymakers. This fact is clearly reflected in
the dearth of information and reference to this minority
in major national health policy guidelines and status
report on minority health. Unlike any other minorities,
APAs have had to bear the burden imposed by the myth
of a "model minority." This inaccurate and most
unfortunate stereotype, created largely by the popular
media, has led many into assuming that APAs are a
11


homogeneous population all of whom are highly
successful, have no particular problems or health care
needs, and do not require special considerations as do
other minorities.
The apparent frustration reflected in Lin-Fu's article is justified
because the overall health status of APAs had failed to capture the interest
of health researchers over the past several decades, especially in the area of
AIDS research. But in this era of AIDS, it is foolhardy to continue to
neglect this issue because APAs are equally vulnerable to receiving and
transmitting AIDS as anyone else, perhaps more so, and, sadly, are being
ignored.
AIDS has been an epidemic in the United States since the late 1970s,
but the APA population has yet to stabilize the increase in the number of
APA HIV cases diagnosed each year. Indeed, just the opposite has
occurred. There have been reports from the Health Resources and
Services Administration (HRSA, 1994) that the APA population is one of
the fastest growing minority groups in the United States to be diagnosed
with HIV more than 50 percent of the new cases can be found in first-
generation Asian populations.
As author Randy Shilts, And The Band Played On (1988), has
thoroughly documented, the U.S.s current AIDS status was caused, in
part, by its "ostrich behavior" (sticking one's head in the sand) displayed
during the early stages of the AIDS epidemic. This "denial," can also be
attributed to the APA population. The effect of the APA "model
minority" myth creates the illusion that the APA communities are
12


somehow being spared from this disease (Gock, 1994), for it is a
characteristic disturbingly accepted by the APA population itself. As
captured by Lee and Fong (1990, p. 19):
The fact that Asians and Pacific Islanders are viewed as a
"model minority" lends itself to misconceptions that tend
to perpetuate stereotypes, not only by the greater society,
but even among Asians and Pacific Islanders themselves.
Even they see themselves as the model minority the
achievers who do not engage in high-risk sexual
behaviors or shoot drugs (emphasis in original).
The illusion of "model minority" has created a dangerous misconception
about the threat of AIDS in the APA communities in terms of education
and prevention. This illusion only exacerbates the current problem.
Over the past 20 years, the public continues to hear about APAs
high academic achievements and economic successes that invariably
promote the "model minority" myth in every aspect of the society.
Unfortunately, few in society are aware of the fact that nearly two-thirds of
the APA population speak their native Asian languages at home and
more than 50 percent do not speak the English language "very well." As
reported by the Department of Commerce Bureau of the Census (1993, p.
5):
Of the 4.1 million Asians 5 years old and over, 56 percent
did not speak English "very well," and 35 percent were
linguistically isolated. The Hmong, Laotians, and
Cambodians had the highest proportions of persons 5
years old and over speaking an Asian or Pacific Islander
(API) language at home. ... Hmong and Cambodians who
13


spoke an Asian or Pacific Islander language at home had
the highest proportion of linguistically isolated, 61 percent
and 56 percent, respectively.
The language barrier has a compounding effect on the both the
culturally insensitive prevention and education efforts and the problem of
accessibility by this group of APAs. In addition, APAs experience a
slightly higher rate of poverty level (14 percent) when compared to the rest
of the nation (13 percent), "despite a higher median family income" (U.S.
Department of Commerce Bureau of the Census, 1993, p. 7).
According to Centers for Disease Control (CDC) statistics and other
local and international publications and conferences reports, people of
color communities, and especially the women in these communities, are
part of the fastest growing segment of the U.S. population to be diagnosed
with AIDS today through heterosexual contact. For instance, in 1993 and
1994, approximately 45 percent of APA women contracted AIDS through
heterosexual contacts. In addition, CDC also reported that APA pediatric
AIDS cases had increased 200 percent between 1993 and 1994 - although,
again, admittedly from a low base number (WHO, 1994; Nyamathi et al.,
1993; BCline, Kline and Oken, 1992; National Conference on Women and
AIDS / HIV Infection, 1990).
It is not surprising that APA women are mirroring the current
AIDS trend that is reflected in both the U.S. and globally. The issues of
powerlessness, biological and social vulnerabilities, misdiagnosis, and
misperception, which were reported in De Bruyn's 1992 article, apply just
14


as saliently today to APA women. In addition, approximately 70 percent of
the APA population are foreign-bom and, therefore, exhibit a stronger
affiliation to their cultural and traditional roles and values.
First generation Asians also tend to have lower levels of
educational attainment, and encounter more problems with learning the
English language (U.S. Department of Commerce Bureau of the Census,
1993). According to the U.S. Department of Commerce Bureau of the
Census statistics (1993), less than 30 percent of first generation Asian
women from countries such as Cambodia, Laos, and Vietnam graduated
from high school. This barrier poses a tremendous problem for these
women to access and understand written AIDS materials both in their
native languages and in English, as sex and death are two extremely
sensitive, even taboo, subjects within the diverse Asian cultures.
Unfortunately, it is impossible to address the AIDS epidemic and its risks
without addressing these two taboo topics.
The other contributing factor was the lack of culturally appropriate
and sensitive AIDS educative materials that could be disseminated to the
people of color communities. This lack of access to relevant and
culturally sensitive AIDS information continues to perpetuate the
misperceptions of AIDS and its risks, including perceptions as to whom
might be at risk.
The purpose of this study was to explore the relationship between
APA women and the AIDS epidemic as well as the issues and barriers that
potentially increase or decrease their risk of contracting AIDS. Current
15


information and research about APA women and AIDS are almost non-
existent other than acknowledging the rising problem and that APAs
follow similar trends of sexual behaviors when they become sexually
active. This study will have a significant impact on future public health
and AIDS education policies because education without behavioral change
is futile.
Due to the exploratory nature of this qualitative study, it is not the
main intent of this study to "generate" new theory or verify the relevance
of the three preliminary theoretical frameworks. The theoretical
frameworks merely provided direction to guide the initial process of the
research. Furthermore, it is impossible to generalize the findings about
the entire population of APA women because of the small sample size.
This research will give us a glimpse as to whether our current and
past general education and prevention campaign against AIDS has been
effective in reaching APA women. Based on the cursory information and
projected statistics from AAWH, WHO, and other national AIDS
organizations, it is evident that APA women may not have fully benefited
from current and past AIDS efforts both in the U.S. and internationally.
The same sources frequently dte cultural forces that are related to gender
issues, to be one of the major barriers that impact the effectiveness of the
current and past AIDS campaign in reaching APA women.
There is no doubt that information gleaned from this research will
contribute to the existing body of knowledge regarding AIDS education
and become one of the very few research studies ever conducted with this
16


group of women. The research process itself proved to be an invaluable
learning experience as well as confirmed the findings of existing literature
regarding the insularity of APA communities.
Overall, the findings of this exploratory study suggest that there is
room for improvement in terms of disseminating AIDS information and
messages to the APA population, especially APA women, because their
levels of AIDS knowledge varied greatly. In addition, the study findings
further indicate that additional studies are needed to address the more
pertinent issues that emerged from the data. One of the issues centers
around the notion that the APA women interviewed possess some level
of control over their own sexuality and bodies, but, choose not to exercise
that control. It does not matter whether the issue here is lack of control or
choose not to take control; the consequence is the same at-risk of
contracting AIDS.
The findings of this exploratory study further support the current
recommendations of many respected scholars of public administration
who clearly advocate a "different approach when conducting the business
of public administration. It is evident that the concept of a "value-free"
study or approach is merely an illusion because public issues, such as
AIDS, are highly contentious and value-laden. It is, therefore, impossible
for public administrators and policy makers to design and implement an
AIDS policy without incorporating a policy framework that would
accommodate and interpret the intrinsic value of a public issue such as
AIDS and the APA population.
17


In addition, this study further alerted us to the fact that, as a
discipline, public administration and policy, has a unique position to
accommodate and incorporate knowledge and approaches from other
disciplines to enhance its relevancy. This study has planted many seeds
that have potential implications that could assist AIDS educators and
policy makers in making better future decisions and recommendations
when addressing the issue of AIDS and the APA population.
In conclusion, this study has raised many issues related to future
research areas, as well as questions that specifically address the challenge
faced by public administrators and policy makers in their quest to design
and implement future policies that are effective for the APA population.
This challenge is by no means, easy or logical.
Dissertation Organization
In addition to the Introduction, this dissertation will review the
three theoretical frameworks that provided preliminary guidance to this
study. Following the Theory Chapter is the Method Chapter that guided
the data collection process and how the Findings Chapter was presented.
The Discussion Chapter concludes this dissertation.
18


CHAPTER TWO
THEORETICAL FRAMEWORKS
Introduction
Based on the purpose and proposed research methodology, it is clear
that this chapter does not follow the traditional literature review format of
a standard dissertation. Due to the exploratory nature of the research as
well as the purposes and intention of field research, this literature review
serves a slighdy different purpose. It is prudent to remind the readers that
the three "theories" being reviewed in this chapter merely serve as part of
the guiding theoretical framework for the research, rather than presenting
theories to be verified by the dissertation.
To date, a very limited number of professional research publications
have specifically addressed the joint issues of Asian and Pacific American
(APA) women and AIDS. For example, World Health Organization
(WHO) and international and national media journalists have
consistently alerted the public to the rising infection rate in APA women
since the end of 1990s, but AIDS researchers have consistently managed to
overlook this particular group. In addition, only cursory information
about the current status of APA women has been provided and discussed
19


at womens AIDS conferences, even though it was clear (based on Center
for Disease Control and Prevention reports and other supporting
publications) that APA women are potentially at high risk of contracting
AIDS.
In general, past and current AIDS research and publications have
concentrated their efforts in understanding the epidemiological, social,
and cultural factors from homosexual mens and, later, the entire male
population's perspective. As of today, only limited numbers of
publications on women and AIDS can be found even though women of
color, in general, have been regarded as one of the fastest growing groups
to be diagnosed with AIDS in the U.S. and around the w^orld (especially in
Thailand and India).
A 1989 International Conference on Women and AIDS did raise a
very important issue APA women's sense of pow'erlessness and how' it
relates to their vulnerability to the AIDS epidemic. This issue is
important because no one is looking at why existing AIDS education and
prevention programs and policies have failed to stop the increase in APA
women's AIDS cases (heterosexual transmissions). Granted, this issue is
not unique to the APA population; it also exists in the African-American
and Latina-American communities. In general, pow'erlessness is a major
issue among almost all women, except that each ethnic group experiences
different levels of powerlessness based on different cultural, psychological,
sociological, educational, economic, and religious forces.
20


Many researchers, such as Brown (1992); Parker, Herdt, and Carballo
(1991); and Lyons et al. (1990), agree that thousands of AIDS prevention
programs have been implemented throughout the United States, but
relatively few studies have focused on the importance of demographic and
social variables. This factor is of particular importance because culture
and gender are two of the most important demographic variables singled
out as having an impact on AIDS education and prevention (Brown, 1992;
de Zalduondo, 1991; Nyamathi and Shin, 1990).
In this exploratory qualitative research, three specific theoretical
frameworks have been selected to guide the preliminary direction of the
study while allowing collected data to build on, discard, and/or discover
entirely new' themes or variables to enhance further the public
understanding of APA women and AIDS. (See Chapter Three,
"Methodology" for additional details.) Several themes that may impact or
influence APA women and AIDS have been identified through the
literature review process.
The major theoretical frameworks being reviewed in this chapter
center around the (1) Cultural and Structural Assimilation Theory, (2)
Asian-American Identity Theory, and (3) Powerlessness Theory. These
theoretical frameworks are proposed to have an influence on the
relationship between APA women and their ability to take control over
their lives in relation to AIDS. The above-mentioned themes may also be
found in other people of color communities and women in general, but
this research will focus only on the APA population.
21


Cultural and Structural Assimilation Theory
Culture refers to the beliefs, attitudes, values, behavior
patterns, and modes of communications that are shared by
a group. Insofar as culture affects what people perceive
and how they understand and respond to their
environment... (Uba, 1994, p. 12).
The United States is a nation of immigrants and refugees where
almost every racial group is represented in today's "melting pot." The
APA population (3.3 percent or 7,273,662) is extremely diverse and consists
of 34 major Asian and Pacific ethnic groups (e.g., Chinese, Indians,
Japanese, Koreans, Thai, Vietnamese, etc.) who speak more than 100
different languages and dialects. According to the 1992 US Bureau of the
Census, almost three-quarters (74 percent) of the APA population are first
generation (i.e., foreign-bom). A majority of the APA communities in the
U.S. are, therefore, still struggling with assimilation and acculturation
issues. In addition, many of these first-generation APA individuals
arrived in the United States within the last 15 years.
According to Gordon (1964), immigrants and refugees experience
seven stages of the assimilation process into the American society
cultural, structural, marital, identificational, attitude receptional,
behavioral receptional, and civic assimilation. Structural assimilation is
considered to be the most difficult of the seven stages of assimilation, and
occurs when the newr group enters and belongs to an existing social entity
of the host culture. For example, an APA immigrant or refugee who has
22


accepted and integrated many of the operating values and behaviors of the
host culture is considered to have acquired structural assimilation. He or
she has an adequate understanding of the subtle cultural nuances of the
host culture, and is able to respond in a way that is acceptable by the host
culture. In a nutshell, this new group is accepted by the host culture as
part of the social entity because this new group possesses elements that
identify themselves as part of the host culture. Once this stage is reached
and the process completed, the remaining assimilation stages fall into
place without much problem (Gordon, 1964; Kitano, 1988).
Based on the findings of Michal-Johnson and Bowen (1992), Brown
(1992, p. 286) reiterated the "observation that AIDS education is a cultural
communication process directly affected by both gender and culture." In
addition, Brown (1992) also indicated that APAs belong to the
"collectivistic cultures where group goals and concerns" are the primary
cultural dimension that influences the assimilation process. Similarly,
Gudykunst, Yoon, and Nishida (1987) build on Hodstede's (1984) theory
regarding the dimension of cultural variability that defines the status of an
individual as belonging either to the individualistic or collectivism
category. APAs are judged to belong to the collectivism category;
therefore, APAs perceived AIDS as an outgroup disease and its members
are less open to discussing AIDS issues (Gudykunst, Yoon and Nishida,
1987), thereby making AIDS research and some prevention through
education particularly difficult. Another contributing factor to Browns
(1992) findings was "culture is also expected to influence interpersonal
23


communication about AIDS. In many Asian cultures, conversation of
sexual topics is considered taboo, and health issues are not openly
discussed, again contributing to the present-day dearth of both descriptive
and prescriptive materials focused on APA women (Brown, 1992, p. 280).
In addition to the above-mentioned factors, two other contributing
elements are also prevalent in APA culture insular communities and
the concept of shame that leads to denial. Aoki, Ngin and Ja (1987) clearly
report that there are a number of explanations why APA women seemed
to have a low reported AIDS incidence rate during the 1980s. The low-
reported incidence rate of the late 1980s is now beginning to show' in the
current incidence rate of the 1990s (as stated in earlier section). Excerpts
from their study are indicative of these trends:
Asian communities in the United States tend to be
extremely insular... The general sodobehavioral isolation
of Asian subgroups is not necessarily always a strictly
voluntary one. While Asians often prefer to stay within
the enclaves of their own family-oriented and highly
structured societies, they are often helped into this
isolation by other ethnic groups who tend to shim them...
Among many Asians, discussions of sexual issues are
greatly inhibited, and discussions of terminal illness may
be believed to result in its occurrence. Such
considerations, along with the strong and prevalent
concept of shame and loss of face, might result in
community physicians avoiding diagnosing a patient as
having AIDS... (Iguchi, Aoki, Ngin and Ja, 1987, pp. 59
and 60).
24


According to Gock (1994), there is a tendency for the APA
population to under-report AIDS cases due to several factors related to
their acculturation and assimilation process. Foreign-bom APAs are more
likely to encounter language barriers, and, therefore, are more likely to
seek medical assistance from indigenous folk medicine when having
health problems. This factor increases the possibilities of AIDS cases being
misdiagnosed and not reported to the CDC. In addition, local APA family
practitioners are more likely to comply with the AIDS victim's family's
request to mis-state the cause of illness and / or death, that is, as an illness
other than AIDS-related. The concept of "shame" may play a role in this
matter as well. This factor further perpetuates the "illusion" that the APA
population is somehow less likely to be at risk of contracting AIDS.
In a 1991 study conducted by Cochran, Mays, and Leong on the
sexual practices of heterosexual APA adults, it was clear that the APA
population, in general, is at risk of contracting AIDS even though this
population has low incidence rates. This study indicates that sexually
active APA adults engage in similar kinds of sexual behaviors prevalent
in the general population. The results of their study indicate that sexually
active APA adults also engage in behaviors considered to be "high risk"
such as sex without condoms and anal sex.
In summary, it is clear that future American AIDS policies towrards
the endangered APA communities must reflect the cultural variability
dimensions to increase the effectiveness of AIDS prevention efforts for the
APA population. The responsibility to identify the specific cultural
25


variability dimension such as the insularity element that "rejects" the
idea that AIDS can ever affect the APA communities or to allow
information of such "shame" be made public will rest on the shoulders
of service providers. Over several centuries, the concept of shame or
saving face in the APA communities is still deeply embedded in the mind
and soul of each member in the community. Both the positive and
negative deeds of an APA individual are regarded as the deeds reflecting
upon the entire family and community; therefore, because AIDS is
regarded as a "negative" disease, it would be in the best interest of the
family and APA health care providers to deny the threat of AIDS in the
community.
Public policy and education policy makers, advocates, and service
providers will also need the tools to overcome the way APAs perceive the
AIDS epidemic as an "outgroup disease," where APAs are somehow
"spared" from contracting this fatal disease. Due to the low reported
incidence rate, the media sometimes ignores the real epidemiological
effects of AIDS and continues to perpetuate the belief that APAs are safe
from AIDS, thus, creating a false sense of security for the APA community
and rendering the already limited prevention efforts ineffective.
Asian-American Identity Theory
The most important developmental task facing women today
is the formation of identity, for it is in the realm of identity
26


that a woman bases her sense of herself as well as her vision
of the structure of her life. Identity incorporates a womans
choices of herself, her priorities, and the guiding principles by
which she makes decisions (Josselson, 1987, p. 3).
People, in general, have some sense of their own identity while
simultaneously continuing to struggle with their personal identity
developments. Men and women share some of the same conflicts during
early stages of their identity process, but usually, men and women define
their sense of self and identity quite differently. Josselson (1987, p. 10-11)
has written in detail about a woman's identity:
Identity is the stable, consistent, and reliable sense of who
one is and what one stands for in the world. It integrates
ones meaning to oneself and one's meaning to others; it
provides a match between what one regards as central to
oneself and how one is viewed by significant others in
one's life. Identity is also a way of preserving the
continuity of the self, linking the past and present... What
we choose to value, deprecate, our system of ethics these
form the core of our sense of identity... Identity thus
becomes a way of judging ourselves with respect to a
typology or set of values that is meaningful to others with
whom we identify ourselves.
What is particular about the APA sense of identity? Existing
sociological literature defines identity as a conglomerate of intertwined
values, attitudes, behaviors, personalities, and cultural and social norms
that make up what we call identity. Uba (1994) managed to summarize the
work of many authors, such as Phinney (1990), Ryan and Smith (1989),
Shibutani and Kwan (1965), and others in the following excerpt:
27


Broadly speaking, ethnic identity refers to a person's sense
of belonging with other members of the ethnic group,
based on shared ethnic characteristics. It is a part of self-
concept based on how a person defines himself or herself
vis-a-vis his or her ethnic group and howr a person is
categorized by others. But ethnic identity is even more
than that. It constitutes a schema that (1) engenders the
general knowledge, beliefs, and expectations that a person
has about his or her ethnic group, (2) functions as a
cognitive, information-processing framework or filter
within wrhich a person perceives and interprets objects,
situations, events, and other people, and (3) serves as a
basis for a person's behavior (Uba, 1994, p. 89).
The APA political and social movement emerged in the late 1960s.
Even though the APA population (except for most recent Southeast Asian
refugees and immigrants) has been in the U.S. for more than 150 years,
the 1960s was an era where APAs began to participate and express their
collective voice in the political and social arena. This movement remains
a powerful force that guides and encourages APAs to continue their
struggle to "identify inequities in the existing system and try to rectify
them" (Wei, 1993, p. 271). Because the heart of the movement centers
around the emergence of an "Asian-American identity," this movement
should be significant and important to all Asian and Pacific Americans. A
clear concept of an APA identity should enhance APAs sense of belonging
to and pride in the U.S. because it wdll, potentially, motivate APAs to be
more visible and assertive in a positive way to the political, social, and
economic arenas. Currently, the APA population does not have a single
recognized and highly visible public leader, such as the late Dr. Martin
28


Luther King or Reverend Jesse Jackson for the African American
population, Ms. Norma Mankiller and Mr. Russell Mean for the Native
American population, and Mr. Cesar Chavez or Ms. Dolores Huerta for
the Latino American population.
Equally important, the 1960s APA movement provided APA
women the opportunity to participate and struggle with the problem of
racial and gender inequality in the United States. This opportunity also
opened the eyes of APA women regarding their status and role within the
cultural boundaries. As stated by Wei (1993, pp. 272-273):
Almost from the beginning, they became conscious that
Asian American women suffered from dual forms of
oppression. Even if they successfully ended racism, they
would still suffer from sexism.
The 1960s movement also marked the beginning of the
development of several "models" of distinct ethnic identities. Stanley and
Deraid Sue (1971) were two of the earlier scholars to address the ethnic
identity issue. They proposed that APAs experienced and moved through
these four identity phases/labels Traditionalist, Assimilationists,
Bicultural, and Marginal. The definition and description of these four
phases/labels are consistent with the latter publications of other authors.
The definitions, as presented by Uba (1994, pp. 90-91), are:
Traditionalists - one who adheres with and
identifies with an Asian
culture to the exclusion of
the dominant society
29


Assimilationists one who adopts Euro- American values and behavioral norms to the exclusion of their Asian background
Bicultural one who maintains both Asian and American cultural values and tries to participate in the American mainstream
Marginal one who rejects both American and Asian cultures and feels alienated
The Minority Identity Development model, introduced later
(Atkinson, Morten and Sue, 1989), includes the developmental process of
how an ethnic individual comes to understand his/her tension between
the ethnic culture and dominant culture. The Minority Identity
Development model has five stages. They are as follows:
Conformity Stage rejection of ethnic culture and adoption of dominant culture
Dissonance Stage ambivalent feelings and tension between two cultures
Resistance and Immersion rejection of dominant
culture and total
acceptance of ethnic
culture
30


Introspection Stage
secure about identity
but starting to
question their closely
held beliefs
Synergetic Articulation
has a healthy sense of
individuality and self-
concept and views all
cultural elements
objectively
There is little doubt that first and second generation APAs of both
sexes experience some level of "identity crisis," and any of the presented
identity models would help explain their struggle. This study assumed
that there is a marked difference between APA men and women in their
process of developing an "integrated bi-cultural identity," and that this
difference affects AIDS education and prevention efforts. An APA woman
with an integrated bi-cultural identity minimizes the effects of barriers to
accurate AIDS information, such as the thinking that AIDS is an outsider
disease and the subject of sex is a taboo issue.
An integrated bi-cultural identity is defined as someone who has
struggled and contemplated over what it means to be an APA woman in
the U.S. where a balance between eastern and western cultures and
traditions has been achieved. The intrinsic values and expectations of
both cultures and traditions have been incorporated, and the individual is
"at-peace" with her/ his identity as an APA living in the U.S. This process
is also recognized as an integral part of the acculturation process, which is
dynamic and unique to each individual. All APA individuals experience
31


and stay at various levels of their acculturation process during the course
of their lifespans. In a nutshell, the level of acculturation is contingent
upon time, external and internal conditions, and other factors that
determine an APA's level of acculturation on a continuum. In turn, this
process helps to "establish" when a balance and integrated bi-cultural
identity has been achieved. For example, a bi-cultural identity would be
consistent with the Bicultural phase/labels as defined by Sue and Sue
(1971), or Identity Achievements category as defined by Ibrahim (1992).
According to Takaki (1993), Wei (1993), Song (1992), Ibrahim (1992),
and Espiritu (1992), APA women have been struggling with their
prescribed role, status, and identity since their arrival in the United States.
Overall, the majority of APA womens positions have not changed
dramatically over the last decade because the "invisible hand" of cultural
forces continues to socialize and perpetuate the centuries-old traditions
and values in the hearts and minds of even the younger and more
educated generations. In addition, the continuing influx of Asian
immigrants and refugees (especially parents) allow the "second class"
status to reinforce and perpetuate the cultural cycle in foreign-bom APA
women.
Even though tremendous diversity exists among the Asian ethnic
groups, the one cultural element that transcends and crosses all ethnic
lines is one that defines the role and identity of Asian women throughout
the region within the Confudan philosophy (Takaki, 1993; Song, 1992).
32


There is no doubt that Confucianism plays a powerful role in defining
traditional Asian women's status and identity. Song (1992, p. 203) unites:
The function of a woman within the teaching of
traditional thought is simple and clear. Throughout the
history of most Asian countries, a woman's obedience has
been unquestionable and absolute regarding her duties
and obligations.
This element is further supported by Takakis (1993, p. 209) interpretation
of an APA womans role and identity:
Confucianism defined the place of a woman: she was
instructed to obey her father as a daughter, her husband as
a wife, and her eldest son as a widow. ... Women of all
classes were regarded as inferior to men and were expected
to remain at home, attentive to family and domestic
responsibilities.
APA women were, and still are subjected to multiple
discriminatory practices even though their male counterparts deal with
just a few. APA women are discriminated against because of their race,
sex, and low socio-economic status (Espiritu, 1992). Many APA women
continue to accept their "prescribed position" because the "invisible hand
of cultural forces" are far more powerful than what the eyes can see. For
example, single Asian woman do not share a similar status with married
Asian women, and male children are still considered to be more valuable
than female children. In addition, Asian women are subjected to a
different set of "moral" restrictions, e.g., the issue of virginity is more
33


important to a APA woman than a APA man because a traditional Asian
man and his family want his bride to be a virgin; it is not an issue if the
man is not. The effects of this discrimination are difficult to discern with
any precision, but it would be easy to assume with confidence that they do
have a profound effect on an APA womans sense of self-identity.
In addition, the low7 levels of prescribed political and feminist
consciousness among APA women contribute to their passive acceptance
of their "second class" status (Wei, 1993). The political and feminist
consciousness mediums are tw7o of the most effective ways for women, in
general, to gain some awareness and control over their lives and rights as
individuals. In addition, such positions would conflict directly with the
tenets of Confucianism. It is obvious that APA women have not done
well in the political arena because there are no visible political APA
female leaders today on a national level, although there are some on state
levels.
Asian culture, on the whole, has deep roots in the traditional
philosophy of group ideals and collectivism. APAs, therefore, are more
likely to view7 themselves subjectively in relation to the group rather than
objectively (Leong and Chou, 1994). The role and behavior of an APA
individual is heavily influenced by social group norms regardless of the
situation or objectivity of the issue. In other words, APAs do not view7
themselves as autonomous individuals w7here the consequences of their
individual behaviors or decisions have no impact on other members of
the family or community. The outcomes of their decisions, both positive
34


and negative, are shared by the family, extended families and community.
According to Leong and Chou (1994), APA women can be divided into
three categories 1) Traditionalists, 2) Marginalists, and 3) Asian
American. These three categories are not mutually exclusive, as the
development and acculturation process of APAs may or may not alter
their identities with the passage of time. The following is description of
the three identity categories as defined by Leong and Chou (1994):
The Traditionalist is strongly guided by internalized Asian
values where obedience and loyalty to the family are
extremely dominant. The core of this category is defined
by behaviors and actions that bring "honor to the family.
A Traditionalist Asian American woman will conform to
her prescribed role and identity without questioning the
authority figure (father, husband, and/or eldest son).
The Marginalist is highly aggravated by the two
conflicting cultures and values. A Marginalist Asian
American woman is imwilling to accept the prescribed
role and identity with absolute obedience and without
question. On the other hand, a Marginalist Asian
American woman may feel extremely guilty and hostile
toward her ethnic culture. In order to resolve the crisis,
she may become very Americanized and denounce her
ethnic culture and identity.
The Asian American is balanced and at peace with her
ethnic culture and expectations, and the American
culture. An Asian American womans self-worth is
defined by her bi-cultural identity where both ethnic
values and American values are integrated and balanced.
Josselson (1987) discussed the patterns of a woman's identity'. Four
identity categories were presented 1) Foreclosures, 2) Identity
35


Achievements, 3) Moratoriums, and 4) Diffusions. Ibrahim (1992)
utilized these four categories and expanded her research specifically to
explain the identity status of APA women. These four categories are
placed on a continuum in terms of degree of separation and individuation
from the culture of origin. On one end are the Foreclosures who have not
acculturated into the American culture and accept the prescribed
traditional role and identity. On the other end are the Diffusions who
have denied their own original culture and values and totally adopt
American values. The Moratoriums have a strong sense of the dominant
culture, but cannot achieve a balance between the two extremes. The
Identity Achievements are between the Moratoriums and Foreclosures
demonstrating that an integrated bi-cultural identity was achieved.
In short, APA women frequently find themselves in social and
cultural situations where they are caught between two extremely different
worlds. Ibrahim (1992, p. 50) succinctly presented the writings of Noda
(1989) and Josselson (1987) in her paper:
On the one hand, they [Asian women] are forced to
preserve their ethnic identity in a racist and hostile
environment, and, on the other hand, the same values
they defend become a source of oppression and
discrimination. ... [We] find Asian American women
caught between two worlds. Neither world supports
them nor encourages them to be their own person. From
an Asian cultural perspective, women are encouraged to
be Foreclosures. They are encouraged to be "good girls or
women" by having no personal goals and pursuing what
Asian cultures and parents insist are appropriate goals and
36


behavior. Although education is encouraged, free
thinking is not, which creates another double bind.
Both the Leong and Chou (1994) and Ibrahim (1992) models share some
similarities, especially Leong and Chou's (1994) Asian-American identity
compared to Ibrahims (1992) Identity Achievements category.
In summary, it is a study assumption that APA women lack a
strong and integrated cultural and individual identity, and, as such, they
might have a higher susceptibility to contracting HIV. An APA woman
with an integrated bi-cultural identity will less likely ignore AIDS
prevention messages and information as well as be able to negotiate for
safer sex practices. Thus, she will reduce her risk of contracting HIV
through unprotected sex and other high risk activities. This study
assumption is made based upon the identity models that define
"traditional or less-acculturated" APA women as more likely to possess
traditional values that strongly discourage any discussion of sex, as well as
"rejects" information that originates from the outgroup.
Power and Powerlessness Theory
To leam to speak in a unique and authentic voice, women
must "jump outside" the frames and systems authorities
provide and create their own frame ... a way of knowing we
called constructed knowledge began as an effort to reclaim
the self by attempting to integrate knowledge that they felt
intuitively was personally important with knowledge they
37


had learned from others (Belenky et al., 1986, p. 134)
(Emphases in original).
Currently, there is a rich pool of literature written about women
and their unique history, roles, and contributions to society. It is hardly a
secret that women have played very important social and political roles
since the beginning of civilization. Today, existing literature tells us that
women are not given full credit for their contributions to the human race
or to civilization. There are parts of this world where women are still
considered second-class citizens -- less valued, faceless, and voiceless, or,
more directly, powerless and oppressed. Women are best seen, but not
heard (Belenky et al., 1986). For example, just recently, one of the most
respected leaders of the Christian world, Pope John Paul II, continues to
reject the idea that women should be allowed to become priests of the
Roman Catholic Church. He supports equality and fairness for women in
the work place and in the family, but not in the sacred realm of the
Catholic priesthood (Denver Post, 1995).
The concept of "womens powerlessness" is deeply rooted in the
feminist theory that women of all races have experienced "oppression."
Susan Faludi's Backlash (1991) talks about the growing reaction that
women experience today as the American culture continues to move
toward equality of the sexes. Faludi (1991) demonstrates that backlash has
worked on two levels "convincing women that their feelings of
dissatisfaction and distress are the result of too much feminism and
independence, while simultaneously undermining the minimal progress
i
i
38


that women have made at work, in politics, and in their own minds"
(Faludi, 1991, cover page). In short, women appear to manifest degrees of
powerlessness in the dominant male culture. This situation affects not
only what they do, but what they perceive they are able to do.
Belenky, et al. (1986) were considered the pioneer authors who
invested time and effort in trying to understand the differences between
men and women from a psychological and sociological point of view.
Their 1986 publication showed that women do perceive, understand, and
respond to the world differently than men. Their study concludes that
women, in general, still think, feel, and perceive themselves in a
"traditional" role, which continues to perpetuate the powerlessness
concept. The women in their study think and feel that knowledge is
received rather than constructed and, thus, continue to depend on others,
primarily men, to guide and provide leadership.
In addition, Belenky et al.'s (1986) findings also indicated women
will choose others whereas men will choose themselves when confronted
with issues and dilemmas; in other words, women will think of others
first whereas men act in an opposite manner. Women are consistently
raised and socialized to be the traditional caregivers and nurturers who
defer their own sense of self and depend on men to provide their identity.
The following further explains the conclusion of Belenky, et al. (1986, p.
28):
The women see blind obedience to authorities as being of
utmost importance for keeping out of trouble and
39


insuring their own survival, because trying to know
"why" is not thought to be either particularly possible nor
important.
The work of Belenky, et al. (1986), has tremendous implications for
women when it comes to AIDS policies. Based on their findings, it is
assumed that if women continue to consider men as the "authority," the
rate of HIV infection through heterosexual contacts will not achieve a
plateau for quite some time, because men are the predominant
heterosexual carriers of the virus. Women will continue to be at risk of
contracting HIV if they continue to defer their "power" to negotiate for
"safer sex." According to CDC statistics (since 1982 1994), AAWH
Resource Booklet (1993 and 1994) reports, and various articles, the
percentage of women contracting AIDS through heterosexual contacts has
continued to rise and heterosexual contacts are currently the most
common mode of AIDS transmission in the APA community.
Another feminist writer, Elise Boulding (1992), is respected for her
work in the history of women's oppression all over the world. Boulding
(1992) dedicated a segment of her book to describe the oppression
experienced by Asian women in different parts of the world. Asian
women in particular have endured centuries of oppression and
powerlessness due to patriarchal and traditionally male-dominated Asian
cultures. For instance, Chinese women were subjected to foot binding
because small feet are considered to be a "valued" feature by a prospective
mate. It is no secret that more female babies in China are available for
40


adoption today than male babies; alternatively, there is a high rate of
female infanticide. In India, male babies are given more attention and
nutrition while female children are neglected (Boulding, 1992). In some
parts of the world time has not changed womens history of powerlessness
and oppression even though there were some exceptions such as Indira
Gandhi and Benazir Bhutto. Both women "inherited" their positions of
power and respect because of their relationship with their families.
The legacy of the history of oppression in women continues to exist
today in the APA culture. In a "traditional" APA family, the male child is
more valued than the female child because the male child will continue
the family line and the female child will belong to another family (Ho,
1990). Similar to the old Western value, the unequal status of the gender
issue was cogently captured in a 1976 essay of Sheila Ruth:
In our culture, maleness is humaness, male is normal,
male is standard, male is right, desirable, excellent hence
preferred; men are more worthy, more valuable, hence
privileged. Women are not quite human because they are
not quite men, or their humaness is of another
(somehow anomalous, somehow lesser) variety; and their
goodness too, their excellence, is of another variety. ...
Western culture ascribes to womanhood the qualities
not-manhood. In her most positive characterization, her
Marian aspect, woman is nurturance incarnate. ... As the
complement to masculine power, she is fragility and
dependence.... (p. 51).
The gender role of APA women is very much tied to their cultures
and self-identity, and how that prescribed and socialized gender role
41


continues to render them powerless. This aspect of the APA culture adds
another dimension of cultural variability that affects the effectiveness of
AIDS education and prevention efforts through behavioral change. APA
women's ability to institute behavioral change, is of course, closely linked
to their level of perceived powerlessness.
Culturally-based gender roles which reinforce male
dominance and female submissiveness are often dted as
contributing in an important way to gender inequality in
minority communities (Kline, Kline and Oken, 1992, p.
447).
In addition to the concept of powerlessness, this literature review
would not be complete without touching the work of Carol Gilligan, who
provides insights into the way men and women make judgments and
decisions. According to Gilligan (1982), there is no right or wrong way,
just different ways of perceiving a situation. The core of Gilligan's book,
In A Different Voice, is well summarized by Faludi (1991, p. 328):
In her book, Gilligan aims to show how womens moral
development has been devalued and misrepresented by
male psychological researchers, how ethics has been
defined only in male terms. Since at least the '50s,
Gilligan observes, researchers have evaluated women's
and men's ability to make moral judgments on the basis
of one all-male study. ... Gilligan proposes that women
are more likely to make moral choices within the context
of particular situations and out of concern for specific
individuals -- rather than on the basis of impersonal rules
of fairness and rights. This does not make women
morally "immature," she says just different.
42


Further in support of Gilligans work, more recent studies regarding
women and decision-making indicate that women perceive and use
"power" in a way that is different from men. Women use their "power"
selectively when it is absolutely needed, and "not using it as a poor
substitute for other things like cooperation" (Miller, 1986, p. 118). There
is evidence that women do have some level of "power" but the "power"
women possess may not be apparent to the naked eye because women
make decisions based on different sets of priorities (Veeder, 1995), and that
power is often utilized in a more cooperative, social mode than its
masculine counterpart.
In summary, if APA women also make their choices "based on
concerns" for others, they might possibly forgo all the offered AIDS
information to preserve harmony in the relationship or to make another
person (i.e. lover or spouse) happy. The negative combination between
APA women's perceived level of powerlessness and their concerns for
others is, and will continue to be a detrimental barrier in the current effort
to contain the spread of AIDS to this population. In addition, as stated in
the identity theory section, an APA woman's identity is usually defined by
her affiliation with either her father, husband, or oldest son. All these
elements combined further hinders the effectiveness of our current AIDS
prevention education and efforts.
43


Conclusion
There is no doubt that information gleaned from this exploratory
research will contribute to the existing body of knowledge regarding AIDS
education and prevention efforts, and to the APA population because of
its potential implications on future AIDS policies. The three theoretical
frameworks, Cultural and Structural Assimilation, Asian-American
Identity and Powerlessness, provided the preliminary guidelines that
helped to formulate the research process. These theoretical frameworks
are considered to be relevant components that have the potential to
enhance the purpose of this exploratory study in its attempt to understand
the relationship between APA women and AIDS.
44


CHAPTER THREE
METHODOLOGY
In the present-day United States, AIDS is the fourth-leading cause of
death among women ages 25-44 years. In addition, the rate of HIV
infection among women is currently higher than men in the U.S.
(AAWH Resource Booklet, 1994). From a public policy perspective, we
have a vested interest in learning more about how this disease can be
prevented from infecting more women, and specifically, Asian and Pacific
Islander (APA) women. The purpose and design of this research rests on
the posited perception that there is a relationship between APA women
and their inability to take full control of their lives, which makes them
vulnerable to contracting AIDS.
Researchers have struggled between employing a quantitative or
qualitative research methodology for a particular study. Because the
choice of methodology is guided by the purpose of the study, this choice, is
usually resolved once the purpose of the intended study has been defined.
In addition to the purpose, existing literature and the research area also
help determine the appropriate research methodology.
The term "qualitative" research is an overall umbrella that includes
field research (fieldwork), naturalistic observation, case study, grounded
theory, phenomenological approach, life histories, and ethnography. The
45


one common thrust of these research labels, which falls under the
umbrella of qualitative research, is the agreement that qualitative (as
opposed to quantitative) methods can better capture the essence or
perceptions of the phenomena from the view of the persons involved in
the process being studied. Quantitative methods are usually defined by
large amounts of (or access to) well-defined data whose relationship to a
defined dependent variable is well-articulated and a clear theory is
understood. Other research efforts, however, require alternative research
approaches, again as a function of their purpose.
The validity of the former option is supported by a number of
researchers such as Reissman (1994), Locke, Spirduso, and Silverman
(1993), and Strauss and Corbin (1990). These researchers/authors firmly
support the usefulness and appropriateness of a qualitative research
approach when dealing with topic areas that requires in-depth
understanding of a phenomena based on the "perceptions and
experiences of the participants" (Locke, Spirduso, and Silverman, 1993, p.
99). In addition, a qualitative research approach allows the discovery and
understanding of a phenomena about "which little is yet known" or "that
are difficult to convey with quantitative methods" (Strauss and Corbin,
1990, p. 19); in other words, it leads to exploratory research.
In summary, qualitative research is best described and explained by
the following:
Qualitative data provide richness, diversity, accuracy, and
contextual depth. They can be used to characterize a group
46


or process; uncover the analytic ordering of the world
being studied; develop categories for rendering explicable
and coherent the flux of raw reality; and locate structure,
order, patterns as well as variations (Reissman, 1994, p.
33).
Futile efforts to find academic and professional publications and
books addressing the vulnerability of APA women to AIDS strongly
suggest that the proposed dissertation will be looking at unexplored
territory. Based on both related literature review and careful assessment
of the topic area, it is clear that the very nature of the study itself is
exploratory and heavily grounded in trying to understand a community's
(i.e., APA women) perceptions, attitudes, and beliefs as they relate to the
AIDS epidemic.
Research Guidelines
Qualitative research usually requires a series of research guidelines
that generally define and guide the research design. Based on upon the
review of the theoretical frameworks in Chapter Two, the following
research guidelines are posed.
1. In what ways, if any, can APA women take control over their owrn
intimacy/sexuality, particularly with respect to their
vulnerability/risk of contracting AIDS?
47


2. In other words, what are the facilitators/barriers (cultural,
psychological, political, economic, sociological, familial constraints,
etc.) that help and/or impede APA women from accessing accurate
AIDS information?
3. In other words, what are the facilitators/barriers (cultural,
psychological, political, economic, sociological, familial constraints,
etc.) that help and / or impede APA women from sustaining
behavioral change?
4. What if, if anything, can public policy makers, public
administrators, and educators do to assist these APA women who
wish to gain some control over one important aspect of their lives?
Design
Before proceeding any further, it is valuable to present an overview
of the general research principles of qualitative research, field research
(fieldwork), as well as grounded theory approach and all its rigor as a field
method.
Guba (1981) is a strong proponent of qualitative research
methodology, which he called Naturalistic Inquiry. Over the past 15 years,
Guba's major recommendations have been modified, improved, adapted,
and enhanced by other proponents of qualitative research. Drawing upon
Guba, Erlandson, Harris, Skipper, and Allen (1993, p. 16) summarize the
general principles of qualitative research:
48


(1) While both qualitative and quantitative methods
can be used, qualitative methods are generally
preferred, primarily because they allow for thick
data to be collected that demonstrate their
interrelationship with their context.
(2) While both relevance and rigor are important in
research, relevance is paramount.
(3) Grounded, emergent theory is preferred to a priori
theory. All theory should be grounded at some
stage before it is applied.
(4) Tadt knowledge (including intuitions,
apprehensions, or feelings) is treated differently but
on an equal basis with propositional knowledge
(knowledge that is explicated in language).
(5) While the researcher may use a variety of
instruments to gather data, the primary research
instrument is the researcher (emphasis in
original).
(6) Research design emanates from the research itself.
(7) A natural setting is always preferred to a laboratory
or controlled setting.
In this particular study, two specific types of qualitative research
approaches, field research (fieldwork) and grounded theory, guided the
research framework and process. It is inevitable that both field research
and grounded theory, not unlike most research approaches, evolved with
time and accumulated knowledge in the field. Field research or fieldwork
as it is currently called, has evolved from a traditional model where
research is conducted in natural settings (naturalism) to include a more
49


contemporary practice of field work that emphasizes how the research is
conducted and not where it is conducted. In other words, the research
does not need to occur in a natural setting of the phenomena being
studied. Contemporary fieldwork is best explained by Emerson as (1983):
... fieldworkers derive the essence of the method less from
the place in which research occurs than from the way it is
conducted. ... What distinguishes the field method in this
view is not the "observer's physical presence at the
location where interaction occurs" but his or her "ability
to grasp the symbolic nexus between thought and action
in a particular social milieu" (p. 2) (emphases in original) .
At the core of fieldwork is not the collection of "facts" or
the controlled observation of "objective" events, but
rather a deeper holistic experience of learning about the
lives, behaviors, and thoughts of others. Much fieldwork
is at least potentially a deeply personal and transformative
experience, as the fieldworker's self, providing the major
research instrument, is often fundamentally affected by
and perhaps changed in the process (p. 15).
Traditional field research or contemporary fieldwork still share the
same fundamental philosophy, framework, and purpose. They are not
mutually exclusive but "differ in emphasis" because each advocate a
"distinctive way of knowing" (Emerson, 1983, p. 2). For this particular
study, contemporary fieldwork approach is one of the two methodological
choices.
Even though the overall research design adheres to the general
guidelines of qualitative research, more specifically fieldwork, an
adaptation of grounded theory approach by Barney G. Glaser and Anselm
50


Strauss (1967) and A. Strauss and J. Corbin (1990) was also utilized to
enhance the rigor and strength of the research. That is, the overall
qualitative research principles, fieldwork, and grounded theory approach
were utilized concurrently in the research design, sampling, observation
methods, and data analysis.
Grounded theory was originally conceptualized and established by
Barney Glaser and Anselm Strauss in 1967. The 1967 work of these two
highly respected researchers and scholars provided the theoretical base for
grounded theory as well as the framework for the research process.
Anselm Strauss continues to refine the theoretical base and
methodological process of grounded theory. Strauss and Corbin (1990, p.
23) define grounded theory as:
A grounded theory is one that is inductively derived from
the study of the phenomena it represents. That is, it is
discovered, developed, and provisionally verified
through systematic data collection and analysis of data
pertaining to that phenomenon. Therefore, data
collection, analysis, and theory stand in reciprocal
relationship with each other. One does not begin with a
theory, then prove it. Rather, one begins with an area of
study and what is relevant to that area is allowed to
emerge.
The ultimate goal and purpose of grounded theory, is to generate
theory through the research process itself. The focus of grounded theory is
constructing and developing as many diverse and relevant theoretical
categories as possible based on data that emerge from the systematic
process of conducting research. In a nutshell, grounded theory research is
51


considered to be a process of discovering and understanding meaning
while generating theory concurrently through the "general method of
comparative analysis." This foundation of grounded theory approach is
clearly reflected in both Qaser and Strauss (1967) as well as Strauss and
Corbin (1990).
This study, however, employs field research in combination with
an adapted version of the grounded theory approach by allowing
reviewed theoretical frameworks to construct general interview' categories
to guide the preliminary direction or general areas of the study. In other
words, this adapted version of grounded theory incorporates the concept
of utilizing related literature, not a complete tabula rasa concept
recommended in grounded theory research in its theory construction
process to guide the general research categories. The research process
itself, not logical deduction, determines whether preliminary theoretical
categories are relevant and what other categories are relevant to this
research process. The preliminary and general theoretical categories are
subject to change and/or complete elimination based on collected data. In
addition to changes and elimination, newr theoretical categories are created
to accommodate any trends that emerged from the research.
To be useful in specifying and clarifying the definitions of the
concepts being studied, comparative analysis is the recommended method
utilized to generate conceptual categories and properties of the study.
Basically, comparative analysis employs the logic of comparison to analyze
empirical data and, thus, generate theoretical categories to guide the study
52


to the level of discovering and understanding meanings from the data
(Glaser and Strauss, 1967). Unlike quantitative research that seeks to
verify an aggregated result pattern, qualitative research strives to
understand, interpret, and report the diversity and variations that occur
from the phenomenon being studied (Strauss and Corbin, 1990; Miles and
Huberman, 1988; Emerson, 1983).
The explicit purpose of grounded theory is to generate theory that
consists of categories relevant to the area of study. This purpose, once
again, fits Guba's overall qualitative research principle where, "the design
emerges as the investigation proceeds" (Guba, 1978, p. 14). The identified
and defined categories allow the researcher to potentially generate and
propose a "theory" that might contribute and enhance the existing
knowledge about APA women and AIDS in relation to future public
policy, AIDS education, and preventative policies and efforts. Due to the
exploratory nature of this particular study, a new "theory" may or may
not emerge from the data.
In summary, both fieldwork research and grounded theory
approaches share many theoretical and methodological principles and
concepts. The one major difference is that grounded theory advocates for
an almost tabula rasa approach when conducting the research, while
fieldwork allows the preliminary direction of the study to be guided by an
existing knowledge base. In this particular study, both research approaches
were utilized because of their complementary nature, with the exception
53


that the preliminary direction of the study was guided by related literature
of the general topic area.
Sampling
Purposive sampling is the appropriate choice among sampling
options based on the purpose of the research. Babbie (1994) and Erlandson,
et al. (1993), in their specific recommended qualitative methods, state that
purposive sampling is usually the choice of preference based on the
purpose and nature of qualitative research. The following excerpt best
reflect Erlandson, et al.'s (1993, p. 82) explanation of purposive sampling:
Central to naturalistic research is purposive sampling.
Random or representative sampling is not preferred
because the researcher's major concern is not to generalize
the findings of the study to a broad population or
universe but to maximize the discovery of the
heterogeneous patterns and problems that occur on the
particular context under study. Purposive and directed
sampling through human instrumentation increases the
range of data exposed and maximizes the researcher's
ability to identify emerging themes and take adequate
account of contextual conditions and cultural norms.
In addition, the definition of theoretical sampling in grounded
theory is also consistent with the above explanation of purposive
sampling that is commonly used in qualitative research approaches.
Strauss and Corbin (1990, p. 177) further define theoretical sampling in
grounded theory' as:
54


... sampling on the basis of concepts that have proven
theoretical relevance to the evolving theory. The term
proven theoretical relevance indicates that certain
concepts are deemed significant because (1) they are
repeatedly present or notably absent when comparing
incident after incident, and (2) through the coding
procedures they earn the status of categories. The aim of
theoretical sampling is to sample events, incidents, and so
forth, that are indicative of categories, their properties,
and dimensions, so that you can develop and conceptually
relate them (emphases in original).
Strauss and Corbin (1990, p. 183)) further state that, You may look,
purposefully, for data bearing on categories, their properties, and
dimensions. That is, you deliberately choose sites, person, documents"
(emphasis in original).
Initial sampling decisions are not "based on preconceived
theoretical framework," but "based only on a general sociological
perspective and on a general subject or problem area" (Glaser and Strauss,
1967, p. 45). But following the initial sampling decision, subsequent
sampling occurs "on the basis of the theoretical relevance of concepts"
(Strauss and Corbin, 1990, p. 179) "where additional data are collected ...
new observations are made in order to pursue analytically relevant
concerns rather than establish the frequency or distribution of
phenomena" (Emerson, 1983, p. 96).
Also included in the rigor and process of purposive sampling and
theoretical sampling is the issue of flexibility. Some degree of planned
flexibility is required in this sampling method because subsequent samples


are selected based on the direction dictated by previously collected data.
Strauss and Corbin (1990, p. 178) describe the importance of flexibility:
Theoretical sampling ensures the noting of variation and
process, as well as of density. By the same token, a certain
degree of flexibility is also needed because the investigator
must respond to and make the most out of data relevant
to situations that may arise while in the field.
In this study, the purpose of an existing theoretical framework is to
guide the research's initial study direction. But, the collected data
ultimately decide the direction of the research and determine the studys
relevance and conceptual categories ( Strauss and Corbin, 1990; Glaser and
Strauss, 1967).
Even though this study employs a purposive sampling strategy, it is
still important to understand fully what was required in this phase of the
study. Ingram and Schneider (1991) define the target population as a
group of individuals or entities selected for change in policy behavior as a
function of behavioral change. Identifying and setting parameters for the
defined target population are important to the success of the policy in
this case, the success of a future AIDS policy for APA women.
The target population identified for this dissertation is APA women
of diverse generational status, ethnic groups, educational levels, marital
status, age, and religious backgrounds. The unit of analysis for this study
is comprised of selected APA women with diverse backgrounds residing
in the Denver metropolitan area. The sampling criteria (e.g., generational

56


status, ethnic groups, etc.) were determined based on the theoretical
frameworks and recommendations that resulted from the various
meetings with Asian Pacific Development Center professionals. Based on
reviewed theoretical frameworks, especially the Cultural and Structural
Assimilation Theory and Asian-American Identity Theory, the mentioned
sample characteristics are considered to have an effect on how APA
women perceive the AIDS situation today. For example, the acculturation
level of an APA individual could be indicated by their generational status
and age; or the exposure levels to AIDS materials could be indicated by
their educational background and marital status. The selected sample
characteristics are deemed to have an effect on how APA women perceive
and respond to the AIDS epidemic in the U.S. because some of the
characteristics may reduce or increase APA women's risk of contracting
AIDS.
According to Glaser and Strauss (1967) and Strauss and Corbin
(1990), the sample size of a study is dependent on the guidelines and
concepts of "theoretical saturation." Strauss and Corbin (1990, p. 188)
define theoretical saturation as:
The general rule in grounded theory research is to
sample until theoretical saturation of each category is
reached. This means, until: (1) no new or relevant data
seem to emerge regarding a category; (2) the category
development is dense, insofar as all of the paradigm
elements are accounted for, along with variation and
process; (3) the relationships between categories are well
established and validated. Theoretical saturation is of
great importance. Unless you strive for this saturation,
57


your theory will be conceptually inadequate (emphases in
original).
Patton (1990, p. 186) also supports the notion of sampling to the point of
saturation, writing:
In the end, sampling size adequacy, like all aspects of
research, is subject to peer review, consensual validation,
and judgment. What is crucial is that the sampling
procedures and decisions be fully described, explained and
justified so that information users and peer reviewers
have the appropriate context for judging the sample.
In summary, theoretical saturation must occur once relevant
categories have been determined by collected data to ensure the relevancy
of the emerging theory. Theoretical saturation occurs when enough data
have been collected to "fill out, saturate and exhaust the category"
(Emerson, 1983, p. 125) of a specific research. In other words, additional
data would not contribute anything new to the existing knowledge and
understanding of a particular research category.
For this particular study, the sample size was determined by the
dissertation committee; a total of 10 APA women were interviewed. This
study did not achieve theoretical saturation in every category due to time
constraints. In addition, the small sample size is an obvious limitation of
this exploratory research.
The research design was implemented based on reviewed
theoretical frameworks and numerous meetings with various members of
the Asian Pacific Development Center staff (APDC). APDC is a non-profit
58


501 (c)(3) human service agency that provides culturally sensitive and
linguistically appropriate services to the APA population in Colorado.
The latter are professional APA women who are well-versed regarding the
diversity of Asian cultures, values, and communication patterns, and
remain as resource people for the research. In addition, the researchers
own professional background as an analyst and community activist was
utilized. In combination, several conceptual categories were established,
which, in turn, guided the preliminary direction of the study and
formulation of the interview categories.
Based on the 1995 Asian Chamber Business Directory, there are
currently more than 120 Asian organizations located in the Denver
metropolitan area. In addition, there are 45 Asian groups that welcome
all ethnic groups; the remaining organizations in the directory represent
15 distinct Asian ethnic groups such as Afghanistans, Cambodians,
Chinese, Filipinos, Hmong, Indians, Indonesians, Japanese, Koreans,
Laotians, Nepalese, Pakistanis, Thais, Tibetans, and Vietnamese.
Research participants were selected based on the recommendations
of community leaders/liaisons and definition of purposive sampling
selecting participants who might provide the most "information-rich cases
for study on depth" (Patton, 1990, p. 169). As stated earlier, 10 APA women
were selected, based on the recommendation from the various ethnic
community organizations and leaders such as religious leaders, presidents
of social organizations, and the Asian Pacific Development Center. These
APA women were selected based on sample characteristics that were
59


determined by existing literature, as well as access that was made possible
by these ethnic leaders. Strauss and Corbin, (1990, p. 181) have observed:
The aim of sampling here is to uncover as many
potentially relevant categories as possible, along with their
properties and dimensions. ... The sampling is open to
those persons, places, institutions that will provide the
greatest opportunity to gather the most relevant data
about the phenomenon under investigation.
Research participants were selected based on several criteria: (1)
APA women between the ages of 25-50 years (a balanced number between
the 25-37 years and 38-50 years of the age groups), (2) diverse ethnic
backgrounds, and (3) different generational status (a balanced number of
first and second generation). Because there are several or many
organizations in several ethnic specific groups, the research focuses on the
organizations that either responded to the researchers request, or those
with which this researcher already has an existing relationship. The
selected community leaders were the liaisons for the initial contact,
suggesting whether or not the selected APA woman would be willing to
participate in the study. Once consent had been obtained, this researcher
was responsible for all follow-up measures.
Observation Methods
Phase l Procedures and Instrumentation
This study employed semi-structured in-depth interviews with
some demographic questions. A set of semi-structured open-ended
60


interview categories aimed at understanding and capturing the attitudes,
knowledge, behaviors, perceptions, negotiation power, and culture of APA
women in relation to AIDS was used. These interview categories were
tools assisting the researcher with the interview process so that the
researcher focused on the categories considered to be important to the
general topic area of the study.
The researcher always began with a general question that was
relatively comfortable for the participant to answer, such as, the
participant's background. Subsequent interview' questions depended upon
on where each participant led the researcher. The researcher then decided
w'hat follow-up probes were used next. In addition, there were two
interview' categories where the researcher asked specific questions based
on the overall purpose and research area of the study. First, the researcher
needed to verify each participants level of understanding of AIDS and its
transmission modes because this study is related to AIDS. Second, the
researcher needed to assess each participant's recommendation(s) for
future AIDS policies.
Initial process of Phase I included seeking assistance from "experts
(e.g., Asian Pacific Development Center staff) who are well-versed in
Asian culture and research to develop a set of relevant and "valid"
categories. This exercise helped sharpen the researcher's sensitivity and
awareness to the subtle nuances and essence of the widely diverse Asian
cultures, traditions, and often indirect behaviors. In addition, the
researcher prepared and practiced "mastering" good interviewing skills
61


before the actual interviews took place. Other initial preparation included
developing a system for field note taking, storing of data, and analysis of
data.
Phase II Data Collection
Given the diversity of languages within the APA community, the
research involved the use of interpreters. Prior to conducting any
interviews, the researcher trained and worked with the various
interpreters to clarify the roles, ethics, and issues of confidentiality. In the
past four years, this researcher has provided and coordinated the only
professional interpreters' training for Asian Pacific Development Center
(APDC) in Colorado, personally participating in three state-wide
interpreters' trainings with one of the only two federally certified court
interpreters in Colorado. This researcher is acutely aware of the rigors and
preparation of being a good interpreter; therefore, the interpreters were
schooled on both terminology and their comfort levels in addressing the
subject area.
In addition, during the process of contacting and setting up the
interviews, each participant was asked to sign a standard consent form as
specified by the University of Colorado at Denver Human Research
Committee. (The form specifically states that all interviews will be audio-
taped and transcribed, but all information will remain confidential. A
copy of the consent form can be found in the Appendix section.)
62


The interviews were conducted based on the refined semi-
structured interview categories at a location chosen by the participant.
Interviews lasted between an hour to an hour-and-a-half and were
conducted with full confidentiality. (Please see Table 3.1 for interview
categories.)
Interviews were audio-taped to ensure response accuracy.
Participants were given the choice of having an interpreter present. In
addition, only the first name of each participant or any kind of identifier of
their choice was recorded. Participants were assured that their
participation would remain anonymous.
The final step to Phase II was the accurate transcription of interview
data. Grounded theory requires that collected data be coded and analyzed
concurrently, even while the researcher is still in the process of gathering
data. Strict guidelines, therefore, determined the acceptable duration of
lapsed time (within one week) for transcribing an interview session.
The research interview categories were developed with careful
consultation with several Asian Pacific Development Center staff
counselors and directors. After many hours of consultation with these
experts in the field, a conclusion was reached that the semi-structured
interviews needed to include categories geared toward family, social,
ethnic food and traditions, and affiliation to country of origin, as well as
questions that are directly related to AIDS. According to the APDC experts,
it was agreed that the relationship between an APA woman and her
family, social structure, and traditions, and affiliation to her country of
63


origin have a great impact on how an APA woman deals with sensitive
and personal topics such as the subject of AIDS and sex.
Because the interviews were not rigidly structured, the order of the
conversations regarding semi-structured categories varied with each
participant, thus allowing for a more natural interview process. The
interview guidelines and process protocols were purposefully set up to be
flexible, and included changes that occurred during the research, such as
repeated interviews with the same participant if the collected data so
dictated.
The most important section of the research package included the
interview guidelines and consent form. The crux of this research
revolved around the semi-structured categories and probes. There are 10
semi-structured interview categories and multiple probes under each
category. The 10 categories provided the researcher with a broad and
flexible framework to navigate the data collection process. The probes
functioned as potential questions and directions that could be explored
during the interview process. The probes changed with each set of data
gathered, as well as with each new participant, based upon new data and
where the participant lead the researcher. Upon analysis, and with each
individual participant, the probes were either retained, modified, or
removed from the interview guidelines to reflect the direction that was
dictated by each new set of data. (Refer to Table 3.1 and Table 3.2 for
details.)
64


TABLE 3.1
Interview Guidelines
1. Category: Probe: Family and traditional background Relationship between members of the family, specific traditional beliefs and practices, and personal and family values
2. Category: Relationship with your country of origin or older relatives
Probe: Traditional events and ethnic foods Positive or negative memories or relationships, levels of cooking skill, understanding the significance of traditional events
3. Category: Probe: Circle of friends and your social life Who are her friends? Does she feel alienated or outgoing? What type of belief systems or values or traditions does she share writh her circle of friends?
4. Category: Probe: AIDS and source of information How does she feel about the AIDS epidemic? Does she think that the APA population is at-risk? Why or why not? Who does she think is at-risk of contracting AIDS?
5. Category: Sexually active Choice of birth control Decision making
Probe: Reason behind choice, why he or she gets to decide on choice, type of communication regarding this issue, perception of this issue and AIDS.
6. Category: Probe: Personal risk of contracting AIDS Is she currently sexually involved or how would she address sex when she does get sexually involved? Has she changed her sexual behaviors with education and information?
65


7. Category: Probe: Known/knows anyone with HIV/AIDS Blame the victim? Role in society. Personal feelings
8. Category: Probe: Family or significant other attitude/ feelings about AIDS victims Blame the victim? Gay family member
9. Category: Probe: Personal reaction to being HIV positive Family support, denial, community expectations
10. Category: What are your recommendations, if any, to the government regarding AIDS and the APA population?
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TABLE 32
Demographic Form
First Name:___________________________________________
Age:_____________
Occupation:______
Arrival Age:_____
Family Size: ____
(Family of origin)
Religious Affiliation:________________________________
Spouse/Partners Religious Affiliation:_______________
Spouse/Partner's Ethnicity:___________________________
Spouse/Partner's Occupation:__________________________
Spouse/Partner's Education Level:_____________________
Ethnicity:________
Marital Status:___
Years in the U.S.: _
Country of Origin:
Education Level:
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Data Analysis
Data analysis is the process of bringing order, structure,
and meaning to the mass of collected data. It is a messy,
ambiguous, time-consuming, creative, and fascinating
process. It does not proceed in a linear fashion; it is not
neat. Qualitative data analysis is a search for general
statements about relationship among categories of data;
it builds grounded theory (Marshall and Rossman, 1989, p.
112).
Data analysis is the final component needed in all research
endeavors before a particular study can be concluded. Both field research
and grounded theory share many common data analysis procedures and
techniques that are utilized by researchers when analyzing their collected
data. The fundamental data analysis framework that is common to both
field research and grounded theory is called comparative analysis, where
open coding process and flexibility are two critical elements. In addition,
constant comparative analysis requires that there be a simultaneous and
systematic collection, coding, and analysis of data during the entire
research process (Strauss and Corbin, 1990; Marshall and Rossman, 1989;
Miles and Huberman, 1988; Glaser and Strauss, 1967).
Grounded theory, as a whole, prepares the researcher and guides the
study toward being consistent and complementary from the very
beginning of the research process. It is evident that data analysis is closely
linked to earlier pieces of the research procedures for data analysis to
occur. For example, the fundamental thrust of theoretical sampling is to
pave the way for the subsequent research process data analysis utilizing
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comparative analysis. Constant comparative analysis can only prevail if
the chosen sampling method is appropriate and flexible. As explained by
Glaser (1978, p. 39):
Theoretical sampling is, then, used as a way of checking
on the emerging conceptual framework rather than being
used for the verification of preconceived hypotheses.
Comparisons are made continually between kinds of
information to generate qualifying conditions, not
disprove hypotheses. While in the field, the researcher
continually asks questions as to fit, relevance and
workability about the emerging categories and
relationships between them. By raising questions at this
point in time the researcher checks those issues while he
still has access to the data. As a result, he continually fits
his analysis to the data by checking as he proceeds.
In this particular study, constant comparative analysis was utilized
to analyze the collected data. According to Strauss and Corbin (1990, p. 62),
" Two analytic procedures are basic to the coding process, though their
nature changes with each type of coding. The first pertains to the making
of comparisons, the other to the asking of questions" (emphases in
original). These two analytic procedures occur simultaneously and
concurrently throughout the entire data collection, coding, and analyses
processes, therefore, variations and changes in the interview categories are
inevitable with subsequent sets of data. In other words, the subsequent
conceptualization of concepts and development of categories will dictate
the "direction" of the data collection and analysis process because constant
69


comparative analysis requires that the variations, differences, and
similarities be verified and validated with actual additional data.
In summary, constant comparative analysis is a process where
ongoing comparison occurs between collected data and theoretical
categories on a continuous basis. Changes to or elimination of existing
theoretical categories is inevitable as each new set of data continues to
inform, verify, and enhance current and existing theoretical categories.
Constant comparative analysis ensures that the theoretical categories stay
true to the direction dictated by the data, thus, fulfilling the principles of
grounded theory. As suggested by Strauss and Corbin (1990, p. 109):
It is just as important in doing grounded theory studies to
find evidence of differences and variation, as it is to find
evidence that supports our original questions and
statements. The negative or alternative cases tell us that
something about this instance is different, and so we must
move in and take a close look at what this might be.
Following through on these differences adds density and
variation to our theory (emphases in original).
Once the variations, differences, and similarities are identified,
systematic groupings of categories are needed to organize the collected data
before in-depth analysis and interpretation can occur. According to
Strauss and Corbin (1990, p. 132), "they are grouped along the dimensional
ranges of their properties in accordance with discovered patterns. This
grouping again is done by asking questions and making comparisons."
Other authors, such as Miles and Huberman (1988), also suggest that
data analysis should occur simultaneously with data collection to generate
70


theoretical or conceptual categories to constantly enhance the coding and
analysis process. These sets of codes are revised and modified based on
subsequent interviews. In addition, these codes are considered to be
"retrieval and organizing devices" that allow the researcher to cluster all
components related to a particular concept, thus, setting the "stage for data
analysis" (Miles and Huberman, 1988).
It is equally important to understand that there will be times where
some codes will be eliminated because they are no longer applicable, i.e.,
that coding and interpretation is to be an iterative process. Miles and
Huberman (1988) present several suggestions to guide qualitative data
analysis:
One simple rule of thumb is this: Always code the
previous set of field notes before the next trip to the site. ...
Make certain that all the codes fit into a structure, that
they relate or are distinct from others in meaningful,
study-important ways. Dont casually add, remove, or
reconfigure codes. Keep the codes semantically close to
the terms they represent.... Define the codes operationally
and be sure all analysts understand the definitions and are
able to identify rapidly a segment fitting the definition
(Miles and Huberman, 1988, p. 64) (emphasis in original) .
It is also evident in Glaser and Strauss' (1967) grounded theory and
Miles and Hubermans (1988) writings that the role and experience of the
researcher are highly valued as well, that there is not fact-value
differentiation as is the numerical core in quantitative methodologies.
Based on this criteria, "unspoken messages" such as, body language, eye
contact, hand gestures, and other non-verbal communication cues that are
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culturally relevant are also recorded by the researcher during the data
collection process. Further, these non-verbal data are carefully analyzed
and interpreted using a culturally appropriate perspective. Strauss (1987,
p.ll) writes that:
Equally important is the utilization of experiential data,
which consists not only of analysts technical knowledge
and experience derived from research, but also their
personal experiences. These experiential data should not
be ignored because of the usual canons governing research
(which regard personal experience and data as likely to
bias the research), for those canons lead to the squashing
of valuable experiential data.
In summary, this phase of the research concentrated on developing
categories, properties, and variables/ conditions of the data that helped
describe and inform and possibly provide some insights to the proposed
research guidelines. Ongoing comparison between collected data and the
theoretical categories occurred on a continuous basis in order to define and
verify the relevancy of the categories and properties as each new set of data
continued to add further insight and information (fill out or saturate) to
the various categories and properties. The categories and properties were
developed based on the findings, whereas, variables/conditions were
identified based on the theoretical frameworks, and later verified by the
findings as to their relevancy. These variables/conditions are: a) Age, b)
Level of Acculturation, c) Religious Affiliation, d) Perception of Personal
Risk, and e) Levels of Knowledge Regarding AIDS and Its Transmission
72


Modes. The definitions of these variables/conditions are presented in
Chapter Two, Theoretical Frameworks, and Chapter Four, Findings.
Validity, Reliability, and Limitations
Every research study struggles with issues that range from purpose
to policy design. These analyses issues are related to peer and public
acceptance of the study itself. Peer acceptance and endorsement of a
particular research are usually based on the overall relevance as well as on
the common issues of research such as validity, reliability, and
generalizability. This dissertation research was no exception; therefore,
the methodology section of this study addressed the connected issues of
validity, reliability, generalizability, and limitations.
We can view validity as having three facets face, construct, and
content. In this study, the issue of face validity was resolved with the
realization that the observation and analyses techniques "appear" to
measure what they are supposed to measure. In field research and
grounded theory, this particular facet of the validity issue is not as
relevant because there is no "preconceived" or rigid set of propositions to
guide the study from beginning to end. In addition, field research and
grounded theory do not yield "proof' from its analytic process, but
validation of relationships within and among the categories.
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Construct validity is defined as ... an evaluation of the extent to
which ... the constructs of theoretical interest [are] successfully
operationalized in the research" (Kidder and Judd, 1986, p. 28). "Construct
validity is based on the logical relationships among variables" (Babbie,
1994, p. 127). In this sense, the thesis is responsible for making sure that
"concepts" being studied are guided by the preliminary theoretical
constructs, collected data, and verification from constant comparative
analysis.
"Content validity refers to the degree to which a measure covers the
range of meanings included within the concept" (Babbie, 1994, p. 128).
Content validity is not usually an issue because the methodology of
grounded theory is geared towards constantly seeking the conceptual
relevance of the data to the emerging theory during the entire process of
data gathering and interpretation.
In summary, validity is the strength of this study because the data
gathered are valid to the participants who provided them. It becomes a
little more challenging in qualitative research when the issue of reliability
is raised. Babbies (1994, p. 124) definition of reliability as, "a matter of
whether a particular technique, applied repeatedly to the same object,
would yield the same result each time," addresses the core issue with
regard to a qualitative study. In a quantitative research design, the specific
data collection instrument utilized in the research yields a similar pattern
of results when administered to a different sample population or utilized
by a different researcher.
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On the other hand, a qualitative research design may or may not
yield a similar pattern of results when administered to a different sample
population. However, the chance of the research also indicating an
additional pattern or excluding prior patterns are just as high. Simply put,
this situation is the inherent nature of grounded theory. In this particular
study, reliability will be a "subject open to debate" because the
methodological approach is highly flexible to accommodate continuous
guidance from the data itself. The obvious limitation of this study,
therefore, is related to the issue of replicability of findings an issue of
reliability. In addition, the small sample size further contributes to the
limitation of this exploratory study. While in many studies this lack of
reliability is debilitating, it is to be expected in an exploratory research
design.
By the same token, qualitative research results are difficult to
replicate in other studies. Existing bodies of literature and proposed
research addressing APA womens issues continue to struggle with the
issue of external validity and generalizability. A more appropriate use the
findings of a qualitative study is to see if the discovered findings relate to
or possess any power of explanation that is relevant to the area of inquiry
of new research (Glasser, 1987) or a different population. Further, it was
the intent of the study to identify a potential set of findings that could be
"generalized" to the proposed theoretical frameworks, thus, attempting to
"resolve" some of the issues surrounding external validity.
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CHAPTER FOUR
FINDINGS
The purpose and design of this exploratory research rests on the
perception that there is a behavioral relationship between Asian and
Pacific American (APA) women and their inability to take "control" over
significant areas of their lives, which, in turn, makes them especially
vulnerable to contracting AIDS. In general, the World Health
Organization (WHO) have found that women of color have been one of
the fastest growing groups to be diagnosed with HIV and AIDS in the U.S.
and around the world today (AAWH Resource Booklet, 1994). It is,
therefore, the intent of this study to explore the issue of "control" over
one's own sexuality and body, specifically as it relates to AIDS. The issue
of control is closely related to the concept of power, and control, in itself, is
a form of personal power. In this study, control is defined as an APA
woman's ability to take charge of various aspects of her life specifically as
it relates to her own sexuality and body.
To date, a very limited number of professional research publications
have specifically addressed the relationship between APA women and the
contraction of AIDS. It is, therefore, also the intent of this study to explore
whether our current and past general education and prevention campaign
against AIDS has been specifically effective in reaching APA women. In
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addition, we will examine some of the perceptions that are shared by this
group of women regarding AIDS and their ability to protect themselves
from this lethal disease.
Before proceeding further, we need to revisit briefly the nature and
core of this exploratory study. It was not the main intent of this
qualitative research to generate "new theory" and generalize its findings to
the entire APA population. Rather, the strength of this study lies in its
ability to point and guide future research in continuing to address this
much needed topic area. The overall and specific findings of this study
should be looked at as a platform for new research to build upon because
this work was truly an exploratory study that yielded many potential areas
for further research.
Chapter Format
This chapter begins with the Demographic Summary that, using the
interview data, provides an overall picture of the participants'
backgrounds and characteristics. Next, the two major categories, View of
Sex and Traditional Gender Roles, that emerged from the interviews will
be addressed in Overall Framework of Findings section. The relevant
properties and variables related to the two major categories will be
presented to describe the two major categories. Following the Overall
Framework of Findings is the summary of themes to describe further the
properties that are relevant to individual research guidelines.
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This study has four research guidelines. Each of the research
guidelines are addressed in the sequence presented in Chapter Three. The
four research guidelines are:
1. In what ways, if any, can APA women take control over their own
intimacy/ sexuality, particularly with respect to their
vulnerability/risk of contracting AIDS?
2. What are the facilitators/barriers (cultural, psychological, political,
economic, sociological, familial constraints, etc.) that help and/or
impede APA women from accessing accurate AIDS information?
3. What are the facilitators/barriers (cultural, psychological, political,
economic, sociological, familial constraints, etc.) that help and/or
impede APA women from sustaining behavioral change?
4. What if, if anything, can public policy makers, public
administrators, and educators do to assist these APA women who
wish to gain some control over one important aspect of their lives?
This dissertation provides an overview of the research process (e.g.,
formal interview period and informal interview period) as well as the
overall observations regarding the participants and their "unspoken
messages." (These unspoken messages represent body language, nods and
78


hand gestures, eye contact or lack of eye contact, etc., that were mentioned
in Chapter Three.)
In addition, informal interviews refer to the times when
participants continued to share and provide insights relevant to the study
after the audio tape had been switched off. It was apparent that the
participants felt more comfortable to elaborate and address difficult issues
when their responses were not recorded on tape. This limitation is
further addressed in another section of this chapter.
Summary of Demographic Information
Ten APA women from eight different ethnic groups and of various
ages, educational, and occupational backgrounds, religious affiliations,
marital status, etc., were interviewed. The eight ethnic groups represented
in this study were Cambodian (two participants), Chinese (two
participants), Filipino, Hmong, Japanese, Korean, Thai, and Vietnamese.
Five of the participants were married; four of the participants were single;
and one was divorced. Two participants were in their twenties; six
participants were in their thirties; and two participants were in their
forties. All ten participants were heterosexual women.
All ten participants were working at least part-time and/or actively
involved in their individual communities. Seven of the participants had
completed college either in the United States or in their country of origin.
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Eight of the ten participants belong to a mainstream religious affiliation
such as Buddhism, Catholicism, and the Church of the Latter Day Saints.
Six of the ten participants have been in the United States for more than 12
years. Four of the five married participants are married to a Caucasian
(White) man; the fifth is married to an Asian.
Only one participant required the assistance of an interpreter during
the interview process. The language capabilities of the remaining nine
participants ranged between average to excellent and, therefore, they did
not require an interpreter.
Overall Framework of Findings
Before proceeding to the overall framework of findings, an
overview of the terms in the findings presentation would be useful.
Because constant comparative analysis was utilized to analyze the data,
definitions of terms in Strauss and Corbins, Basics of Qualitative
Research: Grounded Theory Procedures and Techniques (1990), were
further used to "structure" the findings of this study. In grounded theory,
category, properties, and dimensions represent specific hierarchical
positions as well as meanings. The definitions of the terms used in this
study as defined by their hierarchical order (Strauss and Corbin, 1990, p. 61)
are:
Category A classification of concepts. This classification
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is discovered when concepts are compared one against
another and appear to pertain to a similar phenomenon.
Thus the concepts are grouped together under a higher
order, more abstract concept called a category.
Properties Attributes or characteristics pertaining to a
category.
Dimension Location of properties along a continuum.
The two major categories that emerged from the data center around
the issues of how the participants (1) view sex and (2) integrate traditional
gender roles in their lives. These two major categories are as closely
related as their properties and variables. It is also important to remember
that the properties within specific categories are inter-related and inter-
dependent, which, as a whole, provides a clearer picture describing each
category.
Five relevant properties extracted from the data fall under the
umbrella of View of Sex Category. The five properties include:
1. Generally uncomfortable discussing sex openly.
2. Generally uncomfortable to even use the word
"sex," especially when referring to themselves.
3. General uncertainty about APA population being
at-risk of contracting AIDS (more of a homosexual,
poor, drug users, etc., issue).
4. Have not given AIDS much thought due to the
perception of being not at-risk.
5. Generally not interested in enhancing their
knowledge of AIDS topics (e.g., susceptibility).
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The issue of sex and how APA women view sex is one of the two
major categories that emerged from the data. It is not possible to separate
the issue of sex from AIDS because sexual activity between two people is
one of the most common, if not the most common mode of AIDS
transmission. It was clear from the data that topics or questions related to
sex were "generally uncomfortable." All ten participants, though, openly
acknowledged their verbal discomfort regarding sexual discussion during
or after the formal interview session as well as non-verbally with their
body language.
On many occasions, the participants would usually break eye-
contact and fidget when addressing any issues related to sex. It was also
clear that as long as the issue was discussed "in general," and did not
specifically address or relate to the participants' lives, their level of
discomfort decreased. Based on some of the variables or conditions, which
will be presented in subsequent paragraphs, the discomfort levels varied
with each participant.
In addition, it was not easy for the participants to talk to a "stranger"
(this researcher) about the most intimate aspect of their lives.
Furthermore, it was apparent that the participants had not given the
subject of AIDS and how it relates to sex much thought until the
interview. All the relevant properties of this category will be further
described in detail when each individual property is highlighted.
The other major category, Significance of Traditional Gender Roles
in Decision-making Regarding Sexuality Category (also referred to as
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Traditional Gender Roles), consists of three relevant properties. The three
properties gathered from the data are defined as:
1. Assumed power differential between males and
females with males holding positions of power by
virtue of being male.
2. Men are given the sanction and authority to lead in
sexual relationships because of women's trust in
men's ability to make appropriate decisions.
3. Choose not to exert power/ control in making
decisions regarding sexuality even though women
exert influence over husbands/partners in other
aspects of their lives.
This major category that emerged from the data indicates that
traditional gender roles in decision-making regarding sexuality have a
significant impact on how participants respond or relate to the AIDS
situation and transmission modes. All participants have some level of
AIDS knowledge but AIDS was not a main factor when making a decision
about engaging in sexual activities.
Further, none of the ten participants interviewed said that condom
use would be their long-term choice of birth control or to protect
themselves from sexually transmitted diseases, such as AIDS. It was clear
that each individual participant had her own set of criteria (such as one-
time HIV test, partner's sexual history, etc.) that each employed to
calculate her risk of being infected with HIV. According to all participants,
safer sex practices would be replaced with other types of birth control
options because all participants believed that their partners were safe, and
they would know if "something were wrong."
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There were strong indications that all ten women would most
likely accommodate their spouses or partner's decision regarding the type
of protection used. Again, the properties of this category (Traditional
Gender Roles) are affected by the variables and conditions that exist in this
study.
In addition, the "View of Sex" and 'Traditional Gender Roles"
categories also share several variables or conditions that may have an
impact on the respective properties of each category. The five variables or
conditions that have been identified in Chapter Three include: a) Age, b)
Level of Acculturation into the U.S. Host Culture, c) Religious Affiliation,
d) Perception of Personal Risk (self assessment of risk), and e) Levels of
Knowledge Regarding AIDS and Its Transmission Modes. The following
section addresses the findings that lead to the development of the two
major categories and all their properties.
Category View of Sex
Under the 'View of Sex" category, there are a number of observed
properties. The five properties include: 1) Generally uncomfortable
discussing sex openly, 2) Generally uncomfortable to even use the word
"sex," especially when referring to themselves, 3) General uncertainty
about APA population being at-risk of contracting AIDS (more of a
homosexual, poor, drug users, etc., issue), 4) Have not given AIDS much
thought due to the perception of being not at-risk, and 5) Generally not
84


interested in enhancing their knowledge of AIDS topics (e.g.,
susceptibility).
I. Generally uncomfortable discussing sex openly.
Based on the information gathered from both the formal and
informal interviews as well as body language such as eye contact, fidgeting,
and hand gestures, it was clear that sex is an issue that is generally not
discussed openly, especially with a "stranger." This factor seemed to cross
generational status, age, ethnicity, acculturation levels, etc., because the
first major break in the eye contact occurred when the researcher asked the
first sex-related question. This change was apparent in every interview
because this researcher always began with a topic that dealt with the
participants' background and family a topic area that is relatively
"general" in nature and "non-threatening."
The degree of discomfort exhibited by each individual varied. The
two variables or conditions that had significant effects on the degree of
discomfort were levels of acculturation and age.
The participants' levels of acculturation were determined by
participants' own acknowledgment of their "status." Other factors such as
the number of years in the U.S., indication of acceptance of the dominant
culture (e.g., prefer living in the U.S.), involvement in the community,
and their social circle consisting of both ethnic and "others" also help
determine their levels of acculturation.
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Participants were then assessed based on various factors as either
traditional or acculturated. Younger participants (25-30), especially,
seemed to exhibit the least amount of discomfort when the issue of sex
was initiated. Listed are some of the excerpts from the formal interviews
that highlight this tendency (Reminder All partidpants' names are
fictitious; ethnidty is real):
I tried to initiate [a conversation] with my mom and it was
cut off. It's very hard. I mean, my mom she's probably
more open-minded than a lot of people. But when it come
to the subject of sex, it's a very, very taboo [topic] and she
[would] just say, "You don't do it until you are married!"
(Florence Hmong)
You mean in the beginning. I mean when we are having
relationship. That sexual thing. You know we didn't talk
about it. (Lee Korean)
So, it's hard for me to bring it up sometimes. But most of
the time, the type of people I go out with, they bring it up
themselves, even before I brought it up. That was nice.... I
think it's not a comfortable topic for anyone. (Candy -
Chinese)
2. Generally uncomfortable to even use the word "sex," especially when
referring to themselves.
During the interviews, partidpants hardly uttered the word "sex,"
espedally when answering questions that were related directly to them.
Partidpants had less reservations of the word "sex" when they talked
about the topic area in general or as it related to AIDS. Once again, age and
level of acculturation had an impact on this property. Younger and more
86


acculturated participants possessed less inhibitions when using the word
"sex." Listed is an excerpt that reflects the "indirect" way a participant
addressed the subject:
And the girl [must have] responsibility for themselves so
they have to take care of herself. If you are messing
around, no guy will want to come into your life. (Lan -
Cambodian)
3. General uncertainty about APA population being at-risk of contracting
AIDS (more of a homosexual, poor, drug user, etc., issue).
One of the most common questions the participants raised during
the interviews centered around the studys topic regarding AIDS and APA
women. Participants were interested in knowing why the subject area
dealt with AIDS and the APA population, and if the APA population was
really at-risk of contracting AIDS. Several did not think that AIDS was or
will be a problem for the APA population because they felt that AIDS is
usually linked with such conditions as homosexuality, injected drugs,
promiscuity, and lower economic levels. Listed below are a few of the
responses related to the perception that the APA population is at low-risk
of contracting AIDS:
Well, regarding AIDS victims,... I feel sorry for them ...
But if they are gay or lesbian, I don't feel as sorry ... (Angel
Face Filipina)
Compared to other races, I think they [Asians] have a
lower chance of getting it only because they should know
better. I mean I don't know if that's true like I said. But
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I don't see a lot of Asians who use or are into drugs or
using needles. I don't know why I picture that all the
time. But I see poorer Hispanic or the Black population.
(Jessica Chinese)
4 Have not given AIDS much thought due to the perception of being not
at-risk.
As indicated at the beginning of the Overall Framework of Findings
section, the degree of risk (of contracting AIDS) each participant perceived
varied greatly. These findings are based on each woman's individually
defined set of criteria that "calculated" her risk of contracting AIDS. Only
two of the participants clearly indicated that they have given the AIDS
issue some serious (as opposed to passing) thought because they were
concerned about their own risks. But both later went on to justify their
decision to not practice safer sex based on their set of screening criteria.
Once their sexual partners fulfilled those criteria, they did not think about
AIDS any more.
The remaining eight participants perceived themselves to be not at-
risk because they are in monogamous relationships, are currently not
engaging in any sexual activities, or have full trust in their spouses or
partners. Based on these factors, these women said they have not given
the matter much thought. Listed below are some of the responses shared
by these women:
I guess, it kind of crossed our minds but I dont know. ...
We never really asked each other to get tested. It was kind
of weird. ... You still have that ignorant trust in
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relationships where, "Oh, I am never going to have
anything" ... I never had that thought in my brain.
(Madonna Japanese)
It wasn't that serious; it was, but it wasnt that open. But
the point is I didn't think about it. (Lee Korean)
5. Generally not interested in enhancing their AIDS knowledge.
The one last property that contributes to the overall picture of this
category is associated with the participants' interest level in obtaining
more information about AIDS. Eight of the ten participants indicated that
they either have a sufficient level of AIDS information or were not at-risk,
and, therefore, there was no need nor desire to expand their knowledge
base beyond what they see, read, or hear through the media. There was no
argument that the level of AIDS knowledge varied among the ten
participants, but AIDS was not viewed as priority subject by any particular
interviewee.
In summary, it is obvious that all five properties of this category are
inter-related and all shared some similar variables and conditions. On the
whole, the only variable that seemed to have the least impact on the
properties and category is ethnicity. Furthermore, it seemed that younger
and single participants have less inhibitions when addressing the issue of
sex when compared to older and married participants. The relationship
between age and marital status appeared to be strong because marital status
is commonly associated with age.
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Category Significance of Traditional Gender Roles in Decision-making
Under the 'Traditional Gender Roles" category, there are three
observed properties. The three properties are: 1) Assumed power
differential between males and females with males holding positions of
power by virtue of being male, 2) Men are given the sanction and
authority to lead in sexual relationships because of women's trust in men
to make appropriate decisions, and 3) Choose not to exert power/ control
in making decisions regarding sexuality even though women exert
influence over husbands/partners in other aspects of their lives.
1. Assumed power differential between males and females with males
holding positions of power by virtue of being male.
Both overt and subtle statements made by all participants strongly
suggest that there is difference between Asian males and females regarding
the issue of power. All participants still possessed ideas, values, opinions,
and stereotypes that are gender-specific as defined in traditional gender
roles in Chapter Two and other existing gender role literature. Again, the
degree of subscription to these roles varied greatly among the women.
Overall, it was evident that all ten participants exhibited this
property along the continuum between traditional and contemporary
stereotypes. Traditional gender roles are defined as power and authority
given to men based on their gender, not proven ability. Men are regarded
to have the "knowledge" and "superior ability" to resolve almost all issues
because of their gender, not because they actually possessed those skills.
90


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