Promoting African American women and sexual assertiveness in reducing HIV/AIDS: an analytical review of the research literature

African American women, including adolescents and adults, are disproportionately affected by the transmission of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). HIV/AID is a health disparity issue for African American females in comparison to other ethnic groups. According to data acquired from 33 states in 2005, 64% of women who have HIV/ AIDS are African American women. It is estimated that during 2001-2004, 61% of African Americans under the age of 25 had been living with HIV/AIDS. This article is an analytical review of the literature emphasizing sexual assertiveness of African American women and the gap that exists in research literature on this population. The multifaceted model of HIV risk posits that an interpersonal predictor of risky sexual behavior is sexual assertiveness. The critical themes extracted from a review of the literature reveal the following: (a) sexual assertiveness is related to HIV risk in women, (b) sexual assertiveness and sexual communication are related, and (c) women with low sexual assertiveness are at increased risk of HIV As a result of this comprehensive literature, future research studies need to use models in validating sexual assertiveness interventions in reducing the risk of HIV/AIDS in African American women. HIV/AIDs prevention interventions or future studies need to target reducing the risk factors of HIV/AIDS of African Americans focusing on gender and culture-specific strategies.     

Recruitment and cardiovascular risk characteristics of African American and Caucasian midlife women

This article describes the use of multiple strategies to recruit women, particularly African American women, into a home-based, moderate-intensity walking intervention and compares African American to Caucasian midlife women on cardiovascular risk characteristics at entry into the program. One hundred seventy-three women aged 45 to 65 years were recruited using a variety of strategies. Baseline findings showed that, on average, the women in the program had modifiable cardiovascular risk factors with proportionately more African American women than Caucasian women having hypertension and low physical fitness. The findings also illustrate the importance of using multiple recruitment strategies to encourage midlife African American and Caucasian women to participate in intervention trials.     

Comparing the Influence of Childhood and Adult Economic Status on Midlife Obesity in Mexican American, White, and African American Women

ABSTRACT Objective: This research addresses the following 2 questions. What is the effect of childhood and adult economic status on midlife obesity in Mexican American women? How do these economic patterns in Mexican American women compare with patterns seen in White women and in African American women? Method: Data were drawn from the U.S. National Longitudinal Survey of Youths 1979–2002 waves. The sample consisted of 422 Mexican Americans, 2,090 Whites, and 1,195 African Americans. The economic indicator used for childhood economic status was parent education; for adult economic status, the participant's own education and adult per capita income were used. Unadjusted and adjusted odds ratios were estimated for the relationship between midlife obesity and economic indicator, stratified by race/ethnic group. Results: There was an increased risk for midlife obesity with disadvantaged economic status measured during childhood and at midlife in Mexican American women. The economic effects on midlife obesity in Mexican American women were similar to those found for White, but not African American women. Few economic influences on obesity at midlife were found for African American women. Conclusions: Strategies that broadly improve the economic conditions of Mexican American women may be one important way to address the obesity epidemic in this population.     

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.     

Understanding the HIV risk reduction needs of heterosexual African American substance-abusing men.

With the increasing prevalence of HIV/AIDS, nurses find themselves caring for diverse populations at risk for HIV. One subpopulation at risk is African American men with a history of substance use. To better understand the risk reduction needs of these men, a focus group was conducted with 16 African American men attending an outpatient drug treatment program in Philadelphia. The purpose was to identify perceptions of HIV risk, engagement in HIV risk behaviors, and barriers to condom use in order to generate recommendations for risk reduction programs tailored to the needs of this population. Results revealed that African American substance-abusing men perceive themselves to be at risk for HIV infection and other adverse health outcomes yet lacked adequate information related to HIV prevention. The need for culture- and gender-specific interventions to reduce HIV-related risk behaviors among African American substance-using men is discussed.     

African American adolescent perceptions of vulnerability and resilience to HIV.

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.     

Challenges and opportunities for HIV prevention and care: insights from focus groups of HIV-infected African American men.

Given the inordinate burden of HIV illness borne by African American men, investigations of HIV prevention and care in this population are urgently needed. In this qualitative study, a sample of 20 HIV-infected African American men participated in two focus groups in which they exchanged experiences and ideas about living with HIV. They shared details about how they were personally impacted by HIV, and together they constructed a perspective on the larger societal context in which the HIV infection rate among African American men continues unabated. The men focused on growing complacency about HIV/AIDS in the United States, underfunding of supports and services, stigmas operative in African American communities, and differential care based on race, gender, and diagnosis. They saw opportunity in personal strategies that help individual men infected with HIV to take a more empowered stance to deal with the disease and improve their health but looked for changes undertaken by African Americans at the community level to make a real difference in the epidemic. Their vision included enhanced support for HIV prevention and care from influential community institutions like Black churches, more open dialogue about drugs and sexual behavior, and capacity-building for families whose members are HIV-infected or at risk for HIV.     

HIV risk behaviors in African American males.

Human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) infection is the fifth leading cause of death for people who are 25-44 years in the United States, and is the leading cause of death for African American men ages 35-44. The incidence rates for HIV among African Americans are steadily increasing, despite wide-spread campaigns to educate the public about the disease. The purpose of this article is to review the epidemiology and statistics related to HIV/AIDS, as well as changes in the epidemic among African American males. A review of the literature was conducted which specifically focused on HIV risk behaviors, changing patterns of behavior, and risk modification among African American males. Opportunities for future research are also detailed.     

Adaptation of an HIV prevention curriculum for use with older African American women.

Although African American women over 50 years of age represent the fastest growing group with HIV infection, little attention has been given to their HIV risk reduction needs. This study adapted an HIV risk reduction curriculum for use with older African American women based on input from a sample of women from the target population. Four focus group interviews were conducted with 30 African American women from three churches regarding adaptation of the Sisters Informing Sisters on Topics about AIDS (SISTA) curriculum for older women and the feasibility of implementing the curriculum in a church setting. From these focus group interviews, the authors identified modifications that could be used to adapt the curriculum for older women. After examination of the curriculum, the women expressed increased knowledge of HIV, a sense of bonding with other participants, and willingness to use churches as venues for HIV prevention. Nurses can build upon the study's recommendations to ensure successful implementation of church-based sexuality programs for individuals of all ages.     

The relationship between HIV-related knowledge and safe sexual behavior in African American women dwelling in the rural southeast.

There is an epidemiological shift toward increased rates of HIV infection in African American women, despite widely available information regarding HIV prevention. The purpose of this study was to determine the relationship between HIV-related knowledge and high-risk sexual behavior while controlling for related variables. A multivariate regression model was selected to differentiate the effects of these variables. The participants were 75 African American women, aged 18 to 38. The results indicated a positive relationship between HIV-related knowledge and high-risk sexual behaviors using the Pearson's r correlation coefficient (0.411, p < .001). Age of first sexual experience, number of lifetime sexual partners, income, educational level, and level of HIV-related knowledge were then regressed onto level of high risk sexual behavior using a hierarchical techniques. Only total years of education achieved statistical significance (p < .001 on the first step and p < .05 on the second step).     

Risk behavior, perceptions of HIV risk, and risk-reduction behavior among a small group of rural African American women who use drugs.

HIV/AIDS is a health crisis for African Americans. African American women are exposed to HIV primarily through sexual behavior, which is an increased risk for women who use drugs. The study design was a mixed method consisting of an ethnography with ongoing participant observation and in-depth interviews and a questionnaire. The purpose of the questionnaire component was to explore drug use, sexual behavior, health history, and perceptions. The questionnaire was administered at months 6 and 18. Data for this report were derived from the first questionnaire with 30 respondents. The majority of respondents (82.7%) used polysubstances consisting of cocaine, marijuana, and alcohol. Between 33% and 50% exchanged sex for drugs or money, with less than half ever using condoms. About 37% perceived that they had no risk of acquiring HIV, whereas 52% perceived a 25% chance. The pattern of HIV testing in which 33% of the women were tested 10 times or more was unexpected because of the low perception of risk. The principal conclusion was that there is great need to intervene with prevention efforts targeting rural women who use drugs in an attempt to curb increasing rates of sexually transmitted infections including HIV.     

Influence of communicator's race on efficacy of an HIV/STD prevention intervention among African American and Caucasian college students

ABSTRACT Objectives: The present research examined the influence of communicator's race on the efficacy of intervention videos in the reduction of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among African American and Caucasian college females.
Design: Experimental HIV/STD prevention digital versatile disks (DVDs) featured a White female as a primary or a secondary communicator relative to a Black female, while a control DVD featured 2 Black females. Respondents watched 1 DVD and completed questionnaires before and after viewing the DVD as well as 2 and 4 weeks later.
Sample: 79 African American females and 88 Caucasian females participated.
Measurements: Perceptions of the DVDs, HIV/STD risk, intentions to use condoms, and number of condoms purchased after viewing the videos were assessed.
Results: The intervention was effective in increasing intentions to use condoms with a current partner across the follow-up periods. There was no effect of race of communicator on any variable for African American or Caucasians.
Conclusions: While communicator's race did not affect this intervention, more research is necessary. Future studies should use multiple Black and White communicators to isolate the role of race and should be conducted where larger samples of African American college students can be recruited.     

四川省凉山州艾滋病病毒感染者配偶感染状况调查

目的了解以吸毒感染为主的艾滋病高流行地区感染者配偶的HIV感染状况及危险因素,提出防治建议。方法 2008年1-3月通过入户调查,对凉山州布拖县和昭觉县226名HIV感染者的配偶开展艾滋病知识、态度和行为学调查,同时进行HIV血清学检测。结果感染者配偶HIV阳性检出率达到25.7%,调查对象按国家督导评估方案计算的知识知晓率为50.9%,71.7%的调查对象最近1个月与配偶发生过性行为,最近1次性行为安全套使用率仅为9.1%(11/121)。结论凉山地区HIV感染者的配偶感染状况严重,配偶间无保护性行为发生比例高,针对配偶间危险性行为的干预工作不足,应扩大检测,加强随访干预,提供适宜的预防技术。     

浙江省宁波市在婚与非在婚男男性接触者性行为特征及艾滋病感染状况比较

目的探讨婚姻状况对男男性接触者(MSM)人群艾滋病相关行为和感染的影响,为在该人群中开展有效的预防控制提供科学依据。方法采用滚雪球招募法,对宁波市744名非在婚MSM和455名在婚MSM进行问卷调查和血清学检测,比较两组间性行为特征及艾滋病、梅毒感染情况。结果在婚MSM艾滋病知识知晓率、同性性行为特征、艾滋病及梅毒感染率与非在婚组比较差异无统计学意义,但两组最近半年异性性行为特征差异有统计学意义,在婚MSM无保护性异性性行为发生率高于非在婚组。结论婚姻并不能制约MSM的同性高危性行为,而且更容易促使艾滋病病毒向普通女性蔓延。针对已婚MSM这一亚人群,有必要采用更有针对性的行为干预措施。