Transcript Social Inequalities and HIV-Risk Behavior among Black

Controlling our Bodies: Social
Inequality and Risk for HIV
Infection among Black Women
Kimberly R. Jacob Arriola, Ph.D., MPH
APHA Annual Meeting, Atlanta, GA
October 22, 2001
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Problem of HIV/AIDS among
Black Women
Population
demographics for US
women
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13% Non-Hispanic
Black women
71% Non-Hispanic
White women
12% Latina women
5% other racial
backgrounds
HIV Infection
demographics for US
women
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68% Non-Hispanic
Black women
23% Non-Hispanic
White women
7% Latina women
1% other racial
backgrounds
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A Black Feminist Framework
(Collins, 2000)
Black feminist
Black female sexuality
epistemology
 Sexual objectification
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Lived experience
generates wisdom
about intersecting
oppressions
Dialogue is a tool for
assessing claims of
knowledge
Black women’s
subjectivity is at the
center of analysis
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Commodification
Exploitation
Pornography,
prostitution, rape, &
sexual violence
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Social & Environmental Factors
that may Influence Risk
Pornography
Commercial sex work
Rape, abuse & (physical & sexual) violence
Exposure to “Drug Culture”
Perceived limited partner options
Financial dependence on men
Poverty & homelessness
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Purpose of this Study
What is Black women’s level of HIV risk?
What social inequalities shape
respondents’ daily life experiences?
How do these inequalities influence
respondents’ risk for HIV infection?
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Method: Participants
30 Black women
Age 18 to 47 years
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38% < $10,000
28% $10-$19,999
34% > $20,000
Sexual identity
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M = 27.4, SD = 8.2
Household income
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Level of education
90% Heterosexual
10% Bisexual
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3% Less than HS
41% HS or equivalency
24% vocational school or
some college
31% college or grad degree
Marital status
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90% Single/Never married
10% Married
Children
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33% 0
40% 1
27% 2-6
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Method
Recruitment
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Employment training
agency in East Point
Semi-independent
residential facility for
recovering addicts
Program for abused,
suicidal, & low-income
Black women
Transitional house for
recent releasees
Word of mouth
Screening to ensure
that participants:
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Considered themselves
Black or African
American
Were at least 18
Had been sexually
active within past 6
months
Had at least 1 male
partner
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Method: Procedure
Participants were met at the employment training
agency (23) or my office (7).
Semi-structured interview (approximately 1 ½
hours)
Written questionnaire (approximately 10 minutes)
Participants were paid $40-$70
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$40 base amount
$20 for childcare
$10 for coming to the office
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Results: Risk for HIV Infection
Perceived low risk of getting AIDS virus

70% indicated very or somewhat unlikely
Low condom use behavior
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19 reported using condoms never or sometimes
Few sex partners

20 had 1 partner in past 6 months
Sex-Drug exchanges (8)
History of CSA (19)
History of active drug use (5)
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Qualitative Findings
Limited partner selection
Lack of control over sexual decisions
Sexual objectification
Exposure to rape, violence, and abuse
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Limited Partner Selection
Relatively small number of marriageable
Black men
Cultural values emphasize the importance
of having a male partner
K
Perceived need to secure & maintain
intimate relationships
Implications for risk: Little desire to insist
on condom use
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Lack of Control over Sexual
Decisions
Some respondents felt “coerced” into
having sex

Obligatory sex with boyfriend
Some respondents were coerced into
condomless sex
Implications for risk: Lack of ability to
protect herself if protected sex is desired
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Sexual Objectification
Advantages of being a Black woman include
that they are often looked upon as being
beautiful & exotic
Disadvantages of being a Black woman
include feeling like sexual objects
Being touched, grabbed, fondled, used
 Commonplace of sex-drug exchanges
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Implications for risk: Black women are
encouraged to use their bodies for gain while
lacking the power to protect themselves
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Exposure to Rape, Abuse, &
Violence
16 participants described exposure to rape,
abuse, or violence in their interviews
Nature of the experiences
Physical & sexual abuse by partner (male & female)
 Rape by acquaintance (part. surrounding drugs)
 Childhood sexual abuse
 Physical fighting with boyfriend
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Implications for risk: Lack of ability to protect
herself
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Summary
Race, class, & gender intersect to create a
social & economic environment in which
Black women are susceptible to:
The perception of a limited number of partners
 Lack of control over sexual decisions
 Sexual objectification
 Exposure to rape, abuse, & violence
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These factors influence risk for HIV infection
in various ways
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Limitations
Lack of generalizability
Potential social desirability bias
Lack of information on the role of social
support & resources
Questionnaire responses may have been
influenced by having just conducted the
interview
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Conclusions
Findings support key
themes in the literature
Financial dependence
on men was not an issue
Controlling one’s body
is an overriding theme
Increasing women’s
control & decreasing
men’s control is key for
HIV prevention efforts
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