Download 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
RSPH of Emory University
Problem of HIV/AIDS among
Black Women
Population
demographics for US
women




13% Non-Hispanic
Black women
71% Non-Hispanic
White women
12% Latina women
5% other racial
backgrounds
HIV Infection
demographics for US
women




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



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


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



38% < $10,000
28% $10-$19,999
34% > $20,000
Sexual identity



M = 27.4, SD = 8.2
Household income

Level of education
90% Heterosexual
10% Bisexual



3% Less than HS
41% HS or equivalency
24% vocational school or
some college
31% college or grad degree
Marital status


90% Single/Never married
10% Married
Children



33% 0
40% 1
27% 2-6
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Method
Recruitment





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:




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



$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

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

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

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

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
RSPH of Emory University