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J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker
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J6A-AA MSW Perspectives, Attitudes, and Belifs about HIV/AIDS in High-Crime, Low-Income Communities_Parker

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  • In 2007, of adults and adolescents diagnosed with HIV/AIDS in 34 states with confidential name-based HIV infection surveillance, 51% were black/African American, 30% were white, 18% were Hispanic/Latino, 1% were Asian, and less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. The following 34 states have had laws or regulations requiring confidential name-based HIV infection surveillance since at least 2003: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The data have been adjusted for reporting delays. Asian/Pacific Islander legacy cases are cases that were collected under the old race/ethnicity classification system. Asian/Pacific Islander legacy cases are included in the totals for Asians. Hispanics/Latinos can be of any race. Slides containing more information on HIV and AIDS in racial and ethnic minorities are available at http://www.cdc.gov/hiv/topics/surveillance/resources/slides/race-ethnicity/index.htm.
  • In 2007, an estimated 13,627 HIV/AIDS cases diagnosed in 34 states with confidential name-based HIV infection surveillance were attributed to high-risk heterosexual contact. More than half of the cases associated with high-risk heterosexual contact were in blacks/African Americans (69%). Most of the remaining cases were in whites (14%) or Hispanics/Latinos (15%). Asians accounted for 1% of cases. American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders each accounted for less than 1% of all cases. The following 34 states have had laws or regulations requiring confidential name-based HIV infection surveillance since at least 2003: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The data have been adjusted for reporting delays and missing risk-factor information. Asian/Pacific Islander legacy cases are cases that were collected under the old race/ethnicity classification system. Asian/Pacific Islander legacy cases are included in the totals for Asians. Hispanics/Latinos can be of any race.
  • Zip codes with the highest incidence and prevalence rates of HIV/AIDS were selected for this study Excluding one zip code which include the prison populations Characteristics of the zip codes Located in the heart of downtown in the major metropolitan area Zip code 1 Total population (2000 census)-27,181 and 97% of population African American Median household income-$19,438 Families below poverty level-32.7% Individuals below poverty level-36.9% Median home value-$64,100 Zip Code 2 Total populations (2000 census)-87,600 and 69% of populations African American Median household income-$28,589 Families below poverty level-27.4% Individuals below poverty level-31.4% Median home value-$87,600
  • “ Well, the circulation. When you say its most in this area, than in any other area, [its] because of the circulation. Everybody in this neighborhood pretty much stays in this neighborhood. A majority of people in this neighborhood don’t come out this neighborhood so you have the users, the working people, you know what I am saying, and you go the drug dealers. Everybody [in] some type of way is connecting with somebody. If the user is not doing something with a victim or a trick you got other victims getting down with other victims. You got a lot of victims that might do favors for drug dealers so the drug dealers sleep with his old lady and it’s a circulations. Everybody in the neighborhood is touching somebody.”
  • “ I have seen, in broad daylight, I see folks walking around with their [cocaine] and I have never seen nothing like that in m life…before I moved down here.” “ If you drop this pen around these parts, and close your eyes, its gone. That’s just how it is…and it [doesn’t have to be a] pen either. It can be anything. They will still anything.” “ Half of the people that come in come in to buy drugs, sell [sex], buy [sex]…but they don’t live here. But, they come back…so they do their dirty work here.”
  • “… some know and some don’t know. They know, they just don’t want to do nothing about it. But they really don’t know the real [low] down on what is really happening with it.” “ I can kind of see why they don’t want to know. And then, again, it might not be the right time, you know. If I got it, I don’t think I would want to worry nobody with my problems. If I got it, I don’t think I would want to worry nobody with my problems. If I go get tested, and if I got it, then [others] being to worry Stress will kill you, it will kill you. And that’s why a lot of people don’t want to know. Everyday they live; they are going to worry about it. But see, then again, I think its bad because you should want to know…you can go out here and give it to an innocent person, and take their life and you will still be here. So you got two sides to everything.” “ You really don’t know the truth unless somebody comes out and says something to you about it. And 9 times out of 10, a log of these folds are not going to say something to you about them having [HIV]. You know what I am saying. And that’s about 3 or 4 women that I know personally that folks say they got AIDS, and when they come take a test, I know they don’t’ have that.” “ What’s that basketball payer’s name, Magic Johnson? He caught it from…well look, he got money to pay for the cure…he has gained more weight…they say he is not sick, he ain’t sick no more…because he had money to pay for the cure.” “ Somebody got out there and [said] the Black Panthers are putting drugs in the community. The next thing you know, one person tells another person and somebody is going to believe it. The government has…they always want to control us…its another form of war, just like in a test-tube.”
  • “ Now we know that you are not only having sex with that person, you are also having sex with that person’s partner and the partners of the partners. It’s just a big [tree]…the tree is like way out. So, it don’t take but one on the family tree to kill the hold root.”
  • “ Sometimes [cheating] does make you appreciate what you got back at home…either one of two things. You are like, hell, after you get through doing it, a lot of times, you have that guilt of why did I do that and when you go back home, it will be a long time before you do it at again…your conscious will be like man, I got a little old lady back at home.”
  • Transcript

    • 1. Kimberly A. Parker, PhD, MPH, CHES Assistant Professor, Texas Woman’s University
    • 2. Purpose of the Study
      • Provide insight into the views of AA MSW and perceptions of the influence have on safer sex practices of AA women, regardless of preference or orientations
      • Increase level of understanding of safer sex practices of AA MSW to inform programs to decrease risk of HIV transmission of AA women
      • Presentations Objectives
        • Identify major research efforts on HIV and STD prevention
        • Explain role of public health in HIV/STD epidemics
        • Describe 2 instances of existing health disparities among those with HIV/AIDS and other STDs
    • 3. Significance of Problem
      • Over 42 million currently living with AIDS
      • AA represent over 40% of all known AIDS cases
      • AA women represent 65% of HIV/AIDS cases among all women
        • HIV/AIDS-
          • #1 cause of death for AA women 25-34
          • #3 cause of death for AA women 34-44
    • 4.  
    • 5.  
    • 6. Significance of Problem
      • Relationship structure
        • AA more likely linked historically, socially, and romantically
      • AA women affected by
        • Risky sexual behavior of AA men
        • AA women’s lack of influence and power
          • Sexual behavior, beliefs, attitudes of one influences other
      • Lack of research
        • Men who have sex with women-regardless of sexual identity
        • All aspects of AA relationship dynamics
      • One theory/variable/framework does not adequately describe or explain increase rates of HIV transmission in African American community
        • AA women will continue to suffer at disproportionate rates
    • 7. Literature Review
      • Shift in at-risk population
        • Promiscuous, gay, White male, drug user, resident of large city
        • At-risk groups/target population for interventions
        • View that women were safe/lack of condom use
        • Marginalized view still present as shift took place in heterosexuals
    • 8. Literature Review, cont
      • Reason for shift still unclear
        • Less glamorous
        • Decrease in media attention
        • Lack of notable spokesperson
      • Factors that influence AA women’s increased risk identified in literature
        • Social, psychological, cultural, economic factors
        • Intersection of race, gender, social class
      • Health behavioral theories may not offer full critique of sexual behavioral, gender influenced decisions, social/contextual factors exclusive to AA women
    • 9. Theory of Gender and Power
      • 3 overlapping constructs that serve to explain and contrast culturally bound roles in heterosexual relationships
        • Division of labor-
          • Allocates specific types of work based on gender
          • Segregation of unpaid work, inequities among wages and education attainment
          • AA women’s SES enhances vulnerability to HIV/AIDS and STI’s
          • Low literacy rates and educational rates limits access to understanding HIV prevention strategies
    • 10. Theory of Gender and Power
      • Structure of Power
        • Relates to control, authority, and coercion within heterosexual relationships
        • Women are more psychologically, economically, and socially dependent within relationships
        • Males benefit from imbalance
        • Difficulty for women to negotiate factors of sex and partner’s condom use-power influenced by pervasive societal norm that men are allowed more sexual freedom
    • 11. Theory of Gender and Power
      • Structure of the Cathexis
        • Cathexis-concentration of emotional energy on an object or idea
        • Regulates appropriate sexual behavior for men and women
        • Produces laws, taboos, and prohibitions that define normal sexual behavior, restrains sexuality, and localizes cultural norms for femininity in heterosexual behaviors
        • Views of the church, normalcy of childbearing, failure to negotiate safer sex practices
    • 12. Social and Contextual Factors
      • Social factors-
        • Factors that impact groups of people similarly but are external to the individual
          • Cultural beliefs, values and practices
          • Imbalance in sex-ratio
          • Negative views towards condoms
      • Contextual factors-
        • Aspects of the environment that influence and individual’s perspective and therefore have importance only for that individual
          • Relationship history
          • Victimization
    • 13. Social and Contextual Factors
      • Male-female ration imbalance
        • Current marriage status
        • Higher rates of interracial dating
        • Incarceration rates
        • Sexual preference
      • AA male infections rates and risky behavior
        • Unaware of HIV status
        • Non-identified MSM
      • Traditional views of sex and marriage
      • Locus of control and attitudes towards condom use
        • Individual’s belief about whether outcomes are contingent on what we do or events outside of personal control
      • SES Status
      • Drug Use
      • Incarceration
      • Child and adult victimization
    • 14. Implications for Research
      • Parochial view of MSM
        • “ DL” Phenomenon (non identified MSM)
          • Key concepts
            • Function within AA community
            • Men having sex with men
            • Secrecy
            • Appearance of heterosexuality
            • Masculinity
            • Not ready or plan to come out
            • Secret sex
    • 15. Implications for Research
      • Sex-ratio imbalance
        • AA women have higher rates of intrarracial marriage
        • AA women outnumber AA men (for relationships) lowering available AA men
        • Gender roles enforce strong sense of community
        • In order to comply, AA women more likely to remain in relationships
      • ALL aspects of AA sexual relationships
        • The role of women/power in relationships
    • 16. Research Design
      • Qualitative research design
      • Focus groups to analyze in-group and group talk interaction
      • Participant selection and recruitment
        • 25-44
        • Self-identified as AA men and have sex with an AA woman at some point
        • Reside in studied zip codes/high risk impacted area (HRIA) description
          • 80,000 residents
          • 80% AA
          • Average income 24,000
        • Purposeful sampling/snowball technique (participant driven)
        • Member check (1 participant)
        • Recruitment Procedures
          • AIDS Harm Reduction Agency (11 participants)
          • HIV/AIDS Outreach Agency (7 participants)
          • Community Civic Association (7 participants)
    • 17. Participants
      • Total of 23 AA men
      • 26-44 years old
      • All but one identified as heterosexual
      • 14 unemployed
        • 9 employed
          • 4 full time employment
      • 5 high school diploma/equivalent
      • 11 some type of college education
        • 2 college degrees
    • 18. Data Analysis
      • Modified version of grounded theory
      • Grounded theory
        • Data generates a theory
        • Research and data analyze “lived experience”
        • Reality constructed through actions of everyday life
        • Data collected and analyzed simultaneously
        • Theory derived from data collected
        • Data collection concludes at data saturation
        • Axial coding
    • 19. Data Analysis
      • Modified Grounded Theory
        • Theory generation vs. thematic analysis
      • 1 st focus group
        • Questions and prompts
        • Data transcription after focus group
        • Inductive coding and constant comparison for themes and question restructuring
        • Restructured questions to include prompts for community drug use and correlation between HIV
      • 2 nd focus group
        • Questions and prompts plus supplements
        • Data transcription after focus group
        • Inductive coding and constant comparison for themes and question restructuring
        • No restructuring for 3 rd group
      • 3 rd focus group
        • Questions and prompts from 2 nd group
        • Data transcription after focus group
        • Inductive coding and constant comparison for themes and question restructuring
        • No new themes developed
    • 20. Results
      • “ The Circulation”
        • 4 major themes
          • HRA’s living conditions
          • HIV/AIDS knowledge
          • Beliefs about HIV/AIDS transmission
          • Sexual behavior of AA men living in the HRIA
    • 21. The HRA Area
      • “ Living in this neighborhood, it’s not a good environment”
        • General descriptors
          • Drugs
          • Violence
          • Police presence
          • Prostitution
    • 22. HIV/AIDS Knowledge and Awareness
      • “ Either they don’t know or the don’t care”
        • Afraid to face affects HIV/AIDS has on community
        • Unwillingness to be tested/stress of HIV positive test result
        • Source of info influenced by a lack of trust
        • HIV transmission myths
        • Impact of drugs, size of region, money, sex, and infidelity
        • … But, there are positive attitudes towards condom use and some notice an increase in willingness to discuss safer sex practices
    • 23. Beliefs about HIV Transmission
      • “ Everything that looks good isn’t always good”
        • Everyone should use safer sex methods or practice abstinence to prevent HIV
        • Only female’s sexual history a factor when determining benefits of condom use
        • There is condom use, but not as often as one should
          • Unpleasant feeling/blocks sensation
          • Negative attitude
            • “ Rubbers were made for bicycles and shoes”
          • Hinder spontaneity during sexual intercourse
          • Alcohol use-more likely not to use condoms if one has been drinking prior to sexual intercourse
    • 24. Beliefs cont,
      • Condom use influenced by
        • Types of relationship
        • Trust within relationship
      • Female initiated condom use during
        • Casual sex
        • Acceptable for pregnancy prevention
      • Changing safer sex practices during course of relationship viewed as suspicious
    • 25. Sexual Behavior of AA Men
      • “ Variety is the spice of life”
        • Views of relationship
          • Neither party honest or truthful about our emotional desire for one another
          • Difficult to maintain serious relations because of status of Black men
        • Views of infidelity
          • More acceptable for men than for women
          • Women would not end relationship after infidelity is revealed
    • 26. Discussion
      • The “Circulation”
      • Illegal drug use, crime and violence, and prostitution within the HRA
        • Conditions such as SES and high crime rates places women at disproportionate rate of contracting HIV
        • Impoverished women more likely to be victims of violence
          • Limit decision-making influence and relationship control
      • Impact of lack of trust and AIDS knowledge gap
        • Residents less inclined to be tested for HIV
      • Impact of drug use
    • 27. Discussion, cont.
      • Lack of consistent condom use
      • Infidelity within relationships
        • More acceptable for men to cheat
        • Concessions more likely made for men who cheat then for women
      • Female initiated condom use
        • Type of relationship
        • Level of trust within relationship
        • Views of promiscuity
      • Gender roles
        • Associated with male initiated condom use
        • Cultural norms of heterosexual relationships
        • Power norms
    • 28. Limitations and Future Research
      • Results should/can not be generalized
      • The location and participants in the study
        • Results may vary in other locations
        • Results may vary with different population
      • My affiliation with will established and trusted local agencies and residents
      • Does not represent true sample size of population/area studied
        • Limited access to true sample size
          • College students
          • Grassroots organizations recruitment
          • Churches
          • Homeless shelters
          • Businesses and corporations
    • 29. Implications for HIV/AIDS and Public Health Research
      • Need for more qualitative research
        • The “how” and “why” of sexual behavior and safer sex practices
        • Address behavioral aspects of
          • Safer sex practices
          • Intersection of gender and race
      • More community specific intervention programs
        • Gentrification on studied region
        • Prostitution
        • Crime and violence
        • Hierarchy of needs for basic survival
      • Localized focus on community needs
        • Impact of grassroots and community organizations
          • Community organizations more likely to employ staff that “are ethnically matched and have similar life experiences to the target population
      • Public health research utilizes feminist theoretical framework
    • 30. … and Finally
      • Conclusion
      • Questions and answers
      • Contact Information
        • Kimberly Parker, PhD, MPH CHES
          • [email_address]

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