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

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