The document discusses a study on the influence of father-son relationships on HIV risk among Black men. It found that poor or absent father-son relationships were common, often due to divorce, incarceration, or fathers not being present. This absence was found to cause trauma and influence men to engage in risky behaviors like substance abuse to cope. However, fatherhood itself encouraged some men to engage in protective behaviors like HIV testing to be there for their own children. The conceptual framework suggests poor father relationships can lead to mental health issues and situational risks that promote HIV transmission.

1. The influence of father-son relationships
on the situational context of HIV risk
among Black men
David J. Malebranche
Emory University Division of Medicine
HIV Prevention Conference
August 15, 2011

2. DISCLOSURE STATEMENT
Speaker: David Malebranche
I have nothing to disclose.

3. Background
• HIV disproportionately affects Black men
• Psychological distress associated with high-risk
sexual behavior
• Poor father-son relationships may cause
psychological distress
• “Absentee father” narrative common when
discussing Black men
• Few explorations of father-son relationships
among Black men in context of HIV disparity

4. Study Details – Project Adofo
• R01 – National Institute of • Brandi Park – Project
Nursing Research (NINR) Coordinator
• Collaborators • Jeffery Roman – Senior
– Lisa Bowleg - Drexel Research Interviewer
University • Bernard Owens – Research
– Robert Agans/Bill interviewer
Kalsbeek - University of • Leonard Moore – Research
North Carolina interviewer
– Matthew Hogben/Thurka • Alanna Stone – Research
Sangaramoorthy – CDC interviewer
consultants

5. Dedication – Dr. Robert Scott
(1944 – 2009)
ADOFO = Ghanaian boy’s name meaning “one who
loves” or “courageous warrior”

6. Figure 1. Proposed conceptual framework for HIV
Protective and Promoting Behavior among Black Men
JOHN
SOCIAL FACTORS HENRYISM
Racism experiences RISK PROTECTIVE
Socioeconomic status BEHAVIOR
Consistent condom use
Recent HIV testing
MENTAL HEALTH
DETERMINANTS
Perceived Stress
Depression
Gender role conflict RISK PROMOTING
BEHAVIOR
Unprotected anal/vaginal sex
Multiple sexual partners
DEMOGRAPHIC
FACTORS
Geography (MSA) COOL POSE
Age

7. Objectives – Phase I
• Describe the social context of Black men’s
lives residing in metropolitan and non-
metropolitan areas in Georgia
• Explore reported structural influences on
mental health and coping strategies among
these men
• Identify how mental health (stress and
depression) and other factors serve as
facilitators of condom use

8. Methods
• Semi-structured qualitative interviews with 90 Black men
in Georgia (30 in Atlanta/Columbus/Valdosta)
• Recruitment venues:
– Community sites; Internet; Grady Hospital
– Snowball sampling*
• Inclusion criteria:
– Black male; Age 18-65; HIV negative/unknown
• $50 compensation
• 4 Coders (> 85% agreement); Nvivo8 software
• Sub-analysis of Atlanta sample (n = 30)

9. AGE
Descriptive stats – ATL cohort
Variable Number (%)
44.4 (mean)
EDUCATION
Did not complete HS 9(30)
HS Diploma/GED 3(10)
Some Higher Education 7(23)
College Degree 4(13)
Technical school/Grad school 7(23)
SEXUAL ORIENTATION
Heterosexual 28(93)
Homosexual 2(7)
INCOME
<$15000 23 (77)
$15000-$30000 4 (13)
>$3000 2 (7)
No Response 1 (3)
HIV TEST IN PAST YEAR? (n=23)
Yes 17 (74)
No 6 (26)
Unprotected sex with female in past year (n=23) 13(57)

10. INTERVIEW GUIDE
• Domains: • Emerging Father
– Current life experiences themes
– Manhood expectations 1. Trauma of father
absence
– Life stressors and coping
strategies 2. Disruptive presence of
alcohol
– Childhood experiences
3. Influence of
– Healthcare utilization
incarceration
– Condom use practices
4. Full circle fatherhood
and HIV testing

11. Poor or absent father-son
relationships common*
Varying explanations:
1. Divorce/Separation
2. Illness/Death
3. Incarceration
4. “Left” mother
5. Custody/mother kept away
6. Father just “not there” for unknown reasons
* NOT ALL “DEADBEAT DADS”

12. Trauma of father absence
• “… I guess there was a longing to have him
[biological father] tell somebody or say to me
publicly, ‘You are my son.’ And so that went on
and I had resentments against him most of my
life.” Daniel, age 51
Perceived origin of negative life course
• “If my dad was around I wouldn’t have turned out
the way I am now. I probably would have, who
knows?” Jake, age 25

13. Trauma impact – seeking guidance
• “It’s stressful because when I was younger I made a lot of
bad decisions because my father really wasn’t like all the
way in my life like he’s supposed to be and it was just my
mother raising two kids…She was strong enough to do it
but …she couldn’t turn a boy into a man…it takes a man to
raise a man, to show him things.”- Chris, age 29
• “[My father] left my momma when I was probably like 10
years old. So that’s how I ended up getting into the street. I
can’t use that against him…but it did play a big part of me
being out there because it was just too much stress
because my momma she working and she got four kids; my
brother always, before he got killed, he always been on the
streets and making money on his own.” - Noah, age 30

14. Disruptive presence of alcohol
Early exposure to alcohol and sex
• “Slid my first shot of gin over to me and til this day I believe…I
had a genetic predisposition for alcohol because my dad was an
alcoholic…I took a little sip. It was like drinking a hot fire! He
said, ‘Nah you got to throw it back.’ You know, I threw it back
and boy I mean the feeling, the euphoria, I done had my first
sexual experience and you know first drink with my dad, you
know, I mean I was on Cloud Nine!” - Aiden, age 56
Intersection with abuse
• “Sure he [father] was, he was abusive…whether it was mentally,
physically, psychologically. An alcoholic in the family, man, can
do nothing but tear it down…cause disruption.” - Cooper, age
50

15. Disruptive presence of alcohol (cont’d)
Influence on mental health
• “My childhood I guess was normal for that time and
that environment. Um, my dad is an alcoholic user… I
guess society would say a weekend alcoholic. He
went to work every day [laugh] we could hardly get
two words out of him, but on the weekend he drank
and raised plenty of hell, and uh, we consequently
we caught the brunt of that…I was brought up, you
know fearful, a lot of fear, and uh, with low self
esteem.” – Sebastian, age 54

16. Influence of Incarceration
• “…At the time when I got home [my parents]
were fighting and um one of the neighbors
called the police so my dad went in jail and
when he got out he never came back home
and so from that time um I didn’t have a male
figure in the home.” - Andrew, age 57

17. FULL CIRCLE FATHERHOOD
LIKE FATHER, LIKE SON
• “At first I said well I’ll never be like my father but consequently
somehow I ended up being just like him, you know drinking and
carrying on, acting out, you know I uh, never hit women or
anything like that, but I wasn’t there for my kids, you know for a
long time uh, I…verbally abused women that was in my life
and…I wasn’t being a man, you know just wasn’t being a man.” -
Sebastian, age 54
LEARNING FROM FATHER’S MISTAKES
• “It affected me because it just makes me stronger because he
wasn’t there in my life all of the time or when he needed to be
so me being a father it makes me be there all of the time for
everything. Every… every little thing; it don’t matter what it is,
I’ll be there.” - Chris, age 29

18. Fatherhood as HIV risk protective
Encouraging HIV-testing
• Interviewer: “What in your life makes you want to
get tested for HIV?”
• “My kids…like for instance, my oldest son. When I
was younger, we would play racket ball and we
would play so hard; we’d look around and it would
be like 50 people watching, you know, and I always
thought to myself if I ever had any more kids, and
now I do, that I’d want to do the same thing with my
youngest kid.” – James, age 49

19. Conceptual Framework
Situational HIV Risk
- “Streets”
- Incarceration
- High HIV prevalence
- Low condom access
Absent/Poor Father-
son relationship HIV Risk behavior
- Drugs/alcohol
Trauma - Multiple partners
Depression - Reduced condom use
Anger/Stress
Low self-esteem
Alcohol/Sex
exposure
FATHERHOOD

20. Limitations
• Convenience sampling
• Not generalizable
– Small sample, older men
– All men living in South
– Half of ATL sample from Gateway Center
• No analysis of other racial/ethnic groups
• Only Atlanta analysis

21. Conclusions
• Father-son relationships described as large influence
on participants’ lives
• Both quantity and quality of interactions important
– Absence as trauma
– Early exposure to alcohol/sex
– Few positive narratives
• Oversimplified depiction of “absentee Black fathers”
• Cyclical nature of father-son relationships
• High risk HIV situational contexts may emerge from
absent or poor father-son relationships

22. Future Directions
• Research
– Analysis of entire sample/comparison of ATL, COL & VAL
– Father/son relationship as variable in probability samples
– Facilitators of positive father son relationships
– More studies among Black MSM samples
• Interventions
– Mental health to address father/son relationships
– Fatherhood interventions – FIP (Philadelphia)
– Manhood development initiatives
– Merging of fatherhood initiatives and HIV prevention
programs

23. Acknowlegements
• The men who allowed us to interview them
• Columbus Wellness Center: Luella Rhodes
• The Boyz Salon Barbershop : Shannon Buckner
• Valdosta Department of Health: January
Smith, MPH and Brenda Mims, RN
• Dixon Transcription Services
• Our Community Advisory Board

24. THANK YOU!