AIDS prevention in high-risk African American women: Behavioral, psychological, and gender issues

Abstract

A three-year longitudinal intervention study was implemented to reduce high-risk drug and sexual behaviors in methadone-dependent African American women. Participants were recruited from four inner-city methadone maintenance programs and randomly assigned either to an eight-week peer counseling and leadership training group or to a control group. The 107 trainees and 97 controls completed pretests and posttests at two, four, and seven months. This paper focuses on final data related to the subjects' sexual beliefs, attitudes, knowledge, and behaviors that put them at risk for HIV/AIDS. Reasons for not using condoms are categorized and discussed. Despite the women's awareness of the seriousness of AIDS, perceived powerlessness to negotiate condom use, negative attitudes about the use of condoms, influence of drugs, and unavailablility of condoms interfered with safer sex practices. The inability of education alone to prevent many high-risk sexual behaviors suggests that more serious consideration be given to expanded distribution of condoms as well as needle exchange programs and legalization of illicit drugs.

HIV Transmission Risk Behaviors among HIV‐Infected Persons Who Are Successfully Linked to Care

“…Regarding the increased sexual risk behaviors of women, compared with men, prior studies have highlighted the challenges faced by HIV-positive women in convincing their male partners to use condoms. These challenges include not feeling confident about discussing condom use with their partners and not feeling confident about being able to disclose their HIV infection status to their partner [28][29][30]. Having depressive symptoms was also a significant factor for engaging in highrisk sexual behavior.…”

Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women

“…A third explanation is that the effects of drug treatment on sexual risk reduction may have been moderated by gender. In this regard, Hetherington et al (1996) found that women in methadone maintenance felt powerless to actually achieve safer sex despite their perceived vulnerability to HIV. Other authors concluded that cultural and ethnic norms may circumscribe women's adoption of safer sexual behavior and that, thus, although they may want to have safer sex, women operate within gender role contexts that make it difficult (Grella et al, 1995).…”

“…Another review found modest reductions in risky sexual behavior for drug treatment-based HIV prevention programs (Prendergast, Urada, & Podus, 2001). Other studies suggest that the effects of drug treatment may differ by gender (Grella, Annon, & Anglin, 1995;Grella, Etheridge, Joshi, & Anglin, 2000;Hetherington, Harris, Bausell, Kavanagh, & Scott, 1996;Wells, Calsyn, Clark, Saxon, & Jackson, 1996). Furthermore, carefully conducted trials involving intensive long-term detoxification coupled with cognitive therapy (Sees et al, 2000), as well as community-based harm reduction strategies such as needle exchange and bleach distribution (Lurie & Reingold, 1993), have shown improvements in injection-related risk behavior but minimal or no impact on sexual risk practices.…”

Culturally Competent HIV Prevention Strategies for Women of Color in the United States

“…Attention also must be paid to the influence of gender role socialization on prevention efforts. Research findings suggest that many African American women perceive themselves to be powerless over conditions that place them at risk such as multiple sex partners, incarcerated partners, and drug use (Battle, Cummings, Yamanda, & Krasnovsky, 1996;Harris & Kavanaugh, 1995;Hetherington, Harris, Bausell, Kavanaugh, & Scott, 1996). For example, Black women may consider themselves confrontational (with their sex partners) if they have to discuss previous sexual history, monogamy, condom use, and so on.…”