Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource‐Poor Communities in the South

Abstract

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.

Examination of Behavioral, Social, and Environmental Contextual Influences on Sexually Transmitted Infections in At Risk, Urban, Adolescents, and Young Adults

“…These findings are consistent with previous research indicating associations between African American/Black race [3–5] and unstable housing [19,24,25] and STIs. It is also well documented that unstable housing is consequence of low socioeconomic status, which is associated with increased sexual risk and STIs.…”

“…However, increasingly, researchers have called for broader perspectives to account for social determinants and environmental influences on STI risk and acquisition [22,23]. As such, a growing body of research has examined social, environmental, and other contextual factors associated with STI-related risk among AYAs, including influences related to housing instability or homelessness [19,24,25], unemployment [26], and exposure to community violence [27]. Yet, there is still limited research focused specifically on social-environmental contextual influences related the acquisition of STIs among AYAs [13,26].…”

“…We assessed the relative influence of a number of factors known to be associated with STIs among AYAs, including ones that are not reflected in any single study in current literature. To extend current research, we included a number of other variables including age-appropriate measures of financial hardship to take into account the influence of factors related to housing instability and income vulnerabilities [19, 24–26]. A measure of Internet use to meet sexual partners was also included based on increasing evidence regarding STI risk and use of the Internet to extend reach beyond one’s immediate neighborhood and social network [28].…”

Experiences with food insecurity and risky sex among low‐income people living with HIV/AIDS in a resource‐rich setting

“…Population-based studies in diverse regions have shown that food insecurity is associated with inconsistent condom use [10–15], sexual exchange [10], multiple sexual partnerships [13,14,16], a lack of control in sexual relationships [10], sexual relations with older or gang-affiliated partners [16], sexual violence [17], symptoms consistent with sexually transmitted infections [12,15] and substance use before sex [16]. Some of these links were demonstrated in resource-rich settings [11,13,16].…”

“…Some of these links were demonstrated in resource-rich settings [11,13,16]. In San Francisco, food insecurity was longitudinally associated with unprotected sexual activity and having multiple sexual partners among 154 homeless and marginally housed PLHIV [13].…”