Structural Violence and Racial Disparity in HIV Transmission

Abstract

Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Urban African-American Men Speak Out on Sexual Partner Concurrency: Findings from a Qualitative Study

“…According to this theory, individuals are more committed to their relationships when satisfaction with and investment in the relationship is greater, and when the perceived quality of available alternatives to the relationship are fewer (Rusbult, 1983). In particular, the numerous alternatives to these men's primary relationships, due to the low male-to-female ratio in the African-American community (Lane et al, 2004;McNair and Prather, 2004), may have led these men to be less committed to their primary relationships. Indeed, some men spoke as if ending their relationships would be relatively easy.…”

The Male-to-Female Ratio and Multiple Sexual Partners: Multilevel Analysis with Patients from an STD Clinic

“…The low ratio of men to women among African-Americans has been hypothesized to increase sexual risk behavior, by leading to multiple sexual partners for men (Lane et al, 2004;Logan et al, 2002;Mays and Cochran, 1988;McNair and Prather, 2004); this partner concurrency is hypothesized to increase risk for female partners who tolerate "man-sharing" (Ferguson et al, 2006) rather than forgo the benefits of an intimate relationship with a male partner. This is one of the first studies to investigate the relation between percentage of men and number of recent sexual partners, quantitatively, in a large urban sample using multilevel modeling.…”

“…In turn, women may feel compelled to be more tolerant of a male partner's concurrent partnerships. Although the potential impact of the shortage of men on sexual behavior is often noted (Lane et al, 2004;Logan et al, 2002;Mays and Cochran, 1988;McNair and Prather, 2004), supporting evidence is scarce.…”

The Trauma Response Team: a Community Intervention for Gang Violence

“…[23][24][25][26] Syracuse's school district graduation rate among students completing 4 years in high school was 51 %, and the New York State Attorney General found that the school district had one of the highest school suspension rates in the nation. 27,28 Unemployment among African Americans in Syracuse reaches 17.1 %; among Latinos it is 16.5.…”