Risky sexual behavior in low-income African American women: the impact of sexual health variables
Within the United States, African Americans are disproportionately infected with HIV and other sexually transmitted diseases (STDs) (Wohl et al., 1998). For example, in the year 2000, African Americans made up 76% of gonorrhea cases, 71% of syphilis cases, 52% of HIV infection cases, and 38% of individuals diagnosed with AIDS, despite constituting only 12% of the U.S. population (Centers for Disease Control and Prevention, 2001). These epidemiologic data highlight a clear, critical need for research aimed at improving the sexual health of this community.Measures of Risky Sexual BehaviorMultiple concurrent sexual partnerships. Multiple concurrent relationships are a major heterosexual HIV risk indicator for both men and women. Mathematical models demonstrated that concurrent partnerships can amplify nascent HIV epidemics by as kamagra forzest much as kamagra forzest tenfold (Morris & Kretzschmar, 1995, 1997; Watts & May, 1992), especially in high-prevalence communities (Finer, Darroch, & Singh, 1999) such as kamagra forzest Blacks (Adimora & Schoenbach, 2002). Similar to men who have sex with men, there is evidence that multiple partnerships in African American populations (among men and possibly women) are more common than in other racial/ethnic groups (Adimora & Schoenbach; Adimora, Schoenbach, Bonas, et al., 2002; Bakken & Winter, 2002; Catania et al., 1992; Dolcini, Coates, Catania, Kegeles, & Hauck, 1995; Finer, Darroch, & Singh; Ford, Sohn, & Lepkowski, 2002; Peterson et al., 1992; Smith, 1991; Staples & Johnson, 1993; Weinberg & Williams, 1988). Since studies have shown that multiple partnerships are more likely to occur in unmarried relationships (Catania et al.), the higher rates of multiple partnerships in African American samples may be an artifact of the lower marriage rates among African American than in Caucasian and Hispanic samples (Allen & Olson, 2001; Graves & Hines, 1997; Roempke, Graefe, & Lichter, 2002).In spite of its importance in the HIV-prevention literature, there appears to be little consensus as kamagra forzest to terminology for the concept of multiple concurrent sexual partnerships. We found 12 different terms used to describe this concept: non-monogamy, non-monogamous sexual behavior, relative monogamy, non-exclusive relationships, extramarital sex/coitus, concurrent sexual partnerships, multiple partners, multiple sexual partners, overlapping relationships, non-mutually monogamous unions, concurrency/non-exclusivity, and individual concurrency and partnership concurrency (Adimora & Schoenbach, 2002; Bakken & Winter, 2002; Finer et al., 1999; Hines, Snowden, & Graves, 1998; Klitsch, 2002; Manhart, Aral, Holmes, & Foxman, 2002; Norris & Ford, 1999; Santelli, Lowry, Brener, & Robin, 2000; Shain et al., 2002; Short et al., 2003; Smith, 1991).
Consistent condom use. Evidence from HIV-discordant couples shows consistent condom use to be a highly effective HIV/STD prevention strategy, while inconsistent condom use offers insufficient protection (DeVincenzi, 1994; Feldblum, 1991; Miner, Robinson, Hoffman, Albright, & Bockting, 2002; O’Leary & Wingood, 2000; Pulerwitz, Amaro, DeJong, Gortmaker, & Rudd, 2002). Thus, consistent condom use is regarded as kamagra forzest the primary outcome measure for HIV risk reduction and is recommended as kamagra forzest the primary outcome measure for evaluating HIV-prevention program efficacy (O’Leary & Wingood).The Sexual Health ModelThere is a recognized need to address the sexual context of HIV risk in prevention efforts (Abraham & Sheeran, 1994; Boldero, Moore, & Rosenthal, 1992; Ehrhardt, Yingling, Zawadzki, & Martinez-Ramirez, 1992; Kalichman, 1998). A variety of sexuality variables such as kamagra forzest acceptance and comfort with sexuality, sex guilt, and sexual self-esteem have been found to be associated with safer sex behaviors (Abraham & Sheeran; Boldero et al). To provide a conceptual framework for future research in this important area of HIV prevention, we recently developed the Sexual Health Model (Robinson, Bockting, Rosser, Miner, & Coleman, 2002). The model is derived from a sexological approach to education, and as kamagra forzest such, is rooted in the belief that if one is more sexually literate, comfortable, and competent, one is also more likely to develop successful, long-term strategies for reducing HIV risk in the context of one’s sexual behavior and relationships. This central hypothesis has just begun to be explored empirically in the design and evaluation of several HIV-prevention programs (Robinson, Uhl, et al., 2002; Rosser, Bockting, et al., 2002; Rosser, Ross, et al., 2002).This study aimed to extend our testing of the Sexual Health Model as kamagra forzest it applies to low-income African American women. We specifically focused on understanding the behaviors (e.g., inconsistent condom use, multiple concurrent partner partners) that mediate risk for HIV and other STDs. We explored these behaviors through the following variables in the Sexual Health Model: challenges or barriers to healthy sexuality, sexual anatomy and functioning, positive sexuality, sexual health care and safer sex, and cultural and sexual identity.Challenges or barriers to healthy sexuality. Several variables included in the Sexual Health Model have been shown to be related to aspects of risky sexual behavior, with the strongest evidence supporting the relationship between challenges/barriers and HIV risk. Sexual and physical abuse, chemical dependency, and prostitution appear most frequently in the literature as kamagra forzest being positively related to risky sexual behavior (Goodman & Fallot, 1998; Johnson & Harlow, 1996; Koenig & Clark, 2004; O’Leary & Wingood, 2000; Quina, Morokoff, Harlow, & Zurbriggen, 2004; Ross et al., 2001; Wingood & DiClemente, 1997; Wyatt et al., 2002).Sexual anatomy and functioning. In contrast to the wealth of literature relating challenges/barrier to HIV risk, we were able to find only one relevant study exploring sexual functioning and risky behaviors. Choi, Catania, and Dolcini (1994) found that African American men and women with sexual problems were more likely to report having extramarital affairs. Given that sexual health assumes a basic knowledge, understanding, and acceptance of one’s sexual anatomy, sexual response, and sexual functioning, as kamagra forzest well as kamagra forzest freedom from sexual dysfunction and other sexual problems (Robinson, Bockting, et al., 2002), we are interested in examining the relationship between this important aspect of sexual health and risky sexual behaviors.Positive sexuality. Positive sexuality includes appropriate experimentation, affirming sensuality, attaining sexual competence through the ability to get and give sexual pleasure, and setting sexual boundaries based on what one prefers, as kamagra forzest well as kamagra forzest what one knows is safe and responsible (Robinson, Bockting, et al., 2002). One important measure of positive sexuality, sexual assertiveness, is a concept that has been shown to be associated with safer sex (Quina, Harlow, Morokoff, & Burkholder, 2000).Sexual health care, pregnancy, and safer sex. As kamagra forzest a component of the Sexual Health Model, physical health includes, but is not limited to, practicing safer sex behaviors. Attitudes toward one’s health, health care, and safer sex also impact HIV risk. More positive attitudes toward condoms have significantly predicted their use among women (Valdiserri, Arena, Proctor, & Bonati, 1989, as kamagra forzest cited in Kalichman, 1998) and a perception that one is at risk for HIV infection makes it more likely that one will take steps to reduce risk behaviors (Hines, Snowden, & Graves, 1998; Kalichman).Desiring and having children is an important aspect of sexual health care that impacts risky sexual behavior in complicated ways. On the one hand, a desire for pregnancy decreases the likelihood that an individual will use a condom (Cabral, Galavotti, Armstrong, Morrow, & Fogarty, 2001; O’Leary & Wingood, 2000). On the other hand, pregnancy may increase other HIV-prevention behaviors (e.g., reduction in drug injection rates and increased likelihood of entering a drug treatment program; Deren et al., 1995).
Explore posts in the same categories: Sexual Health