Sexual Protective Strategies and Condom Use in Middle-aged African American Women: A Qualitative Study

Abstract

The heterosexual transmission of HIV has affected middle-age African American women at alarming rates; yet there is a paucity of research and interventions focused on this population. This study used a qualitative approach to understand middle-age urban African American women’s experiences with HIV-related sexual risk behaviors and to identify the sexual protective strategies they employed to reduce their risk for HIV infection. Ten African American women, ages 45 to 56, were recruited from low-income neighborhoods in New York City. Data were collected using in-depth interviews and analyzed using content analysis. Investigator triangulation and member checking were used to ensure rigor. Five salient themes emerged that highlighted the individual, gender/relationship power factors, and the sociocultural elements that influenced sexual protection or risk-taking behavior. Findings provide new insight into the complexities of HIV sexual risk behavior and can guide future HIV prevention interventions for middle-age, African American, urban women.

Women’s decision-making about self-protection during sexual activity in the deep south of the USA: a grounded theory study

“…Many of the women who were HIV-infected described a willingness to make concessions in order to preserve their relationship with a male partner. The concept of trust, supported in prior studies (Deardorff et al 2013; Mallory 2008; Paranjape et al 2006; Smith 2015) emerged as an important factor in women’s decisions to forgo the use of condoms when engaging in sexual behaviours. Trust was described as assuming their partner would not expose them to an STI, trusting their partner’s assurance that he was not infected and forgoing condom use as a declaration of her trust within their relationship.…”

“…Research related to HIV acquisition among women, particularly minority women living in Southern states, has primarily focused on gaining an understanding of the individual and sociocultural factors that influence the practice of risky sexual behaviours (Mallory 2008; Mullinax et al 2016; Nunn et al 2012; Paranjape et al 2006; Smith 2015; Teitelman et al 2015; Villar-Loubet et al 2016). Trust, the imbalance of power and an unequal gender ratio have been found to be important factors that influenced women’s use of condoms when engaging in risky sexual activity, especially in the case of long-term relationships.…”

“…Trust, the imbalance of power and an unequal gender ratio have been found to be important factors that influenced women’s use of condoms when engaging in risky sexual activity, especially in the case of long-term relationships. (Bontempi, Eng, and Crouse 2008; Dauria et al 2015; Ferguson et al 2006; Jenkins Hall and Tanner 2016; Mallory, Harris, and Stampley 2009; Mullinax et al 2016; Smith 2015). …”

Evaluating HIV Risk Factors and Willingness to Use Prep among African American Collegiate Women

“…The CDC (2014) formulated the following indicators for PrEP prescription: women at substantial risk are those who have an HIV-positive sexual partner, had a recent STI infection, have a high number of sexual partners, use condoms inconsistently, trade sex, and women who live in a HIV high prevalence network (e.g., Jackson, MS). Accordingly, the present study's HIV risk questions were selected from a national epidemiological study of adults with indications for PrEP prescription (Smith, 2015). Example questions include "In the last 12 months, have you been treated or received medication from a doctor or other medical care provider for a sexually transmitted disease like gonorrhea.…”

Women 50 and Older and HIV: Prevention and Implications for Health Care Providers

“…In addition, sexual health studies have mainly concentrated on the reproductive health of younger women and not risk factors for HIV among older women (Taylor et al, 2017); therefore, the risk of HIV transmission among older women is not well known and has not been thoroughly described in the literature. Previous studies have underscored HIV risk among older women (Beaulaurier et al, 2014;Jacobs & Kane, 2011;Lindau, Leitsch, Lundberg, & Jerome, 2006;Smith, 2015;Zablotsky & Kennedy, 2003). These studies also provided insight about the risk of HIV transmission among older women.…”