‘Pain on Top of Pain,Hurtness on Top of Hurtness’: Social Discrimination,Psychological Well-Being,and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT

This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than $10,000 per year (80%), and acquired HIV through heterosexual sex (58%). Analyses demonstrated that social discrimination manifested in the women's lives as poverty, HIV/AIDS-related stigma, and gender inequality. These experiences caused intense psychological distress and limited WLH/A's ability to implement the safer-sex skills that they learned during the intervention. We discuss the applied and theoretical implications of our findings, advocating for HIV and sexual risk-reduction interventions that are based on an ecological framework that addresses holistically the individual, relational, and sociostructural factors that affect women's sexual risk behaviors.     

Masturbation and Sexual Health

Abstract

In this study we applied research examining the hypothesized benefits of masturbation in dealing with sexual problems to the urgent health crisis posed by the HIV/AIDS pandemic. This is the first study to test the hypothesized relationship between masturbation and HIV risk as predicted by the Sexual Health Model, a sex-positive approach to sexual health developed in response to the need for a more explicit focus on sexuality and relationships in HIV prevention. This is also the first study to examine the relationship between several masturbation variables (i.e., masturbation guilt, lifetime masturbation, and current masturbation) and HIV-related sexual behaviors and attitudes in a sample of African American women (N =239). Data was collected using face-to-face structured interviews as part of the Women's Initiative for Sexual Health (WISH), a randomized, controlled trial of an HIV prevention intervention based on the Sexual Health Model, targeting low income, adult African American women. Contrary to expectations, results showed that participants who reported masturbating were more likely to report having multiple partners, being in a nonmonogamous relationship and engaging in high-risk sexual behaviors. There was no significant relationship between level of masturbation guilt and HIV risk nor between masturbation and consistent condom use or attitudes toward condoms. This study adds to the growing empirical support for associations between sexual health variables and safer sex and argues for a more explicit focus on sexuality in HIV prevention.     

Delivering LGBT-sensitive substance use treatment to sexual minority women

Abstract

Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for “lesbian, gay, bisexual, and transgender (LGBT)-specific” services and culturally tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N?=?10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.     

Gender attitudes,sexual violence,and HIV/AIDS risks among men and women in Cape Town,South Africa

This study examined gender attitudes and sexual violence‐supportive beliefs (rape myths) in a sample of South African men and women at risk for HIV transmission. Over 40% of women and 16% of men had been sexually assaulted, and more than one in five men openly admitted to having perpetrated sexual assault. Traditional attitudes toward women's social and gender roles, as well as rape myths, were endorsed by a significant minority of both men and women. Multivariate analyses showed that for men, sexual assault history and rape myth acceptance, along with alcohol and other drug use history, were significantly related to cumulative risks for HIV infection. In contrast, although we found that women were at substantial risk for sexually transmitted infection (STI), including HIV, women's risks were only related to lower levels of education and alcohol use history. We speculate that women's risks for STI/HIV are the product of partner characteristics and male‐dominated relationships, suggesting the critical importance of intervening with men to reduce women's risks for sexual assault and STI/HIV.     

Achieving the Optimal Vaginal State: Using Vaginal Products and Study Gels in Uganda,Zimbabwe, and South Africa

Preferences and practices related to the vaginal condition have implications for the use of vaginal HIV prevention products. The authors used qualitative methods to explore narratives relating to the vaginal state amongst women in South Africa, Uganda, and Zimbabwe who had previously participated in a biomedical HIV prevention trial. They investigated women's behaviors related to optimizing the vaginal state, experiences and perceptions of the gel's effect on the vaginal state and on penile-vaginal intercourse, women's narratives on male partner perceptions, and how preferences relating to the vaginal state may have interfered with gel use.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Strengths and coping strategies in the life narratives of sexual minority women

This study explored self-described strengths and strategies for coping with stress among sexual minority women (SMW), drawing on qualitative narratives of sexual minority and heterosexual women who were recruited from a population-based sample. In-depth follow-up qualitative telephone interviews were conducted with 48 women who had participated in the National Alcohol Survey, a U.S. population-based survey. Participants included 25 SMW and 16 matched exclusively heterosexual women. Narrative data were analyzed using inductive thematic analysis and constant comparison to explore the study aim, with an emphasis on themes that diverged or that were particularly salient for SMW relative to heterosexual women. Strengths and coping strategies that were especially meaningful in the narratives of sexual minority women emerged in two areas. First, participants described development of intrapersonal strengths through nurturing an authentic sense of self and embracing multifaceted identity. Second, participants described multiple strategies for cultivation of interpersonal resources: navigating distance and closeness with family of origin, cultivating supportive friends and chosen family, connecting to community, finding solace and joy with animals, and engaging in collective action. Findings underscore the importance of considering protective factors that are salient to SMW in developing or refining prevention and intervention efforts.     

Rapid Ethnographic Assessment of HIV/AIDS among Garífuna Communities in Honduras: Informing HIV Surveillance among Garífuna Women

ABSTRACT

Garífuna, an Afro-Caribbean ethnic group in Honduras, have among the highest HIV prevalence rates in Central America; 15- to 49-year-old Garífuna have HIV rates comparable to heterosexual transmission rates in regions of sub-Saharan Africa. The heightened rates in this age range pose a significant risk of vertical transmission from woman to child at birth. In 2006, a Behavioral Surveillance Survey plus Biomarkers (BSS+) reexamined seroprevalence of HIV, sexually transmitted infections, and HIV-related risk behaviors among Garífuna to inform HIV prevention activities and monitor trends in HIV transmission over time. To inform the BSS+ survey protocol, we conducted a rapid ethnographic assessment (REA) in Garífuna communities to specifically examine acceptability among Garífuna to be surveyed, suggest ways to minimize HIV-testing related stigma, and determine female gender-specific concerns among BSS+ respondents. Data were collected in 2 weeks in November, 2004, using a semi-structured interview guide for key informant interviews and focus groups. Seventeen key informant interviews and three focus groups were conducted; participant observation and 11 site visits were also conducted. Major findings included high Garífuna acceptability to participate in the BSS+ with key member involvement and incentives. Maintaining confidentiality at HIV testing sites is required to minimize Garífuna women's risk of intimate partner violence. Recommendations to BSS+ partners from this REA informed the BSS+ study protocol and was expected to increase participation and validity and decrease potential risks associated with women's survey participation.     

A Model Program for Increasing Treatment Access for African American Women Who Use Crack Cocaine and Are at Risk of Contracting HIV

ABSTRACT

In the United States, the threat of HIV/AIDS to African-American women's health has become the focus of much concern. This article describes a federally funded community-based program that provides services to African-American women at risk for HIV/AIDS in Nashville, TN. This program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important to the continued development of culturally relevant interventions that are vital to stemming the disproportionate rates of HIV/AIDS within the African-American community by ensuring treatment access to all populations.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.     

HIV Testing Among Heterosexual Young Adults: The Influence of Partners' Risk Behaviors and Relationship Dynamics

Using relational theory and survey data from the Toledo Adolescent Relationships Study (n = 665), this article examined whether individuals were tested for HIV while intimately involved in a current or recent heterosexual relationship. The analyses included the respondent's and partner's sexual risk factors (non-exclusivity and lifetime number of partners), relational variables, prior testing, and demographic characteristics. It was found that 39% of respondents had an HIV test while involved in their current or most recent sexual relationship, and women (47%), compared with men (29%), were significantly more likely to have been tested. Whereas some predictors operated similarly (number of sex partners and pressured to have sex), others displayed significant gender differences (partner's sexual exclusivity, sexual communication difficulties, and pregnancy), particularly related to women's testing behaviors. Excerpts from qualitative interviews with male respondents suggested that some relational dynamics, not well reflected in relational theory, played a role in their testing. Results highlight the need to consider gendered dynamics when targeting young adults for routine HIV testing.     

HIV Prevention Programs in the Black Church: A Viable Health Promotion Resource for African American Women?

ABSTRACT

Nearly 40 million people worldwide are living with the human immunodeficiency virus (HIV). The Centers for Disease Control report that women account for more than 50% of the existing 40 million HIV/AIDS cases to date. Moreover, African-American women are infected with HIV/AIDS 25 times more often than white women and four times more often than Hispanic women, making HIV/AIDS the leading cause of death for black women ages 25–34. Given the increasing rate of transmission with this population, the purpose of this article was to review the existing literature to investigate the risk factors associated with African-American women with HIV/AIDS and identify an effective method of HIV prevention for them. A discussion of religion and African-Americans in terms of the Black church and its health promotion efforts was also included. The article concludes with a discussion of program elements of HIV prevention programs in the Black church and possible challenges faced for the programs.     

After Breast Cancer: Sexual Functioning of Sexual Minority Survivors

Research on sexual difficulties after cancer has neglected sexual minority women (SMW); for example, lesbian and bisexual women. Clinicians treating these women are therefore at a disadvantage as they lack information about sexual problems in this population. This study tested the hypothesis that SMW with breast cancer have poorer sexual function than SMW without breast cancer, distinguishing partnered from unpartnered women. Using convenience sample recruitment, we conducted a case-control study to compare survivors of breast cancers who are SMW, in other words, cases to controls, that is, SMW without cancer. Anonymous survey data were collected from 85 cases after they had completed active cancer treatment and 85 age- and partner-status matched controls with no history of any cancer. Participants' self-reported sexual frequency and sexual function measured by the Female Sexual Function Index were evaluated. Cases and controls did not differ in risk of sexual dysfunction or the level of overall sexual functioning; however, cases had lower sexual frequency and scored lower on desire and ability to reach orgasm, and higher on pain compared to controls. Results inform clinicians about sexual minority survivors' sexual domains affected by cancer. When discussing sexual problems and therapeutic options, sexual orientation should be ascertained.     

The Prison Lesbian Revisited

Abstract

One aspect of women's imprisonment that has received consistent scholarly and public interest is homosexuality. These experiences are generally seen as a subcultural adaptation to the stresses and deprivations of the environment, that is, as situational, and little attention has been given to the implications they might have for the sexual identity of the women involved or to the possibility that some women may continue involvement in same-sex relationships after prison. In-depth interviews with 40 incarcerated women were conducted to explore their experiences with same-sex relationships in prison. Some condemned same-sex relationships but others became involved in them for companionship and other reasons. While some women saw their involvements as limited to prison, others were questioning their sexual identity and thought they might continue the same or other same-sex relationships on the outside.     

Young Parents’ Relationship Characteristics,Shared Sexual Behaviors,Perception of Partner Risks,and Dyadic Influences

Rising rates of heterosexually transmitted HIV among youth and young adults, particularly from ethnic minorities, create an urgent need to understand risk factors and perceptions of risk within the context of couple relationships. This study examined reports of young mothers and fathers (predominantly Latino) about background characteristics, relationship quality and length, HIV-related risk factors, and perceptions of partners’ behaviors and personal history. Higher concordance was found for relationship characteristics and partners' personal history (e.g., incarceration) than on shared sexual behaviors. Most males and females stated that they were monogamous; however, those whose partners reported concurrency were unaware of this. Many were unaware of their partners’ HIV testing status. Relationship quality was higher when females accurately perceived their partners' self-reported HIV-related risk behaviors. Length of the relationship did not influence concordance. Findings support the need for HIV prevention programs to promote open discussion about condom use and HIV testing within sexual partnerships.     

HIV prevention barriers in transgender women: a qualitative study

Abstract

Sexual contact is still one of the most important routes of HIV transmission. The aim of this study was identify the factors that underlie the higher prevalence of high-risk sexual behaviors in a sample of transgender women in Iran. The qualitative study used face-to-face, semi-structured, in-depth interviews in a sample of 15 transgender women. Our participants used sexual practices as a way to be approved/accepted as a woman. Using sex for this purpose led them to engage in high-risk sexual relationships. It is essential to consider these issues in consulting and education about high-risk behaviors.     

Sexual orientation differences in HIV testing motivation among college men

Objective: To investigate sexual orientation differences in college men's motivations for HIV testing. Participants: 665 male college students in the Southeastern United States from 2006 to 2014. Methods: Students completed a survey on HIV risk factors and testing motivations. Logistic regressions were conducted to determine the differences between heterosexual men (HM) and sexual minority men (SMM). Results: SMM were more motivated to get tested by concern over past condomless sex, while HM were more often cited supporting the testing program “on principle” and wanting a free t-shirt. SMM and HM differed in behaviors that impact HIV risk and other demographics. However, differences in testing motivation by concern over past condomless sex or wanting a free t-shirt persisted when controlling for these demographic and behavioral differences. Conclusions: Appropriately designed HIV prevention interventions on college campuses should target SMM's distinct concern over past condomless sex as a testing motivation.     

“It's a Different Condom,Let's See How It Works”: Young Men's Reactions to and Experiences of Female Condom Use During an Intervention Trial in South Africa

Although male partner cooperation is often essential for successful use of the female condom, only a few studies have directly assessed men's experiences of using the device. We examined barriers to and facilitators of female condom use via qualitative in-depth interviews with 38 young men (18 to 28 years) in South Africa whose partners, all university students, were enrolled in a female condom intervention trial. In all, 21 men used the female condom; the remaining 17 did not attempt use. The main facilitators to female condom use were convenience of use for men, curiosity to see how female condoms compared to male condoms, enhanced sexual sensation, and perceptions of better safety and comfort of the device compared to male condoms. The main barriers were men's limited familiarity with the device, insertion difficulties, and men's concerns about loss of control over sexual encounters. We recommend that human immunodeficiency virus (HIV) prevention and condom promotion programs around the world target men directly for education on female condoms and that they also work with couples jointly around issues of safer-sex communication and negotiation.