Abstract: African American women, including adolescents and adults, are disproportionately affected by the transmission of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). HIV/ AID is a health disparity issue for African American females in comparison to other ethnic groups. According to data acquired from 33 states in 2005, 64% of women who have HIV/ AIDS are African American women. It is estimated that during 2001-2004, 61 % of African Americans under the age of 25 had been living with HIV /AIDS. This article is an analytical review of the literature emphasizing sexual assertiveness of African American women and the gap that exists in research literature on this population. The multifaceted model of HIV risk posits that an interpersonal predictor of risky sexual behavior is sexual assertiveness. The critical themes extracted from a review of the literature reveal the following: (a) sexual assertiveness is related to HIV risk in women, (b) sexual assertiveness and sexual communication are related, and (c) women with low sexual assertiveness are at increased risk of HIV. As a result of this comprehensive literature, future research studies need to use models in validating sexual assertiveness interventions in reducing the risk of HlV/ AIDS in African American women. HIV/ AIDs prevention interventions for future studies need to target reducing the risk factors of HIV/ AIDS of African Americans focusing on gender and culture-specific strategies.
Key Words: HIV/AIDS, Sexual Assertiveness; African American Women; Communication
African American women, including adolescents and adults, are disproportionately affected by the transmission or Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). In the United States, health disparities exist related to HIV / AIDS among African American females in comparison to other ethnic groups (Arya, Behforoz, & Viswanath, 2009). HIV /AIDS is rising among African American women (CDC, 2008; CDC, 2007b). Currently, HIV /AIDS is the leading cause of death for black women (including African American women) in the 25-34 years age group. It is the third leading cause of death for black women aged 35^4 years and the fourth leading cause of death for black women aged 45-54 years (CDC, 2008; CDC, 2007b). African American women are affected with HIV / AIDS 25 times more than white women and four times more than Hispanic women (Hatcher, Burley & Lee-Ouga, 2008).
Healthy People 2010 Initiative is a set of 10-year health objectives by the Surgeon General developed to improve the health of the American people (CDC, 2010). This initiative continues to address the disproportionate impact of HIV /AIDS among certain racial and ethnic groups such as the African American women (CDC, 2010). According to data acquired from 33 states in 2005, 64% of women who have HI V / AIDS are African American women (CDC, 2007a; CDC, 2007b). It is estimated that during 2001-2004, 61% of African Americans under the age of 25 had been living with HIV/AIDS.
Having unprotected sex with a man who has HIV is the most common way African American women acquire HIV/ AIDS (CDQ 2007a; CDC, 2007b). Abstinence, sexual contact without the exchange of bodily fluids, and latex condom use are three ways that women can protect themselves (Quina, Harlow, Morozoff, & Burkholder, & Deiter, 2000). Yet, sexually active women must assert themselves in heterosexual relationships by communicating information, initiating wanted sex, refusing unwanted sex, and preventing pregnancies and sexually transmitted diseases (Morokoff et al., 1997). While these options are available to women, the dramatic increase in HIV /AIDS over the years is evidence that women are not protecting themselves.
The HIV / AIDS prevention intervention literature, which has traditionally focused on individual variables, has been criticized for ignoring contextual variables (Amaro & Raj, 2000; Logan, Cole, & Leukefeld, 2002; Mize, Robinson, Bockting, & Scheltema, 2002; Morokoff et al. …