Condoms and Consequences: HIV/AIDS Education and African American Women

Article excerpt

Low income African American mothers of elementary school children in Oakland, California, participated in six prevention training sessions that fused education about HIV/AIDS with other life-skills and resources. This exploratory intervention, known as the Healthy Mamas Project, was based on the Theory of Reasoned Action with inclusion of self-efficacy. Responses to a questionnaire at baseline and at 3-month follow up show that all women (N=15) entered the training program with, and sustained, a high level of knowledge about HIV/AIDS. Based on self-reports of attitudes and behaviors at the 3-month follow-up, training affected only some women beneficially. Overall, 42% of the participants expressed increased trust in and resolve to use condoms to reduce the likelihood of acquiring HIV infection. Differences in demographic characteristics and sexual practices distinguished women who accepted the educational messages about condoms from participants who did not. The intervention did not sufficiently recognize or address the social contexts that informed the beliefs and behaviors of the women. In particular, women who were not beneficially influenced by the training prioritized short-term goals (such as establishing a sexual relationship, fulfilling emotional needs, providing for children) over long-term goals (such as avoiding HIV infection).

Key words: condoms, AIDS, women, intervention, risk; US, California, Oakland

Faced with the knowledge that in the US more than half of the women with AIDS are African American and that this population has been underrepresented as a target for AIDS education, an interdisciplinary team created a six session HIV/ AIDS education program for Black women. Based on Ajzen and Fishbein's (1980) Theory of Reasoned Action, the project designed its training sessions to cover topics such as: developing ethnic and gender pride, understanding facts on HIV/AIDS, undergoing assertiveness training, enhancing communication skills, eroticizing condom use, and learning behavioral selfmanagement of sexual practices, and coping skills. This report describes this exploratory intervention/education program, and evaluates its impact on a small group of low-income, mainstream African American women. This intervention was unable to effect behavioral change with respect to condom use in this most vulnerable segment of the population, because it overlooked the social context(s) in which women were negotiating their sexual contacts.

Women at Risk

For nearly a decade the proportion of cases of HIV/AIDS among women has been on the rise. In 1994, 18% of those in the US with AIDS were women, nearly triple the 7% proportion reported in 1985 (CDC 1995). One-fourth of HIV infection is transmitted heterosexually. Male-to-female transmission of HIV is between two and 12 times more likely to occur than femaleto-male transmission (Amaro 1995; Mongella 1995). In accordance with this disproportionate risk, it is estimated that around three quarters of the cases of HIV infection transmitted heterosexually are reported by women (Stuber 1995). It is, therefore, imperative to educate women about HIV/AIDS and to teach them skills to reduce heterosexual transmission of the virus.

Although African Americans represent 12% of the US national population, the Centers for Disease Control report that 54% of women diagnosed with AIDS are African American (Amaro 1995). Rates of HIV in African American women are 16 times higher than in white women (CDC 1995).

There are limited studies that examine behaviors in relation to HIV transmission among low income African American women outside of sub-groups engaged in high risk behaviors (Hahn 1991; Rosenberg et al. 1992). Most studies conducted among low income African American women that have investigated HIV testing, sexual and behavioral characteristics, and prevalence of seropositivity, have focused on drug rehabilitation clients, sex industry workers, and women attending sexually transmitted disease (STD) or prenatal clinics (CDC 1990; Corby et al. …