Sex With Bisexual Men Among Black Female Students at Historically Black Colleges and Universities

Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal?

Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.

Using Qualitative Methods to Understand Perceptions of Risk and Condom Use in African American College Women: Implications for Sexual Health Promotion

BACKGROUND

Young African American women are disproportionately affected with sexually transmitted infections (STIs) and unintentional pregnancies. Despite adequate knowledge, assertiveness, and negotiation skills, consistent condom use remains low.

AIMS

We sought to assess the role of pregnancy and STI risk perception in condom decision making among African American women.

METHOD

We conducted a phenomenological qualitative study. Utilizing a purposive sampling strategy, 100 African American women (18-24 years) were recruited from a historically Black college and university for an open discussion of condom use. Thirteen focus groups were conducted via a semistructured interview guide and analyzed with an inductive thematic approach.

RESULTS

Uniformly women perceived pregnancy as a greater threat than STIs which appears to be maintained by (a) their sense of fertility, (b) self-care concept, and (c) experiences with condom failure. Thus, women were skeptical about using condoms as a form of contraception. Women perceived casual sex as having the greatest HIV/STI risk and emphasized the importance of assertiveness and self-respect to negotiate condom use. However, condom use in monogamous relationships is less likely due to (a) testing/knowing partner's status, (b) relationship trust, and (c) the use of hormonal contraception for pregnancy prevention. Perceived threat of infidelity increases condom use.

CONCLUSION

The implications of these findings suggest sexual health promotion programs may focus on improving women's estimate of the effectiveness of condoms to prevent pregnancy and addressing women's reliance on testing for STI prevention.

Partnerships between Black Women and Behaviorally Bisexual Men: Implications for HIV Risk and Prevention

Although an estimated 87% of new HIV infections in Black/African American women are attributed to sex with men, many women are unaware of their male partners' HIV risk factors. Research on women who are aware of a high-risk male partner may inform HIV prevention. We analyzed transcripts from semi-structured interviews with 20 Black women who reported sex with at least one man who had sex with men and women (MSMW) in the prior 5 years. We applied Choice and Sexual Network theories to the interpretation. The majority described their partnerships as committed and involving emotional or instrumental support. Substance abuse was a common component of the relationships and very few involved consistent condom use. Although nearly all respondents described it as alarming to learn of their partners' involvement with other men and several ended the relationships, many continued the relationships without protective changes in their sex behavior. These narratives indicate that although many leave, many other women remain in relationships after learning of a male partners' high-risk activity. Substance abuse, financial instability, and a desire to remain in intimate partnerships may discourage preventive actions in these women.

Beyond the bisexual bridge: sexual health among U.S. men who have sex with men and women

CONTEXT

Men who have sex with both men and women (MSMW) experience health problems in ways that distinguish them from men who only have sex with men (MSM) and men who only have sex with women (MSW). Historically, an undue focus on MSMW's potential role in transmitting HIV to women has resulted in limited understanding of these men's unique sexual health needs. This article discusses the sexual health of MSMW in the U.S.

EVIDENCE ACQUISITION

The author searched PubMed, Sociological Abstracts, PsycINFO, and GoogleScholar to acquire peer-reviewed studies pertaining to MSMW that were published during January 2008 and December 2013. Reference lists for these studies provided additional studies not acquired through this search.

EVIDENCE SYNTHESIS

MSMW are more likely than MSW to be infected with HIV. MSMW may be at increased risk for some other sexually transmitted infections (STIs) compared with both MSW and MSM. Some factors that affect their sexual health include unprotected sex, early sexual debut, forced sexual encounters, increased numbers of sexual partners, substance use, exchange sex, risk behaviors of their male and female partners, and pregnancy-related considerations. These factors uniquely shape MSMW's vulnerability to HIV/STIs and other sexual health problems. Anti-bisexual sentiment, socioeconomic marginalization, culturally specific masculine ideologies, and sexual identity can negatively influence their sexual partnerships and likelihood of disease acquisition.

CONCLUSIONS

Risk-reduction interventions alone are likely insufficient to improve MSMW's sexual health. Efforts should also address the social contexts affecting MSMW in order to decrease HIV/STI vulnerability and mitigate other barriers to MSMW's sexual health.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

HIV risk behaviors among Black/African American and Hispanic/Latina Female partners of men who have sex with men and women

We examined the frequencies of HIV-related risk factors among women reporting and not reporting sex with a man who has sex with men and women (MSMW).We used data from 15,625 visits of Black and Hispanic/Latina females, ages 15–64 years, to Los Angeles County HIV testing sites (2007–2008). The following risk factors were associated with reporting an MSMW partner: number of sex partners, use of party drugs, anal sex, and sexual partners with other risk factors. Overall, females who reported an MSMW partner differed little in their likelihood of testing HIV positive (0.93%) compared to those who did not (0.58%, p value = 0.19). Among females reporting one male sex partner, having an MSMW partner was strongly associated with HIV (2.8 vs. 0.63%, p = 0.03). Interventions targeting women who report other risky behaviors may reach many who have been with MSMW. Women with one partner are an important focus of such efforts.

The paradox of risk: historically black college/university students and sexual health

OBJECTIVE

This literature review provides an analysis of the current state of the empirical research on sexual health among students attending historically black colleges and universities (HBCUs).

METHODS

Several electronic databases were used to identify 24 empirical studies that met criteria for inclusion in this review.

RESULTS

The results indicated that perceived human immunodeficiency virus (HIV) risk, religiosity, HIV testing, condom use, and substance use were as high or higher for black HBCU students in comparison with students of other racial/ethnic groups.

COMMENT

Consistent with past findings, sexually transmitted infections continue to be of concern among HBCU students, as seen in the general black population.

LIMITATIONS

This review only examined cross-sectional studies published between 2000 and 2013.

CONCLUSIONS

The findings in this review suggest the importance of moving beyond individual risk models to examining structural barriers and assets related to promoting sexual health on HBCU campuses.

African American women's perspectives on 'down low/DL' men: implications for HIV prevention

African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as 'down low' or 'DL'. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.