African American women's safer sexual practices: the influence of ethnic-racial socialisation and body esteem

Being fast or cautious? Sociocultural conditions influencing the sexual pathways of Black females in the United States

BACKGROUND

Black females in the United States face unique sociocultural conditions that impact their sexual development and increase their risk for sexually transmitted infections (STI), including but not limited to chlamydia, gonorrhea, and HIV. Research has not adequately explained how sociocultural conditions contribute to this increased risk. The purpose of our investigation was to explore the sociocultural conditions that influence Black cisgender females risk for STI.

METHODS

This grounded theory study involved in-depth audio-recorded interviews with 20, primarily heterosexual, Black females ages 19-62.

RESULTS

Findings informed a conceptual model that builds on previous theory about the sexual development of Black females and explains how sociocultural conditions impact two, participant identified, sexual pathways: Fast and Cautious. Movement on these sexual pathways was not always a linear trajectory; some participants shifted between pathways as their sociocultural contexts changed (i.e., sexual assault, STI, and level of protection). The Fast sexual pathway often led to greater STI risk.

CONCLUSIONS

This model may inform future research designed to prevent STI/HIV and promote the sexual health of Black females across the life course.

A Systematic Review Exploring Racial Disparities, Social Determinants of Health, and Sexually Transmitted Infections in Black Women

OBJECTIVE

To explore and describe racial disparities, the role of social determinants of health, and individual risk behaviors among Black women as related to sexual health and/or sexually transmitted infections (STIs).

DATA SOURCES

Electronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2010 to 2020 were considered.

STUDY SELECTION

Thirty-two studies met the criteria and included data for a total of 18,904 Black women.

DATA EXTRACTION

Data were extracted from each study using the subheadings author (year), purpose, design, sample demographics and setting, key measures, key findings, and quality assessment. In addition, PRISMA-E and PROGRESS-Plus guided data extraction to illustrate health inequity.

DATA SYNTHESIS

Black women who were more likely to report having an STI over the course of their lifetime engaged in behaviors associated with greater risk, the most common of which were unprotected sex, disproportionate partner power, and substance abuse. The primary social determinants of health associated with increased risk were lower income and lower levels of education. Black women were less likely to discuss or feel comfortable discussing their sexual health with health care providers. By contrast, engagement in safe sexual practices stemmed from internal, social, and relationship factors.

CONCLUSION

Identifying Black women who are at risk of contracting an STI is essential in driving clinical decision-making. Health care providers should be cognizant of the long-standing mistrust that Black women have of health care providers and, therefore, work to establish positive respectful and trusting relationships with open communication.

Trichomoniasis, a new look at a common but neglected STI in African descendance population in the United States and the Black Diaspora. A review of its incidence, research prioritization, and the resulting health disparities

Structural racism plays a significant role in limited access to higher education, financial resources, employment opportunities, and high-quality healthcare for African Americans. The lack of healthcare equity and infrastructure has directly contributed to overall poor healthcare outcomes for the Black community. Studies have shown that adverse health outcomes such as sexually transmitted diseases (STDs) are more prevalent in African Americans, regardless of their socioeconomic factors and lifestyles. For example, trichomoniasis, transmitted sexually by its etiological agent, Trichomonas vaginalis (T. vaginalis), predisposes those infected to co-infections with other STDs, such as human immunodeficiency virus (HIV), herpes, and other related infections. Our review showcases the impact of trichomoniasis on the health of the Black community with an emphasis on African American women. A critical examination of the socio-demographic history of Black people in the United States (US) is vital to illustrate the origin of past and current racial health disparities. Further, we expand the complex and nuanced conversation on the intersectionality of racism, health equity, and innovative epidemiological and biomedical research strategies needed to eradicate this global public health threat.

Body Image Related to Sexual Health: Development of the Concept

INTRODUCTION

Disturbances in body image can have an impact on sexual health and are prevalent in women of reproductive age. Although body image is important, the definition of this concept is inconsistent across the disciplines of nursing, medicine, and psychology. Use of a consistent definition in clinical practice and research could lead to a more comprehensive understanding of disturbances in body image, thereby advancing research-based knowledge and clinical practice. The purpose of this concept development was to advance the concept of body image as it relates to sexual health among women of reproductive age from the perspectives of 3 disciplines with a strong focus on body image: nursing, medicine, and psychology.

METHODS

Strategies for concept development as described by Rodgers provided the basis for this work. The process includes a search, review, and synthesis of the literature surrounding the concept of interest.

RESULTS

Seventy-one articles, mostly qualitative and quantitative descriptive, were included and used to develop the concept. Body image related to sexual health in women of reproductive age is a multifaceted concept that is composed of an emotional and behavioral response to one's perceived appearance, sexuality, and degree of femininity. An individual's body image is influenced by sociocultural identities, race, ethnicity, and health status. It has both physical and psychological impact on health outcomes.

DISCUSSION

This interprofessional and comprehensive definition of body image should enhance understanding, assessment, and management of body image disturbances, thus bridging disciplines and enhancing interprofessional research and practice.

Addressing sexually transmitted infections in the sociocultural context of black heterosexual relationships in the United States

RATIONALE

Black girls and women are disproportionately affected by sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Research shows sexual networks, sexual concurrency, and assortative mixing impacting racial disparities in STI/HIV. However, the underlying sociocultural conditions of these phenomenon have yet to be fully explored within a framework of Black girls' and women's sexual development.

OBJECTIVE

This grounded theory study investigated the sociocultural conditions and processes of becoming a sexual Black woman in order to understand the sociocultural drivers of STI/HIV rates among this group.

METHOD

We used theoretical sampling to select and interview 20 Black women aged 19-62 years old from a Midwestern community.

RESULTS

This study revealed sociocultural conditions related to Black heterosexual relationships and STI/HIV risk. Protecting Black men, silencing Black girls and women, cultural norms and messaging about sexuality, and gendered societal expectations and sexual stereotypes contribute to STI/HIV risk in Black girls and women.

CONCLUSIONS

Our findings demonstrate how the intersection of social and systemic structures (i.e.,history, incarceration, unemployment) shape the context of Black heterosexual relationships. We suggest STI/HIV prevention efforts address these systemic, cultural, and societal factors in order to effectively reduce racial disparities in STI/HIV risk.

Safer sexual practices among African American women: intersectional socialisation and sexual assertiveness

Scholars have posited that childhood socialisation experiences may play a key role in influencing behaviours and attitudes that contribute to the acquisition of HIV. This study examined the links between past ethnic-racial and gender socialisation, sexual assertiveness and the safe sexual practices of African American college women utilising a cluster analytic approach. After identifying separate racial-gender and ethnic-gender socialisation profiles, results indicated that ethnic-gender socialisation cluster profiles were directly associated with sexual assertiveness and safer sex behaviour. Greater levels of ethnic socialisation and low traditional gender role socialisation were found to be associated with greater sexual assertiveness and safer sex behaviour. Further analysis showed that sexual assertiveness mediated the links between the identified ethnic-gender socialisation profiles and safer sex behaviour. Implications for policy and programme development are discussed.

Toward a Relational Understanding of Objectification, Body Image, and Preventive Sexual Health

There is a wealth of empirical support for objectification theory. Researchers have suggested an extension to the theory that includes risky sexual behaviors as a consequence of body shame. However, there are no known studies that place the association between body image and sexual behavior in the context of the interpersonal sexual relationship. The current study was grounded in objectification theory and relational cultural theory and sought to better understand how negative self-objectification, body appreciation, relationship quality, and preventive sexual health behaviors are related. An online survey was conducted with 399 emerging adult women in the Midwest, and the proposed model was tested using structural equation modeling (SEM). The results suggest that, among this sample, negative self-objectification was indirectly related to preventive sexual health behaviors through body appreciation alone and through both body appreciation and relationship quality. Implications for clinical practice and future research are discussed.

"Condoms are the standard, right?": Exploratory study of the reasons for using condoms by Black American emerging adult women

Condoms are considered a highly effective form of sexually transmitted infection prevention for heterosexual sex. Black American women (BAW) have been and are at elevated risk for heterosexual exposure to human immunodeficiency virus (HIV) because they have been and continue to be less likely to negotiate condom use with a partner that supports them financially. However, BAW who have made tremendous educational gains may still encounter challenges regarding the distribution of power that can affect condom use and negotiation. The purpose of this exploratory study was to examine the reasons that highly educated, emerging, adult BAW reported for using condoms. One hundred twenty-seven emerging adult BAW (ages 18-29 years) completed a mixed-methods online survey during the spring of 2013 (January-May). Approximately 80% of the women were in college or college graduates. They had a high rate of previous HIV testing (68.5%). Through the use of an interpretive paradigm and grounded theory, three themes emerged regarding the reasons that the participants in this sample used condoms as their primary form of protection: (1) the reliable "standard," (2) pregnancy prevention, and (3) cost effective and "easily accessible." Findings are discussed in terms of their public health significance for this seemingly lower-risk population.

Self-objectification and condom use self-efficacy in women university students

This study investigated the roles of indicators of the self-objectification process in women's condom use self-efficacy. Data were collected from 595 college women. Self-objectification variables were assessed with measures of internalization of cultural standards of beauty, body surveillance, and body shame. Participants also completed measures of perceived control over sexual activity, acceptance of sexuality, and condom use self-efficacy. Measurement and structural invariance were supported, indicating that the measurement model and hypothesized structural model did not differ across participants who were or were not sexually active. Structural equation modeling results were consistent with hypotheses and prior evidence indicating that body surveillance partially mediated the link between internalization of cultural standards of beauty and body shame. Results also indicated that body shame was associated with lower condom use self-efficacy both directly and indirectly through the partial mediation of perceived control over sexual activity; acceptance of sexuality was not a significant mediator of this link but was associated directly with greater condom use self-efficacy. These results connect the substantial literature on the self-objectification process with women's condom use self-efficacy. Specifically, these results point to interrupting the self-objectification process and reducing body shame as well as to enhancing acceptance of sexuality and control over sexual activity as potentially fruitful targets for interventions to promote women's condom use self-efficacy.

'Men don't need to know everything': a field trial of a discreet, female-initiated, contraceptive barrier method (FemCap™) among Haitian-American women

Worldwide, women report the need for safe, non-hormonal, woman-initiated methods of family planning. Cervical barriers provide such technology but are under-researched and under-promoted. In the USA, there are few studies of cervical barriers among women at high unmet need for contraception. A feasibility study of the FemCap™ was conducted among US women of Haitian origin. Participants were heterosexual and seeking to avoid pregnancy. At first visit, participants completed baseline assessments, underwent group counselling and were fitted with FemCap™. Women were asked to insert or use the cap at home. The second visit (2-3 weeks) included an interviewer-administered questionnaire and a focus-group discussion. Participants (n  =  20) were Haitian-born (70%), married (55%) and parous (85%). Their mean age was 32.6 years. Seventy percent reported recent unprotected sex. All women inserted the device at home and 9 women used it during intercourse, including 5 without prior partner negotiation. Of 20 women, 11 liked FemCap™ very much or somewhat; 7 considered it 'OK'; 2 disliked it. Best-liked attributes were comfort, discreet wear and reusability. Difficulties with removal abated over time. Qualitative data revealed a high value placed on lack of systemic side effects. Use of FemCap™ was feasible and acceptable, supporting expansion of research, particularly among relevant populations with unmet need.