Are African American women worried about getting AIDS? A qualitative analysis.

The aims of this study were to explore and describe AIDS-related worry among African American women and determine whether AIDS risk behaviors were associated with women's AIDS-related worry status. Of 142 women interviewed, 36% (n = 51) expressed some worry about getting AIDS, compared to 64% (n = 91) who did not express worry. In general, both worried and nonworried women were equally likely to report risk behaviors such as no condom use or having risky sexual partners and no significant relationships were found between worry status and self-reported HIV/AIDS risk behaviors. Women gave several reasons for why they did or did not feel worried about getting AIDS. For example, 23% of worried women responded that they were worried about getting AIDS because of the uncertainty of their sex partners' risk behaviors. This contrasted strongly with the nonworried women, 10% of whom reported trusting their partners and 64% of whom reported engaging in some type of protective behavior. Results indicate that regardless of worry status, women were not protecting themselves by using condoms or using careful partner selection. Therefore we recommend that future HIV/AIDS educational intervention programs appeal to and encourage participation for all women whether or not they express concern about contracting the disease. In addition, programs must carefully address the issue of denial, and provide skills for assessing and modifying risky behaviors.

HIV risk among low-income African American mothers of elementary school children.

Data from 119 African American low-income mothers of school aged children in Oakland, California show that 38% engaged in behavior that might place them at risk of exposure to the human immunodeficiency virus (HIV). Risk behaviors that were investigated included having multiple partners and having a partner with an incarceration history. Of women studied, 23% were at risk because of multiple partners, while 15% were at risk as a result of having had an incarcerated partner. Women who were < or = 35 years of age were three times more likely to report having had an incarcerated partner compared to women > or = 36 years of age (22% vs. 6%) mean 2 = 5.59, P < or = .01). Single women were also more likely to report having had a partner who had been incarcerated, 21% compared to 9% of married women (mean 2 = 3.73, P < or = .05). Although no significant relationships were found with respect to condom use, a larger proportion of women with an incarcerated partner reported never using condoms (71%) compared to women without an incarcerated partner (63%); whereas, fewer women with multiple partners reported never using condoms (56%) compared to women without multiple partners (67%). Findings suggest that low-income African American women outside of traditional high-risk groups (i.e., generally studied in high-risk settings such as drug treatment centers, sexually transmitted disease [STD] clinics, hospitals or from the sex industry) may be at risk and should be targeted in HIV risk prevention programs. These women may not consider themselves to be at risk and are not generally targeted in HIV risk prevention programs because they are mothers, housewives, and working women.

HIV testing among low-income African-American mothers.

HIV testing patterns were examined among low-income African Americans who were mothers of young school-age children. In-person interviews were conducted to determine whether African-American women had been tested for HIV; their sexual behaviors, including the number of sexual partners and condom use; and health care access and utilization. Forty-one percent of the women had been tested for HIV; 18 percent tested more than once. Levels of education, source of primary health care, and type of insurance were not associated with HIV testing. The total number of sexual partners for their current lifetime and within the past five years was significantly associated with their HIV testing status (chi 2 = 39.97; DF = 3; p < .01 and chi 2 = 66.68; DF = 3; p < .01 respectively). Women who have used condoms during their last intercourse (20%) were less likely to have been tested than women who did not use a condom (50%) (p < .01). Results suggest that low-income African-American women get tested for HIV. This suggests that these women understand the concept of risk and how certain behaviors may place them at risk. However, these women still confront conditions that place them at risk, such as having sex with multiple partners and/or partners with a history of incarceration, in addition to drug use. HIV testing may not serve as the most effective intervention for this sub-population of women. Educational and preventive measures should extend to women outside traditional high-risk populations by incorporating methods to promote protective behavioral changes which will empower women with self-esteem and confidence.

Change in junior high school students' AIDS-related knowledge, misconceptions, attitudes, and HIV-preventive behaviors: effects of a school-based intervention.

A school-based AIDS-prevention program for junior high school students was developed and implemented in an inner-city area in northern California that serves predominantly African-American and Asian students. The curriculum, taught by science teachers, consisted of twelve classroom sessions using both didactic and interactive exercises covering sex education, HIV biology, drug use, decision-making and refusal skills, and public response to AIDS and community resources. Changes from baseline of self-reported responses to questions on pre- and posttests concerning AIDS knowledge and misconceptions, tolerance toward persons with AIDS, and high-risk behaviors were compared between intervention and control schools. Students in the intervention schools had a significant increase in AIDS knowledge (p < .0001) and became more tolerant of people with AIDS (p < .001) compared with students in the control school. Changes in high risk behavior could not be detected, perhaps due to the small number of sexually active students (24% of the sample). Students who increased their AIDS knowledge (p < .0001) as a result of the intervention became more tolerant of people with AIDS. A school-based HIV-prevention curriculum, taught by trained classroom teachers, can modify middle adolescents' HIV-related knowledge about the casual transmission of HIV, and their attitudes toward persons with AIDS.

Accessing an understudied population in behavioral HIV/AIDS research: low income African American women.

Most HIV/AIDS behavior research involving African American women has focused on traditional high risk populations, such as those in drug treatment centers, STD clinics, and hospitals. Few studies have examined the health needs and behaviors of African American women in the general population (i.e., working mothers and homemakers). The Parent Health Project examined beliefs and concepts of illness, including AIDS, of low income African American mothers of young children. We used a variety of methods of community outreach and recruitment strategies to gain access and trust from these African American women, including (1) recruitment of women who had children in a related research project, (2) subject reimbursement, and (3) culturally sensitive community based outreach. Of approximately 200 women contacted, 147 (74%) agreed to participate in a two-hour face-to-face interview about concepts of health and illness. Through our efforts, we were able to gain access to a population generally not studies in HIV/AIDS research. We were also exposed to a number of issues, concerns and behaviors faced by women not classified as high risk, yet who are at risk as a result of their own and/or their sexual partner's(s) risk behaviors.

What do minority elementary students understand about the causes of acquired immunodeficiency syndrome, colds, and obesity?

Elementary school-age children's conceptual understanding and factual knowledge about the causes of acquired immunodeficiency syndrome (AIDS), colds, and obesity are poorly understood, particularly among black children living in low-income, urban neighborhoods. We examined minority children's conceptual understanding about the causes of these illnesses. In addition, children's knowledge and misconceptions about the causal agents of AIDS, colds, and obesity were investigated. A developmentally based, semistructured interview was developed to measure children's level of understanding about the causes of each condition. Interviews were conducted with 239, predominately black, first, third, and fifth grade students attending two public elementary schools in a low income city in northern California. Interviews were verbally administered and tape recorded for later verbatim transcription. Children's responses to questions about causality first were scored based on their level of conceptual sophistication. Responses then were assigned to thematic categories reflecting the children's factual knowledge about the causes of AIDS, colds, and obesity. Increases in grade level were associated with higher scores for causality of AIDS (p < .0001), colds (p < .0001), and obesity (p < .01). In all three conditions, causality scores increased between first and fifth grades, but did not significantly vary between third and fifth grades. Gender, socioeconomic status, and number of adults living in the household were not significantly associated with causality scores. Within each grade, the finding of lower causality scores for AIDS, as compared to colds and obesity, points out the need for developmentally appropriate explanations to children about the causes of AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors associated with multiple sex partners among junior high school students.

Twenty-one percent of a sample of inner-city junior high school students were found to be sexually active (n = 403). Only 31% of them reported a single lifetime sexual partner, 25% reported two partners, and 43% reported three or more partners. Logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on the adolescents' lifetime number of sex partners. Respondents whose sexual debut occurred before age 13 years were nine times more likely to report three or more sex partners compared with those whose first sexual intercourse was at age 15 or 16 years, blacks were four times more likely than non-Hispanic whites to report three or more sex partners; and males were four times as likely as females to report this number of sexual partners. Factors not independently associated with the number of sex partners included: age, Asian or Hispanic ethnicity, human immunodeficiency virus (HIV) knowledge, self-efficacy (belief that one can protect oneself from the virus), condom use, and alcohol and drug use. We conclude that a significant proportion of school-based middle adolescents are sexually active and that most of these are at risk for contracting HIV because of behaviors such as having multiple sexual partners. Topics often stressed in school-based HIV education, such as factual knowledge about HIV, avoiding drugs and alcohol, and condom use are not associated with adolescents' choice about their number of sex partners. Intervention programs will have to identify and then target each specific HIV risk behavior and its motivations in order to reduce adolescents' risks of contracting and transmitting the disease.

Determinants of condom use among junior high school students in a minority, inner-city school district.

Condoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.

AIDS knowledge, attitudes, and behavior among inner city, junior high school students.

To gain information about AIDS knowledge, attitudes, and behavior of junior high school students, 1,967 students in three junior high schools in an inner city school district were surveyed. Ages of the participants ranged from 11-16 years, and 48% were male. Ethnically, 33% were Asian, 31% African-American, 24% Latino, and 5% white. African-American students had greater AIDS general knowledge than Asians and similar general knowledge to Latinos and whites. Most students wanted to be taught about AIDS in school. Misconceptions about casual contagion of AIDS were common. Students with these misconceptions were more likely to believe that students with AIDS should not be allowed to attend school. A high proportion of students had engaged in high-risk behavior including sexual intercourse, drinking alcoholic beverages, and using street drugs. More boys than girls reported each of these activities. Of individuals having had sexual intercourse, a positive association was found between the belief that condoms are effective in preventing HIV infection and use of condoms. These findings support the possibility that improving knowledge about HIV transmission would result in more tolerance toward students with HIV infection and would result in less high-risk behavior.

PIP: In June 1988, researchers analyzed data from 1235-1882 questionnaires concerning AIDS knowledge, attitudes, and behavior among inner city, junior high school students [90% ethnic minorities, especially Blacks (61%)] in San Francisco, California to get baseline data so educators could design relevant AIDS prevention programs geared toward minorities. Asians knew less about AIDS than Blacks (p.001), Latinos (p.001), and Whites (p.001). Most students knew what activities were high risk for acquiring HIV, but up to 50% often thought HIV could also be transmitted via casual contact. The students who had such beliefs were more likely to believe that students with AIDS should not be allowed to come to school (p.001-.05). Boys (42%) were more likely to have had sexual intercourse than girls (18%; p.001). Further they tended to use street drugs more (11% vs. 5%; p.001). More Blacks claimed to have sexual intercourse than Latinos (p.001), Asians (p.001), or Whites (p.01). On the other hand, whites reported significantly higher drug use than Blacks (p.001), Asians (p.001), and Latinos (p.01). More boys believed condoms hindered pleasure than girls regardless of level of sexual activity. 25% of the boys found it difficult to find places that sells condoms compared to 18% of girls (p.01). 59% of all students, especially girls (p.001), said that their often was disagreement about using condoms or not with their sex partners. Sexually active students who believed condoms prevent transition of HIV (80%) used them more often than those who believed they work a little (47%; p.01). 89% wanted AIDS education in school, especially those who believed it unlikely or not possible to contract AIDS from casual contact (p.001). In conclusion, AIDS education course designers should consider anxiety about peer pressure and sexual matters since anxiety could hinder acquiring and retaining information about AIDS prevention thereby preventing adolescents from planning for the consequences of sexual contact and drug use.