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Reaching rural African American women difficult
Researcher discusses chief issues
Poverty and inequality are among the major challenges faced by the rural African American women at risk for HIV infection, and these increase this population’s potential for becoming infected, an expert says.
"The types of sexual networks people have also help amplify transmission," says Adaora Adimora, MD, MPH, an associate professor of medicine in the division of infectious disease, department of medicine at the University of North Carolina School of Medicine in Chapel Hill.
Adimora is scheduled to speak about prevention targeting rural African American women at the Centers for Disease Control and Prevention’s 2005 National HIV Prevention Conference, scheduled for June 12-15 in Atlanta.
"This is not simply due to increased numbers of sexual partners, because some of the women, according to a case control study we did, do not necessarily have a lot of partners," she says. "But they are women who have high-risk partners or whose partners have concurrent partnerships."
Another factor that goes hand-in-hand with the women’s poverty and educational disadvantages is ongoing or past drug use, Adimora notes.
"It’s not clear to me that the crack epidemic in North Carolina is over," she says. "We still see a lot of HIV transmission related to current or past crack use and a fair amount of HIV transmission related to the risk behaviors of the women’s partners."
However, social context and sexual networks are major contributors to the HIV epidemic’s impact on African American women, Adimora’s research has shown.
For example, studies involving interviews with focus groups of African Americans from rural North Carolina have shown there is a social context to their sexual relationships that includes pervasive economic and racial oppression, boredom, lack of recreational opportunities in the community, and substance abuse. Those are combined with a perception that there is a shortage of black men and this shortage’s role in concurrent sexual partnerships.1
These social context factors may contribute to sexual patterns that place individuals at greater risk for infection from HIV and other sexually transmitted infections (STIs), Adimora explains.
"People talked eloquently in the focus groups about what their lives are like, and the way they talked about them made it pretty clear they were aware of the risk," she says.
"They talked about the extensive racial discrimination in employment, things that made it difficult to own houses, and they talked about the imbalance of men to women," Adimora notes.
"The sex ratio among African Americans is much lower than for other racial ethnic groups in the U.S. because of the deaths of black men from disease and violence, and it’s further lowered by the incarceration of black men."
These perceptions were pervasive among the black men and women, ages 18 to 59, who participated in the focus groups, she adds.
"The second thing we did was look at the prevalence of concurrent partnerships among African Americans in Eastern North Carolina and in some other rural areas," Adimora says. "And we found that, once again, it was associated with a person being a man, being single, or having a sex partner who was incarcerated."
Investigators were surprised to find that a fourth of the men included in the study of a general population of African American men in rural Eastern North Carolina had a history of incarceration, she notes.
"There was a high prevalence of concurrency of overlapping partnerships in the past five years of black people in this region, and most of the people believed their recent partner had a concurrent partnership," Adimora adds.
The relevance of the concurrent partnerships is that it may increase heterosexual HIV among the rural African American population, another study concludes.2
"We also did look at people with newly diagnosed HIV infections, and they were more likely to have concurrent partnerships," she says. "The striking thing about the HIV cases was they were more likely to be poor than the general black population."
HIV clinicians and public policies promoting HIV prevention may find it especially difficult to target interventions to rural African Americans because of the social context that cannot be easily addressed Adimora explains.
"We’re used to having a tool, something that we can use to fix the problem, and in this situation there are fairly profound social structural reasons, social-political, and socioeconomic reasons that contribute to the current problem," she adds. "We need to reframe the debate and do something about social factors, such as making meaningful change to racial disparities, poverty, and inequality, and advocating for research and interventions that have the potential to impact underlying causes and inequality."