A Multi-Level Profile of African-American Women

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A Multi-Level Profile of African-American
Womens Sexual Risks Partnerships, Context, and
More

• ADAORA A. ADIMORA, MD, MPH

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STI BEHAVIORAL EPIDEMIOLOGY NEW PARADIGM

• Population-level parameters, including sexual
  network patterns
• Pattern of linkages critical in STI transmission
• e.g., sexual interaction between subpopulations
• African Americans
• Dissortative mixing (peripheral blacks 5x as
  likely as whites to choose partner from core)
• Segregated partner choices (more likely to choose
  other blacks as partners)
• Laumann E, Youm Y. STDs 1999 26250
• Prevalence of concurrent partnerships

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NATIONAL SURVEY OF FAMILY GROWTH

• 10,847 U.S. women interviewed in 1995
• CAPI with calendars to improve date recall
• First and last date of sexual intercourse with
  partners
• Computer algorithm gt2 current partnerships or
  overlapping dates of partnerships
• Visual review of computer records

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NSFG CONCURRENCY PREVALENCE (1)
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NSFG CONCURRENCY PREVALENCE (2)
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CONCURRENT PARTNERSHIPS, WOMEN, U.S. (1995, NSFG)
Adimora AA, Schoenbach VJ, Bonas DM, et al.
Concurrent Partnerships among Women in the US.
Epidemiology 2002 13320-327
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Marital Status by Ethnicity
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NSFG CONCURRENCY ODDS RATIOS
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• Social Context of Sexual Relationships Among
  Rural African Americans
• ADIMORA, ADAORA A. MD, MPH SCHOENBACH, VICTOR
  J. PhD MARTINSON, FRANCIS E. A. MBChB, MPH,
  PhD DONALDSON, KATHRYN H. MPH FULLILOVE,
  ROBERT E. EdD AND ARAL, SEVGI O. PhD
• Sexually Transmitted Diseases 20012869-76

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FOCUS GROUPS

• Employment and economic opportunities
• There are no jobs for anybody coming right out
  of high school
• You can have all the schooling in the world, but
  if youre black you cant get a good job.
• Most of the temporary agencies like to send the
  blacks to jobs in factories
• Every job here is dead end with terrible pay.

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FOCUS GROUPS

• Racism/Race relations
• A lot of things are divided racially you have a
  white side of town, and the black sidedoesnt
  usually mix. Its sort of covert. You dont
  have white folks walking around in robes or
  anything, but in the schools and things you can
  see it.
• Its hard to get a loan to get a house. Banks
  dont just give black people loans. You got to
  know somebody.

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FOCUS GROUPS

• Racism/Race relations (cont)
• I would say it was greatly polarized. When I
  was going to school here in the high school, the
  type of classes you could get into, like the
  college prep courses, had a lot to do with what
  type of family you came from, your race,

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FOCUS GROUPS

• Relationships between men and women
• To get to the next semi-urban city, if you dont
  have a job, or a good education, youve got to
  depend on somebody to get you there. For young
  black women, its not a good position to be in
  without a good job or a good education.
• The choices in men are very limited around here.
  I guess the women put up with the men they have
  because there arent that many.

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FOCUS GROUPS

• Relationships between men and women
• Theres so many black men in prison, strung out
  on drugs, or dead, that if a decent black lady
  finds a decent black man, shes going to do
  whatever it takes to get him.
• Its not that many good men worth anything in
  this area.
• The ratio of women to men is very high.

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FOCUS GROUPS

• Concurrent partnerships
• Most unmarried couples arent going to be true
  to each other.
• If they arent planning on getting married,
  theyre probably going to have relationships on
  the side.
• I say its quite common for people to be
  involved in relationships with more than one
  person at a time.

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FOCUS GROUPS

• Respondents described
• Pervasive economic and racial oppression
• Lack of community recreation, boredom, resultant
  substance abuse
• Shortage of black men (higher mortality and
  incarceration rates
• Widespread concurrency among unmarried people
• Conclusion
• Contextual features may promote sexual patterns
  that transmit STIs
• Adimora, Schoenbach, et al. Sexually Transm Dis
  20012869-76

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RISK BEHAVIORS, GENERAL POPULATION
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GENERAL POPULATIONPARTNER RISKS
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GENERAL POPULATIONINCARCERATION
gt 24 hours in past 10 yrs
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CONCURRENCY PREVALENCE ()
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CONCURRENCY ODDS
controls
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CONCURRENCY ODDS
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CONCURRENCY ODDS MULTIVARIATE ANALYSIS, MEN
WOMEN, NC
CONTROLS
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SEX RATIO AMONG SELECTED ETHNIC GROUPS, US, 2000
Source US Bureau of the Census. Census 2000
Summary File 1. Vol 2003, 2000.
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CONTEXT-NETWORK PATHWAYS
POVERTY
Marital instability
Pool of marriageable men
CONCURRENCY
SEX RATIO
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CONTEXT-NETWORK RELATIONSHIPS
Residential segregation by race
Concentration of adverse social and economic
influences (poverty, drugs, violence)
Selection of partners from neighborhood
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CONTEXT-NETWORK RELATIONSHIPS
INCARCERATION
Disrupts partnerships
Pool of men in community
Employment prospects
New long-term links with antisocial networks
Inmates sex in Pool with HIV prevalence
SEXUAL NETWORKS
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HIV/STI RACIAL DISPARITY

• Networks/Population parameters
• Concurrency
• Evidence of dense sexual networks
• Sexual bridging between general population and
  high-risk, high prevalence subgroups

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HIV/STI RACIAL DISPARITY

• Socioeconomic forces that inhibit stable
  partnering and increase adverse network patterns
• Racial discrimination
• Economic oppression
• Low sex ratios

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ACKNOWLEDGMENTS

• Victor J. Schoenbach, PhD
• Francis Martinson, MD, PhD
• Dana Bonas, MPH
• Sevgi Aral, PhD
• Ward Cates, MD, MPH
• JoAnne Earp, PhD
• Robert Fullilove, EdD
• Amy Lansky, PhD
• Greg Samsa, PhD
• Stephanie Betran, RN
• Kathryn Donaldson, MPH
• Tonya Stancil, MPH
• Merritha Williams, RN
• NC HIV/STD Control Section