Sexual Health Risk and HIV Prevention: An Exploratory Study of Behavior among Heterosexual, African American Men and Women in Birmingham, Alabama

Abstract

The Deep South of the U.S. continues to have increased incidence of new cases of HIV since its inception, despite many advancements in HIV testing, treatment, and prevention. According to data by the CDC, rates are increasingly high among heterosexual African American (AA) men and women compared to their non-AA counterparts (CDC/HIV, 2017). In 2015, heterosexual transmission accounted for a share of new diagnoses for AA men and is the most common transmission route for AA women (KFF, 2017). The primary population affected by HIV/AIDS in Alabama is men who have sex with men (MSM) at 62.2%, followed by heterosexual males and females at 30.8% (CDC, 2015). However, research among the general population, specifically heterosexual AAs men’s numbers have declined considerably since the mid-1990s. Research has shown that HIV-related stigma significantly impacts people living with HIV (PLWH), (Beaulieu, Adrien, Potvin & Dassa, 2014; Bennett, Hersh, Herres, & Foster, 2016). Yet, little is known about how HIV-related stigma affects this population or their sexual health behavior (risk or preventive) decision making. The present study explored the sexual health risk, HIV prevention, and perceptions of HIV-related stigma of heterosexual, African American men and women in Birmingham, Alabama. Guided by the Theory of Planned Behavior and using Venue-based sampling, the study recruited 134 participants at local grocery stores, retail shops, and libraries. Participants completed a one-time survey instrument, in addition to being provided to HIV and PrEP education materials and resources to access services. Further guided by three aims and four research questions regarding the relationship of sexual health risk with HIV prevention and HIV-related stigma, the study identified several areas of sexual health risk within this population where additional work is needed based on participant responses. Additionally, analyses found multiple significant associations between sexual health risk and HIV prevention, even after controlling for relevant demographics. Additionally, there was only one significant association found between HIV-related stigma and HIV prevention variables. Ultimately, the findings of the study suggest a need for additional sexual health and HIV related research involving heterosexual Africa Americans. Specifically, the present study suggests that more needs to be done to address the education and awareness of HIV, sexual health risk, and HIV prevention gaps in this population.