Practical understanding of HIV risk in young black African women living in the United States

Abstract

Little is known about the sexual experiences of young black African women living in the US. This study explored the cultural meanings, concerns, and practical understandings of the risk of contracting HIV infection in sexually experienced black African women living in the United States. The purposive sample was comprised of 12 single women, between 20 and 25 years of age, from nine African countries living in a Midwestern city. Participants detailed their sexual histories in a modified Event History Calendar. Multiple interviews were conducted over two to four visits in approximately monthly intervals. The interviews elicited detailed accounts of women's meaningful and difficult sexual experiences, their safer sex practices, and their concerns related to HIV/AIDS and contraception. The interviews were transcribed verbatim and analyzed using interpretive phenomenology.

Two major themes reflected participants' practical knowledge. Themes included patterns in coping with cultural contradictions, and patterns of sexual agency defined as, the ability to recognize the power to shape one's sexual situation. Few women in the sample expressed sexual agency with intimate partners and self-understanding with health care providers. These women revealed that HIV infection scares, and trusting family relationships provided crucial learning experiences that enhance sexual agency. A few women revealed how acceptance of cultural contradictions, self-silencing, shaming, and sexual violence inhibit sexual agency. Most women strongly rejected cultural contradictions and social practices supporting premarital abstinence.

Altogether, narratives illustrate that safer sex is less a knowledge problem than a problem of diminished sexual agency. Women's concerns and priorities were focused less on reducing the risk of contracting an HIV infection than on finding marriageable partners. Women valued social expectations and familial identities associated with marriage and childbearing. Such expectations provided women with a sense of identity and fulfillment. In the context of cultural contradictions, this study suggests that HIV prevention and sex education programs are inadequate when they overlook young women's sexual agency. Nurses need to listen to black African women's sexual concerns, coach, and engage them so as to reveal priorities in coping with cultural contradictions. This study underscores the need for developing mentoring programs that cultivate sexual agency.