African American Adolescent Women’s Sexual Socialization and the Sexual Double Standard: Implications for Heterosexual Risk Reduction Amy M. Fasula, PhD, MPH, ORISE Fellow Kim S. Miller, PhD Jeffrey Wiener, MS Presented by Lari Warren-Jeanpiere, PhD ORISE Fellow Division of HIV/AIDS Prevention, CDC November 7, 2007 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

Presentation Objectives Background Study objectives and methodology Themes from qualitative analyses Application of themes Implications for multi-level interventions

Young African American Women and HIV Risk Rate of new AIDS cases approximately 23 times higher for African American than for white women (CDC, 2004) AIDS leading cause of death, African American women ages 25-34 (Anderson & Smith, 2005) 13 to 19 year olds have the highest proportion of AIDS cases among females (43%) (CDC, 2004) Unprotected heterosexual contact primary mode of transmission.

Intervention Approaches Address multiple social levels Begin early, prior to establishing sexual scripts Speak to African American women’s lived experiences of their intimate relationships with men

In This Study Qualitative approach African American mother-adolescent discussions about sexual risk reduction Sexual double standard (SDS) Present at multiple social levels Affords males more freedom and power than females to engage in and direct heterosexual interactions

Methodology: Sample Convenience sample 129 African American mother-adolescent dyads Reported SDS attitudes 35% The Bronx, NY; 65% Montgomery, AL Adolescents 14-17 years old 53% Female 40% Sexually active

Methodology: Analyses Follow-up, open-ended responses from structured interviews Mother’s sexual risk reduction messages Why sex discussions came up Topics of reoccurring arguments Constant comparative method Adolescents’ gender Adolescent sexual behavior

Results: Key Themes “Good”/ “bad” girl dichotomy “Clean”/“dirty” girl dichotomy Sexual guidance for sons, conflict and control for daughters Discouraging daughter’s sexual risk reduction preparedness Challenges to passive condom preparation for daughters Proactive condom preparation for sons

Results: Clean and Dirty Girl Dichotomy Intersection between Good and Bad Girl dichotomy and STDs Mothers’ messages to sons about avoiding STDs/HIV “[I told my son to use condoms] whether or not he thought the girl was clean…” “[My mother told me that to prevent HIV] … use a condom if you’re gonna have sex. Don’t bring a slutty girl into the house…” “I told him that appearance says nothing, she can be the prettiest girl in school and infect everyone on the football team….”

Results: Sexual Guidance for Sons, Conflict and Control for Daughters Daughters: consistent theme of conflict and control over sex, pregnancy, dating, and contact with boys. Sons: rare conflict over sexual issues. Son’s interest in girls often used as impetus for sexual guidance discussions.

Results: Discouraging Daughter’s Sexual Risk Reduction Preparedness Some daughters (but no sons) discouraged from obtaining safe sex methods “[I told my daughter that] no birth control method is foolproof…. I told her that she did not need it and not to participate in the school programs where birth control is distributed…” “[My mother said] that if I wanted to be on birth control it was for people that slept around. She says the best way to prevent pregnancy is not to have sex.”

Results: Challenges to Passive Condom Preparation for Daughters “… [I told my daughter] not to be ashamed to provide her own condoms.” “[I told my daughter]…Don’t depend on the man [for condoms]….”

Results: Proactive Condom Preparation for Sons Mothers provided sons (but no daughters) with condoms. Condoms part of pubertal guidance and skills “[My son and I have] talked about condoms. I gave him packages of them that told how to use them on the back. I told him he need to use them to ask me and I’ll get them for him.”

Effects on Young Women’s Sexual Risk Reduction: Good/Bad Girl Dichotomy Limits sexual-self development Barriers to developing strong attitudes about their own sexual decisions Promotes romance script with active male and passive female

Effects on Young Women’s Sexual Risk Reduction: Clean/Dirty Girl Dichotomy Additional layer of stigma to Good/Bad Girl Dichotomy – not only deviant, but dangerous and diseased Condoms run counter to the good or clean girl image, due to meanings of disease, promiscuity, and non-monogamy

Effects on Daughters’ Sexual Socialization for Risk Reduction Prohibitive approach promotes environment of conflict, secrecy, and missed opportunities Neutral approach leaves critical gaps in daughters’ sexual risk reduction skills and access to resources

Proactive Sexual Risk Reduction for Sons “Teachable moments” Condoms introduced early in pubertal development Provided access to condoms

Directions for Intervention: Individual-Level Young African American women Develop ability to identify and communicate sexual needs Promote attitudes of empowerment (not shame) for being in command of their own sexuality Young African American men and women Illuminate and challenge SDS expectations Encourage heterosexual scripts that emphasize open communication, and mutual respect and responsibility

Directions for Intervention: Familial-Level Group-level interventions with parents Provide supportive environment Explore SDS attitudes Identify negative effects of SDS Develop confidence and tools for sexual risk reduction socialization without reinforcing SDS

Directions for Intervention: Community-Level Fill gaps for sexual risk reduction behaviors Information Encouragement Resources