1. RSPH of Emory University Controlling our Bodies: Social Inequality and Risk for HIV Infection among Black Women Kimberly R. Jacob Arriola, Ph.D., MPH APHA Annual Meeting, Atlanta, GA October 22, 2001

2. RSPH of Emory University Problem of HIV/AIDS among Black Women Population demographics for US women 13% Non-Hispanic Black women 71% Non-Hispanic White women 12% Latina women 5% other racial backgrounds HIV Infection demographics for US women 68% Non-Hispanic Black women 23% Non-Hispanic White women 7% Latina women 1% other racial backgrounds

3. RSPH of Emory University A Black Feminist Framework (Collins, 2000) Black feminist epistemology Lived experience generates wisdom about intersecting oppressions Dialogue is a tool for assessing claims of knowledge Black women’s subjectivity is at the center of analysis Black female sexuality Sexual objectification Commodification Exploitation Pornography, prostitution, rape, & sexual violence

4. RSPH of Emory University Social & Environmental Factors that may Influence Risk Pornography Commercial sex work Rape, abuse & (physical & sexual) violence Exposure to “Drug Culture” Perceived limited partner options Financial dependence on men Poverty & homelessness

5. RSPH of Emory University Purpose of this Study What is Black women’s level of HIV risk? What social inequalities shape respondents’ daily life experiences? How do these inequalities influence respondents’ risk for HIV infection?

6. RSPH of Emory University Method: Participants 30 Black women Age 18 to 47 years M = 27.4, SD = 8.2 Household income 38% < $10,000 28% $10-$19,999 34% > $20,000 Sexual identity 90% Heterosexual 10% Bisexual Level of education 3% Less than HS 41% HS or equivalency 24% vocational school or some college 31% college or grad degree Marital status 90% Single/Never married 10% Married Children 33% 0 40% 1 27% 2-6

7. RSPH of Emory University Method Recruitment Employment training agency in East Point Semi-independent residential facility for recovering addicts Program for abused, suicidal, & low-income Black women Transitional house for recent releasees Word of mouth Screening to ensure that participants: Considered themselves Black or African American Were at least 18 Had been sexually active within past 6 months Had at least 1 male partner

8. RSPH of Emory University Method: Procedure Participants were met at the employment training agency (23) or my office (7). Semi-structured interview (approximately 1 ½ hours) Written questionnaire (approximately 10 minutes) Participants were paid $40-$70 $40 base amount $20 for childcare $10 for coming to the office

9. RSPH of Emory University Results: Risk for HIV Infection Perceived low risk of getting AIDS virus 70% indicated very or somewhat unlikely Low condom use behavior 19 reported using condoms never or sometimes Few sex partners 20 had 1 partner in past 6 months Sex-Drug exchanges (8) History of CSA (19) History of active drug use (5)

10. RSPH of Emory University Qualitative Findings Limited partner selection Lack of control over sexual decisions Sexual objectification Exposure to rape, violence, and abuse

11. RSPH of Emory University Limited Partner Selection Relatively small number of marriageable Black men Cultural values emphasize the importance of having a male partner  Perceived need to secure & maintain intimate relationships Implications for risk: Little desire to insist on condom use

12. RSPH of Emory University Lack of Control over Sexual Decisions Some respondents felt “coerced” into having sex Obligatory sex with boyfriend Some respondents were coerced into condomless sex Implications for risk: Lack of ability to protect herself if protected sex is desired

13. RSPH of Emory University Sexual Objectification Advantages of being a Black woman include that they are often looked upon as being beautiful & exotic Disadvantages of being a Black woman include feeling like sexual objects Being touched, grabbed, fondled, used Commonplace of sex-drug exchanges Implications for risk: Black women are encouraged to use their bodies for gain while lacking the power to protect themselves

14. RSPH of Emory University Exposure to Rape, Abuse, & Violence 16 participants described exposure to rape, abuse, or violence in their interviews Nature of the experiences Physical & sexual abuse by partner (male & female) Rape by acquaintance (part. surrounding drugs) Childhood sexual abuse Physical fighting with boyfriend Implications for risk: Lack of ability to protect herself

15. RSPH of Emory University Summary Race, class, & gender intersect to create a social & economic environment in which Black women are susceptible to: The perception of a limited number of partners Lack of control over sexual decisions Sexual objectification Exposure to rape, abuse, & violence These factors influence risk for HIV infection in various ways

16. RSPH of Emory University Limitations Lack of generalizability Potential social desirability bias Lack of information on the role of social support & resources Questionnaire responses may have been influenced by having just conducted the interview

17. RSPH of Emory University Conclusions Findings support key themes in the literature Financial dependence on men was not an issue Controlling one’s body is an overriding theme Increasing women’s control & decreasing men’s control is key for HIV prevention efforts