Online Program

Whatever I got, you gonna get: HIV risk and perception of male condoms among incarcerated African American women in North Carolina

Monday, November 4, 2013

Claire E. Farel, MD MPH, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
Sharon Parker, PhD MSW MS, Division of Infectious Diseases, Brown University School of Medicine and The Miriam Hospital, Providence, RI
Kathryn E. Muessig, PhD, Department of Health Behavior, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Catherine A. Grodensky, MPH, Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
Chaunetta Jones, MPH, MA, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
Carol E. Golin, MD, Department of Health Behavior and Health Education and Department of Medicine, University of North Carolina at Chapel Hill Gillings School of Public Health and School of Medicine, Chapel Hill, NC
Cathie Fogel, PhD RNC FAAN, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
David A. Wohl, MD, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: HIV is five times more prevalent among incarcerated African-American (AA) women in North Carolina (NC) than among unincarcerated AA women. Outside prison, HIV transmission is primarily driven by sex with men; however, decision-making surrounding condom use is incompletely understood. Methods: We recorded qualitative interviews with 29 AA women (15 HIV-positive, 14 HIV-negative) newly entered into NC prisons. Following social ecological theory, we explored pre-incarceration HIV risk factors from community-level (e.g. condom accessibility) to intrapersonal (e.g. sexual practices). Two researchers thematically coded interview transcripts and a consensus committee reviewed coding. Results: Women reported low rates of consistent condom use with male partners and no barrier methods with female partners. At the individual level, women worried about HIV and sexually transmitted infections (STI) and described the importance of condoms. However, prevalent transactional sex and crack cocaine use among HIV-positive women was described in association with low condom use. Interpersonal-level barriers to condom use included relationship power dynamics and widespread intimate partner violence (18/29). Condoms were described in contrast to relationship trust: among women with children (n=23), few used condoms with fathers of their children. Several women described continued unprotected sex with men who gave them STIs or had concurrent female partners. At the community level, all participants described ready availability of condoms. Conclusions: Study participants described a high level of condom awareness and accessibility, however, multiple factors limited consistent condom use. HIV risk reduction efforts must extend beyond condom promotion to address women's agency or provide female-controlled methods of HIV prevention.

Learning Areas:

Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Clinical medicine applied in public health
Diversity and culture
Social and behavioral sciences

Learning Objectives:
Describe the context of the disproportionate burden of HIV prevalence among African American women in the US. Describe the multi-level influences on sexual behavior and condom use among incarcerated African American women at risk of HIV in North Carolina. Explain the intersection of individual and community-level factors that place this population at risk for HIV. Describe the challenges of identifying at-risk women in this population and potential HIV prevention strategies in this population.

Keyword(s): Incarceration, Condom Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a graduate research assistant, I helped to analyze the qualitative data for this study, and subsequently, worked closely with the PI to develop a quantitative instrument based on our findings. I am a doctoral candidate in Medical Anthropology and have conducted qualitative research on HIV/AIDS, treatment adherence, and chronic illness management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.