Are Black Women At Higher Risk For STDs?

Socioeconomic, cultural, and gender barriers limit the ability of some young women of color to receive information on sexually transmitted infections (STIs), including HIV, access culturally appropriate health care, and reduce sexual risks.

Statistics by ethnicity can be misleading due to relationships between socioeconomic status and ethnicity; yet, illuminating the epidemiology of HIV in different populations may promote prevention efforts in under-served communities. The estimated prevalence of HIV and other STIs is especially high for young women of color many of whom lack health insurance and have little or no access to health care. A lack of well-funded prevention programs specifically addressing young women of color further limits the capacity of some these young women to protect themselves against HIV infection.

Behavioral and Socioeconomic Factors Negatively Affect the Health of Young

Women of Color

Poverty and access to care —Young women of color are disproportionately members of the working poor who often lack access to affordable, culturally sensitive, and youth-friendly health services. As a result many YWOC receive little preventive health information, including strategies that reduce their risk for HIV infection.

Heterosexual Contact —The largest category for being infected with HIV among women of color is heterosexual contact—having sex with a man who uses injection drugs, is HIV-infected, or whose HIV status is unknown to the young woman. For example, in 2002 among cumulative HIV/AIDS cases, 77 percent of Asian and Pacific Islander women, 74 percent of African American women, 72 percent of Latinas, and 62 percent of Native American women reported heterosexual contact as their risk factor.

Communication — Patterns of communication about sexuality differ by ethnicity, age, socioeconomic status, and level of acculturation. Reticence in discussing sexuality occurs among minority populations as frequently as among the U.S. population as a whole. Some Asian Pacific Islander and Latino cultures prohibit or discourage open discussion of topics like condom use, disease, and sexual behaviors. African American adolescent females, on the other hand, report receiving information about and discussing HIV and sexuality at school and with family. Young African American women also report feeling comfortable in assertively asking about partners’ past sexual risks, although they are often reluctant to ask about same-sex sexual behavior or substance use—behaviors of male partners that can put the young women most at risk.

Cultural discomfort with conversations about sexuality and sexual behaviors poses difficulties for some young women of color as they attempt to negotiate safer sex practices and set limits with a sex partner. Numerous studies indicate that African American women and Latinas are concerned about HIV infection but may not use condoms. While most young women of color report a strong desire to use condoms, those who have low incomes frequently report fear, discomfort, and intimidation about negotiating condom use with their sexual partner. Some young women fear that young men will be angered or offended by questions about past risk behaviors and by requests that they use condoms.

Trust in monogamy —The safety provided by monogamy is limited by each partner’s past and current risk behaviors. Trusting a male partner who is not monogamous is a serious risk factor for any woman and may put many young Latina and African American women at risk for HIV and other STIs. Since different people define monogamy in different ways, safer sex should probably be urged for all sexual relationships.

Furthermore, serial monogamy —a series of short-lived monogamous relationships—is fairly common among adolescent women, nearly 16 percent of whom report four or more lifetime sex partners. Having multiple sexual partners (usually four or more) is frequently identified as a risk factor for HIV infection. Early onset of sexual intercourse is often associated with reports of more lifetime sex partners than are reported by young women who initiate sexual intercourse later. Compared to other teens, a higher percentage of African American and Latina young women also report initiating sexual activity at early ages, putting them at higher risk for HIV infection.

Older male partners —A quarter of sexually active men ages 22 to 26 and 19 percent of males ages 20 to 21 report sexual intercourse with a teenage partner during the last year.A significant proportion of Latina and African American adolescent females also report first sexual intercourse with older male partners. Sexual intercourse with older men can expose young women to a sexual partner who has had sex with multiple partners, varied sexual experiences, and/or a history of injection drug use. Differing age and sexual experience may also create power imbalances that limit the ability of young women, including those of color, to negotiate safer sex. Finally, young women sometimes rely on older sex partners for guidance about protection and may receive misinformation that can negatively affect the young women’s sexual health.

Cultural Barriers May Affect the Health of Young Women of Color

Cultural barriers prevent many young women of color from gaining the skills and knowledge they need to lessen their risk for HIV or other STIs. Ethnic groups may face different barriers posed by customs, religion, and history.

Among Native Americans, communication barriers complicate HIV prevention. Some terms—such as HIV and AIDS —do not translate easily or clearly in many Native American languages. Tribes may be difficult to target with HIV prevention information due to geographic dispersal, individual languages, and differing customs. For example, the Navajo believe that talking about a disease may bring it into existence in the community.

Statistics - may underestimate the rate of HIV infection among Native Americans. Some HIV

infected Native Americans may claim to be of another ethnicity to avoid shaming their communities, and HIV testing officials may misidentify Native Americans as being of some other ethnicity. In one study, nearly 90 percent of Native Americans living with AIDS were listed as Asian, Latino, or other ethnic background. Inaccurate reporting may lead to decreased funding for prevention efforts targeting Native Americans and may also lead Native Americans to deny or underestimate their HIV risk. 

Finally, substance use —the number one health problem among Native Americans —is also associated with sexual risk behaviors. Many Native Americans do not realize the connections between HIV infection and substance use.

The African American community did not initially view HIV/AIDS as a threat. Early case reports indicated that high risk groups included white gay men, injection drug users, hemophiliacs, and Haitians. As a result, many African American women have not recognized their own risk. Historic revelations of unethical experimentation (such as the Tuskegee syphilis study) and misinformation regarding the susceptibility of African Americans to HIV have also affected this community’s views of public health messages and practices. Today, suspicion of government agencies, worry about genocide, and continuing conspiracy theories remain current among many African Americans. These factors may result in an unwillingness to be tested or treated for HIV.