The Influence of Social Determinants on Sexual Risk among Out-of-School African American Female Adolescents

Formative research was conducted to understand the social determinants of HIV risk among African American female adolescents as part of a systematic adaptation of an evidence-based behavioral HIV prevention intervention, the Women’s CoOp. Semi-structured in-depth interviews were conducted between November 2008 and April 2009 with 20 African American female adolescents aged 16–18 who reported engaging in sex, using alcohol or other drugs, and dropping out of school. All interviews were audio recorded, transcribed, and coded for key themes and emergent content patterns. 

The findings indicate that while female adolescents are knowledgeable about HIV and other sexually transmitted infections (STIs), myriad social factors relate to their level of risk. Interpersonal relationships, primarily with older boyfriends and friends, played a pivotal role in their decision-making regarding sex risk behavior, substance use, and educational attainment. A lack of viable employment opportunities, exacerbated by the lack of a high school education, resulted in some young women trading sex to make money. In addition, violence, victimization, and gang involvement are pervasive in their communities. 

Out-of-school African American female adolescents face a plethora of issues that are directly and indirectly related to their sex risk behaviors and consequently their HIV/STI risk. To reach a vulnerable population disproportionately affected by HIV and other STIs, these factors must be addressed in prevention interventions, when feasible. The findings were incorporated into the intervention adaptation that is currently being tested in a randomized controlled trial.

Table 1

Theme 1: influence of boyfriends and other male sex partners.

Subtheme	Illustrative quotes
Influence on substance use	• “I think most girls start smoking [marijuana] from their boyfriends or guy friends and stuff. You know just to be cool or to have an excuse to hang out with that person.…” [#17]
	• “I think the main reason [for substance use] goes back to the peer pressure and wanting to fit in. You hear people saying ‘Oh, this weekend I got so high, I felt so good’…. Like ‘I forgot about all my problems,’ so it’s used to fit in again…. Curiosity and wanting to fit in is a big part of that.” [#16]
Dropping out of school	• “They drop out [of school] because they get pregnant; they drop out because they want to be with a man or a boy…. That’s because of these older men, or these young boys, and they want to be like them…. They have one baby, then they have two babies, and they have nobody to help them.” [#20]
	• “Most teens go with a boyfriend that is older than them, that sells drugs. They already dropped out of school, so you want to be out with them all night, and then they don’t go to school so they sleep the next day. You might want to be with them and your mind is not focused on school anymore.” [#2]
Male partners make decisions about sex	• “… most teens use condoms, but then sometimes it might be the boy who’s like ‘Oh let’s not use a condom’ and then the teen is like ‘Oh I love him, I don’t need to use a condom’…. But some teens that care about their bodies will say ‘No I’m going to use a condom.’” [#11]
	• “By the dude being like ‘Do you want to have sex.’ they might act kind of shy and be like ‘No.’ But the dudes got that talking game, they can make you do almost anything. That talking game is amazing, they can get you to do everything in the book. All they have to say is do one thing, then they will do everything else after that.” [#19]

Table 2

Theme 2: inconsistent condom use despite HIV/STI knowledge.

Dislike feel of condoms	• “A lot of females don’t like it [condoms] and a lot of males don’t like. I guess they don’t get the feeling or whatever.… I think the females don’t like it because number one, it doesn’t feel right, number two, because it chafes your skin a little bit. A lot of people don’t like using them, but they should though, they should.” [#14]
	“[…] a lot of teens these days feel that they don’t want to use condoms because it’s the ‘thang,’ all young girls have babies.” [#2]
Learn to use condoms when it is too late	• “They don’t think about [condoms] until they get pregnant, or until they contract an STD. That should make them want to use condoms from then on.” [#13]
Desire to get pregnant	• “… I was sitting at school here the other day thinking that there are four girls out of my whole school that don’t have kids. All of them have babies; everybody that I know has babies.” [#18]
	• “… some just want to have a baby by that boy, just to have a baby by them so I guess he won’t go nowhere.” [#3]

Table 3

Theme 3: trading sex.

Limited employment opportunities	• “There are a lot of females out here who don’t have jobs, so they get it how they can. You can go out here and take out somebody’s trash, you can mow somebody’s lawn, and you know you can keep an old lady company, read a book to her and they’ll pay you a little money. But they want fast money. Fast money is hopping in and out of cars, and that’s how they get it.” [#20]
	“For a normal female that doesn’t have any problems, parents love them and care about them and all that, where they don’t have to want for nothing … it’s [sex trade] not common in them. It’s common in the ones that dropped out of school, don’t have nowhere to go, don’t have an income, don’t know how to go out and get a job, and can’t get a job and is on drugs. It’s common for females like that.” [#15]
Influence of older men	• “All these old dudes know that there are a lot of young girls they can take advantage of for like $10…. It’s older men out here looking for tricks.” [#10]
	• “It’s an older man that wants to have sex with a young [girl], like older men like young, pretty, it might be African American, it might be any other race, they just see pretty teenagers and they be like, you can make some money come with me, or something like that. So the teens are like, yeah that’s my sugar daddy he’s going to give me money, any time I need money I can call him because he is older he got money and stuff like that.” [#1]

Table 5

Theme 5: involvement in gangs.

Relationships with gang members	• “Yeah, ‘cause like with [a certain gang], if you are officially a [gang member], then the girl he is dating is automatically … affiliated with the gang. Just because of who her boyfriend is … even if she breaks up with him, she is still affiliated because she has all those friends, she won’t be official, but she is definitely affiliated.” [#6]
	• “… that could be a spur of the moment thing, someone can say that to get in, as long as you give me and him some, you can get in. But it’s like, however they want it, whenever they want it, you don’t have any say so about it and stuff.” [#16]
Being “sexed-in”	• “And it’s not just one dude having sex with them, it’s like half of the gang has to come in and have sex with them…. I know that’s for [a certain gang], it has to be at least 15.” [#15]

Full article at:  http://goo.gl/Olj7Lx

By:   Felicia A. Browne,a,b Wendee M. Wechsberg,b,c Vanessa M. White,d Rachel Middlesteadt Ellerson,b Jerris L. Raiford,eMonique G. Carry,e and Jeffrey H. Herbste

^aDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

^bSubstance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA

^cGillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

^dSchool of Dentistry, University of North Carolina, Chapel Hill, NC, USA

^eDivision of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

^*Corresponding author. Email: gro.itr@wmw

 

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