Again, its abstinence until when?

Unveiling Meanings of Sexual Relationships & HIV Risk in Young Black African Women Living in the USA
Presented by: Sithokozile Maposa (RN, PhD) www.usask.ca/nursing

BACKGROUND and Context

HIV rates in Africans six times more than the general US population1 o Pre-immigration practices linked to HIV sexual risk: o Forced sexual intercourse2 o Sexual double standards3 overlooked o Increasing but separate literature on HIV risk and abuse4 in Black women in the United States
o

April 2, 2014 Opportunities & Challenges for Women Empowerment Global Meeting

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STUDY AIM
Evident in the preliminary analyses of narratives: Examine factors that either enhanced or undermined the extent to which young Black African women participated in determining the outcomes of their sexual relationships.

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METHODOLOGY
Heidegerian interpretive phenomenological approach5 as explicated by Benner6 accentuates: o Interpretations are situated in social practices o Ways of coping are visible in everyday practices This approach brings out young Black African womens cultural meanings and sexual practices

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SAMPLE Characteristics (N=12)

A purposive sample of English speaking:
o o

o
o o

Young Black African women 20-25 years Annual Income ranged <$20, 000 to >$20,000 All participants had a high school education 2 to 10 years residing in the United States Two had children, nine in dating throughout the study

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Table 1: Data Collection Schedule

Visit 1 Visit 2
4 -5 wks after Visit 1
Consent form Evaluation of consent form

Visit 3
4 - 7 wks after Visit 2

Visit 4
4 - 5 wks after Visit 3

Demographic form
Event History Calendar Sexual Risk Interview

Sexual History & Meaning Interview Coping with Sexual Relationships Interview *Coping with Sexual Relationships *Coping with Sexual Relationships

*Women who were re-interviewed reported dating and/or sexual experiences since the previous interview. (were asked about meaningful and difficult sexual experiences in multiple interviews)

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Sexual Agency vs. Limited Sexual Agency

Sexual agency captures awareness of sexuality, ability to recognize ones power in sexual situations7 o practical wisdom of HIV sexual risk an essential aspect of sexual health and public health. o Gender and sexual agency seemed intertwined o Figure 1 captures different levels of sexual agency

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Figure. 1: PATTERNS of Sexual Agency

Reality Checks Susan, Dudu, Beauty

Missing Dialogue Philomena, Gloria, Jolene

Tradition of Self-silencing Patty, Sheila, Amina, Lovejoy, Grace, Esther

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REALITY Checks: The Scare of My Life

Susan (graduate student, 25 years) learns from her scare:
I got my scare after I broke up with Larry for cheating, I was freaking out, I thought I had AIDS. I lost weight, I knew something was wrong. I went to my doctor and said I want to know what I am dying from. Again, its abstinence until when? Its not always practical in committed relationships. Frankly, it discourages us from being honest or talking about these emotional issues. Sex is the one thing I dont talk to my mother about.
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MISSING Dialogue vs. Pressure to become a wife

Philomena (supervisor, 25 years) says our elders fail us:
I started dating with trepidation: I learned never to trust men, men are deceptive. Where I come from your world crumbles if you have a child out of wedlock. I wanted a perfect men but I learned through our bad bad fights, precisely, Keith and I both have weaknesses. This is where our elders cheat us. I felt unprepared for the dating scene, we argued a lot. It was a huge learning curve for me.

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Traditions Silence: Lack of Skills in Relating to Men

Patty (college student, 25 years, a history of rape):
Concurs with pervasive practices: Men roam, women wait. Sense of disconnect, want others to express her feelings: I wish I had someone to convince him (to stop cheating) ... when its my own marriage I hope I will know what to do. Passivity: I will put it in Gods hands, I ignore (videos of fianc having sex with other women), and yet I know I dont want to shame my mother and remain unmarried. Non-disclosure of sensitive information: I cannot tell them (therapist) about rape, the soldiers destroyed my goals.
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IMPLICATIONS-Discussion
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Cultural Implications In-depth understanding cultural nuances stigmas Gender and Public Health Implications US cities prime areas, diverse cultural practices Transition to the next life stage Implication Challenges, pressures impervious to modification

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CITED References
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Blanas D, Nichols K, Bekele M, Lugg A, Kerani R, Horowitz C. HIV/AIDS Among African-Born Residents in the United States. Journal of Immigrant and Minority Health. 2012:1557-1912. Skinner J, Underwood C, Schwandt H, Magombo A. Transitions to adulthood: Examining the influence of initiation rites on the HIV risk of adolescent girls in Mangochi and Thyolo districts of Malawi. AIDS Care. 2012/09/09 2012:1. Maposa S. Practical understanding of HIV risk in young black African women living in the United States [Doctoral dissertation]: School of Nursing, Saint Louis University; 2010. Colfax G, Rosenthal L. Addressing the intersection of HIV/AIDS, violence against women and girls, and genderrelated health disparities. Washington, D. C.: Interagency Federal Working Group; 2013. Heidegger M, Dahlstrom DO. Introduction to phenomenological research. Bloomington, Indiana: Indiana University Press; 2005. Benner PE, Tanner CA, Chesla CA. Expertise in nursing practice : Caring, clinical judgment, and ethics. New York: Springer Pub. Co.; 1996. Crown L, Roberts LJ. Against their will: Young women's nonagentic sexual experiences. Journal of Social and Personal Relationships. June 1, 2007 2007;24(3):385-405.

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