Skip to main content
SpringerLink
Log in

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

  • Original Article
  • Published:
American Journal of Community Psychology

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adimora, A. A., Ramirez, C., Auerbach, J. D., Aral, S. O., Hodder, S., Wingood, G., et al. (2013). Preventing HIV infection in women. Journal of Acquired Immune Deficiency Syndrome, 63, S168–S173.

    Article  Google Scholar 

  • Anderson, E. (1999). Code of the streets: Decency, violence, and the moral life of the inner city. New York: Norton.

    Google Scholar 

  • Baird, S. J., Garfein, R. S., McIntosh, C. T., & Özler, B. (2012). Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: A cluster randomised trial. Lancet, 379, 1320–1329.

    Article  PubMed  Google Scholar 

  • Bolland, J. M. (2003). Hopelessness and risk behaviour among adolescents living in high-poverty inner-city neighbourhoods. Journal of Adolescence, 26, 145–158.

    Article  PubMed  Google Scholar 

  • Bolland, J. M., McCallum, D. M., Lian, B., Bailey, C. J., & Rowan, P. (2001). Hopelessness and violence among inner-city youths. Maternal and Child Health, 5, 237–244.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2010). National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention strategic plan, 2010–2015. Atlanta: CDC.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2012a). Youth risk behavior surveillance—United States. MMWR, 61(4), 1–168.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2012b). Youth risk behavior surveillance system: Selected 2011 National Health Risk Behaviors and Health Outcomes by Race/Ethnicity. Retrieved October 5, 2013, from http://www.cdc.gov/healthyyouth/yrbs/pdf/us_disparityrace_yrbs.pdf.

  • Centers for Disease Control and Prevention. (2013). HIV surveillance report, 2011. 23. http://www.cdc.gov/hiv/library/reports/surveillance/2011/surveillance_Report_vol_23.html. Accessed 28 July 2014.

  • Centers for Disease Control and Prevention. (2014). Social determinants of health among adults with diagnosed HIV infection in 20 states, the District of Columbia, and Puerto Rico, 2010. HIV Surveillance Supplemental Report, 19(2). http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed July 28 2014.

  • Cotton, C. R., & Rangle, L. M. (1996). Suicidality, hopelessness, and attitudes toward life and death in clinical and nonclinical settings. Death Studies, 20, 601–610.

    Article  PubMed  Google Scholar 

  • Dean, H. D., & Fenton, K. A. (2010). Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, a nd tuberculosis. Public Health Reports, 125(Supplement 4), 1–5.

    PubMed  PubMed Central  Google Scholar 

  • Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, J. A., & Harlow, S. D. (2004). Transactional sex among women in Soweto, South Africa: Prevalence, risk factors and association with HIV infection. Social Science and Medicine, 59, 1581–1592.

    Article  PubMed  Google Scholar 

  • Dunkle, K. L., Wingood, G. M., Camp, C. M., & DiClemente, R. J. (2010). Economically motivated relationships and transactional sex among unmarried African American and white women: Results from a US national telephone survey. Public Health Reports, 125(Suppl. 4), 90–100.

    PubMed  PubMed Central  Google Scholar 

  • DuRant, R. H., Cadenhead, C., Pendergrast, R. A., Slavens, G., & Linder, C. W. (1994). Factors associated with the use of violence among urban black adolescents. American Journal of Public Health, 84, 612–617.

    Article  PubMed  PubMed Central  Google Scholar 

  • DuRant, R. H., Getts, A. G., Cadenhead, C., Emans, S. J., & Woods, E. (1995). Exposure to violence and victimization and depression, hopelessness, and purpose in life among adolescents living in and around public housing. Developmental and Behavioral Pediatrics, 16, 233–237.

    Article  Google Scholar 

  • Gandelman, A., & Dolcini, M. M. (2012). The influcence of social determinants on evidence-based behavioral interventions—considerations for implementation in community settings. Translational Behavioral Medicine, 2(2), 137–148.

    Article  PubMed  PubMed Central  Google Scholar 

  • Greene, M. B. (1993). Chronic exposure to violence and poverty: Interventions that work for youth. Crime and Delinquency, 39, 106–124.

    Article  Google Scholar 

  • Hallfors, D. D., Iritani, B. J., Miller, W. C., & Bauer, D. J. (2007). Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions. American Journal of Public Health, 97, 125–132.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halpern, C. T., Hallfors, D. D., Bauer, D. J., Iritani, B. J., Waller, M. W., & Cho, H. (2004). Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases. Perspectives on Sexual and Reproductive Health, 36(6), 239–247.

    Article  PubMed  Google Scholar 

  • Hanenberg, R. S., Rojanapithayakorn, W., Kunasol, P., & Sokal, D. C. (1994). Impact of Thailand’s HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet, 344, 243–245.

    Article  PubMed  Google Scholar 

  • Hunter, M. (2002). The materiality of everyday sex: Thinking beyond “prostitution”. African Studies, 61, 99–120.

    Article  Google Scholar 

  • Joiner, T. E., & Wagner, K. D. (1995). Attributional style and depression in children and adolescents: A meta-analytic review. Clinical Psychology Review, 15, 777–798.

    Article  Google Scholar 

  • Kagan, S., Deardorff, J., McCright, J., Lightfoot, M., Lahiff, M., & Lippman, S. A. (2012). Hopelessness and sexual risk behavior among adolescent African American males in a low-income urban community. American Journal of Men’s Health, 6(5), 395–399.

    Article  PubMed  Google Scholar 

  • Kashani, J. H., Suarez, L., Allen, W. D., & Reid, J. C. (1997). Hopelessness in inpatient youth: A closer look at behavior, emotional support, and social support. Journal of Consulting and Clinical Psychology, 51, 504–510.

    Google Scholar 

  • Kazdin, A. E., French, N. H., Unis, A. S., Esveldt-Dawson, K., & Sherick, R. B. (1983). Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1625–1631.

    Google Scholar 

  • Lorion, R. P., & Saltzman, W. (1993). Children’s exposure to community violence: Following a path from concern to research to action. Psychiatry, 56, 55–65.

    PubMed  Google Scholar 

  • Luke, N. (2005). Confronting the “sugar daddy” stereotype: Age and economic asymmetries and risky sexual behavior in urban Kenya. International Family Planning Perspectives, 31, 6–14.

    Article  PubMed  Google Scholar 

  • MacLeod, J. (1987). Ain’t no makin’ it: Leveled aspirations in a low-income neighborhood. Boulder, CO: Westview.

    Google Scholar 

  • Maganja, R. K., Maman, S., Groves, A., & Mbwambo, J. K. (2007). Skinning the goat and pulling the load: Transactional sex among youth in Dar es Salaam, Tanzania. AIDS Care, 19, 974–981.

    Article  PubMed  Google Scholar 

  • Mandarin, J., Murray, C. B., & Bangi, A. K. (2003). Predictors of African American adolescent sexual activity: An ecological framework. Journal of Black Psychology, 29, 337–356.

    Article  Google Scholar 

  • Marshall, B. D., Shannon, K., Kerr, T., Zhang, R., & Wood, E. (2010). Survival sex work and increased HIV risk among sexual minority street-involved youth. Journal of Acquired Immune Deficiency Syndromes, 53(5), 661–664.

    PubMed  PubMed Central  Google Scholar 

  • McLaughlin, J., Miller, P., & Warwick, H. (1996). Deliberate self-harm in adolescents: Hopelessness, depression, problems and problem-solving. Journal of Adolescence, 19, 523–532.

    Article  PubMed  Google Scholar 

  • Miller-Johnson, S., Winn, D. M., Coie, J., Maumary-Gremaud, A., Hyman, C., & Terry, R. (1999). Motherhood during the teen years: A developmental perspective on risk factors for childbearing. Development and Psychopathology, 11, 85–100.

  • Muir, M. (1991). The environmental context of AIDS. New York: Praeger.

    Google Scholar 

  • Nkosana, J., & Rosenthal, D. (2007). The dynamics of intergenerational sexual relationships: The experience of schoolgirls in Botswana. Sexual Health, 4, 181–187.

    Article  PubMed  Google Scholar 

  • North Carolina HIV/STD Surveillance Report. (2012). Raleigh, NC: North Carolina Department of Health and Human Services, HIV/STD Prevention and Care Branch, Epidemiology and Special Studies Unit.

  • Oman, R. F., Vesely, S. K., Aspy, C. B., Tolma, E. L., Gavin, L., Bensyl, D. M., et al. (2013). A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors. Journal of Adolescent Health, 52(6), 779–785.

    Article  PubMed  Google Scholar 

  • Pyett, P. M., & Warr, D. J. (1997). Vulnerability on the streets: Female sex workers and HIV risk. AIDS Care, 9(5), 539–547.

    Article  PubMed  Google Scholar 

  • Reifman, A., & Windle, M. (1995). Adolescent suical behaviors as function of depression, hopelessness, alcohol use, and social support: A longitudinal investigation. American Journal of Community Psychology, 23, 329–354.

    Article  PubMed  Google Scholar 

  • Schmeige, S. J., Ewing, S. W. F., Hendershot, C. S., & Bryan, A. D. (2011). Positive outlook as a moderator of the effectiveness of an HIV/STI intervention with adolescents in detention. Health Education Research, 26(3), 432–442.

    Article  Google Scholar 

  • Shannon, K., Kerr, T., Marshall, B., Li, K., Zhang, R., Strathdee, S. A., et al. (2010). Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a canadian setting. Archives of Pediatrics and Adolescent Medicine, 164(1), 61.

    Article  PubMed  Google Scholar 

  • Sherman, S. G., German, D., Cheng, Y., Marks, M., & Bailey-Kloche, M. (2006). The evaluation of the JEWEL project: An innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care, 18(1), 1–11.

    Article  PubMed  Google Scholar 

  • Silberschmidt, M., & Rasch, V. (2001). Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: Vulnerable victims and active social agents. Social Science and Medicine, 52, 1815–1826.

    Article  PubMed  Google Scholar 

  • Sipsma, H. L., Ickovics, J. R., Lin, H., & Kershaw, T. S. (2013). The impact of future expectations on adolescent sexual risk behavior. Journal of Youth and Adolescence,. doi:10.1007/s10964-013-0082-7.

    PubMed  Google Scholar 

  • Swendeman, D., Basu, I., Das, S., Jana, S., & Rotheram-Borus, M. J. (2009). Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases. Social Science and Medicine, 69(8), 1157–1166.

    Article  PubMed  PubMed Central  Google Scholar 

  • Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science, 280(5365), 867–873.

    Article  PubMed  Google Scholar 

  • U.S. Census Bureau. (2012). 2010 Census of Population and Housing, Population and Housing Unit Counts, CPH-2-1, United States Summary. Washington, DC: U.S. Government Printing Office.

  • Vanwesenbeeck, I. (2001). Another decade of social scientific work on sex work: A review of research 1990–2000. Annual Review of Sex Research, 12(1), 242–289.

    PubMed  Google Scholar 

  • Walls, N. E., & Bell, S. (2011). Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research, 48(5), 423–436.

    Article  PubMed  Google Scholar 

  • Wechsberg, W. M. (1998). Revised risk behavior assessment, part I and part II. Research Triangle Park, NC: Research Triangle Institute.

    Google Scholar 

  • Wechsberg, W. M., Browne, F. A., Poulton, W., Ellerson, R. M., Simons-Rudolph, A., & Haller, D. (2011). Adapting an evidence-based HIV prevention intervention for pregnant African–American women in substance abuse treatment. Substance Abuse and Rehabilitation, 2, 35–42.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wechsberg, W. M., Kline, T., Doherty, I., Lane, S. D., Carry, M. G., Raiford, J. L., et al. (2013). Preliminary outcomes of the Young Women’s CoOp on sexual risk behaviors. Paper presented at the Poster presented at: American Public Health Association, Boston, MA.

    Google Scholar 

  • Wechsberg, W. M., Myers, B., Kline, T., Carney, T., Browne, F. A., & Novak, S. (2012). The relationship of alcohol and other drug use typologies to sex risk behaviors among vulnerable women in Cape Town, South Africa. Journal of AIDS & Clinical Research (S1–15).

  • Wilson, W. J. (1996). When work disappears: The world of thenew urban poor. New York: Knopf.

    Google Scholar 

  • Wojcicki, J. M. (2002). Commerical sex work or ukuphanda? Sex-for-money exchange in Soweto and Hammanskrall area, South Africa. Culture, Medicine and Psychiatry, 26, 339–370.

    Article  PubMed  Google Scholar 

  • Wolitski, R. J., Kidder, P., Pals, S. L., Royal, S., Aidala, A., Stall, R., et al. (2010). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS and Behavior, 14(3), 493–503.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2008). Commission on social determinants of health. Closing the gap in a generation: Health equity through action on the social determinants of health.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-37, Atlanta, GA, 30333, USA

    Jerris L. Raiford, Jeffrey H. Herbst & Monique Carry

  2. Harvard School of Public Health, Boston, MA, USA

    Felicia A. Browne

  3. Substance Abuse Treatment Evaluations and Interventions, Research Triangle Institute International, Research Triangle Park, NC, USA

    Irene Doherty & Wendee M. Wechsberg

Authors
  1. Jerris L. Raiford
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey H. Herbst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monique Carry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felicia A. Browne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irene Doherty
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wendee M. Wechsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jerris L. Raiford.

Additional information

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raiford, J.L., Herbst, J.H., Carry, M. et al. Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South. Am J Community Psychol 54, 243–250 (2014). https://doi.org/10.1007/s10464-014-9668-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10464-014-9668-9

Keywords

Search

Navigation