文章基本信息

标题：Addressing the Unique Needs of African American Women in HIV Prevention
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作者：Nabila El-Bassel ; Nathilee A. Caldeira ; Lesia M. Ruglass 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：6
页码：996-1001
DOI：10.2105/AJPH.2008.140541
语种：English
出版社：American Public Health Association
摘要：African American women continue to be disproportionately affected by the HIV/AIDS epidemic, yet there are few effective HIV prevention interventions that are exclusively tailored to their lives and that address their risk factors. Using an ecological framework, we offer a comprehensive overview of the risk factors that are driving the HIV/AIDS epidemic among African American women and explicate the consequences of ignoring these factors in HIV prevention strategies. We also recommend ways to improve HIV prevention programs by taking into consideration the unique life experiences of adult African American women. Despite more than 25 years of accumulative research demonstrating that behavioral interventions can curb HIV risks among adult women,^{1 – 7} few US-based studies have focused exclusively on African American women and only a limited number of studies tailored for this population have been identified as Centers for Disease Control and Prevention–sanctioned evidence-based HIV prevention.⁸ Recent US incidence data show that the rate of HIV infection is 7 times higher among African Americans than it is among Whites.⁹ In the United States in 2006, African American women had an HIV incidence rate that was 15 times higher than that of White women and nearly 4 times higher than that of Hispanic women.¹⁰ This alarming discrepancy raises several important questions: What is driving the HIV/AIDS epidemic among adult African American women? What unique prevention challenges do these women face? How well do available prevention strategies consider the everyday realities of the lives of African American women? Using Bronfenbrenner's ecological perspective,¹¹ we present factors related to the HIV/AIDS epidemic among African American women that can be used to effectively target prevention interventions. We also describe how the various factors in each system interact and their additive impact on African American women's risky behaviors. An understanding of these factors will inform the development of appropriate HIV prevention strategies. The ecological perspective consists of 4 levels of risk factors: (1) the ontogenetic system , which refers to personal factors such as childhood sexual abuse, posttraumatic stress disorder (PTSD), and substance abuse; (2) the microsystem , which refers to interactional and relationship contexts, such as relationship dynamics and experience and fear of intimate partner violence (IPV); (3) the exosystem , which refers to external stressors that impinge upon the immediate setting and increase the likelihood of engaging in risky behavior, such as poverty and lack of access to HIV prevention services; and (4) the macrosystem , which includes the broad cultural values and belief systems (e.g., gender roles, gender inequalities, social norms, attitudes toward sexual activity and safe sexual practices) that interact with all the other system levels. We discuss how lack of attention to these factors in existing prevention strategies poses major challenges that constitute barriers and prevent African American women from participating in HIV prevention programs. We also identify the types of strategies that are needed to reduce their risks of HIV transmission.