Overcoming STD Disparities Through An Empowering Sexual Health Approach: Findings From Cdc's Concept-Testing Research With African American Adults

Theoretical Background and research questions/hypothesis:  Although African Americans (AAs) make up only 12% of the United States (U.S.) population, the Centers for Disease Control & Prevention (CDC) reports that they account for approximately half of all reported chlamydia and syphilis cases, and 70% of gonorrhea cases. Experts have called for media campaigns to raise awareness of the high STD prevalence among AAs, minimize STD-associated stigma, and promote STD prevention and testing behaviors. CDC sought to develop and pilot-test positive sexual health concepts encompassing both HIV and STD prevention information that empower AAs to adopt protective behaviors (e.g., consistent condom use, monogamy, open communication, and STD testing). The intent of pilot-testing was to inform further testing on a larger scale, for possible campaign development/implementation.

Methods:  Through a contract with RTI International, five concepts were pilot-tested with sexually active AAs (18-45 years old) in Atlanta GA. Small-group discussions (triads), segmented by sex and sexual orientation, were used to explore participant values/perceptions of success, power, HIV and STD’s, sexual health, and healthy relationships; as well as participant reactions to concepts. Discussions were observed by two or more researchers, who took notes and entered data into an electronic data matrix. Researchers reviewed the data for patterns and relationships across sets of interviews, including differences by segment.

Results: 

A total of 36 adults participated, including 13 heterosexual men, nine heterosexual women, six non-gay-identified (NGI) men who have sex with men (MSM), and nine gay-identified men. Values such as independence, self-respect, responsibility, and contributing to one’s community/family were associated with success/power, though values differed across segments. Trust and honesty were associated with healthy relationships, though it was acknowledged across segments that healthy relationships are rare and challenging. Respondents indicated that people don’t talk (or think) about sexual health per se. When probed, meanings of “sexual health” ranged from maintaining general health, to preventing STDs/HIV, taking responsibility, having regular checkups, using condoms/birth control, getting educated, communicating honestly, and ensuring one’s partner has been tested. All groups believed that individuals have a responsibility to take these actions, yet they acknowledged that STD-associated stigma and other factors may prevent them from doing so. Other barriers included gender imbalances, double-standards and stereotypes; lack of perceived power, role models for healthy relationships, and STD/HIV prevention education; and fear of communication, STD testing and STD disclosure.  Two concepts resonated across the sample, while other concepts, such as promoting “monogamy,” were not seen as realistic or palatable.

Conclusions:  This exploratory research indicates that health communication concepts that emphasize positive values/attributes, address gender double standards, increase partner respect and honesty, and normalize STD prevention behaviors should be considered in the design and testing of messages intended to improve sexual health outcomes among African-American audiences.

Implications for research and/or practice: Revised concepts for future consideration will be shared.