How Do African American Adults Understand and Conceptualize HIV and Other STDs? Implications and Opportunities for a More Holistic Approach to Promoting Sexual Health

Background: African Americans (AAs) are disproportionately affected by STDs in the United States, at rates of 8-to-20 times higher than whites. Health communication can help raise awareness of the problem in AA communities and prompt change, but the most effective messaging, including whether HIV and STD messaging can be ‘bundled’ to maximize resources and foster a more holistic approach to sexual health promotion, is unknown.

Objectives: To explore AA audiences’ understandings/conceptualizations of STDs/HIV and message-bundling preferences.

Methods: Triads (n=31) and individual interviews (n=64) were conducted in four US communities with sexually active, heterosexual AA adults, ages 18-45 (N=158). STD-related knowledge/perceptions were explored through free associations with the term STD, and an STD card-sorting activity. Participants were asked whether they thought an STD-prevention campaign should focus on an individual STD, multiple STDs, or a combination of HIV and other STDs. Discussions were audio-taped and transcribed. Three analysts coded transcripts using QSR NVivo8. Card-sorting analysis was conducted using multi-dimensional scaling and cluster analysis. 

Results: Initial reactions to the term “STD” centered on stigma and personal responsibility. Most participants named common STDs, including HIV. Generally, HIV was viewed as an STD, differentiated by its severity and alternate transmission routes. STDs were primarily grouped by their perceived curability and seriousness during card sorting. Clustering was also observed among STDs perceived to be stigmatizing, common, similarly treated, and bacterial or viral. Most participants felt that a campaign should address all STDs generally, including HIV; though specific information should address each STD individually.

Conclusions: STD awareness campaigns may consider bundling STDs with HIV, guided by key STD attributes, as identified in this research.

Implications for Programs, Policy, and Research: Identified bundling strategies can help guide STD/HIV-prevention programs. Research should consider whether combined STD communications impacts message effectiveness, and if bundled messages can be effectively communicated in a broader sexual-health context.