HIV Risk Behaviors and Avoidance Strategies Among Low-Income African American Female Youth in Alabama

Background:  While sexual activity among adolescents is decreasing, condom use among African American high school teens has declined. This is especially the case in low-income communities of the Southeast.  This lack of condom use puts African American females at greater risk of STDs – particularly HIV. The objective of this project is to discover cultural understandings of HIV risk and determine risky and protective behaviors in a low-income community as a way to inform future prevention programs in Alabama.

Methods:  Ten African American adolescent females aged 14-18 participated in private in-depth interviews in order to gain an understanding of their perceptions of HIV risk behaviors and HIV avoidance behaviors in their low-income community. In addition, two focus groups were conducted for clarification of statements made during initial in-depth interviews. The researcher transcribed audio-recordings of interviews and focus groups, and analyzed qualitative data using thematic coding and grounded theory.

Results: HIV risk behaviors highlighted by participants included partner concurrency, transactional sex, and interaction with older men in the community.  HIV avoidance behaviors included staying home, being escorted by an older male family member, limiting sexual partnerships to two or three individuals living in the same community, and avoiding prolonged conversation with older male community residents.  Participants also noted that condom use was viewed as ineffective protection against STDS or pregnancy.

Conclusions: Girls interviewed are using strategies to avoid HIV risk behaviors.  However, this risk is greater because of the ecological challenges that they are exposed to on a daily basis.  HIV risk prevention messages must take into account these ecological challenges experienced by girls living in low-income communities.  Grass roots HIV prevention messages are needed to further educate girls on how to protect themselves from the disease and what avoidance strategies are effective in this and similar low-income settings.