Low Prospects and High Risk: Structural Determinants of Sexual Health Associated with Sexual Risk Among an Economically Disadvantaged Cohort of Young African American Women

Background: The increased risk of HIV and other sexually transmitted infections (STIs) among some African American women may reflect their attempts to survive depressed economic conditions. Furthermore, these women may feel hopeless and engage in risk behaviors as a coping mechanism for their low future expectations given these adverse 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.

Methods: 237 young African American women (16 to 19 years old) from economically disadvantaged neighborhoods in Raleigh and Durham, NC were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention.  Participants were assessed at baseline for several structural determinants of sexual health (e.g., lack of food at home, homelessness, and low perceived prospects for education and employment) and HIV/STI-related risk behaviors (e.g., unprotected sex, number of sex partners, exchange sex). Logistic regression analyses controlling for age predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors.

Results: Some young African American women reported a lack of food at home (22%), homelessness (27%), and low perceived education/employment prospects (19%). Young women reporting these structural risk factors were between 2.2 and 3.8 times as likely as those not reporting these risk factors to report multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex.

Conclusions: In this sample of economically-disadvantaged young African American women in the southeast, 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.