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Reframing Sexual Health for Black Girls and Women in HIV/STI Prevention Work: Highlighting the Role of Identity and Interpersonal Relationships.

ABSTRACT: While Black girls and women are disproportionately impacted by sexual health disparities, there continues to be an overwhelming focus on individual risk behaviors within prevention initiatives, which offers a fragmented narrative of the multidimensional nature of risk and plausibly limits effectiveness of prevention programs and attenuates reductions in disparities. Because sexual health is experienced within an individual's beliefs/values, interpersonal relationships, and behaviors and reflects larger social and cultural systems, it is important to critically examine common theories used to inform HIV/STI prevention interventions for Black women and girls. To fill this gap in the literature, we critique two commonly used theories in HIV/STI prevention interventions, namely the social cognitive theory and the theory of gender and power, by highlighting theoretical and practical strengths and weaknesses. We propose research implications that incorporate key strengths of the two theories while adding new concepts grounded in the intersectionality theory. The overall goal is to introduce a more comprehensive conceptual model that is reflective of and applicable to the multidimensional sexual experiences of Black girls and women within the evolving definition of sexual health and behavior.

SUBMITTER: Opara I

PROVIDER: S-EPMC8621381 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundSubstance use among adolescent girls is associated with numerous risk characteristics, including engaging in sexual risk behaviors, which can lead to HIV and sexually transmitted infection (STI) diagnoses. This is an important phenomenon to target as there is a significant race-gendered paradox that occurs when Black girls use and misuse drugs. When misuse occurs among this group, they are more likely to face harsher consequences and worse health outcomes than boys and other ethnic-minority girls. Therefore, there is a need to understand the risk and protective factors of drug use and sexual risk behaviors among Black girls and develop a robust intervention that can cater for this group.ObjectiveWe propose the development of a strengths-based prevention education intervention for Black girls between the ages of 13 and 18 years to promote protective factors.MethodsA sequential, mixed methods study will be conducted, and we will use the first 3 steps of the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework to begin the development of the intervention. Three aims will be described in this protocol. First, aim 1 is to explore sociocultural risk and protective factors among Black girls between the ages 13 and 18 years in drug use and HIV/STI prevention using focus group methodology and surveys. We will conduct at least 10 focus groups to include up to 75 Black girls or until we reach saturation. Our target sample size for the quantitative portion of the study will be 200 participants. Aim 2 will focus on deciding upon an intervention based on findings from aim 1 and forming a youth advisory board to guide intervention development. Aim 3 will be to conduct a pretest of the intervention with the youth advisory board to determine if the intervention is feasible and will be accepted by Black girls.ResultsThe study is part of a 2-year research pilot study award from the National Institutes of Mental Health. Data collection for this study began in October 2021. For aim 1, data collection is 95% complete. We expect to complete all data collection for aim 1 on or before May 30, 2023. Study activities for aim 2 are occurring simultaneously as data are being collected and analyzed and will be completed in the summer of 2023. Study activities for aim 3 will begin in the fall of 2023.ConclusionsThis study will be one of the few interventions that address both sexual health and drug use together and cater to Black girls. We anticipate that the intervention will be beneficial for Black girls across the nation to work on building culturally appropriate prevention education and building peer social supports, resulting in reduction or delayed substance use and improved sexual health.Trial registrationClinicalTrials.gov NCT05014074; https://clinicaltrials.gov/ct2/show/NCT05014074.International registered report identifier (irrid)DERR1-10.2196/45007.

Project description:OBJECTIVES:We evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention, Angels in Action, within an alternative disciplinary school for adolescent girls. METHODS:All girls who were 16-18?years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used ?² tests to estimate the intervention effect on participants' sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3?months after the intervention. RESULTS:Among the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3?months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3?months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner's age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3?months after the intervention (p=0.09). CONCLUSIONS:This pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls' consideration of partner risk characteristics as a means to enhance their STI prevention skills.

Project description:Limited studies have examined disparities in e-cigarette use among Black/African American adults by sexual identity and whether the relationship between symptoms of anxiety/depression and e-cigarette use varies by sexual identity. We examined the association between e-cigarette use behaviors (never, former, and current use) and anxiety/depression among a nationally representative sample of Black/African American adults who identified as a sexual minority (lesbian/gay, bisexual, and others) or heterosexual individuals. We combined cross-sectional data from the 2011 to 2020 Health Information National Trends Survey (n = 6267), which is a nationally representative data set. We computed weighted e-cigarette use prevalence and multinomial logistic regression results (never use compared with former and current use, respectively). Among Blacks/African Americans, a larger percentage of sexual minority individuals compared with heterosexual individuals reported former and current e-cigarette use. Among sexual minorities, lesbian/gay individuals reported higher former e-cigarette use, whereas bisexual individuals reported higher current e-cigarette use. Among sexual minority individuals, moderate symptoms of anxiety/depression, compared with no symptoms of anxiety/depression, were associated with a higher likelihood of former e-cigarette use. Among heterosexuals, moderate symptoms of anxiety/depression were also associated with a higher likelihood of former e-cigarette use, while mild and severe symptoms of anxiety/depression were associated with current e-cigarette use compared with no symptoms of anxiety/depression. The intersection between sexual identity and anxiety/depression influenced e-cigarette use behaviors in different ways among Black/African Americans. The findings reinforce the heterogeneity within the Black/African American population, indicating the dangers of not considering subgroup differences as a standard part of public health research practice.

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Reframing Sexual Health for Black Girls and Women in HIV/STI Prevention Work: Highlighting the Role of Identity and Interpersonal Relationships.

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