African American Women and Sexually Transmitted Infections: The Contextual Influence of Unbalanced Sex Ratios and Individual Risk Behaviors

• Author: Jennifer R. Havens,Michele Staton-Tindall,Carrie B. Oser,Danelle Stevens-Watkins,Brea L. Perry,Carl G. Leukefeld,Erin Pullen
• DOI: 10.1177/0022042616678610
• Date: 01 October 2017
• Published date: 01 October 2017
• Subject Matter: Articles

Journal of Drug Issues

2017, Vol. 47(4) 543 –561

© The Author(s) 2016

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DOI: 10.1177/0022042616678610

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Article

African American Women and

Sexually Transmitted Infections:

The Contextual Influence of

Unbalanced Sex Ratios and

Individual Risk Behaviors

Carrie B. Oser1, Erin Pullen2, Danelle Stevens-Watkins1,

Brea L. Perry2, Jennifer R. Havens1, Michele Staton-Tindall1,

and Carl G. Leukefeld1

Abstract

This study uses data from 564 African American women to examine the correlates of lifetime

prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions

about the availability of African American males, five partner characteristics, and drug history.

At the bivariate level, women with an STI diagnosis were significantly more likely to have dated

a man who was married, older, had sex with another man, involved in concurrent partnerships,

and had been incarcerated. About half of the participants stated it was difficult to find an eligible

African American male and attributed the limited pool of same-race partners to drug trafficking,

a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having

dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug

use during sex were positively associated with ever having an STI. Individual and contextual

implications are addressed.

Keywords

sexually transmitted infections, sexual partner characteristics, drug use during sex, African

American women, Male Marriage Pool Index

The prevalence of sexually transmitted infections (STIs) is conservatively estimated to be three

times higher in the United States than other developed countries (St. Lawrence & Fortenberry,

2007). However, the risk of contracting an STI is not evenly distributed among the U.S. popula-

tion. African Americans, especially young men and women, are particularly at risk of STIs and

of experiencing their negative consequences (Centers for Disease Control and Prevention [CDC],

2014a, 2014b; Morris, Kurth, Hamilton, Moody, & Wakefield, 2009; Woolf-King & Maisto,

2015), and this relationship is more pronounced when drug use is involved (Adimora &

1University of Kentucky, Lexington, KY, USA

2Indiana University, Bloomington, IN, USA

Corresponding Author:

Carrie B. Oser, Department of Sociology, Center on Drug & Alcohol Research, University of Kentucky, 1531

Patterson Office Tower, Lexington, KY 40506-0350, USA.

Email: carrie.oser@uky.edu

678610JODXXX10.1177/0022042616678610Journal of Drug IssuesOser et al.

research-article2016

544 Journal of Drug Issues 47(4)

Schoenbach, 2005; Aral, Adimora, & Fenton, 2008). Racial disparities in STI prevalence have

devastating health consequences and considerable costs. For example, research consistently indi-

cates that African Americans are more likely to be diagnosed with a variety of STIs including

HIV, syphilis, chlamydia, and gonorrhea (CDC, 2014a, 2014b). In addition, African American

men who have sex with men and women (MSMW) have a disproportionately higher risk of STI

acquisition, and often transmit infections to African American women through sexual contact

(CDC, 2014a). African American women are generally less likely to utilize health services and

are disproportionately more likely to delay seeking health services when compared with White

women (Smedley, Stith, & Nelson, 2003; Wright & Perry, 2010), further increasing the potential

consequences of STIs. In addition, because the rates of infection are based on diagnosed cases

rather than actual prevalence, they are likely an underestimation of the true occurrence of STIs

among African Americans. It is clear that contextual factors in the African American community

are contributing drivers to disproportionate STI rates; however, the precise mechanisms are

unknown. Given these findings and the overall persistence of racial disparities in STI prevalence,

further research is needed to better understand the unique contextual influences that increase risk

of STIs among African American women.

The vast majority of research has focused on proximate individual behaviors such as drug use,

condom use, or beliefs about the likelihood of contracting an STI to explain these racial dispari-

ties. The current study proposes an alternative, drawing conceptually on the role of the Male

Marriage Pool Index (Wilson, 1987), and focusing on how social contextual factors may influ-

ence individual behavioral choices, such as partner selection, and the spread of STIs among

African American women, net of the effects of individual-level risk factors. Specifically, social

contextual factors that reduce the number of low-risk African American males constrain African

American women’s choice of partners and, thus, they may engage in behaviors that unknowingly

place them at greater risk of STI acquisition. Using multivariate logistic regression, this study

seeks to identify whether African American women’s perception of a limited pool of eligible

African American men and their intimate romantic partner characteristics (i.e., having dated a

man who is married, at least 10 years older, has had sex with another man, was involved in a

concurrent sexual partnership, or was incarcerated) are significantly associated with having been

diagnosed with an STI, while controlling for drug history, demographic characteristics, sexual

behaviors, and HIV beliefs.

Contextual Influence, “Eligible” African American Men, and STI

Risk Factors

Substantial research suggests that individual-level risk behaviors and sexual beliefs play an

important role in the persistent disparities in STI rates. Specifically, drug use has consistently

been associated with a higher prevalence of STIs in the African American community (Adimora

& Schoenbach, 2005; Aral et al., 2008). Drug and sexual networks are often overlapping (Flom

et al., 2001) and drug use during sexual encounters is a risk factor for STIs (Celentano, Latimore,

& Mehta, 2008). Also in regard to sexual risk behaviors, less frequent condom use, early initia-

tion of sexual intercourse, engaging in sex work or transactional relationships, and having con-

current partners have been identified as contributing to the greater prevalence of STIs among

African Americans (Adimora et al., 2002; Aral et al., 2008; Edwards, Iritani, & Hallfors, 2006;

Inciardi, Surratt, & Kurtz, 2006; Morris et al., 2009; Staras, Cook, & Clark, 2009; Voisin, Tan, &

DiClemente, 2013). Moreover, the belief that one is at risk of contracting an STI is a necessary

precursor to engaging in prevention behaviors (Rosenstock, Strecher, & Becker, 1988). However,

individual behavioral factors alone cannot fully explain racial disparities in STI rates. African

American women’s risk of STIs may be attributed to their partners’ characteristics rather than