Challenge, Vol. 13, No. 2
African American College Students’ Attitudes toward
HIV/AIDS: Implications for Historically Black
Colleges and Universities
_____________________________________________________
Sandra E. Taylor
Department of Sociology and Criminal Justice
Clark Atlanta University
Tara Jones
Department of Medical Sociology
University of Alabama – Birmingham
_____________________________________________________
Abstract
This paper investigated African American college students’
responses to a set of interview questions selected from a larger survey
instrument in an exploratory study of basic attitudes about HIV/
AIDS. Forty-two participants responded to an interview schedule in
an investigation of student attitudinal domains regarding the HIV/
AIDS epidemic. Results show that while most students’ attitudes
were consistent with expectations, a number of students expressed
attitudes that are counterproductive in the fight against HIV/AIDS.
Given the epidemic within the African American community,
such findings appear ominous and implore strategies, in particular,
from the institution whose primary function is the education of its
populace. Unless aggressive steps are taken to address the problem
across college and university campuses, there can be no lessening
of the epidemic’s impact within this community, and thereby no
positive impact toward the goal of U.S. lowered rates consistent with
recent global trends.
______________________
Please direct all correspondence to Sandra E. Taylor, Department of Sociology
and Criminal Justice, Clark Atlanta University, 223 James P. Brawley Drive, S.W.,
Atlanta, GA 30314 or email to: staylor@cau.edu.
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Introduction
While HIV/AIDS cases have declined worldwide, ironically,
the leading world superpower is not experiencing this optimistic
trend. According to the World Health Organization (2007), 33.2
million people were estimated to have HIV in 2007 compared to 39.5
million who lived with the virus in 2006. In the United States, the
HIV/AIDS epidemic has not hit a similar leveling, in part due to the
high numbers of cases affecting the African American population.
And within this particular population, a further irony is the number
of black college students infected with HIV. While black college
students represent only a very small proportion of HIV/AIDS cases
overall, the significance lies in the African American numbers versus
those in the Caucasian community, and in research showing gaps
in knowledge between these two groups. In one study of ethnicity
and sex differences in AIDS-related variables of knowledge, fear, and
homophobia, the authors found that African American students had
significantly lower scores on these measures (Waldner, Sikka, & Baig,
1999). Moreover, and irrespective to race or ethnicity, one would not
expect such disparities from a sector focused on higher education.
It is too often presumed that college campuses, replete with readily
attainable informational resources, insulate their students from
health-related risks, including HIV/AIDS.
The daunting statistics indicating an increase in HIV
infections among African American young adults do not exclude
the college populace. One might reason that at institutions of higher
learning, students are somehow more “educated” about risk factors
associated with contracting HIV, and thereby, less likely to engage in
high-risk behaviors. However, cases of new HIV infection (84 male
college students, 73 of whom were African American) revealed in an
epidemiologic investigation involving 34 schools in North Carolina,
show that college status is not an insulator. Rates of newly reported
HIV infection among African American college student men who
have sex with men were similar to their non-student counterparts
(CDC, 2004). This research further showed that the majority of
study participants did not perceive themselves to be at risk for HIV
infection despite the elevated rates of high-risk behaviors.
Related literature on HIV/AIDS and college students indicates
that while this population is knowledgeable about prevention
measures and risky behaviors, students tend to underestimate
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their vulnerability. In one sample of 649 African American male
and female college students (aged 18-25 years) attending various
4-year institutions in a major southeastern metropolitan area,
inconsistencies in knowledge and behavior were observed. Data
indicate that while this population overall adheres to certain HIV-
preventive behaviors, they nevertheless violate other important HIV-
prevention practices (Taylor, Dilorio, Stephens, & Soet, 1997). For
example, while the college women were more likely than college men
to use measures that help prevent HIV transmission, both groups
reported practices that expose them to risk, including engaging in
sex without knowledge of a partner’s sexual history. In an earlier
study of African-American male college students, only 26% of
respondents were steady condom users despite knowledge of the risk
of not taking precautions (Johnson, Hinkle, Gilbert & Gant, 1992).
Hence, a significant gap emerges between students’ knowledge and
their actions resulting in new cases of HIV infection.
Reasons for the failure of African-American college students
as well as young African-Americans in general to follow safer
sex guidelines tend to center around their perceptions of being
invincible and somehow being disconnected from the reality that
they might contract HIV. However, other studies suggest that the
gap between student knowledge and behavior might be attributed
to factors outside of the invincibility/invulnerability explanation.
Included among these other factors are lapses in judgment (often
due to alcohol or other substances), and believing that physical
characteristics and appearance can inform one about their partner’s
HIV status. In light of the fact that college experiences can include
experimentation with mind-altering substances, education and
training campaigns attempt to appropriately emphasize the high
risks involved with consumption and dating. Much of the literature
has stressed the need for prevention and information messages that
are tailored to the populations that appear increasingly vulnerable,
including African American college students.
While empirical evidence in accounting for the gap between
student knowledge and behavior has not been consistent, also
inconsistent are factors explaining the gap between HIV rates of
black and white college students. Research by Waldner, Sikka, & Baig
(1999) show that AIDS knowledge scores were significantly lower
for African American university students compared to Caucasian
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students. African American students demonstrated higher rankings
of homophobia as well. Davis et al (2007) found that although it
appeared that white students were more aware of HIV facts than
African American students, this effect could be explained through
sexual status (sexually active students versus abstaining students,
with the sexually active students reporting less knowledge).
A possible factor in the disproportionate number of black
students contracting the virus is the increase of HIV/AIDS in certain
U. S. regions. Reif, Geonnotti, and Whetten (2006) document that
a substantial increase in AIDS cases in the Deep South occurred
from 2000-2003. In contrast, other regions experienced more
stable rates for this same time period. Given that black students
are disproportionately located in the South and data suggesting
colleges as potentially high transmission areas in the rural southeast
(Hightow, Leone, MacDonald (2003), the regional hypothesis
becomes a feasible one.
An epidemic of infection occurring in some North Carolina
college students involving African American men who have sex
with men is described by Hightow et al (2005) in terms of an at-
risk, accessible population deserving further HIV prevention
interventions. In this study of state surveillance records examining
new HIV diagnoses in men 18-30 years old, risk behavior for HIV-
infected men enrolled in college was compared with HIV-infected
male non-enrollees. Newly diagnosed HIV infection was found in
men in 37 colleges located in North Carolina or surrounding states
and a sexual partner network investigation linked 21 colleges, 61
students, and 8 partners of students (Hightow et al, 2005). As a
result, the authors describe an epidemic of HIV infection occurring
in North Carolina college students that has captured the attention of
both researchers and practitioners as well as college and university
officials. The study clearly reveals that college students can no longer
be viewed as a categorically low risk population, in part due to the
nature of developmental stages associated with this age group.
The culture of late adolescence (including the college
population) and the accompanying thought processes do not
necessarily nor consistently coincide with the wider culture. That
is, this population may tend to view sexual phenomena in ways
different from other groups. Specifically, they may hold different
views on what constitutes sex or particular sexual behaviors. For
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example, while penile-vaginal intercourse is viewed as “having
had sex,” oral-genital or penile-anal intercourse is not viewed as
constituting “sex” as perceived by certain college students (Sanders
& Reinisch, 1999). Similarly, Bogart et al (2000) found that vaginal
intercourse and anal intercourse were considered sex by a group of
undergraduates (n=233) under most circumstances. However, this
same group categorized oral intercourse as sex contingent upon the
gender and viewpoint of the actor, and whether orgasm occurred.
This specific study by Bogart et al (2000) assessed the impact of four
factors on respondents’ judgment of whether hypothetical actors
would consider a particular behavior to be “sex.” The subjects read 16
scenarios featuring a male and female and judged whether each actor
would consider the described behavior to be sex. The views of the
subjects indicate the realm of differences related to what constitutes
sex for this population. These findings suggest, as pointed out by the
authors, that items in behavior surveys need to be clearly delineated
to avoid subjective interpretations by respondents. Many studies on
HIV/AIDS and adolescent/young adult age groups have repeatedly
illuminated the inconsistencies that abound in defining “sex” for the
college population.
The training of students in alleviating attitudes and behaviors
that run counter to controlling the HIV/AIDS epidemic is certainly
the purview of the education sector, but also begs for the input of
the religious/faith sector. In light of the stigma and fear associated
with HIV/AIDS, strategies to combat the epidemic within both
sectors have been severely hampered. These key social institutions
within the African American community represent crucial sectors
in impacting the problem, but have only recently begun to engage in
more aggressive initiatives toward addressing the problem.
Given the increased numbers of African American college
and college-aged students who have contracted HIV, and in light of
knowledge and attitudinal gaps, efforts toward understanding the
nature of this population’s psyche relative to the epidemic would
seem feasible. Within this context, an investigation into specific
domains of HIV/AIDS was conducted in illuminating themes that
adversely affect safer behaviors.
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Methods
This research included a sample of African American college
students (n=42) who regularly attended a series of HIV/AIDS
education and prevention activities at a Southeastern historically
black university. Activities ranged from awareness seminars and
forums to health fairs showcasing innovations in HIV/AIDS, with
a major focus on training and education for prevention. Although a
total of 166 participants responded to the larger survey instrument
from which subsequent interview questions were extrapolated,
complete interviews were conducted with forty-two students in
comprising the content analysis for this study. Of the 42 respondents,
the average age of the sample was 20 .2 years with a median of 19
years and a range of 18 – 29. They ranged from freshmen to seniors
and all self-identified as black or African American. A majority of
women in comparison to men were included (26 or 61.9% and 16 or
38.1% respectively).
The larger research used a survey instrument consisting of
open-ended and structured questions to ascertain basic thoughts
and actions of college students. These questions represent part of
an extensive instrument designed to collect an array of measures
on college students’ attitudes and behaviors toward HIV/AIDS.
Specific items were selected for content analysis in order to more
closely investigate the students’ attitudes on critical issues related
to combating HIV/AIDS. The intent was to examine the students’
overall disposition toward HIV/AIDS (i.e., whether internally-driven
(including the expression of accurate information and knowledge
of prevention indicative of high self-efficacy) or externally-driven
(including the expression of inaccurate information and/or responses
indicative of low self-efficacy).
This analysis uncovered in-depth data on three important
domains related to college students’ thoughts and feelings regarding
HIV/AIDS and involve statements alluding to 1. fear, 2. conspiracy
theories, and 3. a gay disease. Questions that showed significant
unexpected responses (e.g., assuming you had put yourself at risk,
would you consent to testing if convenience and confidentiality
were guaranteed?) were extrapolated for the interview schedule.
This follow-up to responses resulted in the dichotomy of internally-
driven students (those who would be expected to engage in safer
sex/risk reducing behaviors, and thereby contributing to combating
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the epidemic) versus externally-driven students (those who would
be expected to attach lesser importance to these same behaviors,
thereby exacerbating the problem).
The three specific themes that emerged from the interview schedule
including 1. students’ fear of individual HIV/AIDS test results,
2. students’ belief that the epidemic is part of a conspiracy, and 3.
students’ association of HIV/AIDS with the gay population indicate
a need for enhanced programs that teach education and prevention
within a culturally-specific context.
Results and Discussion
The domains related to college students’ thoughts and feelings
regarding HIV/AIDS and the resulting themes provide insights
as to how African American college students might be inclined to
violate risk reduction and safer sex practices. For this population,
perceptions appear to be their reality. Hence, messages about HIV/
AIDS prevention must be centered in situational contexts, in an
effort to reach these students based on their experiences, views,
and ways of life. The themes unveiled corroborate past findings
indicating the need for enhanced HIV/AIDS education for an array
of populations.
The theme of “students’ fear” captures sentiments of how
afraid some students are to be tested even in the face of grave risk.
For example, one student explained, “If I find out I have it, then
what? So I would just rather not know.” While the overwhelming
majority of students (78%) stated that they would be tested if they
had put themselves at risk, this leaves far too many behind still not
understanding the importance of HIV testing. Additionally, a few
students who alluded to the “what you don’t know can’t hurt you”
syndrome made statements indicative of their experience with a
large burden of other concerns that would appear to place a concern
about their possible contraction of HIV as a minimal priority. For
example, one student stated, “Right now, I’m dealing with trying to
stay in school and keep my place . . . I just don’t have time to do all
these things that might give me another problem.” While this student
represents a minority view of the total population studied, the finding
shows the myriad of complexities involved in the development of
strategies for HIV/AIDS education and prevention.
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The “conspiracy” domain is particularly interesting but
perhaps is best understood from an African American historical
context. Still, given persons who feel that they are helpless to control
their HIV status because of a master plan, consistent preventive
measures are unlikely. Bogart & Thorburn (2005) show that HIV/
AIDS conspiracy beliefs are a barrier to prevention and may represent
negative attitudes about condoms among black men. While only six
of the 42 respondents for this analysis discussed the epidemic in
terms of a conspiracy designed by the “powers-to-be,” five of the six
had very strong opinions on how the virus emerged. One response
captures the expressions of this group: “I do think that genocide is
being committed to rid society of certain people.” Another student
stated, “I believe it is a plan to wipe out all black people because
it mysteriously surfaced in Africa to a large extent recently, and
the worst effects are on Africa.” Still another stated, “I have proof
that there was a plan . . . we need to know what they did and what
they are still trying to do.” These statements indicate how attitudes
and perceptions shape behaviors; hence, HIV/AIDS training and
education specialists must consider the sentiments of this group in
designing effective prevention messages.
Although HIV/AIDS awareness and prevention campaigns
have done much to educate society in general about the epidemic,
there still tends to be an association of HIV/AIDS almost exclusively
with the gay community. This is particularly disturbing when college
students make such blanket associations. This third domain, “gay
association” surfaces as a theme from the content analysis in that
students do not necessarily view all groups as being at risk. For
example, 8 of the 42 students (or 19.0%) indicated “gays” to the
question, “what populations or groups of people are most at risk for
HIV-infection?” (The expected responses and those which had been
communicated via training seminars and forums center around the
point of “any persons who put themselves at risk or engage in risky
behaviors.”) While the vast majority of student respondents answered
in the expected direction, unacceptable numbers continue to believe
that they are not at particular risk, when in fact (according to self-
identified behaviors), they are indeed. Several students’ responses
can be interpreted in terms of their inability or unwillingness to view
HIV/AIDS as an equal opportunity disease. Overall, in addition to
uncovering consequential attitudes, results from this analysis pose
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an important question: If students who are motivated to attend HIV/
AIDS awareness and prevention activities show adverse attitudes,
do those not attending harbor even more severe attitudes? This and
similar questions are posed for further study.
The fact that college and university students are at particular
risk for the transmission of HIV has resulted in a number of
programs and activities to address this problem. Across America,
historically black colleges and universities as well as majority-
serving institutions of higher education, have housed an array of
projects initially including awareness efforts. More recently, however,
these efforts have begun to focus more on prevention initiatives,
acknowledging the platforms that have been made during the early
nineties addressing awareness.
Given the seriousness of the HIV/AIDS epidemic within the
African American community generally, and the numbers of HIV-
infected African American college students in particular, specific
strategies can be suggested. First, the major social institutions
within the African American community must bolster their efforts
in addressing the problem. The sector of higher education has a
direct opportunity to do this and should take advantage of such
to incorporate HIV/AIDS teaching and learning across various
curricula. The importance of education as the primary response of
higher learning, and the various issues surrounding HIV/AIDS on
college campuses, point to this sector as a natural ally and collaborator
in the fight toward curtailing the epidemic. Other institutions and
community sectors are also critical in this fight, namely the religious
sector or faith community.
The religious/faith community has come a distance in
confronting the HIV/AIDS epidemic, but it has to now compensate
for a stagnant period by taking bolder and more aggressive steps
toward combating the problem. These institutions hold enormous
potential for impacting the problem, as both education and religion
have historically played a major significance in the African American
community.
Secondly, measures that directly capture and sustain the
attention of black college students would seem to make a difference.
For example, given the popularity of hip-hop and rap music to
this group, researchers, practitioners, and activists should greater
explore the relationship between this genre’s appeal and combating
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HIV/AIDS. Previous literature has discussed a model for using hip-
hop music with young adults as having heuristic value in promoting
HIV/AIDS prevention (Stephens, Braithwaite, & Taylor, 1998.)
Recognizing the potential of this genre of music to mobilize the
targeted population, and implementing subsequent catalysts for
change, can be a monumental strategy.
Lastly, reminders of risk to this target population at every
viable opportunity cannot be overemphasized. Because of gross
feelings of invincibility or invulnerability to HIV-infection, college
students too often act as if they were magically insulated from
becoming statistics in the epidemic. Persistent admonitions on risky
behaviors from all socialization agents, but especially the media,
can at a minimum, be a forceful reminder of the epidemic as a
nonrandom culprit.
Ongoing HIV/AIDS education is undoubtedly one of the best
mechanisms for stemming the epidemic within African American
communities. Given an epidemic with no cure and no vaccine,
accurate and timely information is indispensable to the ultimate
goal. Specifically, within the context of African American college
students, studies allude to the importance of increasing the specific
knowledge level of this group regarding the subtleties of sexual
transmission (Bazargan et al, 2000) in empowering them to better
understand their risk.
Conclusion
This research illuminates barriers to alleviating the HIV/
AIDS epidemic among African American college students relative
to their thinking about the disease and how it affects them. While a
number of implications can be gleaned, a primary one is that until
the most likely players (colleges and universities) step up in ways
that only they can, improvements are not likely to occur within the
black college populace.
Although it is difficult to predict specific interventions that
would seem to bring the HIV/AIDS epidemic under greater control,
it appears obvious that the sector of higher education can lessen
the deleterious impact via the very means of its basic function. In
broadening students’ knowledge of the epidemic and in serving as
a catalyst for them to be proactive, historically black colleges and
universities (and all institutions of higher education) across the
country can be a powerful force in the fight against HIV/AIDS.
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Challenge
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Challenge, Vol. 13, No. 2
Ida Rousseau Mukenge
Recommended Citation
African American College Students' Attitudes_resized
HIV-AIDS Perceptions, Attitudes & Behaviors Among HBCU Students_resized
Intersection Between Race, Gender, & Sexual Risk_resized
Promoting HIV Vaccine Research in African American Communities_resized