Challenge, Vol. 13, No. 2
HIV/AIDS Perceptions, Attitudes and Behaviors
Among HBCU Students
_____________________________________________________
Michael Hodge
Morehouse College
Bruce H. Wade
Spelman College
_____________________________________________________
Abstract
College environments are typically considered somewhat
protected zones--protected from the “sins” of the general community.
However, a recent report from CDC placed considerable attention
on the resoundingly high rates of HIV infection among African
American students attending predominately African American
serving colleges and universities in North Carolina. In the “outside”
world, data show that African Americans lead the nation in the rates
of HIV/AIDS infections. This research turns on the light to view
more clearly an oft-shielded group in an effort to identify and assess
the exacerbating or ameliorating social forces that these campuses
imbue. This project uses quantitative and qualitative methodologies
to examine how college age young adults attending HBCU’s respond
to the pandemic / epidemic. In the general African American
population typical intervention approaches have had little to no
positive effects on reducing the persistently high rates of infection.
An in-depth look is taken into the lived-experiences of students
at Historically Black Colleges and Universities as it relates to their
sexual risk taking in the age of HIV/AIDS.
Hodge, Wade 13
13
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
Introduction
The HIV/AIDS pandemic is a significant social problem at the
global, national and regional levels. It impacts persons regardless of
gender, race, ethnicity, sexual orientation or age. This scourge may
even have reached communities thought to be relatively immune to
such incursions—college campuses. A recent report from the CDC
placed considerable attention on the resoundingly high rates of HIV
infection among African American students attending predominately
African American serving colleges and universities (HBCU’s) in
North Carolina (MMWR, August 20, 2004/53(32): 731- 4). One
CDC official states that there is no reason to think that we will not
see this same trend on other campuses as well (see Hightower, L.,
MacDonald P, et al., 2003). This research was motivated by the gaps
in the literature on the sexual risk behaviors and attitudes at HBCU’s
(historically black colleges and universities).
The importance of this project is found in the attempt to
identify the sociocultural aspects of the student populations at
HBCU’s that may place them at greater risk of HIV/AIDS infection.
By socio-cultural context, we mean the ways in which people’s
behaviors are linked to their social settings such as group membership,
race, class, and gender. For example, there are gender dynamics
that fuel the health disparities between black men and women.
Consequently, while black men and women overall account for 40%
of the cumulative AIDS cases through 2005, black females drive 60%
of this rate (Division of HIV/AIDS Prevention, National Center for
HIV/AIDS, Viral hepatitis, STD, and TB Preventions June 28, 2007).
Additionally, for 2005, black women constituted 66 percent of the
female cases of HIV/AIDS (CDC HIV/AIDS Fact Sheet, June 2007).
Although Black men have the highest rates of HIV/AIDS for any
of the racial or ethnic groups in the U.S., HIV/AIDS is the leading
cause of death for Black women aged 25–34 (CDC HIV/AIDS Fact
Sheet, June 2007).
Studies of social context situate health-related behaviors
within the framework of the social meaning, social relations and
transactions of people’s lives (Abel 1991). It is critical to focus on
14 Challenge
14
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
understanding the social and cultural components of developing
healthy lifestyles. Williams, et al point out that African Americans
have the highest overall HIV prevalence, HIV incidence, and HIV
mortality as well as the greatest number of years of potential life lost
to this disease (2003:66). Sero-surveillance reports suggest that the
HIV incidence among African American men 25-44 continues to
increase and is particularly problematic for men who have sex with
men (MSM). Within this group the HIV incidence is 16.7% per year
compared to an incidence of 2.5% per year for white MSM in their
twenties. (MMWR, Valleroy et al. 2000).
Few health behavior surveys have been conducted at
HBCU’s. Notably, however, Taylor, DiLorio, Stephens and Soet,
(1997) reported that only 35% of students in their study reported
using condoms on a regular basis. Until the recent North Carolina
survey the only sero-prevalence study among college students was
published in 1990 (Gayle et al.). College students were considered
to be low risk although at least one publication suggested that
African American college students may be the next group affected
by HIV (Duncan C, Miller DM, Borskey EJ, Fomby B, Dawson P,
and Davis L 2002). For instance, Black females diagnosed between
ages 13 to 24 are twice as likely to contract HIV/AIDS through high
risk heterosexual contact as their male counterparts. Black females
diagnosed in this age group and risk category constitute 17.3% of
new cases compared to 7.7% of men. It is important to understand
the lived-experiences of these students as they negotiate a complex
array of choices within their social settings.
Within the past decade, programs designed to stem the tide
of this epidemic among African Americans have made little to no
significant headway (Williams, Ekundayo, Udezulu, and Omishakin,
2003; Smith, Gwinn, Selik, Miller, Gaitor, Maat, DeCock, and Gayle,
2000). In the African American community, positive results are
slow to be realized. Clearly, there are barriers to these efforts that go
beyond the individual biological and psychological considerations
of most intervention/risk reduction programs. Myers, et al (2003),
for example, point out that “[T]his underscores the need for more
aggressive and targeted risk reduction interventions for African
Hodge, Wade 15
15
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
American men . . . because they do not seem to be getting the
message about the need to be more sexually responsible” (p. 75). The
scope of these risk reduction programs has not been broad enough
in the African American community where, perhaps, cultural issues
are more likely to impact people’s willingness to participate in open
discussions of sexuality and sex, participate in support groups, and
other treatments that appear effective in other communities. Even
when these programs are focused on ‘community’ issues, the efforts
are directed toward individuals.
The National College Health Risk Behavior Survey (Fact
Sheet CDC, 1995) revealed that 79 percent of college students have
ever had sexual intercourse and only 37 percent reported having
used a condom during their last sexual encounter. However, this
same study found that black students take fewer risks than their
white counterparts. For instance, while about 10-percent of whites
fail to use seatbelts when driving, only about 8-percent of blacks fail
to use them. Additionally, about 31% of whites and only 15% of
blacks report that they drink and drive. Focusing on sexual risk-
taking, the national Youth Risk Behavior Survey of pre-college
students revealed that 62.5% of whites used a condom during their
last sexual encounter compared to 72.8% of black students – even
though black students were reported to have been more likely to
have had sex during high school than Whites. Based on an ongoing
health behavior survey first conducted of 1,302 first year students in
the Atlanta University Center (AUC) by the Morehouse School of
Medicine in 2004, 64% of female and 73% of male first-year students
reported having had sex at least once in their lives. Only 48% of the
females reported using a condom during their last sexual encounter
along with 54% of the males. We will explore this rather counter-
intuitive finding later in this paper.
Methods
The findings herein are based on a multi-modal data
collection strategy, including qualitative interviews and survey
research. We briefly describe these techniques. The Internet is an
16 Challenge
16
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
emerging research tool that is proving to be very useful in the social
and behavioral sciences. Most of the studies using the Internet rely
on quantitative survey methods. There are a few that have used it
for qualitative analyses. Focus groups and chat rooms are typically
the choice for qualitative data collection and analyses (see Burgess,
Donnelly, Dillard, and Davis 2001; Bowen, Williams, and Horvath
2004; Hudson and Bruckman 2004). The use of interviewing
strategies, such as the technique described below, is still in its nascent
stages of development (Davis, Bolding, Hart, Sherr, and Elford
2005).
The findings of this research are based on the collection
of data from five (5) predominately African American serving
institutions within a large southern metropolitan area with diverse
student bodies (hereafter called AUC) utilizing secure internet “chat
room” sites. The data reported herein is based on surveys and in-
depth chats with 37 students. Each interview averaged 2.25 hours.
Respondents were paid for their time and potential costs of internet
connectivity. Respondents are interviewed “one-on-one” by a trained
researcher using the Internet as the medium of communication. This
method assures complete anonymity for the respondent, thereby
encouraging open, honest, and frank discussions of material that
potentially could create an uncomfortable setting for the respondent.
Focus groups and dialog sessions were also held with students.
Additionally, more systematic data were collected by survey
methodology. The findings discussed below are based on an
annual survey completed by first-year students within the AUC.
The research protocol was approved by the Institutional Review
Board of the Morehouse School of Medicine. The questionnaires
were voluntarily completed in large “convocation” settings. While
the actual convocations were required, students were given the
opportunity to “opt out” if they did not want to participate in the
study. The majority of students completed the questionnaires;
however, the lack of privacy and the large group setting undoubtedly
had some impact on the quality of the data. The analysis below is
based on data from the first two years of administration (2004 and
2005). The number of students who voluntarily participated in the
Hodge, Wade 17
17
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
survey (2004 – 2005) was 2,021. The patterns of sexual involvement
correspond to other data from large surveys of college students. The
number of full time undergraduates at the five colleges (according to
published fact books from 2004 – 2006) is 8633. Of this group, 44
percent (3805) is male.
Results
Our multi-method approach yielded several key findings from
the survey analysis as well as important themes related to HIV/AIDS
risk reduction among African American college students. We will
give a brief overview of the survey findings then turn to our more
qualitative aspects.
We compiled data from surveys conducted of first year
students in the AUC in 2004 and 2005. These data are shown in the
tables below. Table 1 shows that males were significantly more likely
to report having had sex than their female counterparts. Overall,
about 63 percent of these first year students indicated that they
had had sex at least once in their lives (56% of females and 71% of
males).
Table 1
Have you ever had sexual
intercourse? Female Male Totals
NO 420
(44.4%)
245
(29.3%)
665
(37.3%)
YES 527
(55.6%)
590
(70.7%) 1117 (62.7%)
TOTALS 947 835 1782
X2 = 42.735, df = 1, p=.000
These data indicate that while a greater percentage of males begin
having sex at slightly younger ages than females, there was no
statistically significant association between gender and the reported
18 Challenge
18
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
age of first sexual intercourse. However, Tables 2 & 3 reveal that males
report a higher number of sexual partners than females (lifetime and
last 3 months).
Table 2
# Lifetime Sex
Partners Female Male TOTALS
1 partner 162 (22.6%) 90 (14.9%) 252 (19.0%)
2 partners 174 (24.2%) 122 (20.2%) 296 (22.4%)
3 partners 99 (13.8%) 87 (14.4%) 186 (14.1%)
4 partners 124 (17.3%) 90 (14.9%) 214 (16.2%)
5 partners 68 (9.5%) 71 (11.7%) 139 (10.5%)
6+ partners 91 (12.7%) 145 (24.0%) 236 (17.8%)
TOTALS 718 605 1323
X2 = 38.936 (df = 5) p= .000 / Gamma = .213 / p= .000
Table 3
# Sex Partners in
last 3 Months Female Male TOTALS
No partners 302 (43.1%) 199 (33.4%) 501 (38.7%)
1 partner 118 (16.9%) 134 (22.5%0 252 (19.5%)
2 partners 198 (28.3%0 154 (25.9%) 352 (27.2%)
3 partners 69 (9.9%) 57 (9.6%) 126 (.09%)
4 partners 9 (1.3%) 22 (3.7%) 31 (.02%)
5 partners+ 4 (.6%) 29 (4.9%) 33 (.03%)
TOTALS 700 595 1295
X2 = 45.008 p= .000 / Gamma = .149 / p= .000
Hodge, Wade 19
19
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
Interestingly, Table 4 indicates that males are more likely to report
having used a condom during their last sexual intercourse than are
females.
Table 4
Condom use the last
time you had sexual
intercourse Female Male TOTALS
NO 246 (34.8%) 193 (28.8%) 439 (31.9%)
YES 461 (65.2%) 478 (71.2%) 939 (68.1%)
TOTALS 707 671 1378
X2 = 5.770, df = 1 p=.016
We wanted to explore this finding a little more deeply. We
analyzed the responses to a 13-item Condom Attitude Scale (DeHart
and Birkimer 1997). The 13-item Condom Attitude Scale had a
mean of 29.69 and a Standard Deviation of 13.412. The Cronbach’s
Alpha coefficient was .9214-demonstrating very good reliability.
This analysis indicates that males, surprisingly, show more positive
attitudes towards condoms than those of our female respondents.
Additional analysis was conducted using multiple linear regression
to ascertain which variables impacted condom attitudes (see
Table 5 below). Surprisingly, neither the mother’s nor father’s level
of education nor parental income had a significant influence on
condom attitudes in this sample. Age at first sex and number of
lifetime sex partners significantly (and favorably) impacted attitudes
towards condoms. This finding reveals that men and more sexually
experienced students are more favorable towards condoms and
condom use. This may be the result of the socialization of males
to favor condoms as a means of disease protection in this collegiate
setting. Gender attitudes probably also help to explain this difference
as females are socialized to emphasize intimacy and closeness in
their relationships.
20 Challenge
20
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
TABLE 5
Condom Attitudes Beta Coefficients Significance
Sex (female = 1) B = -4.915 P = .000
Age of first sex B = 1.566 P = .000
Number lifetime
partners B = .820 P = .043
For women, this may prove to be a dangerous attitude given the
nature of the HIV/AIDS epidemic in the U.S. While the greatest
numbers of Blacks that are diagnosed with HIV/AIDS are between
the ages of 35 to 44, Blacks between the ages of 13 to 24 constitute
60.1% of all recent HIV/AIDS diagnoses. The Centers for Disease
Control and Prevention surveillance data reveal that the primary
modes of transmission among Blacks include MSM (men having sex
with other men, 30,154 new cases), high-risk heterosexual contact
(having unprotected sex with a person who is HIV+, 14,698 new
cases) and injection drug use (10,415 new cases). Black females
diagnosed between ages 13 to 24 are twice as likely to contract
HIV/AIDS through high risk heterosexual contact as their male
counterparts (CDC, 2002). Black females diagnosed in this age
group and risk category constitute 17.3% of new cases compared to
7.7% of males. The primary mode of transmission for Black males
diagnosed at ages 13 to 24 is MSM behavior (19.9%).
These quantitative findings are closely linked to the evidence
provided in our qualitative analysis of students from these campuses.
Careful analysis of indepth interviews, focus group sessions, and
student dialog sessions yielded a number of interesting themes that
provide contextualization of the findings expressed above. These
themes are important determinants of the socio-cultural context
of the AUC. Our findings are also consistent with other research
findings that examine traditional gender roles (see, for example,
Hill-Collins 2004; Cole and Guy Sheftall 2003; Roberts, McNair &
Smith 2004; Sobo 1995). Unpublished data from surveys conducted
Hodge, Wade 21
21
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
by one of the co-authors over the last two years also indicate that
“serial monogamy” and low or inconsistent condom use are common
among undergraduates in the AUC. This research will help to inform
approaches to risk reduction and HIV testing for young African
Americans inside and outside of the academy.
One of the main ideas promoting risky sexual activity on
this consortium campus was the popular media. In particular
these respondents focused on what they termed highly sexual
videos. They suggest that African Americans are more influenced
by the combination of the music and what is seen than their white
counterparts. These respondents see the media, not so much as
causing sexual activity, but at least promoting a carefree sexual
lifestyle. As one respondent said,
Yes, Media do influence my sexual thinking and
especially my behavior. Sex on TV is free. TOO free
sex is so simplified on TV, this makes it seem so cut
and dry. I feel that TV promotes the need and pressure
for sex….
Another respondent believes that “media encourage this behavior
and our generation is easily influenced.” An interesting conversation
centered on these videos and the movies that they [college age
students] tend to watch. They said that none of the videos or movies
ever show or suggest the use of protection in the sex scenes. They
move directly from some minimal foreplay to a naked scene in the
bed to the sleep scene or cut away to another shot.
Sex has been limited to just a normal human activity
for any age these days especially on videos and shows.
i guess its all cos of the change in the way we think and
our being able to be more outspoken than humans
were years ago. the media does influence our sexual
thinking and attitudes and behaviors in a way but then
i wouldnt put too much blame on them cos i think
each and everyperson has the responsibility to process
that information and interprete it as to whether they
want to go by what they have seen or live by statutes
that protect them.
22 Challenge
22
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
Another respondent makes comment on the amount of sexualized
imagery in contemporary media presentations:
There are a lot of shows on television, and in the
movies that promote having a lot of sex with a lot of
people, without having any regard to the safety of the
individuals involved. These depictions of glamorous
and desirable life stages do not present the realities of
sex and sexual encounters. Clearly, no one in these
movies gets an STI or HIV.
An important finding, captured in the students’ comments above
and that is revealed from many of these qualitative interviews is
the normalizing of risky sex. These respondents do not think that
media are setting out to increase risky sex among the viewers of these
images; however, the respondents clearly indict media for depicting
risky sex as normal. In this way, these respondents say, the media
presents sex in such a way that what would be seen ordinarily as
risky behavior is now normal, and even expected. One respondent
was particularly cogent on this point:
It encourages the thinking that promiscuity is not so
bad, and in fact is at times encouraged. And none of the
people represented with the popular media go out of
their way to promote safe sex. This heavily influences
college students, who emulate what they see more
than they would like to admit...like its nothing. Like
its money, and everyone should rush to get as much as
they can from as many different sources as possible.
These respondents point to many of the popular music videos and
some movies where there is no sense of safe sex. Actors are depicted
as having sex with multiple partners, without any indication of
condom usage. And, as pointed out by Hill-Collins (2004), the lyrics
and themes of the videos are also misogynist and patriarchal.
I think that since most young black males want to be
a “player” and try to have sex with as many women
as they can, causes diseases to be spread in our
community. I think that the media encourages this
behavior and our generation is easily influenced.
Hodge, Wade 23
23
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
And, as one male respondent put it, “they allow videos that exploit
sex(naked women).” Consequently, females are tacitly encouraged
and shown to be passive in sexual relationships.
Another theme that is clearly present from the data targets the
sex education received as a teen in high school and from home. We
see these focal socializing agents as integrally connected providing
both complementary as well as conflicting messages. Both agents
seem to be missing the mark on sex education of children. The
respondents agreed nearly unanimously that the standard approach
used in high school was ineffective. They said that high school sex
education tries to scare students away from sex while the realities are
not discussed.
It needs to start in the homes. I think the parents
needs to be knowledgeable about the dangers of
sexual behavior, so that they can relay the info to their
children. So there should be programs implemented
to inform the adults.
A 20 years old male respondent very directly assesses the problem:
Well, I think the fundamental factor lies in the
condition of the home. When I say family grounding,
I mean a person may lack parental reinforcement,
concerning sexual activity.
The men in the group said that the extent of the sex education received
at home was their fathers telling them do not get anyone pregnant
so wear a condom. One respondent said “my father started giving
me condoms in 6th grade.” Another respondent said that he felt his
father was telling him to have sex. His father told him that a “Viagra
erection” was somehow superior to the natural erection thereby
encouraging the use of drugs with his sexual encounters. (Note:
there is information surfacing about the use of Viagra in young men
for whom it is not prescribed and not recommended in combination
with other drugs including crack cocaine and methamphetamines).
One of the most frequently stated ideas about college life
among students is the notion of “freedom from parents.” They
indicate that college provides them with the freedom to engage in
all sorts of activities. Without a strong foundation about sex and
24 Challenge
24
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
sexuality, the likelihood of risky sexual behavior is enhanced.
We note that the majority of HIV prevention programs focus
on male-to-male sexual contact, male bisexual behaviors, injection
drug users, and low-income women considered “at-risk”. By default,
such efforts ignore the needs of Black college women attending
HBCU’s. Our evidence highlights that societal norms, cultural
productions, as well as the college environment itself encourage
sexual experimentation and all types of sexual negotiation. African
American women in college, many of whom arrive from inner cities
and single-parent households, are part of a most recent hip hop
generation that is besieged by misogyny, materialism and sexual
risk-taking. Many African Americans strive to overcome their
ascribed and inferior social status by constantly struggling against
widespread stereotypes and assumptions regarding their very being.
Their patterns of racial identity formation and maintenance influence
how they respond to such representations, even within intimate
relationships. The research herein reveals patterns of thinking
among students, both men and women, which need to be addressed.
A female freshman student reveals her thoughts in a focus group
setting:
It’s hard being a Black woman, you’re fighting off
negativity at every moment. You gotta be strong,
when you’re in the bedroom setting you don’t want
to fight anymore. You become submissive. You relax
and let things flow.
Findings in the AUC corroborate those of Foreman (2003). She
suggests that students used certain strategies to create philosophical
and emotional rationalizations for their behaviors. Women also rely
on a perceived level of commitment in their romantic relations to
determine safer sex practices. Forman also finds that students had
difficulty discussing condom use with sex partners and that many
perceived that they had low levels of HIV knowledge. Our findings
differed from those of Foreman in the area of HIV knowledge.
Respondents had relatively high levels of knowledge even though
many did not use condoms consistently. They were also less likely
than those in the Foreman (2003) study to cite material reasons for
Hodge, Wade 25
25
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
having unprotected sex.
A disturbing circumstance was noted in discussions with
many of the respondents. The main thrust of the issue centered on
attitudes towards risky sexual activity. When the question was asked
why college students might engage in risk-taking behaviors, the
respondents began a type of rational choice process in their responses.
They believe that they weigh (accurately) the risks and determine
that the risk is worth it. Of course, this position is wrapped up with
all the other notions of their sexual activities – from seeing images
in the media, to sex education in school and home. One respondent
summed it up this way: “I’d rather have sex and take the risk and
hope that I don’t get it [HIV/AIDS] than not to have sex.” Another
added: “we continue to have sex because we are scared that we may
not be able to have sex again.” Yet another respondent states that
“disease is not something we think about, we are young and figure we
have time to fix whatever may happen [based on current actions].”
All of these themes fall squarely into the category of invincibility or a
false sense of invulnerability. In other words, these college students
feel that they are incapable of suffering harm from their actions. All
of these behavioral factors appear to be linked to the sociocultural
constraints of the college experience.
Sociocultural Findings
Many of the conversations settled on concerns of a
sociocultural nature. For example, the respondents began to focus
on topics such as what it means to be a college student (particularly
at a black school). Many suggested that college life means that you
have to be having sex, and a lot of it. If you are not participating in
sexual activity, peer groups view you as a child. As one respondent
put it: “you’re told you’re not grown until you get a piece.” Many
of these students may be trying to gain some sense of adulthood
through risk-taking behavior. The links between college culture
and behaviors of the students, no doubt, are complex. Distressingly,
these respondents seem to navigate this complexity in ways that may
enhance the probability of risky sex. The college culture provides
the first sense of independence from parental control. Peer pressure
26 Challenge
26
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
may lure students to engage in activities so that one will not feel left
out or be seen as an odd-ball.
One of the most interesting conversations centered on the
idea of sex as a proxy for the need to feel loved. The interesting
thing about this conversation was that it was most often discussed by
the males in the sample. The discussion from these young males is
similar to literature suggesting that one of the reasons for underage
pregnancy is the girl’s need to feel unconditional love. She is able to
give love and have that love unconditionally reciprocated through
her dependent infant. It can be intoned from this discussion that
students are using sex as a stand-in or substitute for their need to
feel loved. Females are also socialized to emphasize intimacy and
continuity in their relationships. As Sobo (1995) suggests, this
need for intimacy increases the likelihood of sexual risk-taking
among working class women. Our findings suggest that this need
for intimacy among women may also contribute to less favorable
attitudes about condoms and less condom usage - especially in on-
going (vs. casual) relationships with their male partners (see Wade
2007). More investigation is needed to understand the mechanisms
of this phenomenon.
Discussion
Gender as Cultural Context
Cole (2005) aptly describes the HIV/AIDS epidemic among
black women as “a disease of mass destruction” (2005:51). She points
out the limitations of the “ABC trilogy” of prevention. For many
Black women, providing or “teaching” the facts about abstinence,
faithfulness and consistent condom usage (ABC) are not enough to
stem the tide of the epidemic given the societal issues that impact
the broader African American community. The issues of “infidelity,
rape, incest … secret bisexuality, fears of rejection and loneliness,
and serial monogamy” (2005:53) make it necessary to supplement
the ABC model with other approaches to risk reduction. Cole
agrees that it is crucial that Black women receive tailored and
“comprehensive sex education” (2005:57) in response to this set of
Hodge, Wade 27
27
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
issues. Such gender specific programs must: 1) Convey the gravity of
the HIV/AIDS epidemic to women; 2) Influence personal behaviors
and notions of responsibility (abstinence, alternative forms of
intimacy, risk implications of multiple partners); 3) Enhance women’s
sense of personal empowerment (self esteem, self efficacy, condom
negotiation skills), and 4) finally, emphasize HIV/AIDS advocacy to
overcome community apathy, fatalism and conspiracy theories.
Another question related to gender role expectations
and sexual risk-taking for women and men is how to combat the
“valorization of thug life, misogyny, homophobic violence, and a
constant need to prove one’s manhood” (Hill Collins, 2004:81 – 82;
Cole & Guy Sheftall, 2003). Such beliefs, norms and “contextual
factors influence sexual risk-taking” (McNair, 2004:107). These
factors include environmental stress, relationship history, perceived
victimization status, an imbalanced sex ratio – fewer available
partners and an attenuated ability for females to negotiate condom
use (McNair, 2004). In a setting with an unbalanced sex ratio, there
is considerable pressure on women to compete for the attention of
men. Further, Black women in college are less likely to date outside
of their race than men. Consequently, more attention must be given
to these environmental pressures within the framework of HIV/
AIDS prevention for HBCU students.
Although most intervention programs target the individual,
health behaviors can illustrate how the health problems of Americans
and especially youth are embedded in the social, economic and
political structures of society. Evidence suggests that prevention
programs need to begin early in life, before risk-taking behaviors
cement themselves as a part of people’s behavioral repertoires.
Holtzman and Rubinson (1995) observed the impact of parent versus
peer communication about HIV/AIDS among high school students
in the U.S. They found that students who discussed HIV with
their parents were significantly less likely to engage in risky sexual
behaviors and drug injection than their peers who primarily discussed
HIV with other students. Other studies have found convincing
evidence linking family organization and interaction styles to risk-
taking behaviors (see Walker, Vaughn, and Cohall 1991; Leland and
28 Challenge
28
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
Barth 1993). Strategies that facilitate development of pro-social
environments are needed to stem the tide of risk taking behaviors.
Uncovering the social and cultural elements of the lived experiences
of specific at-risk groups will provide much needed information for
positive interventions of their risky sexual behaviors. This type of
preparation for a productive life style may hold the most promise for
reducing unhealthy life choices and the negative outcomes that seem
to be endemic to many communities (see Stokes and Hodge 2000;
Harris, Duncan, and Boisjoly 2002).
Youth and Sexuality in the Age of HIV/AIDS
A study sponsored by The Kaiser Family Foundation/Children
Now initiative (1999) surveyed 348 children between the ages of 10
and 15 in an effort to understand where youth receive information
about subjects such as sex and AIDS. What the survey revealed was
that youth between 13 and 15 years rely on peers as much or more
than on parents for information on sex and sexual relations. For
example, the respondents were asked to whom they would likely talk
if they were thinking about sex. Over one-fourth (27%) responded
that they would talk to friends. When asked if they had ever talked
to their parents about a range of issues, 24% indicated they had never
talked to either parent about AIDS, 19% had not talked to either
parent about basic facts of sexual reproduction, 26% had not talked
about issues surrounding becoming sexually active, and 21% had
not talked to their parents about pregnancy or sexually transmitted
diseases. Respondents also indicated interest in knowing more
about issues concerning sex and its consequences. This and other
studies show that youth are indeed interested in issues pertaining
to reproductive health and health issues in general. Students come
to college campuses with these questions and issues still unresolved.
Many have already engaged in risky activities.
Social forces in the larger societal context operate to either
aggravate or attenuate the behaviors on the college campuses. For
instance, research indicates that African American adolescents
initiate sexual encounters, on average, at an earlier age than their
white and Hispanic counterparts (Bakken and Winter 2002). Most
Hodge, Wade 29
29
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
interventions, therefore, focus on information processing. The idea is
that the more knowledge students have about the negative outcomes,
the less likely they will be to participate in risky behaviors. Seminars
that provide factual information are clearly a necessary component
for reducing risky sexual activity; but they may not be wholly
sufficient. Programs that address the “cultural baggage” of students
are needed to complete the package for effective behavior change.
And, it is important that these programs are based on sound scientific
foundations. We are looking to delineate the social and cultural
structures that circumscribe the behavioral repertoires of these
actors; but, moreso, we seek to understand the inter-relationships
or interaction of the social context with the actor. In essence, we
examine the mutual interpenetration and interdependence of agent
and structure. We do not ask simply what are the social forces
impinging upon each actor; but, what are the actors’ perceptions of
these social forces as they negotiate the cultural milieu of on their
campuses.
Interaction of Culture and Individual
We believe that a major issue hampering effective
intervention on college campuses, particularly HBCUs, is the belief
that it is ultimately the individual that controls his/her behaviors and
is the author of one’s own fate. Yet, sociological theory holds that
individuality is constrained by social forces such as class, race, gender
and social institutions such as family, education, religion, and work,
among others. Factors relating to these social institutions must be
included when trying to implement behavioral change strategies.
Link and Phelan (1995), for example, demonstrate the connections
between family interaction dynamics and risky sexual behaviors.
Bakken and Winter (2002) show that there is an association between
family characteristics and age of sexual initiation as well as the
lifetime number of sexual partners (both variables that are important
in assessing sexual risk). Hence, consistent with long-standing social
science theory, the relationship between health-related behaviors,
risk and knowledge can be incorporated in studies of social structure,
social practices, and agency (Abel 1991).
30 Challenge
30
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
Social structure is defined as the factors involving individuals’
relationships to each other and the attendant power relations. Social
practices are the reflexive activities in which people engage to
make and transform the world. Agency is defined as the ability for
people to deploy a range of causal powers—to “make a difference
to a preexisting state of affairs or course of events” (Giddens 1984).
In-depth qualitative analysis of case studies is the only way to fully
assess the actor within the particular context of the college culture
(Burawoy 1991; Feagin, Orum, and Sjoberg 1991).
Ample evidence exists demonstrating the relationship
between social factors and effective health behavior intervention
strategies. For example, research has shown that carefully designed
interventions that take into account the socio-cultural context play an
important role in reducing risky behaviors of adolescents and young
adults for a variety of problem areas. Kirby et al. (1994) provide a
review of school based programs designed to reduce sexual risk taking
behavior among adolescents. They found that a number of programs
were able to successfully reduce risk taking behaviors. Additionally,
Frost and Forrest (1995) identified five programs that were successful
in either reducing rates of sexual initiation by young adolescents or
increasing the use of contraceptives for those who are engaging in
sexual intercourse. More recently, Stokes and Hodge (2000) examine
the effects of programs such as Upward Bound on the risk taking
behavior of adolescents. These studies and others demonstrate
the substantial influence social factors have as determinants of
health behaviors. For instance, Myers, Javanbakht, Maritinez, and
Obediah (2003) examine the behavioral, demographic, social, and
psychological factors that may be associated with high sexual risk
activities. They find that for heterosexual African American males,
social support provided significantly deacreased risk-taking activities.
In other words, for every mean point increase in social support
there was an associated 2.3% decrease in the likelihood of risky
behaviors among this population group. A recently published study
examined the influence of social context on individual behaviors
that may place people at risk for negative health outcomes (Adimora
and Schoenbach 2005). These researchers found important socio-
Hodge, Wade 31
31
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
cultural factors that may put African Americans at greater risk for
STIs and HIV. They find that sharply contrasting social settings for
blacks and whites, particularly in their social networks, is likely to
maintain the gap in HIV rates. They note that overlapping sexual
partners is more prevalent among blacks. A lot of this finding can be
traced to contextual factors such as incarceration rates of black males,
segregation, and poverty. The study of sexual networks on Black
College Campuses has not been done, to date. Numerous studies
of college students have explored the relationship of knowledge
about HIV and risky sexual behavior (see Parsons JT, Halkitis PN,
Bimbi D, Borkowski T; Bazargan M, Kelly EM, Stein JA, Husaini BA,
Bazargan SH 2000; Dilorio C, Dudley WN, Soet J, Watkins J, Maibach
E. 2000). In many studies knowledge of HIV is not correlated with
safe sex practices (Valentine PA, Wright DL, Henley GL. 2003; Lewis
JE, Malow RM, Ireland SJ 1997) and interventions based on social
cognition models have had limited success in changing risky sexual
behavior (Ogden 2003). Other researchers have suggested the need
to integrate social group process into cognition models for youth and
young adults (Schofield PE, Pattison PE, Hill DJ, Borland R. 2003;
Young RA, Lynam MJ, Valach L, Novak H, Brierton I, Christopher
A. 2001). Several scholars have noted the importance of social
factors and culture on sexual health behaviors of African Americans
(Plowden K, Miller JL, James T. 2000; Plowden KO, Young AE 2003).
College campuses provide an interesting social setting where lives are very
closely intertwined on a number of levels.
Conclusion
Students work, live, play, etc. in a very small space and issues
of privacy are heightened by this type of organic density. These
concerns are particularly salient on Historically Black Colleges and
Universities where there is greater density than on traditionally larger
majority campuses (literally, everyone is, at minimum, familiar to
everyone). Institutional culture develops and changes as the nature
of the interactions of its members adjust to social forces from inside
and outside the institution. The findings chronicled herein, at least,
32 Challenge
32
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
begin to focus much needed attention on the dynamic interplay
among students at historically black colleges and universities. Given
the cultural baggage African Americans bring with them to college,
the lack of (or inconsistent) parental information provided to youth
regarding sexual relationships and the inconsistent condom use
among HBCU and other college students, it is crucial to provide
students with culturally specific risk reduction programming that
addresses the lack of risk knowledge, erroneous and problematic
early life socialization about intimacy and relationships, and the
gender imbalances in intimate relationships.
Hodge, Wade 33
33
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
REFERENCES
Burawoy, Michael, et al 1991. Ethnography Unbound: Power
and Resistance in the Modern Metropolis. Berkeley:
University of California Press.
Campbell, Carole A. 1999. Women, Families and HIV/
AIDS: A Sociological Perspective on the Epidemic in
America. Cambridge:Cambridge University Press.
Centers for Disease Control and Prevention 1997. “Youth Risk
Behavior Surveillance: National College Health Risk Behavior
Survey United States, 1995.” MMWR (46): 1 – 56.
Centers for Disease Control and Prevention 2001. “U.S. HIV and
AIDS Cases Reported Through December 2001.” HIV / AIDS
Surveillance Report 13 (2).
Centers for Disease Control and Prevention 2004. “Methodology of
the Youth Risk Behavior Surveillance System.” MMWR (53):
1 – 13.
Centers for Disease Control and Prevention 2007(b). “Update to
Racial / Ethnic Disparities in Diagnoses of HIV / AIDS – 33
States, 2001 – 2005” MMWR 56(9):189 - 193.
Centers for Disease Control and Prevention 2007. “Cases of HIV
Infection and AIDS in the United States and Dependent
Areas, 2005.” HIV / AIDS Surveillance Report 17 (June, 2007).
Cohen, Sheldon; Tom Kamarck; Robin Mermelstein 1983. “A
Global Measure of Perceived Stress.” Journal of Health and
Social Behavior, Vol. 24 (4): 385-396.
Cole, Johnnetta Betsch and Beverly Guy Sheftall 2003. Gender
Talk: The Struggle for Women’s Equality in African American
Communities. New York: Ballantine Books.
34 Challenge
34
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
Cole, Lorraine 2005. “The Politics of HIV Prevention and Black
Women.” The Harvard Journal of African American Public
Policy 11 (summer): 51 – 62.
DeHart, D.D. & Birkimer, J.C. 1997. “Trying to Practice Safer Sex:
Development of the Sexual Risk Scale.” The Journal of Sex
Research 34: 11 – 25.
Foreman, F.E. 2003 “African American College Women:
Constructing a Hierarchy of Sexual Arrangements.” AIDS
Care 15: 493-504.
Foreman, Faith E. 2003. “Intimate Risk: Sexual Risk Behavior
Among African American College Women.” Journal of Black
Studies 33(5):637 – 653.
Hill Collins, Patricia 2004. Black Sexual Politics: African Americans,
Gender, and the New Racism. New York: Routledge.
Roberts, George W., McNair, Lily D. & Smith, Dawn 2004.
“Introduction” The Journal of Black Psychology 30(1):5 - 10.
Sobo, E.J. 1995 Choosing Unsafe Sex: AIDS-Risk Denial Among
Disadvantaged Women. Philadelphia: University of
Pennsylvania Press.
Stokes, Carla E. and Gant, Larry M. 2002. “Turning the Tables
on the HIV / AIDS Epidemic: Hip Hop as a Tool for Reaching
African American Adolescent Girls.” African American
Research Perspectives 8(2) :71 – 81.
Taylor, S.E., DiLorio, C., Stephens, T.T. and Soet, J.E. 1997. “A
Comparison of AIDS-related Sexual Risk Behaviors Among
African-American College Students.” Journal of the National
Medical Association 89(6): 397-403.
U. S. Department of the Census 2000 Table P34B FAMILY TYPE
BY PRESENCE AND AGE OF OWN CHILDREN (BLACK
OR AFRICAN AMERICAN ALONE HOUSEHOLDER) [20]
downloaded from www.census.gov February 2, 2008.
Hodge, Wade 35
35
Mukenge: Challenge, Vol. 13, No. 2
Published by DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007
36 Challenge
Wade, Bruce H. 2007. “The Disabling Nature of the HIV / AIDS
Discourse Among HBCU Students: How Postcolonial Racial
Identities and Gender Expectations Influence HIV Prevention
Attitudes and Sexual Risk-taking.” in WAGADU: A Journal
Transnational Women’s and Gender Studies Volume 4 (sum-
mer): 125 -141.
Wingood, Gina M., DiClemente, Ralph J., Bernhardt, J. M.,
Harrington, K., Davies, S. L., Robillard, A. and Hook, E. W.
2003 “A Prospective Study of Exposure to Rap Music Videos
and African American Female Adolescents’ Health.” American
Journal of Public Health, 93, 437–439.
36
Challenge, Vol. 13 [2007], Iss. 2, Art. 1
http://digitalcommons.auctr.edu/challenge/vol13/iss2/1
Challenge
2007
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