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A QUALITATIVE APPROACH IN EXAMINING HIV/AIDS
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A QUALITATIVE APPROACH IN EXAMINING HIV/AIDS PREVENTION
MESSAGES AMONG AF RICAN-AMERICAN AND LATINA
LATE-ADOLESCENT FEMALES

By

Callie J. Oneese

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling, Educational Psychology, and Special Education

2006

ABSTRACT

A QUALITATIVE APPROACH TO EXAMINE HIV/AIDS PREVENTION
MESSAGES AMONG AFRICAN-AMERICAN AND LATINA
LATE-ADOLESCENT FEMALES

By

Callie J. Oneese

Despite the large body of research on the antecedent factors in explaining
adolescent sexually risky behaviors that can result in contracting a sexually transmitted
infection (STI), the interaction of these factors that place African-American and Latina
late-adolescent females at disproportionate risk of HIV infection is not yet fully
understood. In addition, studies have also called for gender-appropriate, age-specific,
and culturally-relevant HIV/AIDS prevention campaigns; however, there is a paucity of
research studies that offer tangible models of prevention that has a utilitarian effect. To
address these deficits, this study first challenges the ontological, epistemological, and
methodological assumptions of conventional research designs that predominately are
used in the HIV/AIDS research. Second, a qualitative design grounded in a
constructivist paradigm was employed to extract the complex underpinning of sexually
risky behaviors by identifying themes derived from 19 African-American and Latina
female participants, between the ages of 19 and 22, in several domains, including
knowledge of HIV transmission, conceptualization and behavioral practices of sex and
safe sex, communication patterns with sex partners, and the utility of past and present

HIV/AIDS messages. Qualitative data analysis yielded a conceptual model that accounts

for sexually risky behaviors among this specific population and that can be offered as an
extension of the current Theory of Gender and Power. This study also proposes specific
and relevant guidelines to compliment the existing HIV/AIDS prevention campaigns,
addresses its inherent methodological limitations, and identifies innovative research

avenues that will ultimately benefit populations at risk of HIV-infection.

Copyright by
CALLIE J. ONEESE
2006

To all the adolescent females who are finding their voices and securing their identities

ACKNOWLEDGEMENTS

My vision of bringing about meaningful change at the individual and societal
level has evolved into many forms, one of which is the completion of this dissertation. I
would not have been able to move from thought to action without the social support that I
have received throughout my academic career.

I am indebted to Dr. Gloria Smith, Dr. Robert Fabiano, Dr. Rita Kenyon-Jump,
Dr. Scott Driesenga, Carmen Gear, Dr. Laura Julier, and Dr. Christopher Vanderpool, all
of whom have mentored me and emotionally invested in my professional and personal
development as well as in my general well-being. Each person, in some form and at
different times in my career, demonstrated the kind of faith in me that I needed to leap
forward.

I am grateful to my friends and colleagues, particularly Laurel Sutherland,
Michael Viges, Dr. Dwaine Campbell, and Robert Bastanfar, for giving me the right type
of support at each turning point. Thank you from the bottom of my heart.

I am also equally thankful to my family for providing me unconditional love and support.
A special thanks to my oldest brother, Matthew Bair, for taking emotional risks with me
and continually inquiring about the “Big D,” a boost of encouragement that I did not
know I always needed but was glad to have received. A big, fat, gigantic thanks to my
mom, who celebrated in my talents, loved me in my darkest hours, and put in what felt
like countless hours of editorial assistance.

I am deeply appreciative to Laurel Sutherland, Amy Pettle, and Cathy Bair for the
energy and concentration to edit this study at different stages of progress. Special regards

to the participants in this study and their level of candor. I am also grateful to the

vi

members of my dissertation committee: Drs. Gloria S. Smith, Lee N. June, Peter G.
Gulick, and Douglas R. Campbell, all of whom demonstrated enthusiasm at the
dissertation proposal defense and patience two years later as I complete this project.
Finally, my most heartfelt gratitude goes to my best friend, kindred spirit, and
husband, Dr. Justin Oneese as the combination of his steadfast support, conviction in my
being, and quip remarks were apparent each and every day.
I thank each one of you for your devotion in getting me to exit the tunnel and be

in the light.

vii

TABLE OF CONTENTS
LIST OF TABLES ......................................................................................... x
LIST OF FIGURES ....................................................................................... xi

INTRODUCTION
Significance of the Problem ...............................................................
General Background ..........................................................................
Statement of the Problem ...................................................................
Theoretical Framework ......................................................................
Research Questions ............................................................................

\I\.IUI>—-—

CHAPTER 1: REVIEW OF LITERATURE

Historical Overview of HIV/AIDS .................................................... 9
Youths Engaging in Sexual Activity .................................................. 12
An Alternative to Abstinence: Latex Condoms ................................ 13
Women: At a Greater Risk of HIV Infection .................................... 16
Race/Ethnicity: African-American and Latina Females ................... 19
Existing Models and Their Limitations ............................................. 22
Newly Emerging Theory: Theory of Gender and Power ................... 27
Quality of Existing Prevention Campaigns ........................................ 30
Role of Quantitative Research Design ............................................... 34

CHAPTER 2: METHOD

A Different Kind of Knowing ............................................................ 36

Current Epistemological and Methodological Research in Social

Sciences .............................................................................................. 37

Critique of the Assumptions Underlying Traditional Scientific

Inquiry ................................................................................................ 39

Why Employ a Qualitative Research Design? ................................... 45

Overview of the Research Design ...................................................... 49

Summary ............................................................................................ 64

CHAPTER 3: RESULTS

Survey ................................................................................................ 65

Biography ........................................................................................... 68

Findings .............................................................................................. 77
Summary of Knowledge Regarding HIV Transmission ........ 79

Thoughts and Behaviors about Sex, Participants’ Sexual
Experiences, Safe Sex, and Communication Patterns with

Sex Partners ........................................................................... 81
Definition of Sex ........................................................ 81
Personal Accounts of Past and Present Sexual
Experiences ................................................................ 87
Definition of Safe Sex ............................................... 1 [9

viii

Motivational Factors Not to Employ Condoms ......... 123

Communication Patterns with Sex Partners ............... 126
Effectiveness of Past and Present HIV/AIDS Messages ....... 134
Types of Past HIV/AIDS Messages ........................... 135
Types of Present HIV/AIDS Messages ...................... 140
Suggestions to Increase Consistent Condom Use and
HIV Awareness .......................................................... 146
Summary ............................................................................................ 150
CHAPTER 4: DISCUSSION
Knowledge of HIV Transmission and Awareness ............................. 151
Multiple Definitions of Sex ............................................................... 153
Practical Implications Drawn from Past and Present Sexual
Experiences ........................................................................................ l 59
To Use or Not To Use Condoms ........................................................ 160
Summary of Communication Patterns with Sex Partners .................. 170
Utility of Evaluating HIV/AIDS Message ......................................... 176
Conceptualization of the Themes: The Big Picture ........................... 183
Practical Implications: New and Improved HIV/AIDS Prevention
Campaign ........................................................................................... 187
Limitations ......................................................................................... 193
Future Research Implications: Where to Next? ................................. 193
APPENDICES ............................................................................................... 197
Appendix A: F lyer ............................................................................. 198
Appendix B: Script ............................................................................ 200
Appendix C: Informed Consent ......................................................... 202
Appendix D: Semi-Structured Interview Questionnaire .................... 205
REFERENCES .............................................................................................. 212

ix

LIST OF TABLES

TABLE 1:

TABLE 2:

TABLE 3:

TABLE 4:

TABLE 5:

TABLE 6:

TABLE 7:

TABLE 8:

TABLE 9:

TABLE 10:

A Sample of the Third Stage of the F ive-Stage Analysis of
Qualitative Research ............................................................

A Sample of the Fourth Stage of the Five-Stage Analysis
of Qualitative Research ........................................................

Demographic Variables, Number of Sex Partners,
Condoms Use, and HIV Test ................................................

Themes on the Knowledge Regarding HIV Transmission...

Categorization of Sexual Partners by Number and by
Race/Ethnicity ......................................................................

Condom Use by African-Americans Females ......................
Condom Use by Latina Females ..........................................
Effectiveness of Past HIV/AIDS Messages .........................
Effectiveness of HIV/AIDS Messages across Time .............

Themes Derived from Ways to Increase Condom Use ........

61

63

66

79

88

120

121

138

143

147

LIST OF FIGURES

FIGURE 1: Conceptualization of the Themes: The Primal Motive and
Its Effect .................................................................................. 185

xi

INTRODUCTION
Significance of the Problem

Despite the medical advancement in technology and treatment of HIV, the
understanding of its transmission and the risk factors involved, HIV remains a significant
threat to American youths. The majority of research on HIV/AIDS and adolescents has
been quantified into numbers to describe the frequency, intensity, onset, and duration of
the disease. These numbers have helped in identifying who is at risk, specifically
African-American and Latina late-adolescent females, and to some extent, why they may
be at risk. The existing literature, nevertheless, has floundered to impart a clear
understanding of why these youths are still being infected with a disease that is
preventable. This is largely because of the limitations in the way this pandemic has been
studied, the current epistemology by which knowledge is obtained, and the present
zeitgeist of theoretical framework and education-based prevention programs on which it
is based. The purpose of this study is, therefore, to elicit the perceptions and experiences
of African-American and Latina late-adolescent females on HIV/AIDS. The information
gathered from these participants will inform the researchers, as well as the mental health
and medical communities, about why this population remains at risk and what
specifically is needed so that more effective prevention messages can be generated and
implemented.

General Background

In the United States approximately 440,000 million people have died of Acquired

Immune Deficiency Syndrome (AIDS) and nearly one million people have been infected

with Human Immunodeficiency Virus (HIV) (Centers for Disease Control and Prevention

[CDC], 2001a, 2001b). AIDS is an infectious disease caused by HIV. The process that
destroys the immune system cells is that it attacks the body through three disease
processes: immunodeficiency, autoimmunity, and nervous system dysfunction. $3
Immunodeficiency, for example, results from the way that the virus binds to a protein
called CD4. It is found on the surface of certain subtypes of white blood cells, including
helper T cells, macrophages, and monocytes. HIV attaches to an immune system cell and
then replicates itself within the cell to kill it. The virus also destroys the remaining
function of the CD4 cells.

The course that HIV takes to progress to AIDS usually occurs in three stages:
acute retroviral syndrome, latency period, and late-stage AIDS. The first sign of an HIV
infection, referred to as the acute retroviral syndrome, is at the time the virus enters the
lymph nodes; the resulting symptoms include fever, fatigue, muscle aches, loss of
appetite, weight loss, skin rashes, headache, and lymphadenopathy. These symptoms
impact 45 to 90% of women, who are infected with the virus. The second stage, latency
period, involves a condition where the virus remains dormant for as many as ten years or
more, but continues to replicate itself in the lymph nodes. The final stage, also known as
the late-stage AIDS, is characterized by a sharp decline in the number of CD4+
lymphocytes, typically below 200 cells/mm3, followed by a rise in the frequency of
opportunistic infections and cancers, including pneumocystis carinii pneumonia (PCP),
toxoplasmosis, bacterial infections of the skin and digestive tract, cytomegalovirus
(CMV), herpes simplex virus, Kaposi’s sarcoma, lymphoma, and AIDS dementia

complex. For women, invasive cancer of the cervix is an important diagnostic marker.

In fact, CDC in 1993 added invasive cervical cancer to the list of AIDS-defining
conditions in women with HIV infection (The Body: The HIV/AIDS Resource, 1997).

Intervention and prevention are the two primary methods to address HIV/AIDS.
Medical research largely focuses on determining the most effective class of medication,
such as antiretroviral reverse transcriptase inhibitors and protease inhibitors, in treating
the symptoms associated with the virus. Medical treatment is a form of intervention that,
at best, slows the onset and progression of opportunistic infections. This method cannot
prevent the inevitable: that HIV will lead to AIDS and that the multitude of opportunistic
infections associated with AIDS will eventually lead to death. Lee, Fu, and Fleming
(2006) cited that 50-80% of infected people will perish within 10 years of initial
infection. In fact, there is no vaccine, to date, available to prevent the virus from
destroying the immune system. Journal articles that are mental-health-focused, however,
generally address the AIDS pandemic through prevention measures. These measures
involve three major content areas in examining the problem.

To determine and to create AIDS prevention campaigns, psychology-focused
research articles have first identified who is most at risk for an HIV infection. The rate of
HIV infection is on the rise among young adults, especially among racial/ethnic female
adolescents. According to CDC HIV/AIDS fact sheet (2004), an estimated 4,883 young
people between the ages of 13-24, received a diagnosis of HIV infection or AIDS in
2004, representing about 13% of the persons given a diagnosis during that year.
Approximately two-thirds of 13- to 19-year-olds with AIDS are African-American and
the proportion of Latinos with AIDS is also higher than their percentage of the population

(Futterman, 2003). The AIDS incidence by gender shows similar disparities among

 

young people (CDC, 1999). Among young adults diagnosed with AIDS between the
ages of 20 and 24 and between the ages of 13 and 19, women make up 40% and 50% of
the cases, respectively (F uttennan, 2003). To date, women account for more than one-
fourth of all new HIV/AIDS diagnoses (CDC, 2006). It is evident that HIV/AIDS in the
United States has also disproportionately affected women and people of color (Futtennan,
2003; Sullivan & Moreau, 2002: & Centers for Disease Control and Prevention [CDC],
1998), so much so that minority women are at the greatest risk of infection, while young
women constitute the fastest growing category of new AIDS cases (Roye & Seales,

2001 ). According to the CDC (2006), HIV infection by the year 2002 was the leading
cause of death for African-American females aged 25-34 years old, while 15% of
Hispanic/Latina females are presently living with HIV/AIDS. More alarming is that the
rate of AIDS diagnoses for African-American women was approximately 23 times the
rate for Caucasian women and 4 times the rate for Hispanic women (CDC, 2006), yet the
African-American and Latina women, combined, comprise only one-fourth of all the US.
women.

As the population has been identified, the second phase of research is to
determine the factors that explain the current AIDS pandemic. Specific factors explain
how adolescents, women, and African-Americans/Latinos are at risk of HIV infection.
For the adolescent subpopulation, social and financial issues surrounding the purchase of
condoms, lack of condom negotiation with the sex partner, an increase in the use of
chemically-altering substances, and other forms of sexual activity to contract sexual
transmitted disease are risk factors that have been identified in placing these youths at

risk for HIV infection. Lack of perceived power in a sexual heterosexual relationship,

being in a serial monogamous relationship that leads to the false perception of feeling
guarded against the spread of STDs, and the prevention of pregnancy are the more salient
risk factors leading to the increased rate of HIV infection among women. Finally,
traditional gender roles and cultural norms, as well as the number of sex partners, are
contributing variables risk among African—American and Latino heterosexual
relationships.

The third stage of research involves incorporating the identified risk factors into
an AIDS-prevention campaign targeting the population at risk of contracting sexually-
transmitted diseases. Much of the research on sex education programs has shown that
they are generally ineffective in decreasing the rate of infection of STDs, including HIV.
The curricula for sex education programs have been limited in the content and the degree
to which sex and HIV infection has been addressed, largely because of the ubiquitous
belief that conservations about sex leads to increased sexual behavior. Many of the sex
programs continue to focus on the consequences of being HIV infected as a means to
increase fear in the hope to decrease sexual activity. The antiquated prevention
campaigns have slowly evolved to incorporate a discussion of communication with
adolescents’ sexual partners and with their parents about condom negotiation and
discussion of sex.

Statement of the Problem

Research studies on HIV/AIDS suggested that specific variables—such as age,
gender, race/ethnicity, condom use, and skills in condom negotiation—intersect in a way
that uniquely places African-American and Latina adolescent females at risk for STDs,

including HIV infection. Furthermore, these specific populations have been empirically

shown to use condoms less often than their Caucasian counterparts. These same barriers
may or may not explain the disproportionately high rate of inconsistent condom use
among African-American and Latina female adolescents. No one study, thus far, has
been able accurately to capture and describe the complex intersection of risk factors and
barriers to condom use for these individuals. Much of the research into adolescent high-
risk behaviors has focused on the prevalence and significance of a single factor (Pivnick
& Villegas, 2000) and examines these factors in isolation from one another (F asula &
Miller, 2006). Fasula and Miller (2006) further contended that the interaction of these
multiple social factors must be examined in relation to one another, or important sources
of sexual risk for adolescents will be missed and ignored (Metzler, Noell, Biglan, Ary, &
Smolkowski, 1994). It is no surprise then that the research in the area of HIV/AIDS
struggles to disentangle the complexity of the interaction among the risk factors involved.
This consequently affects the prevalence of AIDS (Jemmott & Jemmott, 2000).

HIV/AIDS studies that have been grounded in a conventional research design fail
to address the crux of the social epidemic and obtain answers to questions such as why
prevention programs have not been effective in motivating African-American and Latina
female adolescents to engage in safer sex practices. The ontological, epistemological,
and methodological assumptions of conventional research designs have yet to capture
fully the exceedingly complex psychosocial phenomenon of AIDS prevention.
Quantitative research designs struggle further with understanding the nuances and
complexity of the way in which these females inconsistently use condoms that is one way
to stop the spread of HIV. The limitation of the traditional scientific method that is

predominately used in HIV/AIDS prevention studies may explain for such failures.

Theoretical Framework

The significance of securing a more comprehensive theoretical framework is to
provide a greater direction in creating a more relevant and more practical prevention
campaign for women who are at risk for HIV infection. This study critically examines
the limitations of two existing, yet commonly applied, theoretical models. The argument
is that such models mainly account for intrapsychic and individualistic factors, namely
self-efficacy, while excluding other equally relevant variables, such as social and
environmental factors. Wingood and DiClemente (2000) further asserted that
interventions for women are less than optimally effective if the existing models fail to
account for the social and environmental factors that impact the lives and the safety of
these young women.

The Theory of Gender and Power is a newly emerging theoretical framework that
illustrates that sexual inequality and power imbalances increase women’s vulnerability to
acquire HIV by addressing the larger contextual issues relating to women’s lives. The
theory recognizes that societal and institutional barriers first need to be scrutinized in
order for behavioral change to occur at the individual level. The Theory of Gender and
Power, first developed by Robert Connell in the 19805, has been extended and elaborated
by Wingood and DiClemente (2000) to identify exposures and risk factors that increase
women’s vulnerability to HIV.

Research Questions

This study is divided into three major sections. The first major section, HIV

Knowledge, determines the extent to which the female participant has knowledge about

the transmission of HIV and to what extent these young people think of themselves in

relation to HIV. The second major section, Thoughts and Behaviors about Sex, Safe Sex,
Participants’ Past and Present Sexual Experiences, and Communication Patterns with Sex
Partners, is firrther divided into four subsections: Definition of Sex, Personal Account of
Past and Present Sexual Experiences, Definition of Safe Sex, and Communication
Patterns with Sex Partner. The third major section, Effectiveness of Past and Present
HIV/AIDS Messages, includes Types of Past HIV/AIDS Messages, Types of Present
HIV/AIDS Messages, and Suggestions to Increase Consistent Condom Use and HIV
Awareness. These three primary areas of inquiry are based on three critical research
questions and they are as follows:

I. To what degree are the thoughts of these young people congruent with their
behaviors regarding safe sex practices?

2. What are the similarities and differences between African-American and Latina
females’ experiences and thoughts about HIV, sex, safe sex, sexual experiences,
communication patterns with sex partners, and proposal of more effective
messages?

3. What kinds of prevention messages can be derived from the clinical observations
made from the data and their own candid perspective in what needs to happen to
halt the spread of HIV and increase consistent condom use?

The results from the data analysis will have a direct bearing on the Theory of Gender

and Power, as well as creating concrete HIV/AIDS prevention programs that are
culturally-relevant, gender-appropriate, and age-specific to the target group of interest

(Morrison-Beedy, Carey, Lewis, & Aronowitz, 2001).

CHAPTER 1: REVIEW OF LITERATURE
Carla is 15 years old, lives in San Francisco, and admitted to having at
least 15 sexual partners. Tracy, a 17-year-old, confessed to worrying
about AIDS by stating, “Well, I do worry about AIDS. Actually, the
anxiety never leaves me,” but her fears are insufficient in preventing her
from engaging in sexual activities, as she continues confessing, “But I still
have sex.” The problem is that it is seldom simple: One by one, the same
girls who began the conversation with me by boasting of how many sexual
partners they had had in a school year ended stories of longing, shame,
and loss. “I just felt like nobody cared about me,” says Carla, whose
mother is a widow. Carla lost her virginity at 13, got pregnant at 14, and
gave up her baby for adoption last May because she says she was not
prepared to be a parent. “Mom and I rarely spent time with each other——
and when I did see her, we constantly argued. I just wanted to feel better
to feel close to someone,” she said (Budord, 2002, p. 212).

Carla and Tracy are no different from “typical” female adolescents. Their
attitudes and behaviors reflect current statistics for sexually active adolescents (Buford,
2002). Heterosexuals who are between the ages of 15 and 24 are most at risk for
contracting HIV/AIDS (Masters, Johnson, & Kolodony, 1988), as sexual intercourse
among adolescents continues to account for the majority of new AIDS cases (Brown,
Lourie, & Pat, 2000). Three million adolescents contract sexually transmitted infections
(STIs) annually (Haignere, Gold, & McDanel, 1999). In fact, 25% of the estimated 12
million new sexually transmitted diseases (STDs) cases reported annually are among
adolescents aged 15-19 years (Boyer et al, 2000; Crosby et al, 2000). Currently, AIDS is
the sixth leading cause of death among adolescents (Langer & Girard, 1999).

Historical Overview of HIV/AIDS

The trends in the populations at risk for HIV infection and the prevention

campaigns to impede the spread of HIV have shifted since the first cases of AIDS were

detected in the early 19803 (Shilts, 1987). At that time, the origin, transmission,

progression, and treatment of the disease were the primary areas of interest, largely
because they were unknown. The only knowledge of AIDS at the time of its discovery
was that people were dying from it.

The first misconception that had Americans standing at attention was learning that
mosquitoes were potential carriers of HIV, which tapped into everyone’s fears,
suggesting that everyone was at risk. It was because of this belief that HIV/AIDS first
became a national concern in the United States. The scientific community has since
proved that there was no validity to this assertion. Later, it was believed, particularly at
the onset of this epidemic that the spread of infection that AIDS only occurred within the
homosexual male communities. Historically, HIV was first defined as “Gay-Related
Immune Deficiency” (GRID) (Shilts, 1987). In the early 19803 the medical community
was ignorant of the etiology and mode of transmission of the virus, and the health field
prematurely referred to it as a “gay disease” that affected primarily White gay men
(Koenig & Clark, 2004). The majority of American people was subsequently under the
assumption that because they did not engage in certain types of sexual acts (i.e.,
homosexual sex), they were immune from infection and therefore had no reason to
demand research attention and medical support. Receiving funding and appropriate
media coverage became less of a salient concern because gay’s issues were equivalent to
being marginalized by the dominant culture.

Three decades into the AIDS pandemic (Dudley et al,, 2002), many of the
questions surrounding HIV/AIDS have been addressed. We now know that HIV is the
cause of AIDS, and there is approximately a 10- to 15-year incubation period (Jemmott &

Jemmott, 2000) during which the virus breaks down the immune system and

10

opportunistic infections develop (e. g., cancers and pneumonia). We also know that in a
majority of cases the virus ultimately leads to death. Finally, we know four body fluids
(blood, semen, vaginal fluids, and breast milk) carry the virus, and these fluids are
commonly transmitted either by risky sexual (e.g., vaginal, oral, and anal sex) or drug-
related behaviors (e. g., intravenous needle use).

These commonly known facts have given the general public a better
understanding of how HIV/AIDS is transmitted and a greater sense of control over this
disease. Since it is now understood that HIV cuts across the lines of sexual orientation
and sexual preferences, AIDS and HIV have become household terms. However, in spite
of the increased awareness of the disease and mode of transmission, the population at
large still fails to recognize that they, themselves, could be at risk.

Although the general fear of HIV/AIDS has declined, there has been a recent
resurgence of attention paid to specific subpopulations who are at a particularly high risk
of HIV infection. The majority of new cases now consist of women, minorities, and
youth, most of whom report that they contracted the virus through heterosexual activity
(CDC, 2000). A number of studies provide supporting evidence that a primary mode of
transmission of HIV is through heterosexual activity (Langer & Girard, 1999; F aryna &
Morales, 2000; Salina et al., 2000), while cases among homosexuals account for a
decreasing percentage of all new cases (Metro Teen AIDS, 2000). Furthermore, these
studies unequivocally eradicate the myth that “AIDS is a gay disease”—an oft-repeated
refrain in the early days of AIDS. Today’s message is clear: anyone, youths included,

who engages in sexual activity is not exempt from the potentiality of contracting HIV.

ll

Youths Engaging in Sexual Activity

Many studies have examined the frequency and prevalence of adolescents
engaging in sexual activity. A national survey revealed that over half of their participants
became sexually active by the age of 14 (F aryna & Morale, 2000). According to the
national Youth Risk Behavior Surveillance Survey (YRBSS), approximately 48.4% of
high-school students have had sexual intercourse with nearly equal rates reported
between males (48.9%) and females (47.7%). In addition, 16% of the same students
reported that they have had four or more sexual partners (17.6% of males compared with
14.1% of females) (Cobb et al,, 2002; Boyer et al,, 2000; Crosby, DiClemente, &
Wingood, 2002; Faryna & Morales, 2000; Crosby, Leichliter, & Brackbrill, 2000; and
Everett et al., 2000) Given the prevalence of risky sexual behavior among adolescents
(e.g., sexual intercourse, multiple sexual partners, and inconsistent use of barrier-method
contraceptives) (Boyer et al., 2000), it is of no surprise that the rate of STDs has been
highest among adolescents (Jemmott & Jemmott, 2000).

In fact, late adolescents and young adults account for one of the fastest growing
categories of HIV and AIDS cases (Chemoff & Davison, 1999). As of 1999, the Center
for Disease Control and Prevention (2000) reported that approximately 406,980 people
under the age of 25 are living with HIV and AIDS. This is equivalent to wiping out an
entire metropolitan city, such as Atlanta, GA (pop. 394,817; World Almanac, 2006).
Haignere et al. (1999) reported that among 20- to 24—year-olds, there were 19,997 AIDS
cases in the US. and 11,818 others known to be HIV-positive, most of who probably
contracted HIV as teenagers. One study showed that one-fourth of all new HIV

infections occur among those under the age of 22 (Brown et al., 2000). Even more

alarming is that cases often go underreported because so many who are infected do not
get tested and the number of infections is on the rise.

Understanding adolescent development from a psychosocial perspective may
explain, to some degree, the reasons that adolescents engage in risky sexually behavior.
While many adolescents wrestle with the physical changes of their bodies, they also
contend with society’s demands for social and emotional maturity (Weiten & Lloyd,
2000). G. Stanley Hall described this period of time as “storm and stress,” where turmoil
and emotional upheaval are common struggles for boys and girls as they become
adolescents. The process of entering into this stage often results in separation from their
parents while engaging in risky experimentation (Pivnick & Villegas, 2000). According
to Erik Erikson’s eight psychosocial stages of human development, adolescents’ critical
crisis is struggling and coming to terms with their identity (Weiten & Lloyd, 2000).
Solidifying one’s identity also entails making independent choices, one of which is
making the decision to become sexually active (Jemmott & Jemmott, 2000; Weiten &
Lloyd, 2000). Therefore, most health and medical professionals and communities
understand that prevention must not solely focus on abstinence, as it is incongruent with
the teen’s psychosocial development. Instead information on prevention to acknowledge
other forms of protective measures is needed. The attention in most contemporary
research articles focuses on the use of condoms.

An Alternative to Abstinence: Latex Condoms

Condoms act as a mechanical barrier, preventing pregnancy and bacterial and

viral STIs (Hatcher et al., 2002; Haignere et al., 1999). Haignere et a1. (1999) observed

that 93-99% of condoms do not allow the passage of HIV, sperm, or other microscopic

l3

organisms. Consistent condom use has remained the preferred method for prevention of
STDs (including HIV) and pregnancy (Crosby et al., 2002; Jemmott & Jemmott, 2000).

Many adolescents do not use condoms on a consistent basis (Jemmott & Jemmott,
2000). According to the 1997 YRBSS, condom use during the student’s last sexual
encounter was reported to be 56.8% (Boyer et al., 2000). Another study confirmed
similar statistical results of inconsistent condom use, showing that among the sexually
active high-school students they sampled, 58% reported using a condom at their last
sexual encounter, but fewer used a condom on every occasion (Tschann et al., 2002). In
order to understand better these troubling statistics, research has expanded to examine the
underlying barriers to consistent condom use.

Even though adolescents think of themselves as “invincible” to the consequences
of risky behavior, they are not invincible to feelings of embarrassment when purchasing
condoms (Tschann et al,, 2002; Roye & Seals, 2001). Other barriers that may explain
inconsistent condom use include, but are not limited to, lack of contraception knowledge,
cost, availability, interference with pleasure, and negotiations with partners (F aryna &
Morales, 2000).

Another risk factor contributing to lower rates of condom use is youths engaging
in risky sexual behavior while under the influence of various forms of substances (e.g.,
alcohol and drugs) (Newman & Zimmerman, 2000). Newman and Zimmerman reported
that youths who engage in high levels of sexual activity and do not consistently use
condoms engage in more AOD (Alcohol and Other Drugs) use during sexual encounters
than youths who engage in less risky sexual behavior. In addition, a study that examined

the relationship between number of sexual partners and health risk factors found that

14

alcohol use was the only risk behavior that was significantly related to an increase in the
number of sexual partners for all race/gender groups (Valois, Oeltmann, Waller, &
Hussey, 1999).

To complicate firrther the issue of inconsistent condom use, adolescents fail to
recognize that oral and anal sex are potential means of contracting a STI. Booeloo and
Howard (2002) argued that the prevalence of adolescents engaging in unprotected oral
sex is enough to cause concern about STI transmission. Approximately 33%-59% of
high school adolescents reported giving or being a recipient of oral sex (Prinstein, Meade,
& Cohen, 2003). Recent medical reported emphasize that unprotected oral sex is a more
frequent cause of HIV transmission than is generally recognized. In addition, it has been
shown that adolescents will engage in oral sex sooner than in penile-vaginal intercourse.
Past studies have shown that 53% of males and 42% of females have experienced oral
sex, and among the adolescents who have not experienced vaginal sex, 25% of males and
15% of females have reported experiencing oral sex (Newcomer & Udry, 1985).

According to Braithwaite, Stephens, Sumpter-Gaddist, Murdaugh, Taylor, &
Braithewaite (1998), heterosexual adolescents limit their condom use to sexual
intercourse, which they defined as vaginal penetration. They asserted that condom use is
not a utilitarian response to a given situation, but more of a response to habitual
associations and learned behavior with specific sex acts (e.g., vaginal penetration). This
creates a concern given that using condoms only during vaginal penetration leads to
taking fewer safety precautions during sexual engagements.

Not only have the adolescents not taken into account other forms of sexual

behaviors, the research community has also fallen short in this area as well, specifically

15

on understanding the ways adolescents protect themselves during oral sex (Prinstein et
al., 2003). The researchers limit the definition of sexual activity to penile-vaginal
penetration. Boekloo and Howard (2002) reported that oral sex is not specifically
measured in most health surveys of adolescents. Minimizing the importance of using
condoms during other forms of sexual acts in research studies has a direct bearing on
intervention programs. Braithewaite et a1. (1998) reported that few interventions target
condom use during oral and anal sex, especially among heterosexual Afiican-American
adolescents and young adults.

Though abstinence was originally the focus for most sex-education programs, the
study of condom use has gained approval and support over the years as the most effective
means to prevention; yet, barriers to condom use still exist. The barriers to inconsistent
condom use, as well as the incidence rate for using condoms, have been explored, but
complicating this area of study are the perceptions of the types of activities that constitute
sexual behaviors, which may also act as a predictor to consistent condom use.

Women: At a Greater Risk of HIV Infection

Heterosexual intercourse and inconsistent condom use account for more than half
of the women, including female adolescents, currently diagnosed with AIDS. AIDS has
become one of the five leading causes of death in women (Salina, et a1., 2000; Hader et
al., 2001; CDC, 2006), and approximately 37% of reported adolescent AIDS cases have
been among female adolescents (Jemmott & Jemmott, 2000). Females are, in general, at
greater risk of infection than their male counterparts because of biological and social
reasons. Heterosexual intercourse continues to place women at risk for HIV

transmission, and is identified as the route of transmission for infection in more than half

16

of the women currently diagnosed with AIDS (Salina, et al., 2000; Hader et al., 2001).
Biologically, vaginal sex has been proven to be more efficient in transmitting this virus
and more likely to transmit the virus from men to women than from women to men

(F aryna & Morales, 2000; Salina etal., 2000; CDC, 2006). In addition, studies indicate
that both women and female adolescents use condoms primarily for preventing
pregnancy, rather than for preventing STD infections. Condoms seems to be an
abandoned method when other forms of contraception are adopted (Crosby, DiClemente,
Wingood, Sionean, Harrington, Davies et al., 2002; Cabra et al., 2001).

From a social perspective, barriers to condom use have a greater impact on
women than on men in heterosexual relationships (Newman & Zimmerman, 2000).
Gender and power are two social constructs that need to be considered as additional risk
factors (Amaro, 1995; Cash, 1996). Gender and power may explain why some women
compromise their ability to refuse heterosexual sex and negotiate condom use (Newman
& Zimmerman, 2000). Because there are differences in perceived or actual power within
intimate sexual relationships, women are less likely to initiate condom use in intimate
relationships than their male counterparts (Salina et al., 2000). Women who insist that
their partners use condoms may risk rejection and accusations of infidelity (Cash, 1996;
Salina etal., 2000).

In addition, males are often held responsible for purchasing, carrying, putting on,
and removing condoms (Jemmott & Jemmott, 2000). Many intervention programs, to
date, focus on the promotion of male latex condoms to prevent sexually transmitted
diseases (Cabra et al., 2001). As a result, men are given more power and control over

women’s safety.

17

The concept of “serial monogamy strategy” is an additional explanation for why
women, including female adolescents, have difficulty negotiating condom use. Several
studies have found that women employ this strategy when they have a few long-term
committed partners (Jemmott & Jemmott, 2000; Newman & Zimmerman, 2000; & Salina
etal., 2000). Tschann et al. (2002) also found that adolescents are less likely to use
condoms with close committed sexual partners than with casual partners. The concern
for young women in long-term committed relationships is prevention of pregnancy (Roye
& Seals, 2001), not STDs (Jemmott & Jemmott, 2000; Newman & Zimmerman, 2000).
Therefore, they may not be motivated to use condoms, especially if they employ other
means (e. g., oral contraception) to prevent pregnancy (Roye & Seals, 2001), thereby
placing these youths at long-term cumulative risk for HIV infection (Jemmott &
Jemmott, 2000; Newman & Zimmerman, 2000).

Biological and social factors, such as the ease of transmission in certain sexes, as
well as gender-related and power-related issues, have helped clarify the reasons that
women are at greater risk of HIV infection than their male counterparts. These factors,
combined with diminished overall control in a sexual context, highlight the complexity of
risk factors involved. These same factors can be extended to other subpopulations—
specifically African-American and Latina female adolescents—but are not entirely
sufficient to explain the disproportionate rates of sexually transmitted infections among
this population. Cultural factors, such as promotion of masculinity via child bearing, are
risk factors that have been explored among the African-American and Latina female

adolescents.

l8

Race/Ethnicity: African-American and Latina Females

Many studies have focused on a wide spectrum of risk factors, including
race/ethnicity (Jemmott & Jemmott, 2000), with the goal of determining who is at risk of
HIV infection. Currently, minorities are disproportionately affected by HIV/AIDS.
African-American and Hispanic women, together, represent less than one-fourth of all
US. women, yet they account for more than three-fourths of the cumulative AIDS cases
among women (Koenig & Clark, 2004). Specifically, among young women aged 13 to
24, African-American and Latina women represent three-fourths of the new HIV
infections through June of 2000 (CDC, 2000). Furthermore, the AIDS incidence among
Latino people in the year 2000 was 22.5 out of 100,000 people, a figure that is
approximately three times as high as their Caucasian counterparts (e. g., 66/100,000)
(Dudley, O’Sullivan, & Morceau, 2002). The US. Surgeon General projects that 80% of
women newly infected with HIV will be African-American or Latina (AIDS Action,
2005). In another study, Latinos have been estimated to comprise 13% of the US.
adolescent population and 19% of adolescents with AIDS (Jemmott & Jemmott, 2000).
More specifically, the Latina female adolescent subpopulation is not only reported to
have the highest rate of sexual activity in the past month at the time of the study (Faryna
& Morales, 2000), they are also less likely to engage in self-protective sexual practices
(Romo, Leflmwtiz, Sigman, & Terry, 2002). Essentially, African-American and Latina
female adolescents with ages between 16 and 21 were seven and eight times,
respectively, more likely as their Caucasian cohorts to be HIV-positive.

The importance of directly studying this particular population is that cultural

values and norms are often vastly different from the dominant group (Caucasian). A

19

significant amount of data, thus far, indicated that childbearing females ofien employ oral
contraceptives, rather than condoms, to prevent pregnancy. This behavioral norm,
however, is quite contrary to the values of Latina female adolescents. This population of
Latinas embraces the notion of motherhood, even at a young age, which can be explained
by their general pessimistic outlook regarding their academic achievement and success in
school (Romo et al., 2002). Consequently, they are less likely to use condoms, which
place them at risk of HIV infection. Other factors, that include increased domestic
violence, traditional gender roles, immigration status, limited English skills, lower socio-
economic status, and religion, need to be considered when understanding the extent to
which the Latino community is exposed to HIV infection (Marin, Tschann, Gomez, &
Kegeles, 1993; Torres, 1991).

African-American adolescents are also at a vastly disproportionate risk, as they
currently account for 37% of those between the ages of 13 and 29 years that are
diagnosed with AIDS (Jemmott & Jemmott, 2000; Newman & Zimmerman, 2000).
While African-American women represent 14% of the US. female population, they
account for 58% of cumulative AIDS cases (CDC, 1998). Similar to Latina female
adolescents, African—American females are also more at risk than their Caucasian female
counterparts. African-American women tend to have a higher mean number of sexual
partners and typically are sexually active at an earlier age than are Caucasian women
(Braithwaite et al., 1998). In addition, results from a large national study showed
African-American high-school students (35.6%) were significantly more likely than

Caucasian (14.2%) to have had four or more sex partners (Valois et al., 1999).

20

In addition, the high rates of multiple sex partners, African-American and Latina
females also tend to use condoms less frequently than their Caucasian counterparts. For
example, Jemmott and Jemmott (1990) found that consistent condom use was reported by
only one-filth of sexually active urban African-American male adolescents, implying that
their female sexual counterparts are equally vulnerable to STDs. Furthermore, African-
American and Latina female adolescents were less likely to use condoms during their last
intercourse than Caucasian females (29% vs. 44%) and they were less likely to use a
condom overall compared to Caucasian females (37% vs. 56%) (Miller, Clark, & Moore,
1997). Finally, female minority adolescents (other than Asians) were more than three
times as likely to be diagnosed with an STD than were Caucasian female adolescents
(Crosby et al., 2000). These statistics can be partially explained by the increased use of
hormonal contraceptives, where young women who use this method are a subgroup of
minority adolescents that is at an elevated risk for HIV (Roye & Seals, 2001). In
addition, these authors asserted that these adolescents may lack the cognitive and
communication skills to negotiate effectively for safer sex behaviors or use condoms only
for the purpose of preventing pregnancies.

Cabral et a1. (2001) believed that identifying and addressing the intersection of
cultural factors, specifically issues of masculinity/ femininity and bearing children, may
account for the inconsistent condom use among African-American teens. Young‘men
who hold traditional attitudes toward masculinity tend to have greater numbers of sexual
partners and believe that pregnancy validates their masculinity (Forste & Morgan, 1998).
The pressure to abide by the traditional masculine role is particularly evident in African-

American and Hispanic/Latino cultures. In a sample of African-American inner-city

2l

adolescents, three times as many girls believed that their partners wanted them to
conceive as reported wanting to conceive themselves (Zabin, Astone, & Emerson, 1993).
Consequently, male partners may be putting women at greater risk of HIV/STDs by
encouraging or pressuring their partners to bear children. This is one more factor that
may explain the inconsistent condom use among this population.

The laundry list of risk factors has been empirically researched to determine who
is vulnerable to STIs. Though each risk factor is intricate in its own right, much of the
research into adolescent high-risk behaviors has focused on the prevalence and
significance of single factors (Pivnick & Villegas, 2000). The studies struggled to
disentangle the complexity of the interaction among the risk factors involved (e.g.,
gender, ethnicity, age, and SES), consequently affecting the prevalence of AIDS
(Jemmott & Jemmott, 2000). Researchers must recognize however that these factors do
intersect in a way that places specific populations at a greater risk—in this case, African-
American and Latina female adolescents. A comprehensive understanding of the
complicated cultural, economic, biological, and political factors that shape these young
women’s experiences is necessary to stem the rising tide of infections, especially women
of color (AIDS Action, 2005). In order to design effective prevention programs that
speak appropriately to African-American and Latina female adolescents, models of
behaviors will be examined in order to evaluate its effectiveness as well as to explain, to
predict, and ultimately to prevent initial risky behaviors.

Existing Models and Their Limitations
Systematically identifying and understanding the predictors of risky HIV-related

behaviors is necessary to formulate effective interventions for at-risk populations who are

22

particularly marginalized by society. These predictors are often conceptualized into
theoretical models to gain a more comprehensive approach to decreasing sexually risky
behaviors and bringing about permanent change. Several theoretical models of
HIV/AIDS intervention have been borrowed from other schools of thought, specifically
from cognitive-behavioral psychology (Jemmott & Jemmott, 2000). For the purposes of
this study, the Theory of Planned Behavior and the Information-Motivation-Behavioral
Skills Model are discussed briefly in order to illustrate that, while they are fully embraced
by the HIV/AIDS research community, these and other theories of behavioral change
have visible limitations (AIDS Action, 2005).

The Theory of Planned Behavior (Jemmott & Jemmott, 20000) proposed that
external variables (behavioral intervention and other external variables) directly influence
the three different types of belief systems (behavioral, normative, and self-efficacy),
which, in turn, influence behavioral intentions, including the intention to engage in sexual
activity or to use condoms. Intention is the sole determinant of behavioral change for
reduction in HIV risk-associated behaviors. External variables include variables that
were not part of the original theory of planned behavior, but the revised version of the
theory include external variables, such as socioeconomic status, gender, race/ethnicity,
duration of relationship, alcohol and drugs, and HIV knowledge, all of which have a
direct bearing on the individual’s three categorical belief systems: self-efficacy,
behavioral, and normative. Self-efficacy belief is the confidence in the ability to perform
a certain behavior (Bandura, 1986), such as purchasing and using condoms. Behavioral
belief focuses on the individual’s perceptions of the consequences of engaging in a

specific behavior. Those who are able to weigh the costs and benefits of engaging in

23

unprotected versus protected sexual intercourse are more likely to have stronger
intentions to engage in safer sex practices than those who do not have the forethought to
weigh such consequences. Finally, normative beliefs are the individual’s perception
whether his or her social support system (friends, family, sex partner, or peers) would
approve or disapprove of his or her behavior. For example, the individual’s friends
encourage him not to use condoms because of the perception condoms are not “cool.”
These three belief systems then impact his/her intentions, which directly impact his/her
behavior.

The Information-Motivation-Behavioral Skills Model (Fisher, Williams, Fisher, &
Malloy, 1999) proposed that information and motivation are two basic determinants that
influence AIDS preventive behavior, specifically practicing abstinence or consistently
using condoms. Information refers to the personal practice of prevention, while
motivation is based on attitudes toward preventative acts, social norms concerning
preventive acts, and perceived vulnerability to infection. This theory proposes that
behavioral changes occur through the application of behavioral skills, which refers to
objective skills for performing acts such as condom use, perceptions of self-efficacy, and
response-efficacy for doing so. The Information-Motivation-Behavioral Skills Model
(1MB) suggests that the amount of information, motivation, and skills the individual
possesses will determine the extent to which he/she will engage in AIDS- preventive
behavior. For example, this model predicts that those who have a great deal of
information regarding HIV/AIDS (transmission and prevention of STDs/ HIV): ( l) are
motivated to practice safer sex, (2) are around others who support their decision to

practice safer sex, (3) have the skills to use condoms properly, (4) can communicate

24

effectively with one’s sexual partner about safer sex, and (5) will engage in higher levels
of AIDS preventive behavior, such as using condoms on a consistent basis (Boyer et al.,
2000)

Though there are many theories, Jemmott & J emmott (2000) argued that there is
considerable overlap in the constructs used, in that though the terminology may vary, the
meanings underlying them are the same. With respect to the Theory of Planned Behavior
and the Information-Motivation-Behavioral Skills Model, the term and conceptual
meaning of self-efficacy did not vary and is integral in both theories. Self-efficacy, first
originated by Albert Bandura (Bandura, 1994), is a fundamental concept across the
majority of these cognitive-behavioral focused theories. Efficacy expectations are an
individual’s beliefs that they can successfully carry out the behavior required to produce
desired outcomes. According to Bandura (1994), differences in motivation, behavior,
and persistence in efforts to change behaviors are a function of individual beliefs about
the connection between their efforts and their results. Cognitive processes play a central
role in the acquisition and retention of new behavioral patterns. In the case of a female
adolescent, these models assume she possesses the belief that she has the ability to
influence her sex partner to practice safer sex consistently in order to produce the desired
outcome of her sex partner wearing a latex condom. The principle of self-efficacy is that
the individual’s perception of self-efficacy can influence his/her choice of activities and
can determine how much effort they will put forth in the face of obstacles.

While self-efficacy provides insights into human motivation and behavior, there
are two inherent limitations. First, self-efficacy primarily operates within a cognitive-

behavioral framework (Center for the Study and Prevention of Violence, 1998). Self-

25

efficacy indirectly attends to the young adult female’s emotions, the impact of her core
family, and her immediate community only through the examination of her behavior,
which in large part is a function of her beliefs and expectations. Yet these young adult
females have rich, complex, and varied upbringings that have a direct impact on their
self-esteem and behaviors. Self-efficacy inadequately addresses these features of her
personal history or the impact of those early experiences on her current sexual behavioral
practices.

The second limitation is that self-efficacy attends to environmental influences in a
cursory fashion. Female adolescents, for example, may not have the belief that they can
influence their sex partner to use a condom in fear that their expectations and efforts
would be met with punitiveness, resistance, or rejection. These models assume that
young women have complete control over their own behavior, but they fail to
acknowledge that the desired outcome of practicing safer sex is dependent upon the
beliefs of the other sex partner involved (Amaro, 1995; Tschann et al., 2002). In the case
of a young women being raped and the perpetrator not using a condom, the concept of
self-efficacy is a mute point in that the environmental factor, that being the perpetrator is
the sole determinant of the unexpected and unwelcome outcome. These cognitive-
behavioral and individualistic-centered models (AIDS Action, 2005) inadequately
account for the broader contextual factors. These include social aspects (e.g., effects of
poverty or family structure), cultural influences (e. g., meanings associated with sexual
experience and substance use in specific subcultures) (Pivnick & Villegas, 2000), and the

context of women’s lives (Wingood & DiClemente, 2000), in particular issues of power

26

and control that place certain, and often marginalized, groups at risk of HIV infection
(Amaro, I995).

The significance of securing a more comprehensive theoretical framework is to
provide a clearer direction in creating a more relevant and more practical prevention
campaign for women who are at risk for HIV infection. Women do not respond
unifome to gender-based prevention messages, as there exists additional entangled, and
equally-relevant, variables including social, cultural, or economic factors (AIDS Action,
2005) that need to be addressed. Wingood and DiClemente (2000) further asserted that
interventions for women are less than optimally effective if the existing models fail to
account for the social and environmental factors that impact the lives and the safety of
these young women.

Newly Emerging Theory: Theory of Gender and Power

The Theory of Gender and Power, at its very core, illustrates that sexual
inequality and power imbalances increase a women’s vulnerability to acquire HIV by
addressing the larger contextual issues relating to women’s lives. The theory neither
places sole responsibility on women to alter her intentions as a means to influence her
behaviors nor expects that she has the necessary control to produce the desired outcome.
The theory, instead, recognizes that societal and institutional barriers first need to be
scrutinized in order for behavioral changes to occur at the individual level.

The Theory of Gender and Power, first developed by Robert Connell in the 1980s,
has been extended and elaborated by Wingood and DiClemente (2000) to identify

exposures and risk factors that increase women’s vulnerability to HIV. This theory posits

27

that there are three social structures (i.e., sexual division of labor, sexual division of
power, and the structure of cathexis) that operate at the societal and institutional levels.

At the societal level, the sexual division of labor refers to the allocation of women
and men in “gender-appropriate” occupations that are often divided in a way that men
typically hold positions of power, such as being administrators or being chief executive
officers, while women typically hold more subservient and service—oriented positions,
such as a teacher or a sex worker. At the institutional level, this division of labor is
maintained by social mechanisms, such that women receive uncompensated time for
child care while attempting to have a career or being severely criticized for being career-
driven. This division directly limits women’s economic potential, confines their career
paths, and creates economic imbalance. Consequently, the sexual division of labor
creates inequities in gender and status, as well as in education, employment, job control,
and access to health care. The women, for example, typically shoulder the majority of
financial responsibility, including health care, food, shelter, and child care, in caring for
their child or children, while receiving 21.4 % less than their male counterparts in the
private sector for the very same position (Mano-Negrin, 2004). Being economically
disadvantaged places women at greater risk of HIV infection and decreases their
opportunities to seek appropriate and necessary medical care.

The sexual division of power refers to having the power to act or change or having
power over others, at the social level. This division is maintained at the institutional level
by social mechanisms via the abuse of authority and control in relationships. This sexual
division of power stems from the effects of abuse of power, including a partner’s power

in a relationship, such as purchasing and wearing a condom, a partner’s ability to have

28

affairs and to abuse intravenous drugs, and lacking the ability to negotiate the use of
condoms. Wingwood and DiClemente (1997a) found African-American women who
were sexually abused as children were 1.4 times more likely to have a sexually
transmitted disease, 2.4 times more likely to have more than one STD, 5.1 times as likely
to have a partner who had been physically abusive in the past month, and 2.6 times as
likely to have a partner who was physically abusive when asked to use a condom.

The structure of cathexis is characterized by the emotional and sexual attachments
that women have with men, and also refers to dictating appropriate sexual behavior for
women at the societal level. The social mechanisms that maintain the structure of
cathexis at the institutional level include social misconceptions and biases of socially-
defined gender roles in the expression of human sexuality. Inequities arise from having
older partners, desiring to conceive, being influenced by family mores, or addressing
culturally conservative gender roles. This is particularly relevant for young women who
believe they are in a monogamous relationship where asking to use a condom physically
and psychologically threatens the integrity of their relationship (Cash, 1996).

The sexual division of labor, sexual division of power, and the structure of
cathexis are rooted in society through numerous forces that segregate power and ascribe
social norms. The social institutions include, but are not limited to, school, work,
medical, religious, and family settings, as well as the media. The social mechanisms,
such as unequal pay for comparable work, discriminatory practices, and imbalance of
power within interpersonal relationships, produce gender-based inequities and disparities
(e.g., unequal access to health care, gender-based expectations of women’s role in

society). Essentially these inequities and disparities are apparent in the public health, the

29

social and behavioral sciences, and medical fields as exposures, risk factors, and
biological properties, all of which interact ultimately to increase women’s vulnerability to
diseases, including HIV.

In reviewing the Theory of Gender and Power, HIV prevention campaigns must
account for two insidious cultural factors: ( 1) HIV risk reduction behavioral practices
may be secondary to basic, and often urgent, survival priorities, such as food, clothing,
housing, and childcare; (2) There is an imbalance in power specifically in a sexual
relationship, where women seeking to employ safer sex practices must negotiate with the
sex partner to wear condoms, whereas men choosing to use condoms is a personal choice.
The underlying implication for asking the male sexual partner to use condoms are
rejection and questions about the partner’s infidelity and character. The theories must
look beyond cognitive-oriented, individually-driven, and intrapsychic influences, such as
the concept of self-efficacy, if the HIV epidemic is to be arrested. Theories must also
incorporate the influences of the broader contextual obstacles unique to women,
especially those that young women of color face. Therefore, HIV prevention strategies
designed for women must continually evaluate the most appropriate point of reference for
interventions for women of varying cultural backgrounds and socio-economic status
(AIDS Action, 2005).

Quality of Existing Prevention Campaigns

Though there have been major strides in shaping prevention programs to reflect
the current attitudes, norms, and acknowledgment of safer sex practices, some programs
continue to be ineffective in preventing the spread of STIs and HIV/AIDS among young

adults. Even though there are current conceptual models to create prevention campaigns,

30

many communities are still torn between their moral values and the reality of teen sexual
behavior. Adults/parents are uncomfortable with explicit sex education and
recommendations to youth regarding the correct and consistent use of condoms (Alstead
et al., 1999). They focus almost entirely on educating adolescents about the
consequences of HIV infection and types of behaviors that will reduce the risk of
infection. In fact, a study cited that the second generation of communication programs in
the 19805 and 19908 focused specifically on behavioral change related to abstinence and
limiting one's number of sexual partners (Bertrand, O’Reilly, Denison, Anhang, & Sweat,
2006)

Focusing on the consequences of HIV infection is designed to instill fear as a
method to reduce risky sexual behavior. However, fear alone does not drive most
sexually active adolescents to use condoms (Rickert, Jay, Gottlieb, & Bridges, 1989). In
addition, studies show that increased HIV knowledge does not appear to be significantly
related to behavior change (Jemmott & Jemmott, 2000; Langer & Girard, 1999;
Braithwaite et al., 1998; Rotheram—Borus, Mahler, & Rosario, 1995). The promotion of
fear as a means to divert attention from alternative forms of contraceptive methods is still
evident in school settings.

Haignere et al. (1999) stated that school districts often limit curricula choices to
teaching abstinence only, with little discussion of condom use. They found that
enthusiasm for abstinence—only education has actually increased at the local, state, and
federal levels. Despite the lack of evidence supporting the efficacy of abstinence-only
education and strong evidence supporting the efficacy of teaching condom safety, some

abstinence educators continue to teach that condoms are inherently flawed at preventing

31

HIV transmission (Haignere et al., 1999). For example, The Pro-Life Activist ’s
Encyclopedia reports that condoms allow HIV to pass through because condom pores are
five microns in size, while HIV is .one micron (Clowes, I994). Irrespective of this claim,
the fact remains that proper consistent use of condoms is the most effective prevention
method for sexually active persons. In essence, although most teenagers in the United
States receive HIV education by the time they are in middle and high school (Alstead et
al., 1999), the content, quality, and emotional relevance of sex education is rendered
ineffective in significantly decreasing the rate of HIV infection.

Even mass media struggles to disseminate important information on condom use.
Most of the mass media campaigns to date have focused on members of the general
public, but not on other high-risk populations (Bertrand et al., 2006). Mass media
campaigns that promote condom use for adolescents have rarely been used in the United
States, largely because it has been feared that talk of condom use would lead to increased
sexual activity among youths (Alstead, et al., 1999), even though other studies found that
talking about condom use has not lead to increased sexual intercourse (Haignere et al.,
1999). Furthermore, in a culture that produces vast quantities of hyper-sexualized images
in all arenas of the media, L’Engle, Brown, & Kennavy (2006) reported that not only the
majority of sexual content in the media depicts risk-free, recreational sexual behavior, but
it also rarely depicts negative consequences from sexual behavior, and depictions of
condom and contraception use are extremely rare.

Overall, earlier programs and even current mass media campaigns have been
ineffective at decreasing the rate of infection. A meta-analysis of intervention

evaluations suggested that current prevention programs often are ineffective in

32

encouraging adolescents to delay intercourse (Fasula & Miller, 2006). A similar
sentiment is echoed by Koenig and Clark (2004) who asserted that the fact that many
people do not respond to prevention messages is well-known (Koenig & Clark, 2004).
They further contended that standard communication and condom skills-building
interventions are particularly less effective for women with a history of sexual abuse
(Koenig & Clark, 2004).

Contemporary models, like the Theory of Gender and Power, are better able to
explain the psychological determinants of AIDS risk behavior, as well as to describe
aspects of AIDS risk behavior that are unique to a diverse population of minority
adolescents. Such models have also directed the type of research that is conducted. It no
longer focuses on abstinence-based curricula, but emphasizes, in particular,
communication patterns regarding condom negotiations, which is the cornerstone for
women-focused interventions (Williams, Gardos, Ortiz-Torres, Tross, & Ehrhardt, 2001).

Sexual activity is complex and interpersonal in nature. Tschann et a1. (2002)
stressed the importance of addressing issues surrounding an interpersonal relationship
that includes sexual activity, particularly the style, content, and process of
communication patterns between the sexual partners involved. Individuals who
communicate about safer sex in general, or condom use in particular, are more likely to
use condoms (Tschann et al., 2002; Williams et al., 2001). Crosby et al. (2002) also
emphasized the need to address partner communication, while taking into account the
relationship among the “risk factors” (e.g., race, gender, and age). Specific topics, such
as discussing safer sex prior to and during sexual contact and techniques to exit unsafe

situations, (Fisher et al., 1999) are a few essential skills that need to be promoted more

33

often in prevention campaigns among this population. Crosby et al. (2002) found that
greater perceived partner approval for condom use was associated with more frequent
condom use among young-adult African-American women (Crosby et al., 2002).
Furthermore, communication between parents and adolescents regarding practicing safe
sex is another factor to consider when creating a comprehensive campaign to impede the
spread of HIV (Crosby et al., 2002; Romo et al., 2002; and Wemer-Wilson & F itzharris,
2001). According to Bertrand et al. (2006) communication programs in recent years have
expanded to address the full continuum from prevention to treatment to care and support.

Hence, contemporary HIV/AIDS interventions that are based on models, like that
of Theory of Gender and Power model, take into account risk factors for disease
transmission, condom negotiation skills, and techniques for overcoming barriers to
condom use (Crosby et al., 2002; Cabral et al., 2001). There is no doubt that
comprehensive education on human sexuality that includes contraceptive methods,
abstinence, and skill-building information not only requires further study (Belzer,
Rodgers, Camarca, Fuchs, Peralta, Tucker, &, 2001), but also has been found to yield
more positive results than abstinence-only programs (Haignere et al., 1999). Such
curriculum also focuses on increasing a wider range of skills, such as teaching peer-
pressure resistance (DiClemente & Wingwood, 1997).

Role of Quantitative Research Design

Research studies in HIV/AIDS have concluded that specific variables uniquely
place African-American and Latina late-adolescent females at high risk for HIV
infection. The significant increase in HIV infection among this population is largely

attributed to inconsistent condom use, as studies revealed. Although there is considerable

34

evidence supporting the use of condoms to prevent HIV infection, and additional research
has directed its focus on understanding the variables involved for this inconsistent use of
latex condoms, Afi’ican-American and Latina female adolescents continue to be at risk
for HIV infection. HIV/AIDS studies that have been grounded in conventional research
design may explain the failure in addressing the crux of this social epidemic and in
obtaining answers to questions such as why prevention programs have not been effective
in motivating Afi’ican-American and Latina female adolescents to engage in safer sex

practices.

35

CHAPTER 2: METHOD
A Different Kind of Knowing

This chapter serves several purposes: first, it describes the origin of the
traditional scientific inquiry, proposes an alternative paradigm, and outlines the
methodology of this study. Next, it discusses the origin of dominant research practices in
the field of psychology in which it has permeated HIV/AIDS research. The assumptions
on which the scientific method rests are not only pervasive, it has also become the sole
criteria for what knowledge is deemed legitimate in the field of psychology, thereby
allowing the way in which data are gathered and examined go unquestioned. Critiquing
this issue more in-depth is necessary as it illuminates the limitation of the underpinning
of scientific inquiry.

This chapter’s other function is to critically examine the conventional
methodologies. Objectivity and context-stripping are key characteristics of traditional
paradigms that have been the standard and the method for legitimatizing scientific
knowledge in the field of psychology. These two particular assumptions underscore the
limitation of the type of data collected to advance HIV prevention campaigns.
Recognizing that all knowledge is not equal, it is imperative that HIV/AIDS prevention
be understood from the perspective of those most affected by it. This implies the need
for qualitative inquiry whose underlying philosophy realizes that knowledge is based on
antifoundationalism and refuses to adopt any permanent, unvarying standards by which
truth can be universally known (Lincoln & Guba, 2000).

The third, and equally important, purpose of this chapter rationalizes the need to

implement a qualitative-based research design that is grounded in a different kind of

36

paradigm—constructivism (Lincoln & Guba, 2000). Qualitative methods, after
experiencing a period of ascendancy from an earlier era of skepticism, is now again being
called into question, under the notion of “scientifically-based research”. Much of the
research training in the fields of clinical and counseling psychology continue to refer to
qualitative methods as an “alternative” approach (Heppner, Kivlighan, & Wampold,
1992), thereby deeming the knowledge gathered from this framework as less credible. It
is, nevertheless, important to realize that the need to discuss the rationale for conducting
qualitative research design is not a requirement, but a necessity, in order to deem the
knowledge collected from this kind of study as being equally valid. Finally, this chapter
concludes with the methodology of this study. It explains the recruitment of subjects, the
measurements, the interviewing protocol, and the analysis of the data.

Current Epistemological and Methodological Research
in Social Sciences

To understand the aim, practice, and prevalence of quantitative research is to learn
first about the epistemological and methodological assumptions in which it is grounded
(Guba & Lincoln, 1994). These assumptions have been rooted in positivism, the
dominant paradigm in the physical and social sciences for the past 400 years (Guba &
Lincoln, 1994). Traditional scientific inquiry has borrowed many of the fundamental
principles of positivism (Guba & Lincoln, 1994), one of which is the assumption that
nature of reality consists of a single and apprehendable reality that operates according to
immutable natural laws (Derry, I999; Guba & Lincoln, 1989). The researcher has the
capacity to discover that reality and its laws, without undue influence: that the researcher
and subject under investigation are independent of each other (Guba & Lincoln, 1994).

Objectivity is a prominent feature of traditional scientific inquiry because of the

37

perception that it prevents biases from influencing the outcome of the study (Philips &
Burbules, 2000; Heppner et al., 1999).

Rather than focusing on differentiating the terms such as positivism and the
received view, the importance lies in critiquing the assumptions underlying the traditional
scientific inquiry and the examination of how past and present practices in psychology
research have been seamlessly interconnected in the goals and standards for studying a
phenomenon. Over time, conventional research methodologies surreptitiously has led to
the advent of the scientific method and statistical analyses in psychology, which are the
most common and most accepted forms of studying scientific inquiry. The scientific
method stems from the ontological assumption that there is one “reality,” governed by
immutable laws. This method, which is based on a priori hypothesis testing and
controlling for confounding variables, (Williams & Monge, 2001; Lincoln & Guba, 1989)
describes that reality and discovers the laws that determine it, which subsequently
predicts and controls ensuing events (Guba & Lincoln, 1989). When employing the
scientific method, the assumption is that the researcher is believed to have the capacity to
remain objective. To increase objectivity, contemporary research methodologies heavily
rely on quantifying the phenomenon (Guba & Lincoln, 1989). Statistical analysis is
thereby the means for achieving that objectivity by determining numerical relationships
with precision and accuracy among operationally defined variables (Philips & Burbules,
2000; Heppner, Kivlighan, & Wampold, 1999; and Neimeyer & Resnikoff, 1982).
Objectivity, accuracy, and precision have, therefore, become the “gold” standards in

psychology’s contemporary research practices.

38

The epistemological and methodological assumptions and goals of conventional
scientific-based research designs are equally prevalent in research literature on
HIV/AIDS prevention and intervention. According to Seal, Bloom, and Somlai (2000),
much of the new generation of sex research has involved quantitative surveys of sexual
behavior, sexual risk predictor studies, and/or assessment of the efficacy of HIV-risk
reduction programs. In fact, many studies have been empirical and quantitative in nature
by identifying populations at risk. The current empirical studies reveal that women,
adolescents, and minorities have been identified as “at-risk” populations for potentially
becoming infected with the HIV/AIDS virus.

Further research has concentrated on prevention, or intervention, strategies that
primarily focus on the quantification and statistics of inconsistent condom use and risk
factors to explain this trend. Condom use continues to be the chief prevention method.
Inconsistent condom use, which is the result of complex interplay of countless risk
factors, is believed to be one important avenue to understand why and how African-
American and Latina female adolescents continue to be vulnerable for HIV infection.

Critique of the Assumptions Underlying Traditional Scientific Inquiry

The assumptions underlying traditional scientific inquiry have been so influential
in the social sciences (Polkinghome, 1984) that rarely has it been challenged from an
epistemological and methodological standpoint (Derry, 1999). While these assumptions
retain its hegemony over research practices (Lather, 1991, p. 2), the received view has
been under assault over the last several decades (Guba & Lincoln, 1994; Polkinghome,
1984). Lather (1991) wrote that the reason for challenging these types of assumptions

“. . .might be seen as an effort to break out of the limitations of increasingly inadequate

39

category systems and toward theory capable of grasping the complexities of people and
the cultures they create,” (p. xvi). These types of critiques have been the impetus behind
the need for fundamental adjustments to the received view (Guba & Lincoln, 1994).
Striving for objectivity and the promotion of context-stripping in hope of “predicting”
and “explaining” the subject matter under investigation are the two fundamental
assumptions of traditional scientific inquiry that will be critically evaluated in terms of
how they have limited the advancement of HIV/AIDS prevention.

The first fundamental claim of the traditional scientific inquiry is the assumption
that objectivity must be attained in order for the knowledge to be deemed “legitimate.”
Objectivity is typically paramount during the concrete stages of conducting a study.
Controlling for confounding variables is one example of precluding biases from affecting
the outcome.

Researchers’ biases, however, can have an equally aversive impact at different
points in a study, beginning with the scientific community to which researchers belong.
Researchers are part of a social community, who share a set of assumptions, techniques,
methodologies, and worldviews (Deny, 1999). This community has been historically
comprised of white, Anglo-Saxon males, who generally came from privileged
backgrounds of wealth and education. Often, they have had the power and privilege to
determine the overall nature of scientific inquiry (e.g., what topics are worthy of further
investigation) and even the criteria used to determine the credibility of “scientific
knowledge.” Bakhtin (1984) echoed this point more than 50 years ago by arguing that
“positionality” weighs heavily in what knowledge comes to count as scientifically

acceptable in historically specific times and places. Examining legitimacy of scientific

40

knowledge is crucial when inquiry focuses on marginalized and oppressed social groups
because their life experiences are often vastly different from those of the researchers.
Consequently, scientific knowledge, itself, can direct the way in which questions are
shaped and variables are selected.

In the area of HIV/AIDS prevention studies, current research designs, which
largely rest on the ontological, epistemological, and methodological assumptions of
traditional scientific inquiry, fail to capture the exceedingly complex psychosocial
phenomenon of human sexual interaction. Quantitative research designs struggle further
with understanding the nuances and complexity of the way in which African-American
and Latina late-adolescent females inconsistently use condoms and, in general, ways to
stop the spread of the virus. The limitations of the traditional scientific method that is
predominately used in HIV/AIDS prevention studies may explain for such failures. More
specifically, the influence of a researcher’s experiences and biases may have a larger role
in “contaminating” the quality and outcome of these studies.

Studies that are based on hypothetico-deductive reasoning, for example, whereby
the researcher’s role is to preselect a risk factor (e. g., child bearing) that the researcher
believes places a population at risk can lead to potential problems. Many of the
HIV/AIDS studies and existing models struggle to recognize and research other equally
relevant risk factors, which may directly relate to the fact that the researcher’s life
experiences are naturally different from the participants, which he/she is studying. A
researcher’s biases and values unwittingly factor into determining which risk factors may

or may not be investigated. For example, a study by Salina et al. (2000) acknowledged

41

that HIV prevention programs have largely ignored important factors that may impact the
use of condoms during sexual relations, such as sex role expectations.

The procedure to verify risk factors through hypothesis testing may be objective,
but selecting a variable (e. g., risk factor) can be more appropriately characterized as a
subjective process. Consequently, the community of social scientists has, and will
continue to unduly influence, one another and the overall discourse of scientific inquiry.
Even if researchers were consciously to refrain from employing dominant disciplinary
concepts and frameworks in the analysis, it is impossible to prevent intrusion of the
researcher’s own taken-for-granted, everyday concepts into the inquiry.

The second fundamental assumption that operates within conventional
methodologies is the practice of context-stripping (Guba & Lincoln, 1994). According to
the principles associated with the scientific method, if the “one reality” is to be studied
and the immutable natural laws that determine it be explained, the variables specific to
the study must then need to be examined, while controlling for all other variables. In
other words, the context of the phenomenon is observed within a vacuum, which
“effectively strips away the context and yields results that are valid only in other
contextless situations,” (Guba & Lincoln, 1989, p. 60). Contextual factors are deemed
appropriate only to the extent to when they can be physically and/or statistically
controlled (Guba and Lincoln, 1989). The results of a study should ideally explain the
variables in a predictable manner and in a variety of situations. However, if context-
stripping is being practiced, Guba and Lincoln (1994) illustrated that the “outcomes can
be properly applied only in other similarly truncated or contextually-stripped situations”

(p. 106).

42

With respect to African-American and Latina late-adolescent females’ sexual
practices, examining their inconsistent condom use during sexual activity in contextless
environments is of no assistance in stopping the epidemic. Instead, the contextual factors
are necessary components in creating an effective HIV/AIDS prevention campaign. This
social epidemic is becoming increasingly complex because of the multitude of possible
variables, and more importantly, the interaction of these variables. Socioeconomic status,
gender, race/ethnicity, age, education, reproductive motivation, infrequent
communication with sex partners, type of sexual activity, limited access to health care,
duration of relationship, use of other contraceptive methods, and illegal substances are
just a few contextual factors that are currently under investigation.

One combination of such factors could explain why one female adolescent would
engage in unprotected sex, while simultaneously failing to explain identical actions of
another adolescent in similar circumstances. The degree to which one wants to bear
children, for example, has been identified as a contributing factor to inconsistent condom
use. Studies show that the promotion of child bearing in the Latino culture is one reason
why Latina females may not use condoms, while Caucasian female adolescents may have
increased frequency of condom use in order to prevent pregnancies. Numerical
relationships regarding the promotion of child bearing as an identified risk factor were
derived from the implementation of the scientific method and statistical analysis; the
explanation, however, behind the promotion of child bearing from one culture to another
culture are based on cultural underpinnings and the researcher’s own assumptions.

This epidemic could be better understood, however, if the assumptions of the

traditional scientific inquiry are explicitly challenged, specifically in the failure of the

43

“gold standard” of striving for objectivity through context-stripping (Guba & Lincoln,
1989). The practice of value-free science and context stripping are counterproductive
and are no longer applicable to the different types of data that are being studied. The new
zeitgeist—diversity among members in the social scientist community and in the topics
of interest—has forced social scientists not only to negate values, but also to accept that
value-neutrality and objectivity are no longer the “ideal” standards in research practices.
The need to examine subjects within their natural settings is essential to clarifying
broader areas of HIV/AIDS studies. In addition, multiethnic and multicultural voices
bring different types of epistemological and methodological approaches to examining
data. Guba and Lincoln (1989) were well aware of the changing times and described this
change as stemming from a failure to accommodate value-pluralism, in that “the question
of whose values would dominate in an evaluation, or alternatively, how value differences
might be negotiated, has now emerged as the major problem,” (p. 34).

Current quantitative research designs have largely been grounded in the received
view of social sciences and heavily practiced in HIV/AIDS prevention studies. They
have been, at best, sufficient in identifying populations that are at risk and, to some
extent, the factors that contribute to these populations engaging in risky sexual behaviors.
This methodological practice has been able to identify that African-American and Latina
late-adolescent females are disproportionately at risk for sexually transmitted diseases
compared to their Caucasian counterparts and that there are a number of risk factors that
explain for their inconsistent condom use during sexual activity.

These research designs not only neglect to address the more pervasive and latent

reasons regarding inconsistent condom use, it also has yet to comprehend fully the more

44

elusive areas of this phenomenon: Why is it that African-American and Latina late-
adolescent females continue to be susceptible to HIV-infection, despite identifying a
plethora of antecedent factors? What are the deciding factors to engage in sexual
relations? What do these females really know about HIV/AIDS? What types of
prevention campaigns will effectively encourage these adolescents to implement
consistently safer sex practices? These types of research inquiries strike at the heart of
the HIV/AIDS epidemic among African-American and Latina adolescent females.
Belzer et al. (2001) asserted that the next critical step in conducting research is to
examine how youth view and use contraception as a means to reduce unplanned
pregnancies and the transmission of HIV.

Conventional methodologies have limited the advancement in HIV/AIDS
prevention, specifically in the areas of describing and implementing culturally-
appropriate and gender-specific HIV prevention campaigns. Because a selected research
method must fit both the phenomenon under investigation and the type of information
sought (Silverrnan, 2001; Heppner et al., 1999), a different type of research design
grounded in a different type of ontological, epistemological, and methodological
assumptions might be more appropriate in examining why HIV remains an epidemic
among African-American and Latina late-adolescent females.

Why Employ a Qualitative Research Design?

A qualitative research design that is situated in constructivist paradigm is a
complimentary methodology (Guba & Lincoln, 1989) to examine African-American and
Latina late-adolescent females’ perspectives and experiences regarding their sexual

practices, barriers to employing condoms on a consistent basis, communications with

45

their sex partners, and HIV/AIDS prevention messages. The main objective for
employing a qualitative research is to capture the narrative perspective of the event that is
being studied in order to extract the meaning and process of the complex phenomenon
(Bogdan & Biklen, 1998).

Constructivist paradigm, though it has been in existence for several hundred
years, is newly emerging as a major contender to the positivist paradigm, and is
appropriate for the purposes of this study. Much of the discussion on paradigm shift
comes from the works of Yvonne Lincoln and Egon Guba (Lincoln & Guba, 2000; Guba
& Lincoln, 1994 &l989). The ontological stance of constructivism denies the existence
of one objective reality, asserting, instead, that realities are social constructions of the
mind, which are socially and experientially based. Agreements about truth may be the
subject of community negotiations regarding what will be accepted as truth (Lincoln &
Guba, 2000). In other words, “findings” are literally created as the investigation proceeds
to the need to strive for “objectivity” and is irrelevant within this framework. Within the
constructivist paradigm, it is understood that values are inevitable and, therefore, are
embraced as an integral part of this inquiry. One cagveat, however, is that because the
paradigm is still in the formative stages, the ideas and discussion on it should be
considered tentative.

Guba & Lincoln (1989) defined four “entry conditions” that must be met so that
the methodology is grounded in the constructivist paradigm. The first is that the study
must be pursued in a natural setting because “contexts give life to and are given life by
the constructions that are held by the people in them”(p. 175). The second is that

constructivists do not assume that they know enough about the context frame a priori to

46

know what questions to ask. The third condition is that the use of a human instrument
suggests that the methods employed should be primarily those that are congenial to
humans—qualitative methods. “Humans collect information best, and most easily,
through direct employment of their senses: talking to people, observing their activities,
reading their documents, assessing the obtrusive signs they leave behind, responding to
their nonverbal cues, and the like. It is for this reason that qualitative methods are
preferred...” (p. 176). The fourth condition is that the researcher has the privilege of
drawing on his or her tacit knowledge, which can be defined as all what we, the
researchers, know minus all we can say (the latter is prepositional knowledge.) “It is
precisely this same tacit understanding of a situation that serves the constructivist in the
beginning stages of an inquiry,” (p. 177). Aucherbach and Silverstein (2003) also share
similar views on the role of qualitative research, which is to ascertain subjective
experiences of the participants. The subject experience is based on the epistemological
assumption of understanding human behavior and that human behavior is incomplete
without insight into the framework within which individuals interpret their own
behaviors, thoughts, and feelings (Neimeyer & Resnikoff, 1982).

Qualitative methods are highly advantageous in exploratory research. When
studying a group that is socially marginalized (i.e., African-American and Latina female
adolescents), employing a methodological approach that is based on qualitative premise
to obtain subjects’ intricate and private experiences is not an option, but a necessity. The
kinds of subjects and the type of topics being studied determine the methodology. With

respect to adolescent sexual behaviors, Tschann et al. (2002) stated that there is a paucity

47

of literature in the ways in which other aspects of the dynamics between sexual partners
might affect sexual behavior, including condom use.

This topic lends itself for qualitative-based research designs that allow the
participants to share their stories regarding their sexual experiences, rather than imposing
cognitive-focused models onto this very complex phenomenon. Seal et al. (2000)
asserted that qualitative research methods designed to understand human behavior, its
meanings, and the impact of the sociocultural context in which the behavior occurs is
necessary. Lichtenstein (2000) echoed a similar point of view with an emphasis on the
subjects’ views and behaviors in a narrative format and in culturally sensitive modalities.
McCracken (1988) also emphasized that the qualitative approach has the capacity to sift
through the data to uncover the cultural assumptions that mediate human behavior.

This approach can help researchers look beyond the dominant disciplinary and
cultural ideologies pertaining to such groups when examining subject matter that is
sensitive, personal, and socially taboo in nature. The goal of this study is to explore the
Afi'ican-American and Latina female late-adolescents’ perspectives regarding their
knowledge of HIV/AIDS, their definition of sex, their own sexual practices, their
perceptions of practicing safer sex, the barriers that they may encounter to practicing
safer sex, the communication patterns between sex partners, and their assessment of the
utility of existing HIV/AIDS prevention messages. Having a thicker and richer
understanding of the participants’ belief systems and worldviews in these areas will
create more appropriate prevention programs that directly address the complex and

intersecting risk factors.

48

Overview of the Research Design
Semi-Structured Interviews
This study utilized a method that is qualitative in nature, and has been grounded
in constructivist paradigm. The use of semi-structured interview in the form of face-to-
face, one-on-one, verbal interchange is the specific means in which the data have been
gathered for several reasons. The first and, more general reason, is that interviews are no
longer viewed as neutral tools of data gathering, whereby the participant passively
answers a set of research questions. It is, instead, seen as an active interaction between
two people leading to negotiated, contextually-based results (F ontana & Frey, 2000).
The interview, according to McCracken (1988), will uncover the silent assumptions that
operate in the everyday, social situations. Conducting one-on-one, face-to—faee
interviews is appropriate and necessary when the topic of interest is complex,
controversial (e. g., HIV/AIDS), or personal in nature (Smith, 1995) and is the most
common form of interviewing (F ontana & Frey, 2000). Given the topic and nature of this
research project, interviews are not only an appropriate method of data gathering, but
they are also consistent with the aim of this study in that “interviews are moving to
encompass the how of pe0ple’s lives (constructive work involved in producing order in
everyday life), as well as the traditional activities of everyday life,” (F ontana & Frey,
2000, p. 646). Finally, one characteristic of an interview is the degree of structure,
ranging from structured to semi-structured to unstructured. The semi-structured
interview format was selected for the purposes of this investigation, as it allowed the
researcher to ensure specific content areas were addressed, while allowing participants to

have the flexibility, depth, and breadth to respond to these areas (Bogden & Bilken,

49

1998). According to Ladany et al., (2000), structuring the questions in an open-ended,
semi-structured format also allows for the researcher to follow up on topics that can be of
particular interest to the research study (Smith, 1995).

Participants

The purpose of this investigation is to obtain the subject’s perceptions on a wide-
range of topics related to HIV/AIDS (e. g., her sexual activity, communication with sexual
partner, and barriers that she found in practicing safer sex). Unlike quantitative research
methodologies where greater randomization and higher frequency of sample size are the
core standards of data collection, qualitative research is less concerned with obtaining a
large sample size. The process selection, instead, involved creating a list of participant
characteristics and subsequently locating those who meet these characteristics (Lecompte
& Preissle, 1993). Smith (1995) echoed a similar viewpoint when stating that the sample
that is selected should be as closely representative of the population of interest as
possible.

The participants for this study were recruited from a large Midwestern University,
and comprised of 10 African-American and nine Latina female student volunteers, who
range in ages from 18 to 22, are heterosexual, and who have engaged in heterosexual
sexual activities. The importance of the participants having engaged in sexual activity at
some point in their lives was necessary in order that the participants had exposure and
experiences from which they could speak.

The rationale for selecting 19 participants is based on several studies that
employed similar qualitative design (i.e., using semi-structured interviews). Hill,

Thompson, and Williams (1997) recommended to sample between eight and fifteen

50

participants, as this sample size allows for determining whether findings apply to several
people or are representative of only one or two people. A small sample size, according to
McCracken (1988), is based on the principle that “less is more,” as the function of n is
not to represent the population, but to offer, instead, a chance to examine the
“complicated character, organization, and logic of culture,” (p. 17). Rich data can easily
be lost if the sample size is too large. Other studies reported similar sample sizes. In
Willig’s (1997) study on construction of sexual practices, she recruited 16 subjects, while
another study using consensual qualitative research (CQR) recruited 11 participants
(Ladany, Miller, Constantine, Erickson, & Muse-Burke, 2000). Given the wide variation
of sample sizes among established researchers, guidelines for deciding appropriate
sample size seemed flexible and, in general, had a proclivity to smaller, rather than larger,
sample sizes. For the purposes of this dissertation study—an exploration of various
meanings, experiences, and contexts of sexual active late-adolescent females’ lives—
qualitative research with a small and diverse sample is appropriate.

Although Hill et al. (1997) recommended that the process of selecting the sample
should be random, other studies (Smith, 1995; Lecompte & Preissle, I993) underscored
that the demographic characteristics of the participants are paramount and reflective of
the research study. This study employed a convenient and snowball sampling
approaches. Participants were made aware of the study by flyers (see Appendix A)
posted in both residence and academic halls, as well as distributed to ethnic-focused
student groups. The content of the flyer consisted of the epidemiology of HIV/AIDS
among minority female adolescents, the researcher’s contact information, and the general

nature of the study. Another form of sampling, the snowball approach, recruited a few

51

research participants in the beginning, and then asked the initial participants to recruit
others to participate in the study (Auerbach & Silverstein, 2003).
Researcher

The primary researcher for this study is a Korean-adoptee, American-raised
female doctoral candidate in counseling psychology, and is 31 years of age. She has
approximately seven years of counseling and clinical experience. Prior to data collection,
expectations and biases of the researcher pertaining to the beliefs about the participants’
sexual experiences were recorded, a procedure known in qualitative research as
bracketing (Rennie, Phillips, & Quartaro, 1988). These expectations and biases were
addressed in order to inform the reader how the researcher’s preconceived ideas were in
part socially constructing the meanings derived from the participants’ responses. In
terms of the summary expectations, I believed that the participants would be well
informed about the ways in which HIV is transmitted, that they would share in detail
accurate information about HIV. This belief stemmed from the notion that they are
college-educated. In regard to their sex knowledge and their sexual experiences, I
surmised that the participants would provide evasive and less-than honest responses,
especially when discussing their own explicit, sexual practices. This assertion is
stemmed from the belief that talking about one’s own sexual practices is a private and
personal, thereby suggests that it is generally not openly discussed and certainly not with
a stranger, the primary investigator. The section in the questionnaire that focuses on
communication patterns with their sexual partners, I presumed that the participants and
their male sexual partners, on average, would avoid discussing safe sex practices, STDS,

and HIV. If these topics were to be addressed, I assumed that the responsibility would be

52

left to the female participant. This assumption was based on the general concepts of
gender role and communication styles in that women generally are the ones initiating
conversation, especially when the topic is taboo and sensitive in nature. The last section
of the questionnaire, where it focuses on prevention messages and their effectiveness, I
thought that the female participants would find that past and present prevention messages
were ineffective, but would provide explicit and detailed steps in generating a more
effective HIV/AIDS prevention campaign.
Procedure

Research conducted on socially sensitive topics, particularly with marginalized
populations, is highly vulnerable to potential abuses of power on the part of the
researcher. Because of this, it is imperative clear protocols were implemented in order to
prevent abuses and to make potential research participants aware of the certain risks and
rights vis-a-vis their study participation. The protocols for this study were reviewed and
approved by the University Committee on Research Involving Human Subjects.
Potential participants who were interested in the study were directed to contact the
researcher either by telephone or e-mail. The researcher would then call each prospective
participant to assess the degree of interest she may have in participating in the study,
adhering to a prescribed screening script (see Appendix B), which summarized the
purpose of the study, the protocol of the study (e. g., the length of the interview), and
assessment of her eligibility to participate. If she identified herself as being either an
Afiican-American/Black or Hispanic/Latina/Chicana female between the ages of 18 and
22 and having been engaged in heterosexual sexual behaviors, she was permitted to

participate in the study. Once she expressed direct interest in participating, a date, time,

53

and a secured location to conduct the interview, based on the participant’s convenience,
was determined. The location for conducting the interview varied, ranged from dorm
rooms, to isolated library rooms, to conference rooms in the multicultural center located
in the student union, and to study halls. Regardless of the location, each interview took
place in a secured facility where confidentially and privacy were intact.

At the outset of the interview, the first step involved reading a prescribed script
(see Appendix B) to each participant, addressing several aspects of the interview,
including the purpose of the study. Being mindful of the power differential between the
researcher and the participant and of the sensitive nature of the topic, the script
contextualized the purpose and protocol of the study in a collaborative manner.
Furthermore, because the participants perceived the study to be Socratic dialogue, her
opinions, thoughts, and concerns were elicited throughout the entire duration of the
interview process by asking her, “Do you have questions?” throughout the screening
script, the interview script, and the semi-structured interview questionnaire. The
participants were also informed that the interview was semi-structured (in that they would
be asked a series of open-ended questions) and were asked to read the consent form (see
Appendix C) in which they were asked to sign one copy and keep the other copy for
themselves.

To ensure comprehension of the consent form, the consent process involved oral
administration of the consent form by reviewing the voluntary and anonymous nature of
the study, the purpose of the study, the kinds of questions being asked, the fact that the
interview would be audio-taped, the length of the interview, the risks and benefits of

participating in the study, and the precautions in protecting the data. In regard to

54

confidentiality, the participant was reminded that the confidentiality of her responses
during the interview would be protected to the maximum extent permissible under the
law. The following precautions were taken to protect her confidentiality. No individual
names would be used in any reports or publications that may result from this study, and
the participant’s name would not be on any of the surveys or tapes. Instead, any
responses provided would only be associated with an identification number. The
identification number would be associated with the consent form. Furthermore, once the
data had been collected and transcribed, the audiotapes would be destroyed, and the
transcription would be saved on a CD in a lockbox for seven years, as this time period
adheres to the American Psychological Association ethical guidelines. After seven years,
all data, including the transcriptions and CD, would be destroyed. Lastly, the participant
was informed that if she decided to participate, she could withdraw from the study at any
time without penalty and loss of benefits to which she was otherwise entitled. If she
withdrew from the study before the data collection were completed, her data would be
destroyed.

Each participant signed the consent form and the interview ensued. Each
interview began with participants answering an orally-administered demographic survey,
which lasted approximately 5 to 10 minutes (see Appendix D for a copy of the
instrument). All interviews were tape-recorded and transcribed. Interviews lasted
approximately 60 to 120 minutes. During the interviews, broad and lead-in questions
were used to encourage narratives on the following four areas of the participant’s life:

HIV/AIDS: knowledge, needs, and perceptions; sex: definition, safer sex and barriers;

55

communication with sex partner; HIV/AIDS messages (see Appendix D). Participants
were given $15 as a form of gratitude at the end of the survey.

The audiotapes have been saved in a lockbox and have been transcribed in a word
processing program. The audiotape and the transcription have been compared to
determine accuracy of the respondents’ interview, and the audiotapes have been erased
and destroyed. The transcribed data have been saved electronically on a CD-ROM and as
a hard copy, all of which have been stored in the lockbox.

Measure

Prior to implementation, a pilot test of the questionnaire was conducted on two
Latina and African-American late-adolescent females, who provided extensive feedback
on the readability, language, and cultural relevance. The questionnaire was administered
at a secured location to protect the confidentiality of the participants. Changes, based on
the responses provided during field-testing, were incorporated into the instrument. Much
of the revision consisted of adding brief scripts throughout the interview questionnaire to
remind the participants that their responses were deemed important, that their responses
remained confidential, and that the overall appreciation of their time and effort were
made known, all of which were to increase trustworthiness (Lincoln & Guba, 1985). An
excerpt of the script is provided:

“Those were tough questions, and we really appreciate your honest

responses. I know this study and your responses will help the women in

your community from getting hurt.”

The revised protocol was re-administered to the same two Latina and African-American

late-adolescent females to determine face validity.

56

The semi-structured interview was comprised of two sections: demographic
questionnaire and interview questionnaire. The demographic question included a 15—
item closed—ended survey that was given to each participant prior to the open-ended,
semi-structured interview. The data were gathered by asking respondents directly to
enter requested information on the following areas: gender; race/ethnicity; date of birth;
current age; highest level of education earned; number of sexual partners; number of
times of engaging in vaginal, oral, and anal sex in the past 12 months; the number of
times condoms were used during vaginal, oral, and anal sex in the past 12 months; the
number of times tested for HIV; the date on which the last HIV test was administered;
determination of receiving the results or not, and, if applicable, reason for not receiving
the results.

The interview questionnaire included an 18-item open-ended questionnaire (see
Appendix D) that explored several topics related to HIV/AIDS. The first open-ended
question inquired about the participants’ perceptions on their general knowledge on HIV
transmission. Questions included: “Tell me what you know about how HIV is passed on
from one person to the next person.” The next broad category consisted of 11 items that
explored participants’ understanding on the types of sexual activities and definitions of
“safer sex.” Two additional questions focused on communication patterns with sex
partners. The last section consisted of four items that concentrated on the participants’
perceptions of the sources and types of HIV/AIDS messages that they have encountered

and effectiveness of these messages.

57

Data Analysis

In looking through several references on qualitative research, there is a paucity of
sources that discuss the steps to analyze in detail of the data (Auerbach & Silverstein,
2003; McCracken, 1988) in a systematic fashion. Despite McCracken’s confirmation
that the data analysis were the least examined area of the qualitative research process
(McCracken, 1988, p. 41), Becker (1998) reminded the qualitative-oriented research
community that the development of concepts should be a “continuous dialogue with the
empirical data,” (p. 109), rather from a hypothetico-deductive process. McCracken’s
five-stage analysis adheres to Becker’s recommendations. The process of analyzing the
current data set was borrowed from McCracken’s five-stage analysis, where each step
represents a higher level of generality. The first two stages involve examining and intra-
comparisons of observations within the interview and for each interview. The last three
stages focus on inter-comparisons of observations and themes across all interviews.

The first stage involved using the broad research questions as a guiding tool to
decipher between relevant and irrelevant data. The relevant material in which
McCracken referred to as “utterances” is examined only in relation to the meanings
contained within its range of implications. In other words, McCracken wanted the
investigator to avoid making assertions from these utterances and prematurely connecting
themes with other utterances. The data were demarcated into three major sections for the
purpose of managing the abundant number of text that was collected. The three sections
are as follows: (1) Knowledge of H! V transmission and relation to HIV infection; (2)
Thoughts and behaviors about sex, safe sex, participants 'past and present sexual

experiences, and communication patterns with sex partners, which was further divided

58

into four subsections: Definition of sex, Definition of safe sex, Personal account of past
and present sexual experiences, and Communication patterns with sex partner; and (3)
Eflectiveness of past and present H1 V/AIDS messages and Suggestions to increase
consistent condom use and HIV awareness. Each transcript was carefully previewed and
the data were categorized accordingly. For each transcript, main points, also known as
“utterances,” were then reviewed and extracted within each category. “Vaginal
intercourse between a male and a female,” for example, is an utterance that was extracted
under the category, Description and meanings associated with sexual behaviors.

The second stage consisted of contextualizing these utterances in relation to other
utterances within the transcript, with the cultural review, and with previous literature.
These observations and assertions were then supported by the excerpts from the
transcripts. This stage essentially examined patterns, relationships, similarities, and
dissimilarities of the main points (also known as “observations”) within each category for
each transcript. An example of an observation made from one of the participants is how
past sexual abuse had a direct bearing on her current cognitive processes regarding her
sexual behaviors. This participant admitted that her childhood sexual trauma influenced
her present outlook, stating “So I turned very rebellious, I turned to drugs, alcohol, and
sex.” Furthermore, she not only viewed sex as, “I don’t see sex as a very special thing,”
but uses sex as a means to gain personal power. As she stated, “It [sex] was just taken
from me when somebody wanted it so now when I want it, I get it.”

The third stage expanded the analysis by comparing the observations with other
transcripts. In other words, McCracken referred to this stage as the “interconnection of

the second-level observations.” Broader themes and patterns emerged by inter-

59

comparing between observations from one transcript and observations from another
transcript. Again, these broader observations, now referred to as themes and patterns, are
further contextualized within the cultural review, with previous literature, and in relation
to the actual data from the transcripts. For this study, the data from all the participants
were compiled into a table where the headings represented one of the six categories and
all the observations were categorized accordingly. Below is Table 1 of the category,

3“

Communication patterns with sex partners, with a sample of participants observations.”
A broad theme resulted from this sample of participants and suggested that HIV
messages are most pronounced in the media which then act as a springboard for the
participants to initiate conversations about safe sex practices. This visual aid eased the
process of comparing the responses across all transcripts and ensured greater accuracy in
that no data were inadvertently discarded.

The fourth stage is the development of themes that were a result from all the

observations. The themes are then under “collective scrutiny” in order to determine the

patterns of intertheme consistency and contradictions.

60

Table l
A Sample of the Third Stage of the F ive-Stage Analysis of Qualitative Research

(McCracken, 1988)

 

 

ID # Communication patterns with sex partners Motivational Factors to increase
communication with partner
12212 I Communication changed over time I Won’t have unprotected
0 Early on, did not discuss it sex, unless in a long-term
0 Changing factor-)heard HIV is a real committed relationship and
issue, hearing about STATS via trust has been established
media

0 Changing factor-)being more mature
and being more career-oriented
(futuristic oriented)

I Use stats and articles to springboard
conversations
I Past two SP talks about HIV

12006 I Condom vs. No Condom is always I Pregnancy scare
discussed I Condom scare

I Media (e.g., Montel Williams)
springboard discussion of HIV, “Urn, a scare. Like, any type of
sometimes pregnancy scare, or um,

I Sex partner typically initiates topic condom scare, or actually with
regarding safe sex practices-) they ask if the guy who I said earlier we
condoms are available or if she is on just um, didn’t have a condom
Birth Control-)she still insists they use and we stopped, when we went
condoms out?”

I Timing
o Condom talk usually occurs when

foreplay (kissing) becomes sexually
intimate

I Actions are consistent with Thoughts-)
when condoms are not available she
does not have sex

11914 I HIV is discussed in the form of Testing I To be more comfortable

I Discussion occurred with those she had I To not be afraid
unprotected sex with I TV shows, PBS address AA

I She always initiates it girl who was HIV positive

and gave birth to 3 HIV +

kid-9 it hit home

61

For the purposes of this study, the emerging interrelationship patterns among the themes
and observations were examined across all transcripts, but within their respective
categories and within their respective ethno-cultural groups between the Latina
adolescent females and the African-American adolescents. The themes were also
examined across both ethno-cultural groups as given in Table 2.

The fifth, and final, stage is generating a conceptual framework from the collected
themes and patterns across all interviews, all categories, and both ethno-cultural groups.
This conceptual framework emerged in the midst of going through the data, which gave
way to the utility of this research project, thereby providing age-specific, gender-
appropriate, culturally-relevant HIV/AIDS messages. The female participants’ responses
regarding their thoughts on solutions and recommendations in increasing HIV awareness
were compared to the principle investigator’s own impressions from the participants’
experiences, thoughts, and behaviors.

Quality Control
A common mistake is to impose quantitative standards when evaluating qualitative
research (McCracken, 1988). McCracken recommended borrowing Bunge’s “symptoms
of truth” in order to evaluate the results of qualitative data and view the data as legitimate
knowledge. During the analysis process, quality control was maintained through the
adherence of the following standards: (I) It be must be exact so that no unnecessary
ambiguity exists; (2) It must be economical so that it forces one to make a minimum
number of assumptions and still explain the data; (3) It must be mutually consistent so

that no assertion contradicts another;

62

Table 2

A Sample of the Fourth Stage of the F ive-Stage Analysis of Qualitative Research

(McCracken, 1988)

 

SubGroups Description and Meanings Associated with Safe Sex

 

Latina
Females

African-
American
Females

Latina and
African-
American
Females

6 Latinas stated Safe sex is defined in terms of Protection

0 Protection frequently referred to birth control (5)

0 Not all said protection, but all nine Latinas referred to condom as a
means of safe sex

2 Latinas Safe sex is Tested

0 La Chingona “then I guess now like my thing is like ok I’m going to
use condoms at the beginning but try to go get tested right away
because I’m not really into this, into using condoms. So, as long as
you get tested, it would be ok.”

0 O’Connor “If you’ve both been tested and you know that you are
both all well and good and you are in a committed relationship with
that person and you do not plan to sleep with anybody during that
relationship either than the two of you”

10 African-Americans defined Safe sex in terms of Condom

3 Afiican-Americans defined Safe sex in terms of Birth Control
3 African-Americans defined Safe sex in terms of Knowing Sex
Partner’s Sex History

All participants said that Condoms are a form of safe sex

Seems that more Latinas believe Birth Control is a form of safe sex,
where only three AA said it was form of safe sex

Equal number of Latinas and AA (3 each) said knowing sex partner’s
history is a form of safe sex

2 Latina and 1 African-Americans believe Getting Tested is a form of
safe sex

 

(4) It must be externally consistent so that it conforms to what we independently know

about the subject matter; (5) It must be unified so that assertions are organized in a

manner that subsumes the specific within the general, unifying where possible,

discriminating when necessary; (6) It must be powerful so that it explains as much of the

data as possible without sacrificing accuracy; and (7) It must be fertile so that it suggests

new ideas that are opportunities for insights.

63

Summary

Objectivity, accuracy, and precision are the “gold” standards in psychology’s
contemporary research practices and in the HIV/AIDS prevention studies that the
assumptions often go unchallenged (Derry, 1999). However, traditional methodological
designs have been, at best, sufficient in identifying populations that are at risk and, to
some extent, the factors that contribute to these populations engaging in risky sexual
behaviors; yet, this social epidemic is going amok because of the multitude of variables
and the complex nature of the interaction of these variables.

The purpose of examining the current methodological practices is not to negate
the viability and utility of positivism, but to illustrate simply that it, too, has its
imperfections. According to the bubble hypothesis, coined by Gelso in 1979 (Gelso &
F retz, 2001), “each attempted solution causes a problem to appear elsewhere,” (p. 79)
similar to a sticker on a windshield. When pressing the bubble in one area, it causes a
new bubble to appear in a different location. Gelso and F retz (2001) reminded the
community of researchers in the field of psychology that “each and every study is highly
imperfect and that each contains some inevitable flaws,” (p. 79), in that each research
design has its strengths and weaknesses. They proposed convergent of findings that
resulted under conditions of methodological diversity will combat most effectively the
bubble effect of any given methodological design that is inherently flawed. The
application of a semi-structured interview to elicit uninterrupted discussion on female
adolescents’ perceptions, beliefs, thoughts and behaviors regarding critical topics on
HIV-related issues is appropriate for this study, and such a study is necessary for the area

of HIV/AIDS prevention.

64

CHAPTER 3: RESULTS

This chapter is divided in three parts. The first focuses on the results from the
survey segment of the interview. The second reveals a snapshot of each participant’s
background, which includes their career aspirations, family upbringing, and sexual
history. The third details the findings for each of the major sections from the open-
ended, semi-structured questionnaire.

Survey

The survey portion of the semi-structured interview extracted information in
several areas: 1) the frequency and types of sexual activity experienced by these
participants, 2) the frequency and consistency of using condoms when engaging in
vaginal intercourse as well as anal and oral sex, and 3) the total number of times they
reported getting HIV tests, and whether or not they obtained their results. The following
data are congruent with literature that has shown that late-adolescent females are
sexually-active and do not take safety precautions to decrease their risk of infection from
a multitude of sexually transmitted diseases. Table 3 summarizes the results of the
survey.

Of the 19 participants who were involved in this study, nine identified themselves
as being Latina and the other 10 identified themselves as being African-American. For
the participants in the Latina category, the mean age was 19.78, while the age range was
between 18 and 21. For participants in the African-American group, the mean age was
20.8, and the age range was between 19 and 22. The Latina group reported a mean of
seven, and a range between one and 23 for the number of partners with whom they have

been sexually active.

65

 

 

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66

The African-American group indicated a mean of 13 and a range between one and 50 for
the number of partners with whom they have been sexually active. Two participants
from the African-American group reported being sexually involved with more than 30
and more than 50 sexual partners, which increased the mean for their respective group
norms. Though the average number of sexual partners among Latina females were lower
than their African-American female counterparts, the mean number of sex partners with
whom Latinas did not use condoms (n = 3.75) was higher than their African-American
counterparts (n = 2.4).

The survey assessed the participants’ types of sexual activity, including oral and
anal sex as well as the extent to which they took safety precautions. Among the Latina
females, three of the nine respondents who reported engaging in anal sex, also reported
not using condoms. Among the African-American females, six out of ten indicated
having anal sex, but only three indicated using condoms at that time. All 19 of the
female participants reported having had oral sex. Sixteen respondents admitted to not
using condoms when engaging in oral sex, one respondent did not provide a response,
one respondent indicated using a condom, and one participant stated that she used a
condom when giving fellatio, but not (a female condom) when engaging in cunninlingus.
Within this sample, participants reported an equal occurrence for oral sex and vaginal
intercourse. However, the results from their responses indicated that condoms were used
significantly less often when oral sex was involved. When asked how they would protect
themselves when performing oral sex, one respondent stated, “Don’t swallow,” and
another admitted, “I wouldn’t know how you would protect yourself from oral sex.”

These quotes from two participants not only revealed that they lacked the knowledge in

67

protecting themselves, but it also revealed how certain methods give them an illusion that
they are free from infection when practicing oral sex. Though their thought patterns were
disconcerting, they were, nonetheless, candid.

The survey also examined the number of “one-night stands” for each participant.
For the purpose of this study, a “one-night stand” is defined by engaging in sexual
intercourse on the same day as first meeting that sexual partner. A total of 11 participants
reported engaging in one-night stands. Two participants reported having one-night
stands, but both stated they could not recall the number of times they had one-night
stands. Of the nine other participants who had one-night stands, the mean was two with a
range between one and four. Five participants admitted to having sex within a week of
meeting their sex partner. Of these encounters, the average number was five and the
range was between one and 19 partners. Three female participants reported both having
one-night stands and engaging in sex with a person whom they met within a week. Eight
participants reported they had not engaged in either a one-night stand or having sex with
a person they met within a week’s time of meeting. Finally, of the ten participants who
sought an HIV test, six of the eight African American and two of the two Latina females
obtained the results of their HIV tests.

Biography

The purpose of providing a brief description of each participant is to capture the
essence of her individuality, which will, in turn, contextualize the results and the
generalized themes derived from their semi-structured, open-ended interviews. Each of
the late-adolescent females was given the opportunity to assign a pseudo-name in order to

protect the confidentiality of her identity and to promote candidness when responding to

68

emotionally-charged, taboo-oriented questions. In addition, the terms protection and
condom are used interchangeably. Lastly, the information is presented in chronological
order as collected from April 2004 through May 2004.

A frican-American Females

Angel is a 21 year old African-American senior who is majoring in marketing.
She stated that her passion is in entertainment, and she would eventually like to become a
model and a dancer. Her parents had five children; Angel is the middle child and has two
older brothers and two younger sisters. Her parents were married for 24 years prior to
her father’s death from a motor vehicle accident. The father was diagnosed with
schizophrenia when she was 5 years old, and was frequently institutionalized for his
psychiatric problems. She described her relationship with her mother as being “really
close.” Angel reported that her fiancé of a year and a half is currently attending college
in another state. She has been sexually active with five partners, with two of whom she
did not use protection. She engaged in vaginal intercourse and oral sex approximately 12
times in the past 12 months, and did not use a condom in any of these incidences. She
stated she has not engaged in anal sex. Her most recent HIV test was in April 2004, but
she did not obtain the results of her test.

Chi-Chi is a 22 year old African-American 5’h year senior, majoring in the food
industry. Her ideal career is to become a talent agent, and a film director in the hope of
using the media as a forum to create public service announcements for young women.
She stated that she would like to use the media as a teaching tool. She has no contact
with her father, as her mother never married. She stated that she is close to her mom.

She has had unprotected sex with one of eight sexual partners. In the past 12 months, she

69

used condoms each of the six times she engaged in vaginal intercourse. She reported that
she has not engaged in anal or oral sex in the past 12 months. She also reported that she
has been tested for HIV on two different occasions.

Chocolate Princess is a 19 year old Afiican-American sophomore who is
majoring in human resources. She eventually would like to advance her education by
attending graduate school in the same field and work in an office. She stated that she
likes to be in control. She was born and raised in a large inner city in the Midwest. Her
parents divorced when she was a year old, but her mother re-married approximately four
years later. She described her relationship with her mother as “getting better,” but
alluded to past interpersonal conflict. The most recent was Thanksgiving, the first time in
5 years that she visited her father, even though he lives within lS-miles of her. She never
viewed her stepfather as a father figure, and instead, felt out of place at home. Of the 13
sexual partners she has had thus far, she reported having unprotected sex with 5 of them.
Though she is not currently in a monogamous relationship, she reported engaging in
vaginal intercourse approximately 50 times in the past 12 months, but only used condoms
half of that time. She also reported not using condoms in the past 12 months either when
engaging in anal sex on one occasion or when having oral sex approximately 20 times.
She sought an HIV test, but did not obtain the results of her test.

Josephine is a 22 year old African-American 5th—year senior majoring in
psychology. Her goals include earning a master’s degree in counseling and owning a
private practice. She would like to use cosmetics as a means to increase self-esteem for
women who have been domestically assaulted. She stated that she was born in the South

but was raised in the Midwest. Her father, who is a pastor, and her mother, who is a full-

70

time homemaker, are still married and have three children. She reported that of the 5
partners with whom she has been sexually active, she had unprotected sex with one of
them. She approximated engaging in vaginal intercourse, on average, three times a week
for the last 12 months, and she approximated her use of condoms as 10 times in the same
time period. In the past 12 months, she also engaged in anal sex approximately four to 10
times, but did use condoms each time. She did not protect herself when practicing oral
sex. In 2002, she was tested for HIV and obtained her results.

Ladybug is a 19 year old African-American sophomore majoring in human
biology, as well as in marketing and management. Her goal is to become and emergency
room physician, and perhaps specialize in pediatrics. She was born in the South but was
raised in the Midwest. Her parents had one child and were married for 6 years. Her
father remarried approximately 12 years ago and had 5 additional children. Her mother
was remarried approximately 17 years earlier and had one additional child. She
described her relationship with her parents and step-parents as being her “best fiiends.”
She reported being sexually active with six partners and was unprotected with two of
them. She is presently in a monogamous relationship and has practiced safe sex half the
time she engaged in vaginal intercourse. She has not engaged in anal sex for the past 12
months and used both a female and male condom each of the 20 times she had oral sex in
the past 12 months. She reported that she obtained the results from her most recent HIV
test in January 2003.

Mary is a 22 year old Kenyan-American female earning a master’s degree in
Social Work. Her goal is to become the first African-American female Mayor of her

hometown. She stated, “It was my calling.” Her father, who is Kenyan-American and a

71

professor in economics, and her mother, who is a finance manager, have been married for
approximately 26 years and have three children with Mary being the oldest. She
currently interns at a local nonprofit AIDS agency. She stated that of the 30 partners with
whom she has been sexually active, she was unprotected with 5 of them. In the past 12
months, she stated that she engaged in vaginal, oral, and anal sex, and only used condoms
during vaginal intercourse, albeit inconsistently. She reported that she was tested for
HIV and received the results of her test in 2002.

Osa is a 21 year old Nigerian-American junior majoring in journalism. She hopes
to work in public relations as a special-events coordinator. She was born in the United
States, whereas her parents, who divorced when she was 13 years old, were Nigerian
born. Her father is a professor (journalism) at a large university and her mother is a
nurse. She described her relationship with her father and mother as being “very good.”
She revealed that she struggled to feel accepted by the African-American community in
high school, and was frequently told that she was “not black enough.” She felt accepted
by her Caucasian peers both in the high school and college settings. She has been
sexually active with one partner who is her current boyfriend. In the past 12 months,
condoms were used approximately 10 of the 20 times she reported engaging in vaginal
intercourse, and none of the times when practicing oral sex. Her primary concern is
prevention of pregnancy, rather than sexually transmitted diseases. She has yet to get an
HIV test.

Poet is a 22 year old African-American senior majoring in advertisement. She
attributes her career goal of wanting to write commercials as being influenced by her

mother’s work in the radio industry. She was born and raised in a large inner city in the

72

Midwest. She reported that her parents are on the verge of separating because of her
parents being “unfaithful” to each other. She also revealed that she has become more
spiritual and more of an advocate for young African-American women. Poet admitted to
being sexually active with more than 50 partners, with four of whom she intentionally did
not use condoms. In the past 12 months, she consistently protected herself each time she
engaged in vaginal intercourse and oral sex. She reported that she did not engage in anal
sex in the past 12 months. She did get an HIV test approximately a year earlier and
received the results of her test.

Spirit is a 20 year old African-American junior majoring in advertising. She
revealed that she would like to one day own a dance studio and create public service
announcements. She grew up in an inner city of the Midwest. Her father died from Lou
Gehrig’s disease at the age of 36. Her mom currently sells real estate. She emphasized
the importance of an education as a means to practicing safer sex and stated that the
average African-American woman does not seek a college education. She reported that
she has been sexually active with five partners, with two of whom she did not use
condoms. She reported that she has not engaged in anal or oral sex in the past 12 months.
She did get an HIV test approximately two years ago.

Tinay is a 19 year old African-American female who is a freshman majoring in
Pre-Nursing. She was born in the Northwest, but was raised in the Midwest by her
biological father whom she described as being strict. In 2004, her mother was
incarcerated for credit fraud. Her long-tenn goals include becoming a nurse, owning a
home, being married, and having a dog. She reported not using protection with one of

the 5 partners with whom she has been sexually active. In addition, she reported using

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condoms approximately eight of the 20 times she engaged in vaginal intercourse in the
past 12 months. She stated that she did not engage in anal sex and did not use condoms
in the 30 times she had engaged in oral sex in the past 12 months. Lastly, she reported
that she has not, to date, sought an HIV test.

Latina Females

Butterfly is a 20 year old Latina sophomore majoring in interior design. Her
long-term goal is to become a community activist. She was born and raised in the
Southwest, and described her family dynamics as being “traditional.” Her father is
employed full-time in the service industry, while her mother works part-time. She
reported being sexually active with two partners thus far and was unprotected with one of
them. In the last 12 months, she reported engaging in vaginal intercourse five times and
being protected each time, but did not use condoms at all when participating in oral sex.
She reported that she, to date, has not been tested for HIV.

Goddess is an 18 year old Latina freshman who is majoring in packaging. She
has been sexually active with seven partners and was unprotected with one of them. She
reported that she has, on average, engaged in vaginal intercourse 24 times in the past 12
months, but did not use condoms on four of those occasions. In the past 12 months, she
reported that she did not engage in anal sex, but practiced oral sex 12 different times, and
did not use a condom during those times. She admitted that she has yet to get an HIV test.

La Chingona is a 20 year old Latina sophomore who has yet to declare a major.
She stated that “La Chingona” means tough and strong. She hopes to become an advocate
for the Latina community as an events coordinator. She was born in Mexico, but was
raised in the United States. Her parents never married each other. Her mother married

and had two additional children. She revealed that of the four sexual partners, she failed

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to protect herself with three of them. She averaged engaging in unprotected vaginal
intercourse and oral sex, a total of both three times a week for the past 12 months. Her
most recent HIV test was in January of 2004, but she did receive the results of her test.

Leslie is an 18 year old Latina freshman majoring in child development. Her
long-term goals include returning to the Southwest area, getting married, having children,
owning a home, and opening a daycare center. She was born in Mexico, but was raised
in the Southwest region of the United States. Her parents had seven children and were
married for 12 years until her father’s suicide when she was 5 years old. She described
her relationship with her mother, who re-married approximately a year earlier, as being
“very good.” For the previous 12 moths, she reported having both vaginal intercourse
and oral sex, with one person to whom she is currently engaged. She stated that she did
not use condoms at that time, and has not sought an HIV test.

Morning Star is a 20 year old Latina sophomore who is majoring in human
biology and in Spanish. She would like to become an emergency room physician and
work in Africa. Technically, she is bi-racial, being both German and Puerto Rican, but
when she is asked to identify her ethnic/cultural heritage, she predominately identifies
with being a Latina. She reported being involved with 12 sexual partners and using
protection with all but one partner. In the past 12 months, she estimated that she has had
vaginal intercourse 10 times and used condoms each time, but did not use condoms-when
engaging in oral sex on approximately four occasions. She stated that she did not have
anal sex. Her most recent HIV test was in the summer of 2002, and she did obtain her

results.

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O’Connor is a 21 year old, Latina senior majoring in political science. Her career
goals include earning a master’s degree in education, as well as a law degree. She
revealed that her father, who was Mexican, died of a heart attack when she was 14 years
old. Her mother, who is Puerto Rican, was a teacher and had three additional children
from previous relationships. O’Connor was born in Mexico, and has dual citizenship. Of
the 23 partners with whom she has been sexually active, she estimated that she used
condoms with approximately one third of her sex partners. She has been sexually active
on a consistent basis for the past 12 months, and reported not using condoms during
vaginal intercourse and oral sex. She also admitted that her fears have prevented her
from getting tested to determine her HIV status.

Princess is a 21 year old Latina senior who is majoring in psychology and she
hopes to become a marriage and family therapist. She stated that her parents, who are
both Hispanic, are still married, and have 4 children. She reported that she has had, to
date, three sexual partners, and had had unprotected sex with one sexual partner. She
approximated engaging in vaginal intercourse twice a week for the past 12 months and
during that time, reported not using condoms on two occasions. However, she appeared
to misunderstand the question, and I believe her response is not accurate to the question
being asked as she stated, “Um, twice and that was just with the last first two before my
boyfriend now.” This response leads me to believe that she has not used condoms with
her most current sexual partner who she identified as her boyfiiend. She stated she has
not engaged in anal sex, but had oral sex on average once a week for the past 12 months,

and did not use condoms. She has yet to get an HIV test.

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Sam is a 19 year old Latina freshman who is majoring in advertising. Her long-
term goals include being financially stable and being content with her job. Her mother
and father, who speak fluent Spanish, are still married. She revealed that she is not
actively involved in the Latina community, and that her friends view her as being
“White,” even though she has expressed interest in the Latina community. She reported
that she has been sexually active with one person, who is presently her boyfiiend, and has
consistently used condoms when engaging in vaginal intercourse, but not during oral sex.
She also reported that she has yet to get tested for HIV.

Vixen is a 21 year old Latina attending her fourth year at a local community
college, and is majoring in photography. Her mother and father, who are Mexican and
Puerto Rican, respectively, never married each other. Her mother is married to her
stepfather, who is African-American. She views him as a role model. She described her
overall childhood experience as being “very good.” Her career goals include being a
photographer and eventually becoming a trainer at SeaWorld. Of the 10 partners with
whom she has been sexually active, she reported failing to protect herself with seven of
them. She estimated that she used protection 20% of the 208 times she had vaginal
intercourse in the past 12 months. She also revealed that she engaged in both oral and
anal sex in the past 12 months, but admitted she failed to protect herself in each of those
instances. In addition, she admitted that she has yet to get an HIV test.

Findings

The type of data analysis for most qualitative research is theme-driven; however,

the themes derived from this study are contextualized within their respective sections and

within the questions that were asked. The results of the data analysis are clearly outlined.

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The first major section, HIV Knowledge, encompasses two questions: (1) What are the
respondents’ understanding of how HIV is transmitted, and (2) How do the women think
of themselves in relation to HIV? The second major section, which is titled Thoughts and
Behaviors about Sex, Participants’ Sexual Experiences, Safe Sex, and Communication
Patterns with Sex Partners, is further divided into four subsections: Definition of Sex,
Personal Accounts of Past and Present Sexual Experiences, Definition of Safe Sex, and
Communication Patterns with Sex Partner. The third major section, Effectiveness of Past
and Present HIV/AIDS Messages is divided into three sections, including Types of Past
HIV/AIDS Messages, Types of Present HIV/AIDS Messages, and Suggestions to
Increase Consistent Condom Use and HIV Awareness.

In addition, many, if not most of the participants, provided multiple responses for
the open-ended questions. For example, when asked to discuss their knowledge of the
transmission of HIV, many of them listed several examples within a given response. La
Chingona’s response serves as an example:

La Chingona: “I know you get it through sex sexually, that’s orally or

anal sex, through blood, like semen or the same thing, sex, sharing of
needles, blood, I’m trying to think how else I think that’s it, I know
you can’t get it through kissing, unless there’s a cut.”
Multiple examples were then delineated into their own categories. The results were also
outlined in a comparative framework between the Latina and Afiican—American late-

adolescent groups. Table 4 summarizes the participants’ responses to the two content

domains: knowledge of HIV transmission and the extent they identify with HIV/AIDS.

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Summary of Knowledge Regarding HIV Transmission

Table 4

Themes on Knowledge Regarding HIV Transmission

 

 

Question Themes (n = 19)
Mode of Transmission
Sexual Contact 18 Total
Vaginal Sex 7
Oral Sex 7
Anal Sex 5
Intravenous Needles 12
Exchange of Bodily Fluids 8
Blood Transfusion 7
Relation to HIV/AIDS
No 9 Total
African-American 3
Lafina 6
Yes 10 Total
African-American 6
Lafina 4

 

All of the participants, with the exception of one, responded to the question of
identifying ways HIV can be transmitted and made some form of general reference to
sexual contact as a means of transmitting the virus. Seven participants made mention of
vaginal and oral sex as a route in which HIV can be transmitted. Osa’s response is
representative of a typical answer; she stated, “Through some type of sexual contact
whether it’s oral sex or vaginal sex.” The five other participants stated that anal sex is a
form of sex, and is thereby, a form of transmission. Twelve participants viewed
intravenous drug use, a phrase denoting the use/exchange of contaminated needles, as
another culprit for the spread of HIV. Exchange of bodily fluids, including blood, semen,

and saliva, was also mentioned by eight respondents. Seven indicated blood transfusion,

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while three indicated childbirth by an HIV-infected mother as a means of transmitting
HIV.

Their responses to the next question—Have you ever thought about yourself in
relation to HIV/AIDS—may clarify this matter. Their responses fell into two equally
divided camps: No and Yes. Six Latina and three African-American females stated that
they do not think of themselves in relation to HIV. Three participants reported a No
without further explanation. For the six other participants who indicated a No response,
the most common explanation given was a combination of being with a “few” partners
and “knowing” their sex partners precluded them from thinking of themselves in relation
to HIV.

Goddess: “No: Like I, everyone who I’ve had sex with, I’ve known and so

I trust them, and I pretty much know who they’ve been with so I feel
really comfortable with them. . .I don’t have many worries about
getting HIV or AIDS.”

Leslie: “No. Because I have been with one person.”

Butterfly: “No. I’ve never believed that about myself. I guess because the

people I have been with, you know sexually active with, they, it was

either their first time, or to my understanding they hadn’t had so many

sex partners.”
The aforementioned statements are indicative of a false belief of being safeguarded from
the possibility of getting infected. Six African-American and four Latina females directly
and indirectly indicated that they have thought of themselves in relation to HIV and the
most common explanation provided was a combination of their own sex history,
including “bad decisions they made,” and the act of getting an HIV test. Poet’s and

Angel’s responses illustrates this theme.

Poet: “Yes, the first time I went and took my AIDS test, I was terrified. I
think I was like 20, the first time I took it, 21 something like that. But

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um, I was really scared to take it because I thought about all the bad
decisions that I made as far as sexual partners. I had a lot of one night
stand and it was like even if I did have it, I wouldn’t even know who
to start calling to find out where I got it from and that was a scary
thought.”

Angel: “Yeah, by me participating in unprotected sex, I think about it

often and I get tested once a year. Yeah, before I didn’t have

unprotected sex so I didn’t feel the need to get tested.”
Television programs (n = 2), educational classes on sex (it = 2), and the need to protect
themselves (it = 2) were other explanations given when these late-adolescent females
think of themselves in relation to HIV.

A subtle pattern emerged regarding why these participants did, or did not,
consider the potential impact of HIV and its bearing on their safety. Latina females
demonstrated a greater incidence to being impervious to the belief that they can become
infected. This is most attributable to false assumptions such as (1) having fewer partners
is safe(r) and/or (2) knowledge of their partner’s sexual history and behaviors.
Alternatively, African-American females were able to conceptualize the relationship
between their history of sexual practices, motivation to get an HIV test, and their

thoughts and actions around the possibility of being HIV infected.

Thoughts and Behaviors about Sex, Participants ’ Sexual Experiences,
Safe Sex, and Communication Patterns with Sex Partners

Definition of Sex

There is a paucity of research studies that has examined the relationship between
condom use and oral sex (Boekloo & Howard, 2002), even though other studies revealed
that adolescents are more likely to experience oral sex sooner than penile-vaginal
intercourse (Newcomer & Udry, 1985). A general concern among the HIV/AIDS

research is that when studying or conceptualizing “sex” and “safe sex,” it is often

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operationalized in terms of vaginal penetration because of an unconscious exclusion of
oral and anal sex. This pervasive, yet silent, assumption has surfaced in the literature,
and has been echoed by the participants being studied. The following results detail the
participants’ definition of sex, conceptualization of anal and oral sex, ages when they
learned the meaning of sex, and sources from which they learned the information.

Among the African-American females eight of the ten respondents defined sex by
providing specific examples of sexual behaviors, which included anal, vaginal, and oral
sex, as well as the exchange of bodily fluids, which was then encompassed under the
broader category of Penetration. Poet’s and Chi-Chi’s responses typify the way the
female participants conceptualized the term sex.

Poet: “Well, sex is, of course, there is intercourse, there’s oral, anal, and
vaginal sex.”

Chi-Chi: “Penetration. [Investigatorz Tell me more about that] If

someone is penetrating the other, then I think that’s when they really
are starting to open themselves up to diseases.”

Josephine and Ladybug further conceptualized sex as being an intimate
experience and a means to express love and affection. Furthermore, sex is not merely a
“past time” or “something just to do,” according to Josephine, but it is to be viewed as an
emotional and personal interaction between two people.

Among the Latina females, seven of the nine respondents also provided specific
examples of sexual behaviors, including vaginal, oral, and anal sex, which was also
subsumed under the category of Penetration. O’Connor’s response, “Vaginally, orally,

anally. There is penetration involved. Penetration into orifices,” epitomized the

Penetration category. Of the nine Latina participants, two referred to sex as heterosexual

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sexual behavior, while two others viewed it as an emotional and intimate experience.
Princess’s and Leslie’s excerpts typify both response sets.
Princess: “Either through oral sex and or just regular heterosexual sex. I
guess anal sex as well, I’d classify that under the category of having
sex just less dirty.”

Leslie: “Yeah, okay, my definition of sex is a way of showing your
primary love. I don’t just want to do just for fun, but the person I do it
with is because I love him.”

When asked to define sex, the majority of the responses across both groups
conceptualized it in regards to Penetration, which is in and of itself an equally broad and
abstract term. Many provided specific examples of penetration, including vaginal, anal,
and oral sex, while others thought of sex in terms of exchange of bodily fluids, and other
respondents qualified penetration or sex as a sexual act in a heterosexual context. Two
participants from each group viewed it more than a mere behavior, but as an emotional,
intimate connection between her and her sex partner, regardless of gender and sexual
orientation. Sex and penetration were largely defined in terms of discrete behaviors (e. g.,
vaginal intercourse), as evidenced in this sample, but when the participants were asked
whether specific sexual acts can be categorically and unequivocally defined as sex, the
responses became less than clear and are evident in the following subsection.

Conceptualization of anal and oral sex. A total of 12 out of the 19 participants,
eight African-Americans and four Latinas, definitively stated that anal and oral sex
constituted sex, while 7 out of the 19 participants, two African-Americans and five

Latinas, revealed a more varied and complex response set. Angel and Chi-Chi, who are

both African-American females, viewed vaginal intercourse as distinctly different, and

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conceptualized oral and anal sex either in terms of losing one’s “virginity” or on a
continuum of “penetration.”

Angel: “Oral, no. Anal, I would actually say, yes, but I don’t know
because to me, losing your virginity is vaginal; it’s not anal and I think
when virginity is first discussed with me, it was brought about as
vaginal. I didn’t learn about anal sex until later on in life. Actually
didn’t learn about it until several years later so I never thought of it as
losing your virginity.”

Chi-Chi: “Yes.” But then later states, “Oral sex is sex but not to the extent
to which penetration is.”

Morning Star and Vixen both indicated that oral sex is “foreplay,” but had
opposing views as to whether anal sex constituted “real” sexual behaviors. Sam also
agreed with Vixen that anal sex is sex, but was uncertain as to how to conceptualize oral
sex.

Sam: “I think anal sex is, I feel like oral sex is sometimes... I don’t know,

I haven’t decided whether it is or isn’t. . .Anal sex is because it would
be penetration whereas oral sex is not, because it’s not necessarily,
well it isn’t. . .kind of... (Laughs nervously)”

Princess stated that both acts were forms of sex, but felt that anal sex was “just
less dirty.” Conversely, Leslie’s response gave a strong implication that she viewed both
oral and anal sex as being “dirtier” as she thinks of them as being “nontraditional” and
“non-conservative” sexual behaviors. She believed that penile-vaginal intercourse is
“normal” sex, and therefore is permissible, based on the premise that vaginal intercourse
can be openly discussed among her peers. However, some topics, including oral and anal
sex, are forbidden from peer-discussions and are considered taboo. Therefore, they are

designated as “not normal” sex behaviors, according to Leslie’s assertions.

Consequently, anal and oral sex are not only perceived as “dirtier” forms of sexual

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behaviors, but the character of the person who initiates these taboo topics is under attack
as well.

Though the majority of respondents indicated that both oral and anal sex
constitute sex, the five other respondents conceptualized these sexual behaviors within
several frameworks: degree of sexual penetration, the cultural norms associated with
“virginity,” and culturally-defined taboos. The following subsections examine the age
and source from which they acquired the meanings associated with sex.

Age and source from which they learned about sex. The most popular response
for how the participants acquired their understanding of sex was through formal sex
education (Latinas = 4 and African-Americans = 5). Six African—Americans compared to
three Latina females indicated that family, especially their mothers, were involved in
their understanding of sex. There was equal mention (n = 3) of various forms of media
(e.g., MTV and BET) that assisted in their acquisition of the term sex. Friends and
personal experiences were also mentioned, but the type of interactions they had with their
family members differentiated the two groups. The Latina participants indirectly learned
about sexual behaviors and social norms from their parents. Examples of imparting such
beliefs and norms included covering the children’s eyes to hide movie and television
scenes that were sexual in nature, and making suggestive comments about waiting to
have sex until marriage. The African-American participants acquired norms and beliefs
about sex from their parents as well, but the messages were more explicit, and the
conservations occurred with greater frequency. Examples of messages that they obtained
from their parents included treating one’s body with respect, revering one’s body as a

temple, and engaging in sexual acts when one is emotionally “ready.” In other words,

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both groups were encouraged to “wait” in having sexual relations, but the Latina females
were told to wait until marriage, while the African-American females were told to wait
for the right person or until the person is emotionally mature. Vixen and Leslie, who are
both Latinas, and Tinay, who is African American, confirm these observations.
Vixen: “[Investigator: Where did you get your description of sex from?]
TV, you know, watched TV and saw the sexual acts and usually my
parents would cover my eyes but I could still see it when they weren’t
around.”
Leslie: [Investigatorz Where did you get your description of sex from?] I
think that is the way I was raised. 1 was told that you are not supposed
to have sex until you get married. I was raised in a way that the best
thing you can offer your husband when you get married is your

virginity.”

Tinay: Everything: Media, parents, friends. [Investigatorz What about
parents?] Trying to wait until I find the right person.”

The majority of Latina (n = 6) and African-American (n = 7) females indicated
that Middle School, which included 4th through 8’h grades, was the timeframe in which
they began thinking about the concept of sex, while three respondents thought about sex
much sooner because of either having an early onset of their menstrual cycle, being
sexually abused, or having early talks with their mothers. Chi-Chi, for example, had her
first discussion with her mother when she was 8 years old; Poet recalled of her first
menstrual period at the age of nine as the reason for having her first discussion with her
mother. LaChingona was forced to conceptualize sex when she was sexually abused at
the age of six.

The purpose of this subsection was to determine the participants’
conceptualization of sex, the sources by which they acquired their understanding of sex,

and the timeframe in which it was learned. Essentially, formal sex education classes in

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school settings, family, and the mass media were identified as the primary sources for
explaining the sources from which they learned about sex predominately during “middle-
school” years. The goal of the following subsections is to examine the intimate details
and personal accounts of these participants, the motivation to engage in past and present
sexual experiences.

Personal Accounts of Past and
Present Sexual Experiences

One approach to understanding better the HIV/AIDS epidemic among minority
adolescent females is to examine the variables that motivate them to engage in sexual
behaviors with each new sexual partner. Understanding the highly interwoven, multi-
layered factors regarding their rationale, motives, and behaviors for engaging in sexual
behaviors may be one key determinant in generating HIV prevention messages, as it will
have significant relevance to the specific population being studied. Three categories
emerged from the data analysis for both Afiican-American and Latina females: low
number of sexual partners (i.e., 1-4), moderate number of sexual partners (i.e., 5-10), and
high number of sexual partners (i.e., > 11). Among the nine Latina late-adolescent
females, five fell in the low number of sex partners, two were classified in the moderate
number of sex partners, and two were grouped in the high number of sex partners.
Among the 10 African-American late-adolescent females, one participant was assigned to
the low number of sex partners, six were categorized in the moderate number of sex
partners, and three were delegated to the high number of sex partners. This information

is shown in Table 5.

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The following subsections are further divided by racial/ethnic groups, where
African-American will be described first, and then the Latina group, followed by a
synopsis of the themes derived for each category.

Table 5

Categorization of Sexual Partners by Number and by Race/Ethnicity

 

 

Low Number of Moderate Number of High Number of
Sex Partners Sex Partners Sex Partners
(1-4 sex partners) (5-10 sex partners) (> 11 sex partners)
African—
Amerrcan 1 6 3
Females
Lafina
Females 5 2 2

 

Low number of sex partners among A frican-American females. Osa lost her
virginity at the age of 20, and stated several reasons why she engaged in her first sexual
experience. The “self-oriented” reasons focused on how she felt mentally and physically
ready to explore sexual activities and that she was tired of being the “only virgin” within
her circle of friends. The other reasons shifted the focus to her sexual partner and how
she “felt a connection” with him, that he was disclosing of his past, and that she was able
to see a potential long-term commitment with him as evidenced in the following excerpt:

Osa: “I guess I felt more of a connection with him and I think I was just

ready. I’ve heard conversations from my friends who have been
having sex, and I just felt like I was almost alone, I never experienced
it. At first I didn’t’ care, but then it started to get to me, and so 1

would say probably, the connection with a person and also the fact of
being the only virgin within my circle of friends.”

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Ironically, though she delayed losing her virginity until the age of 20, she engaged in
sexual intercourse within the first month of meeting her sexual partner and described her
first sexual experience as being in the “heat of the moment.”

Osa: “I was still 20 and it was just kind of the heat of the moment type

thing. Got wrapped up into whatever we were doing and it was, it just

kind of happened, you know. It doesn’t sound too good does it?”
It seems that Osa’s primary motivations to engage in sexual relations with someone who
she knew approximately a month were two-fold: she felt (I) alienated by her peers for
being the “only virgin,” and (2) the need to have an emotional connection with her sex
partner. Osa appeared to gain awareness in how she had protected her sexual identity
only to lose her virginity within a month’s time of meeting her sex partner.

Low number of sex partners among Latina females. Butterfly lost her virginity at
the age of 20 and had a total of two sexual partners. She was motivated to “take that
step” and have her first sexual encounter with her long-term boyfriend because they “had
a lot in common and stuff,” even though she admitted that “I always thought about
waiting until to get married.” She described her other sexual encounter as being “in the
moment.”

Butterfly: “I guess it was just in the moment or something? It wasn’t like

I thought about it. It was more of he was willing—he was more the

one that wanted to do it—and I didn’t really think about it; I just went

along with it. Maybe it was not a good choice that I made.”
Butterfly emphasized the importance of taking the time to get to know her sexual partner,
as evidenced by this statement:

Butterfly: “1 would really have to know the person before I got into any

kind of sexual relationship. I’m not the type of person that will see a

guy, and will just get attracted to him, and like have one night stands,
or something like that.”

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Butterfly then attempted to address the subtle, yet apparent, contradiction:

Butterfly: “The first person, of course, because it was in time. We would

spend every single day with each other because we went to the same

high school and he took me home. But with the second person, it was

more, even though we didn’t know each other for that long of a period

of time, as with the first person, I really felt comfortable with him.

The comfort level came a lot faster, just an attraction towards him.

Maybe it was curiosity. I guess it just varies with different persons.”
The key factors that determined whether or not she participated in sexual acts included
“waiting until marriage,” needing to feel comfortable, needing to take the time to know
her sexual partner, and having a sexual attraction. There seems to be a contradiction
between her thoughts and actions in that she emphasized the value of sex and knowing
her sexual partner, yet overtly condemned attraction as a reason to have sex. Nonetheless
her behaviors remain as evidence that attraction was, in fact, the motivation for having
sex with her second sexual partner.

La Chingona reported being sexually abused by two different male perpetrators at
an early age, with the first being her mother’s brother and the second being her mother’s
husband for two years. She stated that she has had four sexual partners, and emphasized
that her history of being sexually abused did not influence her present behaviors. She
contrasted her own experience with her friend who was also sexually abused:

La Chingona: “I feel like I’ve recuperated over it like really good. I don’t

see sex as anything nasty. I had a friend she told me she was abused
by her step dad, and she never told her mom as far as I know, but she
would use it as an excuse to sleep around. She’s like, ‘I learned about
it so long’ that she started sleeping around a lot. It’s like that’s not
really an excuse for it. I wasn’t really like that. I never really slept
around, and I’ve never felt any weird about sex.”

La Chingona attributed her lack of sexual promiscuity to feeling supported, and having

positive communication about her sexual abuse with her teacher, mother, and first sexual

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partner. This open communication resulted in the legal conviction of her step-father. La
Chingona’s criteria to engage in sexual activity changed over time with each of her four
sex partners. The duration of time spent getting to know a potential partner in order to
have sex became shorter, and the decision to have sex became less of a conscious choice.
In addition, common features among her sex partners were that they were Latinos, that
she felt comfortable and trust was established, and that she was able to connect with her
sex partners. The following excerpt highlights her sexual encounters:

La Chingona: “Like my first experience—I wanted my first time to be
special, not just with anybody. So we dated for almost a year before
we had sex. So at first I thought it was something special, and I wasn’t
going to do it with anybody. Second experience it happened about 3
months into a relationship, and I wasn’t in love with the guy. I wasn’t
going to marry the guy. He was just a great guy. He treated me really
good. He put up with everything, stuff it was like, ‘Wow, would have
never done that!” I felt comfortable enough to experience that with
him. The third time it was with the guy I’m talking to right now. It
happened within a month. We clicked, right away. About a month
after that, October, we started having sex. I liked him a lot, very open-
minded, again, really great. He’s just really great guy, he’s like better
personality. We connected a lot better, and I don’t know, it just
happened. And then the fourth person I was with, it was a one night
thing. I thought I would never have one but I did, so that was just
something crazy. I was just like ‘Why not?’ I was like, ‘Fuck it,’ but
that time I did use condoms with him. He’s kind of a celebrity. I went
to their concert and their music is really famous. I didn’t plan for it. I
was like ‘Should I do it?’ She [her friend] was like “Go ahead.’ I was
like. ‘Okay fuck this.’ I felt something crazy, something to tell later,
so that was kind of crazy but I used protection.”

Another commonality among her partners is that La Chingona felt validated by them
either by the way they showered her with positive attention or by how they had an
unusual level of tolerance for her behaviors and attitudes.

Leslie commented that sex, as she sees it, as an “expression of love,” including

compatibility in values, a sexual partner who is caring and does not place pressure on her

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to engage in sex, and a marital commitment. These are the three key factors that
determined whether or not she would consider engaging in sexual relations. She stated
that in regard to her fiance', she knew within the first four months that they would marry.
She explained that during their courtship, she went about investigating her fiance’s sexual
history by asking his childhood friends and by asking him directly about his past. Leslie
also revealed in the following passage the importance of marriage and being a virgin.

Leslie: “I tried find out about his background from people he grew up

with by investigating through childhood friends if he is very sexually
active. [Investigatorz What kind of person were you looking for then?]
A person that will do it, that will think the same way I think, that will
have sex with a person because they loved them, not just for fun.
After I met him for four months we decided to get married. I was 14
years old. We wanted to get married. He is 21 years old now but then
he was 17 or 18. But we knew we were so young and that people will
be against it, especially our parents. I wanted to be a virgin before
marrying him. We started thinking about sex, but decided against it.”
At the age of 14, she met her current fiance', but waited to engage in her first sexual
experience until they cohabitated when she was 16 years old, even though she had
planned to consummate their relationship on their wedding night.

Princess has been involved with three sexual partners. When she was asked to
identify the factors that contributed to her decision to engage in sexual relations with a
“guy,” she simply began discussing her sexual history. She lost her virginity at the age of
16 with her boyfriend of six months, and perceived the relationship as being “serious”
and meaningful. During their break up, she was sexually active with two additional sex
partners, before returning to dating her first boyfriend.

Princess: “It was a couple of months with him, but what had happened

was that I was dating him, and then we took a break for a while, and
there was those two in the middle, and now I’m back with him. That

was the very first time with him, too, and so we waited a couple
months for that. With the two guys in the middle, it wasn’t some huge

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decision. We were not in a relationship. The first one—it was a couple

of months after me and the first guy, my boyfriend now, took a break

and so I was out and trying to meet new people all the time.”
Interestingly, Princess’s devotion to her first sex partner is apparent, but her attitude and
motivation behaviors with the second and third sex partners can be described as being
less conscientious. Furthermore, her sexual behaviors may seem to be driven by feeling
rejected by her first sex partner, and she, thereby, had a need to seek external validation
through the form of sex with her other partners.

Sam lost her virginity at the age of 18 with her current boyfriend. She
emphasized that long-term commitment and lack of pressure to have sex were two
determining factors in deciding to engage in sexual relations. She stated, “I feel like if I
didn’t know that I was going to be with the same person, then I don’t think I’d want to do
things like that.” Ultimately, the actual act of sex occurred spontaneously, even though
she stated that their decision to have sex was a conscious one.

Sam: “It was pretty conscious, we talked about doing things and I was

just like, I don’t want to do that right now, so let’s just talk about it
later, so we just put it off and then I don’t know, it just kind of
happened.”

Themes among low number of sex partners. A general theme among the six
female participants in the low category is that their values and thoughts were not
necessarily congruent with their behaviors. Specifically, each participant emphasized the
value of believing that the relationship with her sex partner had the potential for a long-
term commitment or for marriage; yet, each of them engaged in sexual activity within the

context of it “Just-Kind-of-Happened.” Leslie, for example, had made a conscious

decision to “wait” to have sex with her fiance', but still lost her virginity before marriage.

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In other words, even the well-intentioned, highly value-oriented females subjected
themselves to spontaneous sexual practices.

Will similar themes appear in the next category, where the participants have been
identified as having been sexually involved with more than four but less than eleven
partners? Six African-American and two Latina females have been categorized in the
Moderate Number of Sex Partners. As with this subsection, themes will be derived from
the summarization of participants’ thoughts, as well as their past and present behaviors on
sex.

Moderate number of sex partners among A frican-A merican females. Angel, who
has been sexually active with seven partners, at the time of the interview, is engaged to be
married. She stated that her reasons to engage in sexual relations included having
chemistry, the ability to trust, and being emotionally and physically comfortable with her
sex partners. However, her sexual history revealed that other factors, namely the Wooed-
Effect and viewing Sex as a Requirement to be in a relationship, were the unconscious
motivations involved in the decision-making process to have sex. Angel’s first sexual
encounter was at the age of 13 with a partner who was 18 years old at the time, and she
justified this by stating, “He said all the right things to me, and I thought in order to be
with him, or to keep him, that I needed to have sex with him.” Angel’s first sexual
experience was further complicated by her 15-year-old girlfriend who pressured her to
have sex. She stated, “I was kind of scared, and very apprehensive, but she was there and
was like, ‘It’s fine.’ And we went in the room, and it happened.” Being Wooed, which is

defined as her partner attempting to increase her self-esteem as a ploy to have sex , and

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perceiving sex as a requirement to be in a relationship, were evident in six of her seven
sexual partners.

Angel: “In the past, [he] just won me over with charm. I feel every guy

that I had sex with in the past, I feel I was misinformed. I felt they

told me things that I wanted to hear to get me in the bed and that’s why

I’m not with them now.”
Angel’s thoughts and attitudes toward sex have changed over time and since her
engagement. She stated, “I feel comfortable expressing my emotions,” regarding her
ability to be emotionally intimate with her fiance', which resulted in this insight: “I
realize that there is more growth to a relationship than just sex, and you should want to
get to know the person more.” She attributed this positive change to increased
spirituality, the realization that older friends can be “stupid,” and a desire for “real love,”
instead of meaningless sex.

Chi Chi, who was 22 years old, lost her virginity at the age of 18, and has had
eight sexual partners. She explained that her focus on high school academics and her
need “to be more comfortable with males,” were reasons that she “was never young”
when losing her virginity. Her first sexual relation was not in the context of a mutually-
exelusive relationship, but instead, was with a person who she was “kicking it with and I
just felt that it was the right time. That’s it.” She recalled that the majority of her past
sexual relationships were with friends, or “that 1 met the guy and we started kicking it
and had sex.” She also asserted that most of her sexual encounters had been based on
“some type of relationship with these people,” prior to engaging in sex with them. Her

sexual relations, however, typically involved a strong emphasis on being physically and

sexually attracted to her partner and “feeling the urge” to have sex.

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Chi Chi: “Number one, if I’m interested in you, I got to be physically
attracted to you. I can see people that I’m not really interested in that
I’m attracted to that I might want to have sex with because physical
attraction goes hand in hand with sex to me. If you attracted to
somebody, you might do something you don’t do usually.”
She provided one instance when she engaged in sexual relations within a week’s time of
meeting her sexual partner and attributed it to feeling “horny,” but attempted to explain
her actions by emphasizing that it was an “experimental phase.” Though Chi Chi’s
attitude and thoughts regarding sex have changed over time, her actions indicate that
there is a pervasive and underlying apprehension toward establishing a long-term,
mutually-exclusive relationship. In other words, she actively engages in sex under the
guise of perceiving the relationship as friendship—a safe emotional distance. Her
general outlook, however, is still characterized as having lack of trust toward men, which
prevents her from becoming emotionally committed to any one partner.
Chi Chi: “It’s hard for me to show people how I like them, or embrace
people when they are trying to love me or let somebody be nice to you
or love you or show you emotions. It’s a lot of deception going on out
here with people telling you certain things or making you feel a certain
way when actually they don’t feel that way about you. Or if they do,
that still doesn’t stop them from messing around on you or they are
still, there are still trust issues there.”
Her most recent sexual partner was in the context of “a long time friendship,” and while
she desired a more mutually-exclusive, committed relationship from this friend, she still
had mistrust toward men, in general, including her friend.
Chi Chi: “I’m at the point of it’s either going to be something else or
we’re going to stop dating. Because he has to make a decision as to
what he wants when it seems like to me guys really can’t have sex

with just one woman. Not at a certain age. It seems like some can.
I’m not saying all guys, but it seems it’s hard for them to commit.”

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Chi Chi initially presented a laisser—faire regard for her sexual attitudes and habits in that
she placed a high premium on the need to be physically attracted to her sex partners and
having strong sexual urges to engage in sex. Upon further reflection, she revealed a more
humane side that is comprised of a deep-seeded fear and mistrust toward men who are
generally thought of as deceitful creatures. It seems that her attitude and behaviors
regarding sex are incompatible. From a psychological framework Chi Chi seemed to
resort to sexual encounters unwittingly in seeking approval from her male partners, but
will embody a laisser-faire attitude as a form of protection.

Josephine, who is 22 years old, lost her virginity when she was 15 years old, and
has been sexually active with five partners. She emphasized the importance of
establishing trust as the primary criterion to have sex, and did so by engaging in candid
discussions with potential partners regarding their past experiences. Conversely, feeling
pressured to have sex, having sex-focused conversations, and failing to communicate
were her reasons for not engaging in sexual activity. The following passage captures her
disdain toward those who pressure her to have sex:

Josephine: “And I know I have bad guys that I’d been dating and it’s just

like, you know, ‘Look, are we going to do this or what? We’ve been
talking for three weeks, and this is the longest I’ve ever waited.’ And
I’m going, ‘And you’re going to wait even longer because you’re not
going to do me anyway.’ For me, that’s been the biggest thing that
more of their verbals get them in trouble than even their actions.”
When Josephine was asked to describe her sexual experiences, she stated that her first
and most recent sexual experiences have been with the same person. Her first sexual

encounter, at the age of 15, involved waiting for approximately five months, having

positive feelings for him, being able to trust him based on their “honest” talks, and

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knowing his sex history, all of which were part of her decision-making process to have
sex.

Ladybug, who is 19 years old, has been sexually active with six partners, and lost
her virginity at the age of 16. She initially viewed sex as “just something to do so it’s just
to say that you’ve done it,” being “pretty overrated,” and symbolizing a rebellious act
against her mother and her father, who gave her a promise ring symbolizing that she
remain a virgin until she wed. Her sexual history revealed that her first three sexual
partners, with whom she characterized as being in a committed, monogamous
relationships, were in the context of Sex as a Requirement in order to sustain a
relationship.

Ladybug: “If I wanted to be accepted by him, if I wanted him to really be

my boyfriend and not go anywhere else, ‘I’ll be your boyfriend but

since we’re not going to have sex, then I’m going to have sex with

someone else just so you know.’ And I didn’t want that. I wanted him

to just be exclusively with me because that’s how I wanted it to be.”
Furthermore, not only did Ladybug believed that sex was a requirement, she was also a
victim of it “J ust-Kind—of-Happened’ ’ phenomenon with respect to her first sexual
encounter:

Ladybug: “It was talked about casually throughout the relationship, and

then he came over to my house and it just happened. When you start
kissing and stuff like that and then your emotions start flaring and,
instead of me stopping it, like I said, ‘What the hell.’ I just did it.”

Over time, Ladybug’s reasons to engage in sexual relations changed from engaging in

sexual relationships to having more of an emotional and meaningful connection as

evidenced in the following excerpt:

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Ladybug: “Now that I am more experienced, and I know exactly what I’m

doing—it’s, once I reached the comfort level with you, and I feel that,

I pride myself, I hold a lot of value in myself, and once I feel like I can

give that to you, and you treasure and hold it as much as I do, then it’s

okay, we can go ahead and take that path.

“In me saying the connection, I feel like I am tied to you because I lay

down and let you have sex with me. Then I’m giving a part of me to you.

And what, I’m always going to be in your life, regardless if you don’t

want to be or not.”
Ladybug’s behaviors unwittingly contradict her perception of sex, whereas she had sex
with her first three sex partners under the guise of “keeping” them as a boyfriend, but
engaged in whimsical sexual encounters based on her “sexual cravings,” with the last
three sexual partners. She explained in one instance that she had sex with a friend
because, “It was that crave, that crave to just be held, to be made love to, so, it was just
something to just quench that thirst.” With regard to her partner who she met the same
day, they engaged in sexual activity, she emphasized that “everybody else wanted him
and he wanted me.” Despite Ladybug’s claim that her views of sex changed over time
and went from being “nonchalant” to “I’ve given a part of myself to that person,” the
need to be validated and accepted by male sexual partners is evident in both her past and
present sexual relationships. Furthermore, the contents of her thoughts are equally
contradictory, since she views sex as an emotional lifetime bond; yet, in the same breath
makes quip statements about sex as being overrated.

Spirit, who is 20 years old, has been sexually active with five partners. Spirit lost

her virginity at the age of 17 with her boyfriend of a year. She reported that with each of
her partners, becoming sexually active was a conscious decision. She is presently in a

committed relationship, and referred to her most recent sex partner as her boyfriend. She

denied engaging in one-night stands, and further elaborated on the importance of

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compatibility with her sex partners. Being able to trust her sex partner, observing how
her sex partners interact with others, including friends and family members, determining
whether they “lie and are safe”, and waiting on average three to four months before
considering having sex, are all part of her decision-making process of whether to be
sexually involved. Conversely, she will not pursue sexual relations if she senses that
potential sex partners are untrustworthy or “fake” and “using bad lines.” Interestingly,
she made a point that consenting to sex is not dependent on perceiving her sexual
relationships as commitment to marriage.
Spirit: “Even if I would say ‘I’m really into this person and I think they’re

the right one, some things are still shady,’ but I would. It wouldn’t be

shady enough to make me say, ‘I don’t want to do this.’ It’s still

conscious for me to know that I’m getting myself into this even though

that maybe we’re not going to get married in the future.”
Spirit’s values and thoughts regarding her own sexual practices seem congruent with her
behaviors.

Tinay is 19 years old, and has been sexually active with five partners, two

of whom were one-night stands. She lost her virginity at the age of 18 with her
boyfriend of six months and she stated that it was both a conscious and mutual
decision. Tinay’s beliefs regarding becoming sexually active are both complex
and contradictory to her own experiences. She declared that if she perceived a
potential partner as having no prospects of being in a committed relationship, but »
finds him “cute and nice,” and “wants some that night, then I’ll do it [sex]” sooner
than later. However, she also stated that if she was genuinely interested in her

partner, then she would postpone engaging in sexual relations until a relationship

has been established. This is illustrated in the following passage:

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Tinay: “Well if I’m really interested in him, I don’t do it until we have a
relationship because I don’t want him to think that she’s easy. And
then I try to hold myself back because I want him to know that I’m
special, and want them to keep persisting after me because I know
that’s what they want, in general, but I want them to keep on staying
around, not just giving it to them and then they can leave.”

This excerpt also exposes another critical motive in delaying sexual activity—desiring
the illusion of being wanted by her suitor. Tinay’s sexual experiences, instead, revealed
that she became prematurely sexually active with partners who she lacked interest in, and
her behaviors were driven by her need to be accepted and wanted. The following excerpt
described an incident with her second sex partner that involved alcohol and peer pressure:
Tinay: “One of them I didn’t want to have. The people that I was with,
they were trying to get me to drink and stuff. I’m a nice person and I
kind of let people run over me and I have a hard time being like
[saying], ‘No.”’
Tinay’s third sexual relation echoed a similar theme in that she became sexually active
despite her own urgency of not wanting to have sex.
“The other time was with this one guy. It really wasn’t the same situation,
but I didn’t want to do it to him either, and he just kept on saying the same
thing, ‘Come on, come on,’ and I said, ‘No,’ plenty of times.” I was like,
‘You know what? Forget it. Just go ahead.’ We did it and it was fine.”
Tinay’s emotional reaction of not wanting to subject herself to sexual activities was again
evident in her fourth sexual relationship where she described submitting herself to sexual
activities in the hope of physically protecting herself from a suitor’s intimidating conduct.
“I wasn’t as strong, kind of afraid because I know in one instance, the guy, he
was over, and he wanted to stay the night, and I was like, ‘Well, if I don’t do
that, I don’t want him to get all rowdy with me.’ I don’t know what he was

going to do. That’s why one of those incidences I was like alright, go
ahead.”

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Tinay’s most recent sexual activity included both her female friend and her friend’s
boyfriend. Though the following passage did not explicitly reveal her reservations, or
even a sense of urgency, to not engage in sexual behavior, it was implicitly alluded to:
Tinay: “It was me and another female and she was my friend and I don’t

want her to get upset with me and I don’t want to seem like I’m trying

to lead people on, so that’s why I kind of went on with it. It wasn’t for

that long.”
In four of Tinay’s five sex partners within a year’s time, her behaviors indicated
consenting to sexual acts, but were incongruent with her reservations and thoughts of not
wanting to have sex. Her sexual history indicated that she conceptualized sex as a means
to an end. Sex was a means in being accepted by her suitors or female peers and/or a
form of protection when perceiving her situation as being physically or psychologically
intimidating. Subjecting herself to sexual relations, despite her own thoughts and
feelings, largely stemmed from pervasive and maladaptive thought processes, which
included her fear of being judged as being a sexual tease, her self-perception of being
weak that allowed others “to run over me,” and a need to be accepted by others. Finally,
there is a clear disconnect between her sexual history and her personal values of
postponing sexual relations with those whom she is genuinely interested.

Moderate number of sex partners among Latina females. Goddess, who is 18

years old, and has been sexually involved with seven partners, believes that she has a
“sixth sense” that enables her to assess within five minutes the quality and nature of her
potential sex partner’s personality, interpersonal relationships with his friends, and with
Goddess, sense of mutual attraction, and availability in that he “doesn’t have a lot of

women around him.” Despite her belief in her ability to ascertain with brevity, and in

detail, his personality profile and his candidacy in becoming her sexual partner, she

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asserted that she would require a minimum of six months of courtship as a means of
“getting to know him” prior to engaging in sexual relations. Her sexual history reveals
that she lost her virginity at the age of 14 to her boyfriend, who at the time was 18 years
old, and asked her father permission to date her. She viewed him as being a “nice guy,”
and “the kind you take home to your parents.” She has had seven sexual partners, and
noted that a mutual attraction was present, which she stated was a requirement to have
sex. In regard to her most recent partner, she stated, “We just clicked.” However she
admitted that the courtship was only two months old before she engaged in sexual
relations with him. Being complimented and feeling validated, which has been described
as the Wooed-Ejfect, played a role in her decision-making process to engage in sexual
activities and is evident in her statement: “I drove him crazy,” and “He always thought
about me.”

Vixen is 21 years old, lost her virginity at the age of 15, has been sexually
involved with 10 partners, and stated, “I tend to fall for guys easily.” The criteria of
whether or not to engage in sexual relations with a potential partner included preferring
her partner to be approximately one to two years older than she is, being lured by the
Wood-Effect as she stated, “They make me feel special, that somebody wants you, that
they pay attention to you, and give lots of compliments,” and needing to feel comfortable,
while hoping to avoid feeling rejected, after their sexual tryst:

Vixen: “I want to feel more comfortable knowing that he’s not going to

just drop me after one night or that having sex with him is a good idea
or a bad idea in the long run.” “You are not just a number.”
Characteristics that she found unappealing included perceiving potential partners as either

“too clingy” or being “too physically aggressive.” Vixen reported feeling ready when she

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described her first sexual encounter with her then 17 year old boyfriend, as she stated, “I
was young, but still I thought I loved him.” Her other sexual experiences did not
necessarily involve being in a monogamous relationship. Instead, experiences typically
involved going on a couple of dates even meeting her sexual partners (i.e., three partners
to be exact) within a week’s time before engaging in sexual relations. She described
most of her sexual experiences as being “spur of the moment,” and was able to recall a
recent experience with a co-worker, whom she found attractive and went on a date. “Then
one thing led to another, and it just happened. I was a little shocked that I did that because
I don’t normally do that, but it was one of those spur of the moment things.” Vixen also
emphasized the importance of finding compatibility, yet reveals in two scenarios with
two different partners her apprehension to engage in sexual relations with them. With the
first partner, she admitted, “I don’t think I was too sure about it, but I really liked him,”
and they participated in sexual behaviors. With the second sex partner, a different reason
motivated her apprehension: “I didn’t want to ruin the friendship, but we ended up having
sex.”

Themes among moderate number of sex partners. Six complex themes were
extracted from the data among the moderate category. The first, and most pervasive
theme, is that six out of the eight respondents inadvertently exposed Inconsistencies
Between their Thoughts and their Behaviors, a similar theme among the low number of
sexual partners category. Angel, Tinay, and Vixen, for example, listed chemistry,
emotional comfort, trust, cute features, nice personality, being sexually stimulated, and
being complimented as their reasons to engage in sexual practices. However, their

actions uncovered a more centralized attitude from various forms of pressure that resulted

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in feeling fearfirl and apprehensive, and resulted in having sex. Angel, who was only 13
years old during her first sexual encounter, was coerced by her female friend to have sex,
despite her own fears and apprehension. Tinay’s sexual journey involved wanting to
avoid sexual encounters with four of the five sex partners, but various forms of pressure
by her female peers and male sex partners, as well as a fear of being perceived as a sexual
tease, contradicted her own feelings, and subsequently she engaged in unwelcome sexual
behaviors. Vixen also disclosed having strong reservations to engage in sex with two of
her sex partners, one of which involved fear of jeopardizing a friendship. The other three
participants also unmasked contradictions between their intentions and their behaviors.
Chi Chi inferred having felt a sense of fear in a sexual encounter where she perceived
him to be aggressive, but then quickly attempted to attribute it to having “sexual urges.”
In addition, despite her deep fears of having mistrust toward men, she still engaged in
sex. Ladybug claimed that her attitude toward sex had changed, and presently viewed
sex as a more lifetime emotional bond with her sex partner, and yet, her last three sexual
encounters with three different sex partners were motivated by her sexual cravings and
gaining a sense of validation from her partners. Finally, Goddess declared that six
months of courtship before engaging in sexual activities with a potential sex partner is a
requirement, yet she had sex with her most recent sex partner within two months of
meeting him. The Inconsistency Between their Thoughts and their Behaviors is not well
understood. It can only be surmised that the respondents lacked the awareness of their
own contradictions between their thoughts, attitudes, intentions, and their behaviors. The
explanation for such inconsistencies can be provided only by the respondents. The data

analysis did result in one clear observation: that the motivations, intentions, and

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behaviors among late-adolescent females are undoubtedly complex and contradictory. It
is no surprise that great difficulty exists in generating gender-appropriate, culturally-
sensitive, age-specific HIV/AIDS prevention that is geared toward this population who
are at high risk for HIV infection.

Another theme that was evident in at least four of the eight participants in this
moderate category is the interplay between being validated by their male sex partners,
known as the Wooed—Effect, and their sexual behaviors. The Wooed-Ejfect came in
several forms: being told compliments, being wanted when other female competition
sought his attention, gaining a sense of self-esteem knowing that she was able to drive
him “crazy,” and a general feeling of being wanted. Regardless of the variation of being
Wooed, the result was the same in that they eventually had sex with their male
counterparts, which is a more accurate explanation for their motivation to have sex.
Though Tinay did not directly mention that her motivation to have sex was based on
being Wooed, she did imply her need for validation and acceptance, which is a broader
concept of the Wooed-Effect.

Four of the eight participants plainly stated that Attraction, with a strong emphasis
on the physicality of the sex partner, was a motivating factor to engage in sex. Attraction
is an evolving concept, and can be conceptualized at multiple levels. It seems that the
participants in this age bracket placed a high premium on the physical form of attraction,
and perhaps, this is appropriate to their development. Two respondents, Spirit and Vixen,
mentioned that compatibility was of importance in order to become sexually active with a
person. Perhaps, then, compatibility is a form of attraction that incorporates more of the

character, values, and behaviors of a person, rather than just the physical aspect, to which

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they are drawn. Irrespective of the way Attraction is conceptualized, and whether it
includes the term compatibility, it was an apparent motivation for these participants to
engage in sex.

Four of the eight participants explained that many of their sexual encounters
occurred in the context of it “Just-Kind—of-Happened" phenomenon, where sexual
relations were not planned or intended. Ladybug and Vixen openly admitted that they
had not intended to have sex with many of their sexual partners, while Tinay’s sexual
history clearly showed that she had not planned, but was instead pressured, to have sex,
and Chi Chi explained that she was “just kicking it” with many of her sex partners and
then decided to have sex. Her narrative implied that she had not anticipated to have sex
at that time, but eventually did engage in sexual acts because of being “caught up in the
moment.”

While the theme, Sex as a Requirement, was mentioned with less frequency, it is
important that it gets discussed in greater detail. Angel and Ladybug both discussed that
they believed that sex was a requirement to sustain a monogamous relationship with their
boyfriends at that time. In fact, Ladybug described how her boyfriend made it abundantly
clear that he would have sex with other partners if she failed to comply with his request.
There is strong suspicion that many of the other participants, and late-adolescent females,
in general, may have fell victim to this threat of abandonment at one point in their sexual
history. This mindset that sex is a means to maintain a relationship with their partners is
a powerful motivation to have sex, despite these female adolescents’ own intentions and

wishes to abstain.

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The results from Josephine’s and Spirit’s narratives were coded the least because
they did not share similar themes as with the other six respondents in this moderate
category. Both Josephine and Spirit placed importance on establishing Trust before
engaging in sexual relations. Josephine explained that she had candid conversations
regarding each other’s sex history with her partner as a means to establish trust, whereas
Spirit waits for approximately three to four months and observed her sex partner’s
behaviors, and interpersonal interactions with his friends and with her as a way of
determining whether or not trust has been established. Spirit’s motivation to establish
trust is well-intended, but it’s not necessarily a complete safeguard to protect herself in
that she made no mention of having open discussions with her sex partners. Though their
responses were atypical, they were, nonetheless, helpful in revealing the stark contrast in
the factors that motivated them to have sex. The comparative analysis suggests that six
of the eight respondents focused on little to no communication when sexual encounters
were involved, and it was only one respondent, specifically Josephine, who resorted to
open dialogue about her and her partner’s sex history and sexual practices.

One major theme emerged from the low number of sex partners group, while six
themes emerged from the moderate number of sex partners category. The next
subsection will unveil themes from the participants, who have been identified as having
been sexually involved with more than 10 partners. Three African-American and two
Latina females have been categorized in the High Number of Sex Partners.

High number of sex partners among A frican-American females. Chocolate
Princess, who is 19 years old, and lost her virginity at the age of 14, has been sexually

active with 13 partners, three of whom were sexual encounters that occurred within five

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days of their initial meeting. Her first four sexual partners were considered to be her
“boyfriends” at the time, and she implied that they were in a mutually-exclusive
committed relationship. Attending her first year in college and being criticized on her
sexual performance by her ex-boyfiiend were the impetuses for her increasingly sexually
risque' behavior. She stated, “Once I got to school, freshman year, I just went buck wild.”
After the break up with her boyfriend, she engaged in anal sex with her next sexual
partner.
Chocolate Princess: “Maybe that has something to do with that because

this was just recently that I started just not being boring. I try different

stuff that I said I would never try before like anal sex.”
Chocolate Princess also candidly revealed her first sexual experience in her freshman
year in college stating, “He was just there. I was not attracted to him. I became a man.”
She achieved a sense of victory over her female peers who overtly rejected her on the
basis of her dark skin color by engaging in sexual relations. She emphasized that “all the
girls wanted him,” when describing her first sex partner at the age of 14. A few years
later, she also described her experience with a college-aged sex partner, stating with
confidence, “I knew he was attracted to me because I heard him tell somebody.” She
described her experience further by stating, “It’s already in the bag. And I felt proud
afterwards.” A similar pattern is evident in another sexual encounter as she explained:

Chocolate Princess: “This guy that would always come to my job, and

talk to me, and wink at me. I ended up having sex with him, and it

wasn’t a relationship or anything, but I knew him. Yeah, I think I saw

dollar signs, too and he showed me a lot of attention.”

Finally, she provided an excerpt of an impulsive sexual encounter with someone who she

met less than 48 hours earlier.

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Chocolate Princess: “The third guy, it was the first day I met him. He
was making sexual advances at me that first day, and I was just like
okay. But the second day, he came around, and he offered to give me
oral sex, and I was like okay. That’s how that happened. It led to the
rest of the sex, but I didn’t plan on having sex with him because at first
I didn’t even like him.”
The Wooed-Ejfect elicited feelings of validation, a sense of victory over her female
competition, and a need to rebel against her mother. In fact, the Wooed-Eflect took
precedence over being physically or personally attracted to a person when engaging in
sexual behaviors, as evident by this statement: “I knew that I could; I even had sex with
people who I wasn’t attracted to.”
Mary, who is 21 years old, a first-year graduate student in the Master of Social
Work, and is interning at a local nonprofit AIDS agency, has been sexually active with
approximately 30 partners. Mary’s explanation for engaging in sexual activity have
changed over time, and are demarcated into three time periods: high school,
undergraduate years, and post-graduation from college. She explained that because her
sexual relations in high school were in the context of a monogamous relationship, having
sex became the socially appropriate and conforming moray as she stated:
Mary: “It was the whole being young, and not too independent, and going
along with the whole thing of ‘I’m your girlfriend and you’re my
boyfriend.”’
Mary referred to herself during her undergraduate years as being sexually promiscuous
and attributed it to heavy alcohol consumption. Between the ages of 19 and 22, she
estimated being sexually involved with eight partners and stated, “I really wasn’t having

too much sex.” Her present views regarding her sexual behaviors are illustrated in the

following statement:

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Mary: “I got to be older. I’m a woman in charge of my own reproductive
health. I can do what I want to do.”

Mary’s criteria of when to engage in sexual relations are dependent on how she perceives
the degree to which her partner will commit. If she believes that there is no potential for
a long-term relationship, and yet is able to find him attractive, she will engage in sexual
activities “sooner rather than later”. On the contrary, if she believes there is a potential
for a long-term relationship with a partner, who is well-traveled and cultured, is
financially stable, lives independently, and is not socially inept, and if she is able to trust
and respect him, she will postpone engaging in sexual relations until a committed
relationship has been established. Her sexual history found that the average age of her
partners is approximately four to nine years older than she is, that she has participated in
a one-night sexual affair, and engaged in sexual relations with a person whom she met
just three days before. Mary also included a list of reasons why she would not become
sexually active, and they are as follows: (1) if they have too many mutual friends; (2) if
he attempts to have sex without the use of a condom; (3) if she is unable to find him
sexually attractive; and (4) if he evidences disrespect for others. In one example, she was
repulsed by her date who cursed at his mother in Mary’s presence.
Poet is 22 years old, and has been sexually involved with more than 50 partners.
Her sexual history dates back to her childhood when relatives sexually abused her.
Poet: “Not my parents, but by some relatives that were a couple of years

older than me. And when I went to counseling that when it happens to

you two things happen. Either that you get totally turned off or you

get totally turned out. And in my situation, I ended up getting turned

out and it’s just like I was a nympho. I couldn’t get enough of it. I

just thought somebody looked sexy and looked like they’d be good in
bed, give me a nice one.”

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Poet attributed losing her virginity at the age of 13 to her curiosity about sex. Her first
three sexual partners were neighbors: “One person lived around the comer from me, and
two people lived on my block.” Poet’s attitude and criteria to engage in sexual activity
between the ages of 15 and 20 can be characterized as being carefree and careless as
evident in the following statements: “I had relationships, but I wasn’t faithfirl to anybody
until I was about 21 .” At this time in her life she viewed sexual encounters as a means to
obtain personal power.
Poet: “And I liked to go after the guys who thought that they could have

any girl that they wanted, and they’d just be a statistic after I had be

done with them.”
She also stated, “Before I even knew their name that I was going to do them.” She even

exhibited perpetrator mentality during this phase in her life.

Poet: “It was hard for me to even find any more prey because everybody
knew my game, and I can’t find any more victims. Game over.”

She also admitted that if the potential partner had a “small penis” and a “bad physique”
she would not engage in sexual activity. Poet’s attitude, values, and beliefs changed over
time. Once she decided that the “game was over”, she decided to “just lay low.” Failed
friendships, because of her sexually promiscuous reputation, and being infected with
herpes by a partner who she thought she loved, were the impetuses of changing her
attitude which resulted in being empathic for her partners. Since being diagnosed with
herpes, she has “decided not to have sex with them until they know about my situation
and I let them know” about her STD status.

High number of sex partners among Latina female. Morning Star, who is 20
years old, and has been sexually active with 12 partners, seems sexually liberated, in that

she does not believe in waiting to have sex, especially when she knows that “I’m clean,”

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referring to her STD status. F urtherrnore, she does not believe that sex is a “monumental
thing.” Though she admitted that many of her sexual encounters involved alcohol
consumption, she asserted that she has been able to maintain personal control over her
actions, implying that every sexual relation was a conscious and mutual decision.
Morning Star exuded confidence when disclosing her ability to assess in detail a potential
sex partner’s character “within two hours,” in whether or not he is genuine, will treat her
well, and is not sexually promiscuous as evident in this statement: “Someone that I know
that doesn’t have sex with everyone on my dorm room floor.” Characteristics that she
finds unappealing and that help determine whether or not to have sex are if the partner
publicly announces their sexual affairs, if he is “racist,” and if he imposes his opinions
onto others.

Morning Star’s sexual history revealed that she lost her virginity at the age of 16
to a person who she met during a trip to South America, and who only spoke Spanish.
She stated that the language barrier elicited feelings of powerlessness, especially when he
requested to remove the condom, and prevented her from denying his request. Most of
her sexual encounters occurred in high school, and she stated that alcohol and a sense of
indifference were involved in her decision-making process to have sex. She believed that
coming from a small town precluded her from STD infection because the “gossip in the
small town” indirectly and naively gave her a sense of information about her sex partners.
Without further elaboration, she then discussed her most recent sex partner who she just
met at a holiday party. She explained that she thought he was “a really nice person,” that
he appeared genuine, that she was able to understand his worldview, and that they were

essentially “compatible.”

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O’Connor is 21 years old, and has been sexually involved with 23 partners. Her
sexual history dates back to the age of four when she was living in Mexico and was
repeatedly sexually violated by her nannies and by her cousin. Her childhood sexual
abuse impacted her outlook and perceptions on sex in that she has become both
desensitized to it and views it as a form of vindication.

O’Connor: “It was just taken from me when somebody wanted it, so now

when I want it, I get it.” In addition, “I don’t see sex as a very special

thing.”
She is not only aware of her rebellious nature, she also attributed her sexual promiscuity
to her history of sexual abuse, her father’s death when she was 14 years old, and her
mother’s religious fanaticism, which created an emotional distance: “My mom and my
brother weren’t really there for me. All I had was me, myself, and 1.” Her raging
hormones, a sexual tension between her and her potential sex partner, a possibility of a
commitment, even with a one-night stand, and a sense of responsibility not to reject men
sexually were her determining factors to engage in sexual relations.

O’Connor: “It’s almost like you’re partly responsible for getting him that

hot and heave and ready to go and it would be just almost rude to get

him to that point and then walk away. That’s something you’d do to

someone you’d hate, not to someone you might want to see again. I

mean not only are they going to experience a lot of physical pain with

all that pent up stuff going on down there, but no one likes to get

rejected so it would hurt in all kinds of ways.”
O’Connor’s sexual history revealed that she lost her virginity, in the context of mutual
consent, at the age of 14, and marijuana was involved. She felt trapped and helpless in

that “I didn’t want it, but I couldn’t get out of it at that point.” Her tendency to blame

herself for her first sexual encounter is apparent in the following passage:

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O’Connor: “At the time I didn’t. ..I just saw it as I let it get that far. I
couldn’t stop it now, so I just sat there, well laid there, and didn’t feel
much.”

A pattern of feeling helplessness and feeling responsible for her partner’s sexual urges

emerged with her other sexual encounters.

O’Connor: “I always start off with the decision that I’m not going to have
sex with him, and it just changed according to how the night goes.”

The night usually progresses to kissing, then petting, pants coming off, and saying to
herself, “Oh shit, we got to this point again and we can’t go back.” All but one sexual
encounter occurred within less than a week of their initial meeting, two of which were
one-night stands. Her most recent sexual partner has been the exception in that “He
waited for me to come to him.” She explained in detail how the relationship evolved, and
it essentially moved from being co-workers to “cuddle buddies” to being sexually
intimate within the context of being mutually-exclusive. Her sexual history and behavior
indicate an underlying sense of helplessness and a responsibility “to not reject them,”
which is contradictory to her initial assertions that sex is a form of retaliation and
personal power.

Themes among high number of sex partner. These young women’s thoughts and
outlook regarding the meanings associated with sex, as well as their recall on their sexual
history, are complex in nature, and at times, contradictory, thereby making it difficult to
delineate derived themes in succinct categories. Furthermore, there seems to be greater
similarities across the racial/ethnic groups, than within the groups.

An apparent theme across the five participants is that many, if not most, of their
sexual relations were in the context of Nonmonogamous Relationships, indicating that

they were not involved in a mutually-exclusive, committed, long-term relationship. All

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five females reported that they had experienced one-night stands and many of their sexual
encounters did not occur in either a monogamous or emotionally meaningful relationship.
Chocolate Princess described that once she realized that a potential sex partner found her
attractive, the possibility of having a sexual encounter was “in the bag.” Mary admitted
that most of her sex partners were during her undergraduate years in college, and did not
involve long-term commitments. Poet candidly stated that she had difficulty recruiting
more “prey” as potential sex partners. The majority of Morning Star’s sexual encounters
involved alcohol. O’Connor admitted that she had sex with most of her sex partners less
than a week of their first meeting. It is clear that a commonality among these five
participants is that most of their sexual relations occurred in Nonmonogamous
Relationships.

Traditionally, women have been covertly taught a ubiquitous societal message
that sexual intercourse is a form of emotional intimacy, whereby partners are able to
express their affection and love for one another. Some of the participants revealed that
they defined sex in terms of emotional and intimate connection with their sex partner. A
theme among these five women in this high category, however, is a shared sense of
Emotional Detachment and a Need for Retaliation are Mechanisms to Seek Personal
Power and Control. Chocolate Princess revealed that being rejected by her boyfriend
motivated her to engage in anal sex as a means to prove to her boyfriend that she was not
a “boring” sex partner, a behavior that she once found disgusting and immoral. She also
seemed to use sex as a form of personal victory when she perceived her female peers as
no longer being a threat. Mary described a “summer fling” which “served a purpose.”

Poet also used sex as a form of power and vindication over her sex partners, where she

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actively sought men who she perceived as being desensitized to sex. O’Connor echoed a
similar sentiment of vindication, stating that she has sex whenever it suits her because “it
was just taken from me when somebody wanted it.” Emotional Detachment and a Need
for Retaliation are Mechanisms to Seek Personal Power and Control theme is comprised
of having a sense of indifference, as it was echoed by Morning Star, that “sex is not a
monumental thing,” and experiencing a forrrr of personal power and vengeance over male
sex partners and female peers who were seen as competition.

All five participants exhibited, in one form or another, a desensitized attitude
toward sex either by engaging in one-night stands or deriving a feeling of personal power
and vengeance toward their sex partners. These participants made their air of
indifference towards sex explicitly known as their explanation for what motivated them
to engage in sexual relations, even against their own wishes, against their lack of
attraction for their sex partners, and against their lack of better judgment because
chemically altering substances, including alcohol, diminished their cognitive capacity.
Ironically, underlying this public display of emotional detachment toward sex and their
sex partners is a deep-seeded Need for Validation andAcceptance. This Need for
Validation and Acceptance was more or less implicit in their responses, but nonetheless,
clearly evident as their primary motivation to engage in sex. For example, Chocolate
Princess was seeking validation that she was not a “boring” sex partner as her first sex
partner asserted, that she was accepted by her male sex partners, even when her female
peers rejected her, and that she felt externally validated by engaging in sexual relations,
even when she was not attracted to her sex partners. Her sexual habits were largely

motivated by external forces (e.g., ex-boyfriends, parents, female peers) in the hope of

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proving to them that she is of equal importance and that she is worthy of being wanted.
Morning Star made it a point to state that sex was not a “monumental thing,” yet in the
same breath she unwittingly revealed that she did not want her sex partners to view “her”
as a mere number, or sex with her as a “random act.” Implicit in her assertion is her need
to feel important even though she, herself, exhibited a form of indifference towards sex.
In the case of O’Connor, she admitted that most of her sexual relations occurred against
her own intentions of not wanting to have sex, and yet what motivated her to subject
herself to quick sex practices is a sense of responsibility not to reject her male sex
partners. She stated, “no one likes to get rejected.” Though that comment was intended
for her male sex partners, perhaps it was ultimately directed toward herself in that she did
not want to feel rejected, and that she used sex as a form of acceptance and validation.
Mary also exhibited a need for validation and acceptance by her peers, especially when
she was in high school, as she stated that having sex with your boyfriend was the thing to
do. Though she did not elaborate on her sexual experiences during her undergraduate
years in college, there is a strong suspicion that her need to be validated and accepted was
present. She, after all, has been sexually active with more than 30 partners, and she is
only 21 years old. The detachment toward sex was exhibited by all five participants, and
seemed to act as a form of a defense mechanism to protect their underlying need to be
validated, accepted, and wanted, which was equally evident among these participants.
Themes were derived from the participants’ thoughts and attitudes, as well as
their own past and present sexual behaviors. The following subsections will explore their
perceptions on Safe Sex, and is outlined by a racial/ethnic group in determining the

presence of cultural differences.

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Definition of Safe Sex
African-American females. Table 6 summarizes the number of sex partners
condoms were employed in various sexual acts among the African-American
participants. All 10 Afiican-American participants reported the use of condoms when
asked to conceptualize safe sex, while three participants also referred to the use of birth
control as a form of protection. Other forms of safe sex mentioned were knowing their
partner’s sexual history, being educated about the transmission of sexually transmitted
diseases as well as knowing the types of “products,” on the market, and getting tested.
Mary, who is a graduate student in the Master's of Social Work Degree Program,
provided several examples of “safer sex”: “Safer sex, to me, is like using condoms, not
sleeping around with too many different people, knowing your partner’s sexual history.”
Ironically, Mary’s own sexual history showed that she had been sexually active
with approximately 30 partners, five of whom she admitted failing to use a condom.
Given her HIV/AIDS knowledge because of her work at a local nonprofit AIDS agency,
she has been made aware of the fact that it takes only one incident to be infected, and yet
she exposed her own fallacy by stating, “Not sleeping around with too many different
people,” is a form of “safer sex.” Josephine offered, but equally gave, an unsettling
response when she was asked how she protects herself when engaging in cunnilingus?
Josephine: “The infamous question to his is always, ‘Did you just wash?’
He and I have not used a condom with oral sex so other than making
sure, at least, because there is a trust level there, of monogamous that
definitely just making sure that we’ve been properly washed and
cleaned beforehand.”

Her need to attain a certain degree of hygiene is not being called into question, but the

assumption that being “clean” through the soap and water, alone, will protect her from a

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STD is troubling because she is not the only person to share similar views, which may
account for lack of condom use when practicing oral sex.

Table 6

Condom Use by A frican-A mericans Females

 

Participants Total it Total n of Frequency Frequency of Frequency of

 

of Sex Sex of Condoms Condoms Condoms Employed
Partners Partners Employed Employed (Anal Sex)
Condoms (Fellatio in (Cunnilingus
NOT the past 12 in the past 12
Employed months) months)
Ladybug 6 2 Consistently Consistently N/A
used Used condom
condoms
Tinay 5 l 0 0 N/A
Josephine 5 l 0 0 Consistently Used
Condoms
Mary 30 5 0 0 Used Condom with
1" Sex Partner
Did Not Use
condom with 2'”d
Sex Partner
Chi Chi 8 l 1 time and 0 N/A
used
condom
Spirit - 2 0 0 Anal sex on one
occasion and used
condom
Chocolate 13 5 0 0 Anal sex on one
Princess occasion and did
NOT use condom
Osa l 1 0 0 N/A
Angel 7 2 0 0 Anal sex on one

occasion and did
NOT use condom
Poet > 50 4 Anal sex on one
occasion and used
condom

 

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Latina females. Table 7 summarizes the number of sexual partners condoms were

employed in various sexual behaviors among the Latina participants. The most common

response, which was mentioned by all nine respondents in defining the term safe sex is

the use of condoms, while five of them also included the use of birth control.

Table 7

Condom Use by Latina Females

 

 

Participants Total it Total n of Frequency Frequency Frequency of Condoms
of Sex Sex of of Condoms Employed (Anal Sex)
Partners Partners Condoms Employed
Condoms Employed (Cunnilingus
NOT (Fellatio in in the past
Employed the past 12 12 months)
months)
Leslie 1 l - - N/A
Sam 1 1 0 0 N/A
O’Connor 23 2/3 of the 0 0 l
23 SP
Morning 12 1 0 0 N/A
Star
Goddess 7 1 0 0 N/A
Vixen 10 7 0 0 Engaged in anal sex on
3 different occasions
with 3 different sex
partners and did not use
condoms in each of
those times
Princess 3 1 N/A 0 N/A
La 4 3 1 0 Engaged in anal sex on
Chingona 2 occasions with same
sex partner and did not
use condoms on either
time
Butterfly 2 l 0 0 DK

 

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Goddess, Princess, and Vixen believed that knowing the partner ’3 sexual history was also
a form of safe sex. Vixen, for example, stated: “Knowing who your partner is and
knowing who they’ve been with. Just kind of making sure that you are ready for that and
that you are protected.”
La Chingona and O’Connor believed that being tested in the early stages of a
relationship gives them a sense of protection against being infected.
La Chingona: “I guess now my thing is, ‘Okay, I’m going to use condoms
at the beginning, but try to go get tested right away because I’m not
really into using condoms.’ So, as long as you get tested, it would be
okay?’
An underlying assumption in La Chingona’s statement is that neither partner in the
relationship would place himself or herself at risk for infection, whether it is through
sexual contact or use of contaminated IV needles, throughout the duration of the
relationship. She has been sexually active with four partners, but admitted to using
condoms with only one of them. O’Connor offered a more complex response but it still
was wrought with misleading assumptions.
O’Connor: “If you’ve both been tested, and you know that you are both
all well and good, and you are in a committed relationship with that
person and you don’t plan on sleeping with anybody during that
relationship either than the two of you.”
O’Connor’s comment incorporated more conditional statements, such as neither partner
would engage in extracurricular sexual activities with other sex partners, which thereby
seemed more intrinsic in believing that she is safeguarded from a STD. O’Connor’s own
sex history ironically revealed that most of her sex partners were not in a serious,

monogamous, committed, mutually-exclusive relationship. In fact, of the 23 partners

with whom she has been sexually active, she admitted to failing in employing the use of

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condoms with approximately two-thirds of her partners. The concern, and the general
point, is that her well-intended thoughts regarding safe sex did not translate into practice,
which consequently placed her in grave risk of HIV infection.

African-American and Latina females. When asked to define safe sex, all 19
participants cited condoms as a mode of safe sex. However, only 30% of the African-
American females compared to 55% of the Latina females mentioned birth control as a
type of safe sex, while there was equal mention (n = 3) from both racial/ethnic groups
indicating that knowing their partner '5 sex history is another form of safe sex.
Interestingly, only one participant from each racial/ethnic group discussed abstinence as a
means of safe sex. The responses that were named with less frequency can be captured
under a broader theme: Myths in Practicing Safe Sex. These college-educated female
participants disclosed with candidness their fallacy regarding safe sex, including having
“fewer” sex partners, implementing hygienic measures when engaging in oral sex,
avoiding the “swallow” method when engaging in fellatio, practicing the “withdrawal”
method when engaging in penile-vaginal intercourse, and getting tested. “Politically
correct,” thoughtful responses were verbalized, but not necessarily translated into action
as evidenced by few of the participants. This section examined their level of
understanding of safe sex from a conceptual point of view. The next subsection, which
captures the essence of the study, explores their rationale and behaviors, as well as the
type of circumstances in which condoms were not employed during sexual activity.

Motivational Factors Not to
Employ Condoms

African-Americans females. All 10 African-American participants explained that

being in a Serious, Monogamous, Committed, Mutually-Exclusive Relationship was their

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primary rationale for not consistently employing condoms during their sexual encounters.
Tinay, Ladybug, Josephine, Osa, Angel, and Poet may not have verbalized that being in a
committed relationship was the reason for not using condoms, but their actions clearly
indicated it. The times that they did not use a condom was because it was with their
“boyfriend,” a term that strongly implied that the relationships comprised of
commitment, exclusivity, and trust. Mary verbalized that being in an exclusive
relationship was her reason for not using a condom.

Mary: “I don’t use condoms when I’m in love. I mean like deep, deep
love and I feel very exclusive”

Spirit talked about the steps that included communicating about one another’s sex
history and STD status, getting tested, and having a “general level of trust,” in which she
determined the seriousness of the relationship and when not to use a condom. She has
been sexually active with five partners, but did not use condoms with two of them. Chi
Chi asserted that marriage was the only context in which condoms do not need to be
employed, as she stated, “I use condoms. I don’t believe in having sex without using
condoms if you are not married.” Her behavior clearly contradicted her thoughts in that
she has been guilty of not using a condom with one of her sex partners with whom she
engaged in sexual activity in less than three months of their initial meeting. Five of the
respondents indicated that being caught up in the Spur of the Moment was another
explanation for failing to use condoms when engaging in sexual activity, specifically in
penile-vaginal penetration. Osa’s comments highlighted the essence of all five
respondents:

Osa: “I think it’s more like I’m ready and/or I’m caught up in the

emotion, and everything and there isn’t, there is no condom around so
instead of just letting all of the sexual tension die, I’ll just give in.”

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These five respondents were direct when talking about being a culprit in not using a
condom and some, particularly Mary, attempted to explain their guilt and hypocrisy.
Mary: “I shouldn’t have done it because after, I mean you can’t not really

be a sane person and have unprotected sex and then work in a AIDS

service organization because you just feel so paranoid and so how can

I say it, ‘Stupid,’ because I got, especially me, because I keep condoms

in my candy dish for my friends, for everybody that comes to my

house. But I have an ample supply of condoms so that’s why I

sometimes, I do let myself get caught up in the moment even me.”
Ladybug, Josephine, and Osa also believed that Getting Tested for HIV is their green

light to permit themselves to use condoms.

Ladybug: “Being tested with current boyfriend. I haven’t used them
[condoms] because I’ve been trusting my birth control.”

Being in a Monogamous, Mutually-Exclusive Relationship, being caught up in the
Spur of the Moment, and Getting Tested are the most common responses given by the
African-American female participants as to why they fail to employ condom usage during
sexual activities.

Latina females. Being in a Monogamous, Mutually-Exclusive Relationship, and
being caught up in the Spur of the Moment were of equal mention by four of the nine
Latina participants as their explanations for not using condoms. Among the Latina
females who attributed lack of condom use to being in a committed relationship, some
also discussed that they would employ condoms in the beginning of their sexual
encounters, but over time, resorted to other methods. For instance, Vixen’s comment
speaks to engaging in risky sexual behaviors.

Vixen: “I was in a serious relationship for four years; and at first, for the

first three months from when we started having sex, we used condoms
and then after that we didn’t, and I wasn’t on anything and neither was

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he. I just kind of went with it, withdrawal from him and if there was
an accident, I would go to a clinic and get the plan B, the morning
after pill.”
These participants were also frank when admitting that they were caught up in the Spur of

the Moment as seen in the following passage:

La Chingona: “In the heat of the moment you just don’t care. You’re just
like, “Okay, who cares, we don’t need a condom.”’

Condom Availability and A dversity to Condom Usage were of equal mention by
three of the nine Latina respondents. The following two passages revealed the thought
processes underlying their adversity to the use of condoms.

Leslie: “1 don’t think is normal to have rubber going inside of you.”

O’Connor: “Well in the case with my boyfriend he can’t wear them. He

goes limp every time he puts one on. It might very well be a very

psychological thing but it still happens. So, it’s easier no condoms or

no sex.”
This theme seems to be unique to the Latina group, as it was not mentioned by the
Afiican-American participants. Overall, this subsection examined the motivation for
failing to use and for employing condoms. The next subsection looks at the themes
derived from communication patterns with sex partners that specifically focused on the
topic of HIV/AIDS.
Communication Patterns with Sex Partners

The majority of sexual encounters occurs between two consenting participants
where the negotiation of when, where, and how the sex encounters are to transpire
materialize from direct and indirect communication, as well as through verbal and

nonverbal cues. The concern is the kinds of conversation that takes place, and the way

they are discussed with respect to the topic of HIV/AIDS. When the respondents were

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asked how they talk to their sexual partners about HIV/AIDS, four themes emerged:
Getting Tested, Newly Acquired Information about HIV/AIDS, Cheating, and Condom
Availability.

Five of the ten African-American females and four of the nine Latina females
reported that Getting Tested prompted them to address HIV/AIDS. Chocolate Princess,
for example, discussed HIV/AIDS with partners with who she had unprotected sex,
which should have been with five of the thirteen partners. When reading the following
excerpts, there are several erroneous assumptions underlying their responses.

Angel: “I generally ask if they have been tested. Majority of the time the

answer is ‘No,’ unfortunately. [Investigator: “That they have not been
tested.”] “Yeah. And it’s usually during a conversation about sex. I
wouldn’t just bring it up out of the blue.”

O’Connor: “I asked if they have been tested, but I don’t specify, 1 just say
tested. And it’s almost assumed. I would say, it’s assumed that it’s
everything, all STD’s and HIV.”

Goddess: “I get a yearly and that’s it. That’s the best I can do. They’re
okay. I’ve had a lot of surgeries in the past couple years so if I had it,
it would’ve shown up by now, and they would have notified me.”

La Chingona: “When we were playing that truth or dare, it was not until
after I got tested that I decided not to tell him, to keep it to myself [that
she was tested positive for an STD]. Anyways I told my roommate.

‘lt’s none of his business anyways.’ It’s not like I’m going to give it to

him. I’m gonna cure it, make sure that I’m fine, use condoms until

everything’s fine.”
The discussion of HIV/AIDS takes place in a variety of contexts, but the most prominent
context—or theme—is Getting Tested. There are several assumptions operating under
this theme, one of which is the act of getting tested. The mere behavior of obtaining a

STD test presupposes a form of safety measure that neither partner will be susceptible to

being HIV-infected after receiving their supposedly negative HIV results. This is simply

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untrue in that transmission of HIV, or any other STD, is possible whenever condoms are
not employed because of the possibility that either partner may be engaging in at-risk
behaviors (e.g., engaging in sexual encounters with another partner, or using
contaminated intravenous needles) that put him or her at the risk to be infected with a
STD. Another erroneous thought is that “getting tested” or getting “annual check ups” or
simply getting blood drawn because of other related medical concerns assumes that
antibody HIV ELISA test is included. However, a typical “annual check up” includes a
breast exam, a pelvic exam, and a Pap Smear test to rule out cervical cancer, gonorrhea,
chlamydia, and human papillomavirus (HPV), but it does not include testing for
treponema pallidum that causes syphilis, herpes simplex virus that causes herpes
genitalis, HIV, and hepatitis B and C. Goddess is under the assumption that she is HIV-
negative because of her medical check-ups, but she, in fact, is ignorant of her HIV-status.
A third, yet subtler, assumption is that even when STD tests have been sought, and then
briefly discussed with their partners, talking about the actual, or being truthful in
disclosing, results of the tests seems to be a separate social construct that is invisible to
the sex partner. In essence, HIV/AIDS is not necessarily addressed directly, but it is
implied when Getting Tested is mentioned. However, the act or the discussion of Getting
Tested, as in the cases of many of the participants, is wrought with erroneous assumptions
that have led them to believe that they are safe from infection, that annual gynecological
check-ups include all STD tests, including HIV, and that the truth of the results would be
disclosed.

Another motivating context—Newly Acquired Information about HIV/AIDS —is

used to springboard discussions for four of the ten African-American females with their

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sex partners. Josephine provided an example in how she initiated the topic on HIV/AIDS
when learning about the epidemiology of HPV on campus:

Josephine: “We’ve only talked, briefly, a few times about it [HIV/AIDS].

Just when I get some new information, or I’ve seen some numbers you

know. ‘My goodness, did you know it was going on like this?’ Or

just this morning I was telling him as far as on this campus is

concerned, one in four women are infected with HPV, and he’s going,

‘What?’ I said, ‘Yeah, that would mean that if you line us up and you

pull three out, out of every other one, you’re gonna have that one that

is infected.”’
All four participants acquired information on HIV through sex education course/pamphlet
or media, such as the Montel Williams Show, that motivated them to increase their
communication skills with their sex partners. Interestingly, no Latina females mentioned
the use of media as a catalyst to discuss HIV/AIDS.

Another context, though it was mentioned with less frequency, specifically by one
African-American female and two Latina females, is Cheating. Leslie, for example, is in
a serious, and presumably monogamous, heterosexual relationship. She asked her partner
to inform her if and when he “cheated” on her so that she is able to make the decision to
leave and essentially protect herself.

Leslie: “1 tell him, ‘Every time you feel like having sex with someone

other than me, not just think about yourself, think about you gonna
have sex with that person and then you gonna come back and have sex
with me.’ And if that person is infected that he is going to infect her
too.”
Most disconcerting, however, is Vixen’s experience with a former sex partner who
admitted to “cheating” on her on two different occasions.

Vixen: “I found out that the guy that I was talking to had slept with

somebody else. I was hurt, really shocked. He had told me, ‘Yes, I
used a condom.’ I said, ‘Oh, did it happen only once?’ ‘No, it

happened twice.’ ‘Did you use it both times?’ ‘Yes,’ because I guess
he knew the girl, but really didn’t know her. I kind of got scared, but I

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was happy in a way that he had the decency to actually use a condom

because he had been with me and he didn’t, we never used to, but that

didn’t last very much longer just because it was on my mind.”
Vixen’s cognitions are deeply flawed. The first, and most obvious, is that she assumed
her former sex partner disclosed the truth regarding the use of condoms on those “two”
occasions. There is a possibility that he may have been dishonest in regard to using
condoms, given that he did “cheat” on her. The other supposition is that her partner had
used a condom at the immediate onset of engaging in all sexual activities. Condom use,
however, is rarely considered when engaging in oral sex, and yet were condoms used at
this time? Condoms are employed at various stages of sexual intercourse, and during
different kinds of sexual acts. For example, the male partner may penetrate his partner
without the condom at the onset of vaginal intercourse, but then decides to put one on
during mid-session, or he may use a condom for vaginal intercourse or anal sex, but not
one for oral sex. It seemed that this level of detail regarding his sexual encounters was
not revealed to her.

Another context for discussing HIV/AIDS is condom availability, or the decision
to use condoms when engaging in sexual activity. One participant from each
racial/ethnic group mentioned Condoms, which seemed to replace the actual discussion of
HIV/AIDS. For Spirit, the topic of condoms is addressed with each sex partner, and
usually when engaged in sexual “foreplay.” O’Connor admitted in failing to
communicate safer sex practices with most of her sex partners, but reported that she has
taken the initiative with “the last few ones,” and the ones with whom she had unprotected

sex.

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O’Connor: “If you don’t have any condoms, then you just have to make
sure to the best of your abilities that you’re not getting yourself into a
sticky situation, and hope that they are telling you the truth.”
The excerpt also exposed a subtle, yet important, gap in her thought processes in that she
inquired the timing of their most recent test, but did not ask the type or the result of the
test.

The four themes/contexts that motivated many of the participants to discuss
HIV/AIDS include Getting Tested, Newly Acquired Information about HIV/AIDS,
Cheating, and Condom Availability. More interesting is the reasons for failing to have
frank and open talks about HIV/AIDS with their sex partners. Though no clearly defined
themes emerged by the majority of the participants’ responses, several reasons have been
provided by a myriad of the female participants. Both sex partners were either wearing a
condom or were virgins, according to Josephine, Sam, and Goddess, were reasons not to
engage in talks about HIV/AIDS. Ladybug felt invincible from a STD because of being
with one partner as she stated, “I guess it was when I started having sex. It wasn’t like I
only did it one time so it’s not going to happen like that.” Mary and Morning Star
explained that the context of their sexual encounters, specifically not being in a
committed, long-term, mutually-exclusive relationship, did not lend itself to discuss a
“heavy topic” like HIV/AIDS. The following passage is from Morning Star:

Morning Star: “With one-night stands type of people, I don’t really sit

down and talk to them about that type of subject. I probably should,
but I don’t. And with my long-term boyfriends, the topic of actual
HIV and AIDS that explicit topic, I don’t think I’d bring up. I do
really bring up the subject of ‘Have you ever been tested?’ and
additional questions about sex partner’s sex history.”

La Chingona’s comment regarding the approach in which her sex partner talks about

HIV/AIDS speaks to the difficulty in addressing a seemingly vulnerable topic, as she

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stated, “Even if a guy just asked me like that, I would be insulted like damn you know.”
Yet, for Butterfly she did not address HIV/AIDS or safe sex with partners who she has
been in a long-term, committed relationship because of being under the assumption that
marriage will ensue. Leslie asserted that talks about safe sex and HIV/AIDS occurred
more frequently at the onset of the relationship. O’Connor admitted that fear and being
na'r've attributed to her failure to have open discussions about HIV/AIDS with her sex
partners:

The second portion of the communication patterns with sex partners focused on
eliciting their thoughts in ways to increase more open dialogue about practicing safer sex.
The data analysis revealed that no distinct patterns emerged that were unique to the
respective racial/ethnic group. The most prominent theme, reverberated by three
African-American and two Latina females, was to generate Forums that are Dialogue-
Oriented, Personal, and Candid, compared to existing sex education classes. O’Connor,
for example, emphasized the importance that guest lectures, who have been diagnosed
with HIV and are living with AIDS, share their experiences, while the audience members
have the opportunity, in turn, to ask sensitive, yet relevant, questions regarding
HIV/AIDS.

O’Connor: “What worked best for me, and what got me to start talking

about it, was hearing that one, the AIDS, 1 want to say victim, but the
AIDS victim who told us his story about how he was the homecoming
king, he was the captain of the football team, he had the best grades,
he never told us how he got it, but he did mention that he got sent to
college, got into a fraternity, got heavy into drugs and alcohol, so I’m
guessing it might have been through sharing needles, but I’m not
entirely sure. Either way, it didn’t matter because the point is that he
did something, he covered the different bases of sex and drugs, so any

of those things could have been it. I mean, he’s not entirely sure,
himself, how he got it.”

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The Personal component infers increased relevancy to the population that the messages
are being targeted. Chocolate Princess, for example, reported increasing her HIV
awareness when watching a Public Broadcasting Services special television programs
that showcased an African-American young female who was HIV-positive and
transmitted the virus to her child. Teenage pregnancy is a topic with which she was able
to identify, given her own family history, where many of the young female family
members (i.e., cousins) became pregnant at a young age. Being Candid in the type of and
delivery of information seemed to be a motivational factor for these participants to
increase their communication skills with their sex partners. Osa reported that “in your
face” type of conversations that are considered taboo in public school settings, but were
addressed in her sorority, increased her awareness in sex, sexual identity, and
transmission of STDs, including HIV/AIDS.

Osa: “My sorority did a safe sex thing this past week, and where I

learned a lot of things they don’t teach you in a health type class. I
think just that type of conversations with people with make me have
conversations with my boyfriend about safer sex.”

Another theme that was represented by one Latina and two African-American
females was to Feel Comfortable and Safe when talking about HIV/AIDS with their sex
partners. Vixen, Angel, and Chocolate Princess emphasized the importance that they, or
women in general, need not to be afraid, but to feel comfortable discussing this subject.
This captured the essence of why young females are unable to discuss sensitive,
emotionally-charged, psychologically-fearful topics with their sex partners. Fear,
associated with the cognitions, needs to be researched further.

By the same token, Spirit, Tinay, and Poet, all of whom are African-American

college students, asserted that a Scare Tactic is needed for them to increase their

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communication with their sex partners. Poet admitted that at one time in her life she felt
invincible until being diagnosed with a STD, which forced her to examine her attitude,
thoughts, and behaviors regarding her sex practices, and essentially living with the
consequences of a STD. Though Tinay and Spirit have not experienced a “scare” in their
own lives, and concern with their mortality, they asserted that it is the motivational factor
needed to address HIV/AIDS within themselves and with their sex partners.

Tinay: “Probably if one of us caught something. That would be the

thing.” [Investigator: “Something that drastic has to happen though?
Do you think there could be other measures that could help or no?”]
“Well, for me to seriously talk to somebody about that, probably so,
not me or him have to get it, maybe a friend caught something.”

There were several other suggestions, usually offered by no more than two
participants for each suggestion, but it seemed that listing them as a Miscellaneous
category was worth mentioning. Getting tested as a couple, being in a committed, long-
terrn relationship, having the male sex partner take the initiative to discuss HIV/AIDS,
and becoming more future-oriented about one’s career and health are other reasons listed
by these female late-adolescent females as to the ways and reasons to increase
communication with their sex partners. The next major section shifts focus from sex,
safe sex, and communication patterns with partners, to their perceptions on HIV/AIDS
messages, and suggestions to increase more effective HIV/AIDS prevention campaign
and awareness.

Effectiveness of Past and Present HI V/AIDS Messages
This final section is divided into three subsections: Types of Past HIV/AIDS

Messages, Types of Present HIV/AIDS Messages, and Suggestions to Increase Consistent

Condom Use and HIV Awareness. Each of the subsections is further delineated by

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racial/ethnic group and by topics. The first subsection looks at the types of HIV/AIDS
messages that these participants heard while growing up. Next, a comparison is made
between the responses of the African-American and Latina females as well as an
examination of the effectiveness of past HIV/AIDS messages in these populations. The
second subsection follows a similar format, but instead focuses on present HIV/AIDS
messages. The third subsection focuses in extracting innovative ideas in increasing
consistent condom use and HIV-awareness.
Types of Past HIV/AIDS Messages
A frican-American females. In this subsection, themes were derived to determine
the types and degree of effectiveness of past HIV/AIDS messages among the African-
American and Latina participants. Among the African-American females, the most
common HIV/AIDS message, which was cited by six of the ten participants, was to
employ consistent Condom Use. Five identified the use of Fear Tactics, which elicited a
sense that HIV is a “death sentence,” as another HIV/AIDS message primarily heard
during their upbringing. Spirit’s excerpt captured the essence of this theme:
Spirit: “1 think more growing up, it was just kind of fearful. Like, people
are going to die, and that’s where my whole notion of like, ‘Ok,
somebody’s gonna get AIDS. They’re gonna die. Everybody’s gonna
get AIDS. We’re all gonna die.”’
HIV is either a gay-disease or that IV drug use as a method of infection (a.k. a. Familiar
Past Messages) is another theme, and was mentioned by five African-American females.
Mary’s quote was a snapshot of this theme:
Mary: “HIV was a White man’s gay disease. Back then, it would be so
medical, like you got a doctor with a white coat, and he’s all old and
stuff and talking about HIV and then IV drug users. I mean, growing

up in the suburbs, that is so far from what I even ever. . .that was like
so not me.”

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Four Afiican-American females reported that Everybody is At-Risk of Infection as
another HIV/AIDS message. Spirit’s comments indicated that she had come to
the realization that HIV does not discriminate.

Spirit: “You can die from it. It doesn’t matter age, race. It doesn’t have a
face or anything on it. Anybody can be affected from it, and that’s
why it’s very powerful.”

Latina females. Themes, Familiar Past Messages and Condom Use, were
discussed by these participants and were also mentioned by the Latina females.
Five of the nine Latina females identified Using Condoms as a HIV/AIDS
message they had heard during their childhood. Morning Star’s comments
summarized using condoms theme with succinctness as she stated, “If you are
going to have sex, wear a condom.” The Familiar Past Messages theme
emphasized “dirty IV needles” as a mode of transmission or that HIV is a gay
disease was cited by four of the nine Latina participants. O’Connor’s comment
best captured this theme:

O’Connor: “Just the sayings: wear condoms, AIDS is bad, that it’s
mainly for problems for homosexuals and drug users more often than
not. It’s referred to for homosexuals and drug users.”

Another important theme that emerged, though with less frequency by
three of the Latina females, was that being sexually involved with Multiple
Partners increased their chances of being HIV-infected. Interestingly, this theme
was not echoed by the African-American respondents.

A frican-A merican and Latina females. When comparing the themes

across racial/ethnic groups, the most prevalent theme was Condom Use, which

was mentioned by a total of 11 of the 19 participants. Five African-American and

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four-Latina females recalled Familiar Past Messages, with an emphasis that HIV
is a “gay disease,” and/or that HIV is associated with “drug users,” as the second
most common theme. Between-group differences were more apparent than the
Fear Tactic theme, which elicits a sense of ominous doom of being a life-long
sentence that HIV ultimately leads to death. This theme was discussed by five
African—American females, yet only by one Latina participant. Interestingly,
three Latina females reported having heard the message that having Multiple
Partners increased their risk of HIV infection and four African-American females
discussed that Everybody is At-Risk of an HIV Infection. However any mention of
these themes was curiously absent fi’om other members of their respective
racial/ethnic groups. One Latina and two African-American females remembered
Abstinence as being an HIV/AIDS message they recalled during their childhood.
Another Latina and two African-American participants reported that Pregnancy
was more of a salient concern, rather than being worried about becoming infected
with a STD.

Effectiveness of past HI V/AIDS message. Table 8 summarizes the number of
respondents reporting the effectiveness of past HIV/AIDS messages by quality and by
three categorical responses and by race/ethnicity. With regard to the efficaciousness of
past HIV/AIDS messages, six of the ten African-American females and four of the nine
Latina female respondents reported that they found the messages to be effective, while

three Latina females stated that they were ineffective.

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Table 8

E jfectiveness of Past H1 V/AIDS Messages

 

 

Effective Past Ineffective Past Mixed Reaction to the
HIV/AIDS HIV/AIDS Effectiveness of Past
Messages Messages HIV/AIDS Messages

African-

American 6 0 4

Females

Latina Females 4 3 2

 

The following example by O’Connor offered illustration:

O’Connor: “Not very because I wasn’t homosexual and it was mostly
geared to homosexual men so it didn’t really apply to me.”

Goddess’s own sexual history revealed that she has been sexually active with seven
partners, one of whom she reported not using a condom with. O’Connor’s statement
revealed an important truth about the ineffectiveness of past messages, in that they were
not geared toward populations other than the “White Gay Man.” Vixen’s response
appeared to encapsulate a cognitive-oriented defense mechanism of having a sense of
invincibility, a common characteristic to this age range’s psysocialsexual development.
Two Latina and four African-American participants provided more complex
responses regarding the effectiveness of past HIV/AIDS messages. Chocolate Princess
reported that her filth grade sex education class placed more emphasis on topics such as
reproductive health matters and were consequently less effective than vicarious “learning
moments”, such as when her cousins and best friend were impregnated before they
graduated from high school. Real-life circumstances of close people increased her
awareness of at-risk sexual behaviors. Ladybug believed that the fear tactics of past

HIV/AIDS message were effective for young children until they reached puberty became

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“curious” and developed an “everyone is doing it” attitude. According to Ladybug, at
this stage of development, specifically at puberty, HIV/AIDS messages need to focus
more on age-appropriate subject matters. Osa spoke about her experience of what felt
like being the “only virgin,” especially when being a freshman in a university setting.
She stated the messages were effective as she remained “abstinent for a long time,” but
became less effective as she aged and her female cohorts became increasingly more
sexually experienced. Mary reported that she was uncertain as to the effectiveness of
past HIV/AIDS messages. She attributed practicing safe sex (i.e., use of condoms) to the
fear of pregnancy. As she stated, “I knew that I didn’t want to have a baby.” La
Chingona believed that past HIV/AIDS messages were helpfirl in her own life, as she
tended to employ condoms with “one-night stands,” but found them to be less so with
respect to long-term relationships and stated:
La Chingona: “When it comes to long-term relationships, like when you

get into a real relationship, like the stuff I’ve heard, I don’t feel like

that’s been very helpful, because I mean once I get to a point where I

feel comfortable and I trust the guy ...off they go... the messages

weren’t too effective.”
Finally, Princess asserted that the messages were effective as it helped her become more
conscientious with her sex partners. However, she found them to be inapplicable to her
life circumstances, given that she was sexually inactive at the time the messages were
being conveyed. A good number of the female participants assessed the HIV/AIDS
messages they heard while growing up as ineffective and their responses were honest and
direct, which will aid in future HIV/AIDS prevention campaigns. In addition, the data

revealed that the perceptions of past HIV/AIDS messages were complex, circumstantial,

and situational. The next subsection reviewed the themes derived from the female’s

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perceptions on present HIV/AIDS messages. Have the messages changed over time? Will
they find the messages to be more, or less, effective?
Types of Present HI V/AIDS Messages
A frican-A merican females. The content of this section shifted focus from
determining the participants’ perceptions on HIV/AIDS messages that were heard during
their upbringing to eliciting their perspective on present HIV/AIDS messages. It seems
that the themes were more varied, and less clearly defined, for this section, especially
among the African-American females. Three of the ten African-American respondents
reported that the present messages were Conflicting HI V/AIDS messages that center on
Mortality versus Longevity. Spirit’s comments, for example, were multifaceted in that she
talked about that one’s quality of life and the mortality rate seemed to hinge on one’s
economic plight.
Spirit: “In a way, now, I almost feel they show a lot of people who live

with it now. So, it at times it almost seems it’s not fatalistic at all. But

knowing other things that I know. Like, to look at the thing going on

in South Africa and in Africa where it’s 1.53 million or something like

that are living with AIDS, and to know that they’re dying because of

the lack of medical attention and things like that. But then to look in

the US, where there’s a lot of people living with it. It’s like, you hear

in certain places like South Africa are dying of AIDS.”
Ladybug addressed similar issues regarding Magic Johnson, who was reported to have the
financial means to pay for the medical costs affiliated with his diagnoses of being HIV-
infected, while others who are less financially fortunate to sustain a healthy quality of life,
were “dying from it” because they lacked access to medical care. Osa also recognized the
AIDS pandemic in third-world countries, such as South Africa, and emphasized the death

rate among the youth, as she stated, “How young the people are starting to die too.”

Increased awareness of the Epidemiology and Statistics of H1 V/AIDS, increased messages

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on condom use, and Public Awareness Promoted by Celebrities were equally mentioned
by two African-American females for each theme. Though the theme of Black Men on
the Down Low (DL) was mentioned by only one female, Mary, it is an important topic to
address:

Mary: “I hear now a lot about the whole deal brothers on the down low

thing and about how a lot of black men are having sex with other men,

and infecting a lot of black women, and I feel that that has something

to do with the fact that women are, black women, are the fastest

growing group of women with AIDS and with HIV with new cases.”
Mary’s assertion is accurate. The present HIV/AIDS messages, according to this
African-American female sample, conveyed less unified themes, and instead,
provided deeply complex and varied responses as to how they perceived present
HIV/AIDS messages. Did the Latina females hold similar views on the present
HIV/AIDS messages?

Latina females. Among the Latina females, six of the nine participants indicated
that the types of HIV/AIDS message they hear presently includes increasing the Practice
of Safe Sex through the use of condoms, while two reported that Knowledge of Partner ’s
Sex History has been promoted with greater frequency. Another theme, Conflicting
HI V/AIDS messages that center on Mortality and Longevity, was echoed by two Latina
females. Butterfly, for example, heard from televised talk shows that people are presently
living with AIDS, while Sam indicated that knowing that children are living and dying
with AIDS scared her. Another theme similar to Mary’s observation was resonated by
Butterfly with regard to the connection between HIV and infidelity.

Butterfly: “Different people talking about their experiences—there were

even people that were infected with HIV that talked about their own
experiences where they didn’t think about it or the person they had

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been with had not been truthful. It’s just ironic. There’s a Latina

magazine, and I was reading it, and they talked about women who had

got infected with HIV/AIDS with their husband, who never really told

her because he was having an affair with somebody that was infected

and he got her—and he divorced her, and so it was a really sad story,

but it does kind of affect you in a way, the way of your thinking.”

African-American and Latina females. Though the themes derived from the data

among the Latina females were less varied than the data from the African-American
females, they were, nonetheless, equally complex compared to that of the themes from the
African-American females’ perception on present HIV/AIDS messages. While 66% of
the Latina females paid attention to the HIV/AIDS messages that focused on the Practice
of Safe Sex, only 20% of the African-Americans spoke about the same topic. Another
difference is that there was no mention of Knowledge of Partner ’s Sex History by the
African-American females, but was mentioned by two Latina participants. Conversely,
there was no mention of either the Epidemiology and Statistics of H1 V/AIDS that impacts
people of color or the promotion of HIV/AIDS awareness via celebrities by Latina
participants, but it was addressed by African-American participants. Both groups
mentioned, with equal frequency, Conflicting HIV/AIDS messages that center on
Mortality versus Longevity, and the connection between HIV and Infidelity, whether it is
via heterosexual contact or by men having sex with men, and then with their heterosexual
partners. Perhaps these intricate themes can speak to the ways in which AIDS has
become a more complicated and diverse social pandemic or that the messages are
becoming more relevant to these late-adolescent females’ lives. The central focus
underlying the examination of past and present HIV/AIDS messages is addressing the

effectiveness of these messages, and the direct impact it may have on their sexual

behaviors.

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Effectiveness of present HI V/AIDS messages. Table 9 summarizes the number of
respondents reporting the effectiveness of past HIV/AIDS messages by quality and by
three categorical responses and by race/ethnicity. Among all 10 Afiican-American
female participants, seven reported that there was a general improvement, while two
indicated that there was no change, and one respondent stated a decline in the
effectiveness when comparing from past to present HIV/AIDS messages. With regard to
the general improvement, an important subtheme surfaced from the data, in that four of
the seven females cited the present messages as having More Relevance to the targeted
population, specifically African-American communities.

Table 9

Effectiveness of H1 V/AIDS Messages across Time

 

 

Subgroups Improvement No Improvement Decline No Response
Afiican-

American

Females 7 2 1 0
Lafina

Females 4 3 1 1

 

Osa, for example, explained that the notion of “everybody can get it” no longer left her
feeling invincible from the virus, while Poet attributed celebrities, such as Magic

99

Johnson, to her increased HIV awareness that “it could happen to anybody. Mary made
a clear distinction in how past messages were ineffective, as they were geared to other
populations at risk, whereas the present messages are geared more toward the African-

American communities and stated:

Mary: “Yeah. They are different because when you heard it growing up,
it was so not you. I mean, like, the people in the commercials now,

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they got on the clothes that I’m wearing, even if they are not black,

they are my age, you know what I mean, or even if they’re not you

now, my age, they are a woman or something like that.”
For the two respondents who indicated that there was no change between past and present
HIV messages, Angel did mention there was an increase in HIV/AIDS statistics, while
Chi Chi stated that there were “less of them.” Both, however, asserted that the
effectiveness and content of the HIV/AIDS messages did not change. Finally, Spirit is
the one female participant who reported the effectiveness had declined over time because
of the perception that AIDS is no longer a “death sentence.”

Spirit: “Oh you can live with it. Cuz if you give too much of a

lackadaisical approach, I would say I wouldn’t think about it as much.

If you’re embedding it into my head that I can die from this, and this is

a big deal. It can be very fatal, that then, I would feel I need to take

every necessary precaution I can ever in my life to not be in that

situation. And then look at some of the messages that they say now, it

seems you don’t even think about it as much as I used to.”

Among the Latina females, Goddess also implied that there was a decline in the
effectiveness of HIV/AIDS messages as she made the following observation:
Goddess: I went to a class called LAM, and there was two or three hick

towns like mine, and they always say a lot of people get pregnant

because there’s nothing else to do in those towns, and that’s very

common in those towns where there’s absolutely nothing to do, so all

they would do is resort to sex, and that’s probably why kids are having

sex younger because it makes them feel more adult I guess.”
Though she did not directly state that the effectiveness of the messages declined over
time, it is apparent that they continue to be ineffective. Three other Latina females also
reported similar views in that the effectiveness of the present HIV/AIDS messages have

not improved. Vixen’s comment of “they are basically the same thing, be protective

when you are having sex,” captured this category. Four participants believed that the

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messages have improved with regard to the effectiveness of them, according to Morning
Star, La Chingona, Butterfly, and O’Connor. HIV has become “a real issue,” according
to Morning Star. She had a first-hand experience in helping those living with HIV/AIDS
when she participated in an intensive week-long volunteer experience helping the
homeless and those living with HIV and AIDS. La Chingona implied that seeing that
resident assistants in the dormitories “giving out condoms like candy” suggested to her
that prevention of STDS, including HIV, has improved. O’Connor stated that being in a
college setting has increased her exposure to STDS, and the promotion of using condoms
when engaging in oral sex. Butterfly believed that the messages improved, as she stated,
“Those kind of messages affect you more when you know that its within your
community,” emphasizing the identification an article read in a Latina magazine of a
married Latina woman who had been infected with HIV by her husband, who was a
culprit of practicing infidelity. She stated, “I guess that’s why it affected me more
because it was someone that was from my community, from my background, from my
cultural values.” Princess did not comment on this general topic.

In general, the data revealed that approximately 58% of the respondents perceived
the HIV/AIDS messages have improved over time, while 26% and 10% of the total
number of participants believed that there was no improvement, and there was a general
decline in the effectiveness of the messages, respectively. The need for HIV/AIDS
awareness can always improve as is evident from the responses in this sample. Another
related, and critical, topic is the examination of the themes obtained from the
participants’ suggestions in ways to increase consistent condom use and awareness of the

HIV/AIDS pandemic.

I45

Suggestions to Increase Consistent Condom Use and HIV Awareness

When the participants were given the opportunity to address factors that would
help young women in similar predicaments, such themselves to increase consistent
condom use during sexual encounters, and ways to “halt the spread of HIV,” several
themes became apparent from the responses of both African-American and Latina
females.

Table 10 summarizes the themes derived from this subsection, Suggestions to
Increase Consistent Condom Use and HIV Awareness, by types of messages and by
race/ethnicity. Of the 10 African-American participants, five reported that
Empowerment-Focused HIV/AIDS Prevention Campaigns were much needed.

According to Spirit and Josephine, the messages need to teach young women to “care for
themselves,” and to impart clear signals that they “are worth something," while Chi Chi
believed that they need to be more future-oriented, as well as goal-focused, which will
help them think about the long-term consequences associated with at-risk sexual
behaviors.

Chocolate Princess and Angel shared similar views that women need not to be
“ashamed for asking questions,” and that “they have the right to speak up,” in order “to
protect their bodies.” Their statements captured the essence of what it means to empower
young women in re-directing and attending to their feelings and thoughts, especially with

regard to engaging in sexual relations and in protecting themselves from a STD.

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Table 10

Themes Derived from Ways to Increase Condom Use

 

Types of Messages among
African-American Females

Types of Messages among
Latina Females

 

n = 9

Empowerment- Condom Use 6
Focused HIV/AIDS
Prevention Campaigns

Direct, Fact-Based
Direct, F act-Based, and Honest 6
and Honest
Age-Specific Issues Centering
HIV/AIDS Prevention on Testing 5
Campaign

Empowerment-
Issues Centering on Focused
Testing HIV/AIDS

Prevention

Campaigns 4
African-American-
Focused HIV/AIDS Age-Specific
Prevention Messages HIV/AIDS

Prevention

Campaign 3

 

Another theme, voiced by four of the ten participants, was that the prevention campaigns

needed to be more Direct, F act-Based, and Honest in the delivery of HIV/AIDS

information. Specifically, the messages need to convey that HIV will eventually “lead to

death,” that it needs to be “in your face” advertisements, conveying that HIV can inflict

“me and my community,” according to Josephine. More information needs to focus on

the biological component of how STDs attacks the body. Three of the participants stated

that Age-Specific HIV/AIDS Prevention Campaign needs to occur at each grade level, and

topics that are grade- and age-appropriate. The prevention campaigns also need to

involve Interactive and Discussion-Oriented Forums, according to three other

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respondents. Mentors should lead and have similar sexual experiences as the peers, and
mentors can generate honest discussions about intimate issues concerning safe sex
practices, fears associated with discussing HIV/AIDS, and addressing embarrassing sex-
related questions. The prevention campaigns should also include ways to increase
discussion about Issues Centering on Testing, such as promoting the benefits of,
normalizing the fears associated with, and conducting role-play in getting tested as well
as discussing condom use. Three participants reported the importance of having African-
A merican-F ocused HI V/AIDS Prevention Messages as a means to convey, more
effectively, the urgency of the HIV pandemic having direct impact on their community.
Josephine, for example, suggested sending flyers to African-American women on campus
that directly addresses the statistics regarding the African-American community. Mary
stated that the role models and celebrities that currently talk about HIV/AIDS in the mass
media need to resemble better the targeted population, the average African-American,
late-adolescent female.

Similar themes were evident among the Latina sample, with one exception in that
six of the nine Latina females reported that an increase in Condom Use is needed, which
was not mentioned by the Afiican—American participants. Goddess, Butterfly, and Sam,
specifically, believed that condom availability should take place in both the high school
and college settings. Butterfly and La Chingona focused their attention on ways of
addressing the feelings of embarrassment and shame associated with condoms, while
Vixen believed condoms that cause vaginal irritation should be publicly addressed.
There was equal mention on the importance of generating more Direct, F act-Based, and

Honest HIV/AIDS Prevention Campaigns. Morning Star, Butterfly, and Sam suggested

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that the messages need to center on the epidemiology of HIV that specifically impacts
their community. Morning Star, for example, suggested that increasing the publication of
the day and a life of a person living with HIV would be helpful. O’Connor discussed the
importance of increasing conversations about Latina males being on the “DL” (down
low), where Latino men are in heterosexual relationships, but will also engage in having
sex with other men. Five of the nine Latina females reported the need to increase
messages that focus on Getting Tested and issues that are associated with it, such as the
emotional component of talking about the fears and embarrassment of getting tested, as
well as the logistical aspects of testing, such as what tests are involved and which clinics
provide such tests. Four Latina participants recommended that the HIV/AIDS prevention
campaign needs to incorporate more Empowerment-Focused messages, such as having
them think more future-oriented, campaigning the message, “you deserve to live,” and
finding that acceptance and validation need not come from the male sex partner. The
other theme, voiced by three Latina females, is that Age-Specific HIV/AIDS Prevention
Campaigns are needed. All three participants placed an emphasis on gearing the
messages toward the “younger girls,” since they are engaging in sexual practices at an
early age.

In comparing the themes derived from the African-American and Latina females’
responses, the Empowerment-Focused HIV/AIDS Prevention Campaigns, Direct, F act-
Based, and Honest, Issues Centering on Testing, and Age-Specific HIV/AIDS Prevention
Campaign were discussed. Themes that became evident were approximately shown with
equal frequency by both groups. The stark difference is that the increase in the use of

Condom Use, the most prominent theme, among Latina participants was not discussed by

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the African-American respondents. Conversely, the African-American participants
promoted an increase in African-American-Focused HIV/AIDS Prevention Messages, but
there was no reference for increased culturally-specific prevention campaigns among the
Latina females.
Summary

The primary function of this chapter was to communicate the results of the
following areas: the survey portion from the HIV/AIDS open—ended questionnaire, a
brief biography of each of the participants, and the themes derived from the three major
sections of the open-ended interview, which included the following areas: Knowledge
regarding HIV transmission, thought and behaviors about sex, participants’ sexual
experiences, safe sex, and communication patterns with sex partners, and effectiveness of
past and present HIV/AIDS messages. Given the myriad, and often complex, responses
and themes that were offered in this chapter, the next chapter will contextualize, explain,
and account for the many of the topics discussed in a cohesive, conceptual manner. The
purpose is to provide a more effective age-specific, gender-appropriate, and culturally-

relevant HIV/AIDS prevention campaigns.

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CHAPTER 4: DISCUSSION

The overall purpose of this research study was to investigate the African-
American and Latina late-adolescent females’ perceptions about their conceptualization
and experiences on sex, safe sex, communication with their sex partners, and on ways to
improve existing HIV/AIDS messages. The aim was that their responses could be
translated directly into creating HIV/AIDS prevention programs that are culturally-
relevant, gender-appropriate, and age-specific to the target group of interest. This chapter
addresses the very crux of this study by summarizing the major findings, providing
recommendations that promote appropriate and relevant HIV/AIDS prevention messages,
acknowledging the limitations of this study, and offering future research implications.

Knowledge of HIV Transmission and Awareness

A common, yet misguided, belief is that oral sex, and even anal sex, are
alternative forms of safe sex, despite the fact that the medical literature clearly indicates
that all forms of sexual contact, where bodily fluids can potentially be exchanged, are
modes of transmitting all forms of sexually transmitted diseases, including HIV.
Determining the female adolescents’ knowledge on this specific topic is of critical
importance. Myths centering on HIV transmission continue to place people in jeopardy,
even those who are college-educated.

Sexual contact, including vaginal, anal, and oral sex, as well as intravenous drug
use and exchange of bodily fluids were most common, and expected, themes when
assessing the participant’s level of understanding in HIV transmission. Blood
transfusion, which was a concern in the 1980s and early 19905, is still being echoed in the
21” century by those in this sample. Blood transfusions, and exchange of bodily fluids,

were equally mentioned between the groups, even though blood transfusions have an

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insignificant bearing on the increased rate of HIV infection among late-adolescent
females. According to Donegan (2003), the majority of HIV-infected cases before March
of 1985 were because of infected blood transfusions; yet, by 2003 the risk of HIV
transmission per unit transfused had significantly decreased to between 1 in 1.4 million
and 1 in 1.8 million units. In addition, HIV/AIDS Surveillance Reports by CDC (2001)
showed that by December of 2003, only approximately 1% of HIV and AIDS cases,
including adults and adolescents, can be attributed to HIV-infected blood transfusions,
blood components, or tissue. An updated CDC report (2004) analyzed data between
1999 and 2002 from 29 states and found that 35% of all new HIV cases were explained
by heterosexually-acquired HIV infections, not by HIV-infected blood transfusions.
Furthermore, 64% of heterosexually-acquired HIV infections occurred in females and
74% occurred in non-Hispanic blacks (CDC, 2004).

Blood transfusions—a mode that significantly decreased the likelihood of
transmitting HIV, given the present-age technology, where all donated blood is screened
for HIV—seem to have an influence in the way college-educated, African-American and
Latina late-adolescent females conceptualize the degree of threat of becoming HIV
positive. In other words, does this once-relevant concern play a role in preventing them
from considering the seriousness and relevance of HIV/AIDS impacting their lives?

More disconcerting is that approximately one-half of the respondents (47%)
admitted that they never thought of themselves in relation to HIV, even though each
participant had a sexual history that exposed them to the opportunity of infection to a
sexually transmitted disease. This detachment was more pronounced among the Latina

participants (67%) compared to their African-American counterpart (30%). The most

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common explanations provided by these participants included knowing their partner’s sex
history and having “few” partners, which led them to believe that they are not susceptible
to contracting HIV.

Essentially, the majority of this sample identified the various modes of HIV
transmission in a seemingly rote manner. Yet, blood transfusion was a repeated theme
that should not have been as frequently mentioned as it had in this sample. This is
indicative to how past HIV/AIDS messages have lingering and unwanted impressions. In
addition, erroneous assumptions, which served to distance the participants cognitively
from the idea of being HIV-infected became more evident when discussing how they
might think of themselves in relation to HIV. This issue suggests that more updated
information about HIV transmission, such as fears underlying HIV/AIDS, and how it can
impact specific communities, needs to be targeted better to the populations that it is being
addressed.

Multiple Definitions of Sex

The typical theme, penetration, in defining the term sex is from a behavioral
perspective, which incorporated other related responses: vaginal, oral, and anal sex, as
well as the exchange of bodily fluids. Four participants, two from each racial/ethnic
group, conceptualized sex from an emotional perspective in that it was viewed as an
expression of love, a form of Emotional Intimacy. Two Latina females defined sex in
terms of sexual orientation in that sex is a Heterosexual Sexual Activity, which suggests
that they defined sex as coital intercourse.

When participants were conversely asked whether or not anal and oral sex
constitutes sex, seven of the nineteen participants’ responses were less than clear and

thereby were unable to be categorized in clearly definitive themes, whereas the other 12

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participants reported that oral and anal sex is defined as sex. Six respondents, four of
whom are Latina females, perceived oral sex as having a “less than” value, in that it was
viewed as “foreplay” and that it is not “penetration” like that of penile-vaginal
intercourse. The results suggest that these participants may be disillusioned into feeling
safeguarded from being infected with a sexually transmitted disease. Though five of the
seven participants defined anal sex as sex, two Latina females had competing views in
that one thought anal sex was “less dirty” because it is not a form of “losing” one’s
virginity; whereas, the other Latina female believed it being “dirtier” because she did not
consider it “normal” sex, implying that it is not coital intercourse.

In assessing the themes derived from the data in the area of defining sex, the way
the questions are posed elicit different responses. For example, subtle, yet important,
differences emerged when asking the females “to define sex” versus asking, “Is oral and
anal sex considered sex?” The literature to date has little understanding about the
psychological reasons, the social benefits, and the sexual risks involved in engaging in
noncoital sexual behaviors (Prinstein, Mead, & Cohen, 2003). In fact, Boekloo and
Howard (2002) reported that oral sex is not specifically measured in most health surveys
of adolescents. Gurman and Borzekowski (2004) echoed a similar concern in that past
research studies that look at, adolescent sexual behavior did not distinguish between anal
or oral sex in the general term sex. Further delineating specific sexual behaviors— ‘
cunnilingus, fellatio, and anal sex—is important to incorporate in the present HIV/AIDS
research, since it has a direct bearing on the transmission of HIV and prevention efforts
(Prinstein et al., 2003). A research implication is elucidating further within a qualitative

framework as to the reasons condoms are not used for each of the specific sexual

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behaviors among adolescents, but particularly among female adolescents and women
who are at high risk of infection. Reasons may vary from one sexual act to the other,
which will subsequently influence the direction of HIV/AIDS prevention messages
(Prinstein et al., 2003).

The prevalence of inconsistent condom use during oral and anal sex is illustrated
by this sample, in which approximately 14 and 17 participants reported failing to use
condoms when engaging in fellatio and in cunnilingus, respectively. Of the nine
respondents who reported in partaking in anal sex, six admitted in not using a condom.
In other words, approximately 32%, 74%, and 89% of the sample did not use condoms
when engaging in anal sex, fellatio, and cunnilingus, respectively. The evidence in this
sample is consistent with previous research. The study conducted by Gurman and
Borzekowski (2004) found that among their sample of 1,821 Latino college students,
fewer than 5% of the participants employed a condom in their most recent oral sexual
encounter.

The findings may account for one of the reasons condoms are used with less
frequency when engaging in anal and oral sex. Ford and Norris (1993) hypothesized that
Latina females may simply be less knowledgeable about sex and have conservative
values with respect to sexual behaviors. Another study suggested that adolescents view
oral sex as more acceptable and less risky sexual behavior (Cornell & Halpem-Felsher,
2006). Yet, when Cornell and Halpem—Felsher (2006) examined the reasons why
adolescents engaged in oral sex, they found that physical pleasure (35%), improving the
relationship or being popular (30%), perceiving oral sex as being less risky sexual

behavior compared to vaginal penetration (16%), and feeling pressured, forced, or fearful

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by peers ( 1 1%) were the most common explanations provided by their sample of 425
ninth-graders. Various external pressures, including peer pressure, the need to sustain the
romantic relationship, and popularity status, were themes that were also echoed in this
study. These external pressures, which may be a more accurate explanation for increased
inconsistent condom use, are legitimate obstacles that female adolescents encounter daily.
The Theory of Gender and Power acknowledges and accounts for the pervasive and
insidious role in which the social and institutional forces influence a woman’s perception
on appropriate gender roles, her own sexual identity, and the failure to seek protection
against STIs in fear of rejection by both her male and female peers. The structure of
cathexis, a component of this theory, particularly speaks to the emotional and sexual
attachments that women have towards their male sex partners. This structure can also
perhaps address their attachments to their female peers as well and their desire to
maintain a certain status quo within their peer group relationships.

A prevention recommendation is to increase awareness in differentiating penile-
vaginal penetration and noncoital sexual behaviors as well as in educating how these
discrete sexual behaviors are efficient modes of HIV transmission (Cornell & Halpem-

F elsher, 2006). Though there has been more interest in studying noncoital sexual
behaviors among adolescents (Prinstein et al., 2003), the focus has been more on oral sex
than on anal sex. Yet anal sex and the use of condoms are a paramount importance and
therefore, in specific, concrete terms, must be incorporated in the sex education
programs. Knowledge, that the route of HIV transmission to the bloodstream is more
efficient via anal sex than either vaginal or oral sex, needs to be communicated. Since

the mucous membranes in the anus are thinner, tearing occurs more easily, and there is no

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natural lubrication when compared to the vaginal area (San Francisco AIDS Foundation,
2006). Essentially, the HIV/AIDS prevention campaigns need to emphasize that condom
use is necessary at all times, and at all stages, of sexual activity.

This study found that much of the sex information was garnered from school-
based sex education programs. However, a contrast did appear when family members
were involved in educating these participants. The results revealed that 60% of the
African-American families compared to 33% of the Latino families had a role in
educating their daughters. When family members were involved among the Latino
group, they were given indirect, yet clear nonverbal, messages that sex was “bad” and
that sex was to take place only in the context of marriage. The results from this study
may be explained by a culturally-driven barrier that “the ‘good’ woman is not supposed
to know about sex,” (Ford & Norris, 1993, p. 316). Whitaker, Miller, May, and Levin
(1999) recognized that having open discussions between the parent and the child about
sex are made difficult by sociocultural taboos and cultural norms. The cultural
assertions made by these studies are congruent with the Theory of Gender and Power as it
speaks to the multicultural racial/ethnic groups that tend to be more patriarchal and more
conservative about a woman’s sexual identity and her sexual relationships. The theory
acknowledges the negative impact that the power imbalance between the daughter and
traditional, patriarchal family dynamics has on the failure to promote healthy sexual
identity in young women as well as the failure to engage in open dialogue on
emotionally-charged, deeply personal issues of sexual attitudes and behaviors.

HIV/AIDS prevention efforts need to be in tuned with the sensitive nature of

discussing discrete sexual behaviors, coupled with couching these talks within cultural-

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driven norms and framework. Among the Latino community issues such as (1) female
gender roles (marianismo) that promote abstaining from sex until marriage, (2) the
decision-making processes that occur at the collective, rather than at the individual, level,
and (3) the value of familismo (central role of the family) need to be part of the fabric of
family communication (Gurman & Borzekowski, 2004). In addition, given the important
value placed on families for both racial/ethnic groups (Kirby, 2002), prevention
campaigns should have parents be involved in sex discussions with their teen. The extant
literature strongly indicated that communication between the parents and their child
regarding sex-related behaviors delays initiation of first-time sex, to have fewer sex
partners, and to use condoms (Fasula & Miller, 2006; Kirby, 2002; Whitaker et al., 1999;
& Metzler, Noell, Biglan, Ary, & Smolkowski, 1994).

Lastly, the majority of the participants in this study reported that they began
learning about sex in Middle School, the same time when half of the adolescent
population has reported engaging in some form of sexual activity. Yet, sex-based
curriculums in public school settings continue to promote abstinence, as opposed to the
use of condoms, even in the Wisconsin Department of Public Instruction’s directory of
resources that is intended for educators, policymakers, and parents on ways to increase
AIDS education and HIV prevention among their youth (Wisconsin Department of Public
Instruction [WDPI], 2001). Yet this directive and other education-driven institutions,
including Public Education Network [PEN], agree that policymakers, community
agencies, school systems, and families need to increase communication with each other,
and work more cooperatively before imparting critical information, such as health and

sex-related topics, to children (WDPI, 2001; PEN, 2002). This means that effective

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HIV/AIDS prevention messages go beyond a 30-second media blip that attempts to get
the youths to abstain simply from sexual practices.
Practical Implications Drawn from Past and Present Sexual Experiences

Among the varying themes in each of the three categories of low, moderate, and
high number of sex partners, four prominent themes emerged. Many, if not most, of the
participants’ actual sexual encounters were not necessarily planned; they “Just-Kind-of-
Happened. " The participants in the high category (being sexually involved with more
than 11 partners) were not coded under the theme of it “Just-Kind-of—Happened," but
they were coded for engaging in Nonmonogamous Relationships, whereby the sexual
activities typically occurred in a noncommitted relationship which suggest their sexual
rendezvous were unplanned too. The motivating factors seem to be based on timing,
sexual foreplay (including petting, kissing, and other forms of sexual intimacy) and the
mere “moment,” as contributing explanations to the “unplanned” sexual liaisons.

Evident across the three groups is the overarching theme, Forms of External
Pressures and Threats, that motivated these participants to have sex, even when it was
against their better judgment, but more importantly, when it was against their wishes and
intent not to engage in sex. Five subthemes are subsumed under this broader theme of
external pressures and threats. The first subtheme is the pressure of female peers. Angel,
Tinay, and La Chingona had a common experience in that they had sex either by the
encouragement of, or the coercion of, a female friend. Tinay, especially, was coerced by
her female friend as she reluctantly participated in a ménage tois with this friend.

External pressures and threats were disguised in other forms, including feeling

victorious overfemale “competition, ” which is the second sub-theme. “Everybody else

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wanted him, and he wanted me,” Ladybug stated. This was a shared sentiment echoed by
La Chingona’s and Chocolate Princess’s sexual experiences. These two sub-themes are
consistent with previous research in the area of peer influence on adolescents’ sexual
conduct (Kirby, 2002). Metzler et al., (1994), for instance, found in their study that the
largest direct predictor of adolescents’ risky sexual behavior was associated with deviant
peers. The research, which usually focuses on the ages between 14 and 18, has
established that adolescents’ sexual conduct is strongly influenced by the sexual attitudes
and behaviors of their peers and friends (Upadhyay & Hindin, 2006). This trend of being
heavily influenced by peers seems to continue into the late-adolescent age group,
including college-aged population as evidenced in this study.

The third subtheme under the broader umbrella of forms of external pressures and
threats is feeling rejected either by female peers or by .male sex partners. In the case of
Osa, who admitted that feeling alienated by her female peers based on being what felt
like the “only virgin,” largely explained why she lost her virginity. Chocolate Princess
also admitted feeling rejected, but by her ex-boyfriend who claimed that she was a
“boring” sex partner. Princess’s narrative implied that her second and third sex partners
were motivated by feeling rejected by her first sex partner with whom she felt was in a
long-term, committed, monogamous relationship.

The fourth kind of external pressure and threat is the threat of being emotionally
abandoned by their sex partners. The participants consequently felt that they were
required “to have sex” as a means to sustain their romantic relationship. Angel, Ladybug,

and Mary explained that their boyfriends, at that time, employed verbal coercive threats

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in order to engage in sexual relations and to maintain their committed, monogamous
relationship.

Being verbally, and perhaps physically, pressured to have sex by their male
partners is the filth and yet most apparent form of external pressure and threat. Tinay,
and many other participants, are examples of females who felt pressured by their male
partners to have sex, even against their own intent. The results from this study are similar
to the findings of other studies. Specifically, social/extemal explanations, including
maintaining social status and improving romantic relationships, may account for
unwarranted sexual activities (Cornell & Halpem-Felsher, 2006). Furthermore, being
pressured by their male partner speaks to the issues of gender, power, and control
regarding sexual activity (Cornell & Halpem-Felsher, 2006; Wingwood & DiClemente,
2006; and Prather, Fuller, King, Brown, Moering, Little, & Phillips, 2006; Quina,
Morokoff, Harlow, Zurbriggen, E., 2004).

The five subtypes of External Pressures and Threats can be best contextualized
within the Theory of Gender and Power. The sexual division of power, one of the three
social structures of this theoretical model, directly explains about the abuse of power men
have over women in sexual relationships. These abuses of power and control come in
various forms, such as when, and if, a condom is employed, verbal pressures to engage in
sexual relations, and the physical force to have sex against their will. The verbal and
physical pressures to engage in sexual activity were not only echoed by the female
participants in this study, but it also has been intrinsically related to issues of gender,
power, and control (Cornell & Halpem-Felsher, 2006; Wingwood & DiClemente, 2006;

and Prather, Fuller, King, Brown, Moering, Little, & Phillips, 2006; Quina, Morokoff,

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Harlow, Zurbriggen, E., 2004). These pressures also manifested itself in the form of
psychological threats of fearing rejection and abandonment. This psychological threat is
particularly an effective tool to manipulate women to engage in risky sexual behaviors as
their livelihood has been shaped by gender socialization, in that they are to seek approval
from others, to maintain a rich social fabric of social relationships, and to desire
monogamous sexual relationships. Fearing rejection by their male sexual partner or
female peers is in turn fear of rejecting themselves and their sense of identity. The
structure of cathexis, the other social structure in the Theory of Gender and Power,
accounts for this social programming. The structure of cathexis also accounts for the
gender socialization that women need to maintain social harmony and status quo in peer
relationships even if it is at the expense of their own well-being, thereby explaining why
women are increasingly placing themselves at risk of HIV infection. The female
participants in this study revealed that they have at one time fallen victim to these
external pressures in hopes of maintaining social status and romantic relationships.
Cornell & Halpem-Felsher (2006) produced similar findings in that maintaining social
status and improving romantic relationships accounted for their participants’ sexual
activities.

The third broad theme is The Need for Validation and Acceptance, which
included the Wooed-Effect. Even though it was not fully endorsed as a theme in the
category of low number of sex partners, two respondents inferred that feeling validated
and accepted largely motivated their sexual behaviors. The other participants, however,
made more explicit comments that illustrated how validation moved them to engage in

sex, as evident in the following: “I want them to continuing wooing me,” said Tinay;

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“He showed me a lot of attention,” and “I knew he was attracted to me because I heard
him tell somebody,” said Chocolate Princess; “I felt like they told me things that I wanted
to hear to get me in the bed,” said Angel; “That someone wants you and makes you feel
special,” said Vixen; “Like someone that I know that doesn’t have sex with everyone on
my dorm room floor,” said Morning Star; and “He was, like, paying so much attention to
me,” said La Chingona.

The majority of studies focusing on antecedent factors in predicting and
accounting for adolescent sexual behaviors largely attended to the ways in which peers
and family relations play a role. Given that the majority of the studies employed a
quantitative approach, they were often limited in measuring teens’ perceptions by
resorting to assessing their perceptions on their peers’ sexual attitude and behavior
(Kirby, 2002; Metzler et al., 1994). These studies were insufficient in understanding the
specificity of the cognitive mechanisms operating within the external pressures (family
and peers) that drive these participants, and adolescents, in general, to engage in sexual
behaviors. This study revealed important cognitive and psychosocial mechanisms—
"Just-Kind-of-Happened,” same-sex peer pressure, same-sex competition, fear of
abandonment by sex partner, social isolation, and the need for validation and acceptance
by partner—underpinning their sexual behaviors and attitudes. This data have direct
impact on generating specific and more effective prevention campaigns.

The final theme, Emotional Detachment and a Need for Retaliation are
Mechanisms to Seek Personal Power and Control, appears to be unique, in particular, to
the participants in the category of high number of sex partners. Regardless, it needs to

have further explication. In the cases of O’Connor and Poet, both of whom admitted to

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being sexually abused, each clearly stated in their narratives that, since their innocence
was “stolen” from them, that they were, in turn, going to take it away from their partners.
Chocolate Princess’s sexual history strongly suggested that her motivations were often
couched in similar sentiment. This is an important area to examine, as this group
increased the risk of infection because of the sheer number of sexual partners with whom
they have been active. F urtherrnore, this seems to be one of the more critical, though less
prevalent, explanatory factors for engaging in risky sexual practices. A possible
hypothesis to account for this theme is determining which participant has been a victim of
child sexual abuse (CSA), and whether the CSA influenced their present sexual practices.

Poet and O’Connor volunteered information regarding their sexual abuse when
being interviewed, but the question of whether or not participants have had a history of
being sexually abused was not posed to all the participants in this study. In hindsight,
determining this specific information should have been pursued, and is needed in future
research, especially since the women, in general, are more susceptible to child sexual
abuse than men. F ergusson and Mullen (1999) estimated that 8% to 62% of women and
3% to 29% of men have suffered from CSA. Paolucci, Genuis, and Violato (2001) cited
that CSA cases occurred, on average, between 15% to 20% of children and adolescents.
Furthermore, approximately one third of women with an HIV infection have a history of
CSA (Koenig & Clark, 2004). Koenig and Clark (2004) conducted a systematic literature
review in examining the relationship between CSA and HIV/AIDS among women and
concluded that CSA “is overrepresented among women with HIV” (p. 87).

Research found a well-established connection between CSA and engagement in

high-risk sexual behaviors as an adult, including sexual compulsivity, indiscriminate or

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impulsive sex, a high number of sexual partners, and a low incidence of condom use
(Zurbriggen & F reyd, 2004; Paolucci, et al., 2001). Zurbriggen and Freyd (2004)
explored the relationship between power-sex link and sexually acting out in an aggressive
style. Their chapter illuminated in detail various cognitive mechanisms, including
reality-detecting mechanism, cheater detectors, and dissociation that may mediate
between CSA and sexually risky behavior. The reality—detecting mechanism,
specifically, asserted that the perpetrator, often in an authoritarian position, will distort
the child’s reality by saying, for example, “All daddies do that with their daughters,” (p.
148). Consequently, the child’s mechanism from which to differentiate between reality
and lies is compromised as a child. This child, thereby, has difficulty as an adult in
assessing reality, which includes appropriate risk evaluation. Another mechanism,
cheater detectors, is used to determine trustworthiness in’others. When a person has been
“cheated” on, a natural defense mechanism is to leave the abuser, but the dependent child
is frequently forced to continue to be in the presence of the abuser who is often the
caretaker. Consequently the cheater detector is compromised in order to function in the
abusive relationship. This defected cognition continues to be evident in adult
relationships. The third cognitive mechanism, dissociation, is to detach from one’s own
feelings of fear, pleasure, or safety when being sexually abused, and this dissociation
continues to be played out in adult relationships. F urtherrnore, Zurbriggen and F reyd
(2004) proposed that those who have a history of CSA will dissociate even when being
presented with sex- and health-related topics as they have difficulty in sustaining

attention and encoding, as well as processing HIV/AIDS information.

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Understanding these cognitive mechanisms has a significant bearing on future
HIV/AIDS prevention campaigns. Addressing these mechanisms in the prevention
classes can help them understand their worldviews and behaviors as to why “they do the
things that they do,” with regard to their sexual behaviors. African American and Latina
females will subsequently be more motivated to find ways to increase safer sex practices,
as they gain a clearer understanding of the cognitive mechanisms underpinning their
sexually risky behaviors.

The apex of the seemingly varied and complex themes is that the sexual history of
these females, their intent, behaviors, and attitudes suggest that their sexual identities
have largely been dependent on others, through female peer pressure, or by the pressures
exhibited by their male partners, or through the need to seek external validation from
their partners, or through the external gratification gained from competing with their
female peers. Their sexual identities have yet to solidify largely as their behaviors and
attitudes have been more or less shaped by other’s evaluation, while failing to take into
account their own needs and their own source of self-esteem. They have essentially
divorced themselves from the decision-making processes when their sexual practices are
involved.

To Use or Not to Use Condoms

When asked to define the term safe sex, all 19 participants cited condoms.
However, only 30% of the African-American females compared to 55% of the Latina
females mentioned birth control as a type of safe sex, while there was equal mention (n =
3) from both racial/ethnic groups indicating that knowing their partner ’s sex history is
another form of safe sex. Interestingly, only one participant from each racial/ethnic

group discussed abstinence as a mode of safe sex. The responses that were named with

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less frequency can be captured under a broader theme: Myths in Practicing Safe Sex.
This sample, who are college-educated, candidly disclosed their fallacy regarding safe
sex, including having “fewer” sex partners, implementing hygienic measures when
engaging in oral sex, avoiding the “swallow” method when engaging in fellatio,
practicing the “withdrawal” technique when engaging in penile-vaginal intercourse, and
getting tested, which was mentioned by two Latina and one African American
respondents. “Politically correct,” thoughtful responses were ideas that were verbalized,
but not necessarily translated into action as evidenced by few of the participants. This
subsection examined their level of understanding of safe sex from a conceptual point of
view. The next subsection, which captures the essence of the study, explores their
rationale and behaviors, as well as the type of circumstances, in which condoms were not
employed.

All 10 African American females and 44% of the Latina females explained that
being in a Monogamous, Mutually-Exclusive Relationship, was their rationale for not
using a condom during sex. The danger lies in the meanings derived from the terms
“monogamous” relationship or “my boyfriend” as they imply feelings of safety, trust, and
exclusiveness. However, these words do not necessarily translate into “really knowing”
their sexual partner, as many of them engaged in sex without the aid of a condom in
relationships of less than three months. This perception of being in a mutually-exclusive
relationship equates to trust, and thereby, false perception of safety from HIV-infection.

Both racial/ethnic groups demonstrated with equal frequency that being in the
Spur of the Moment to have sex was another reason for failing to employ condoms when

engaging in sexual activity. There is a strong suspicion, however, that many other

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respondents would have admitted to being a victim of the Spur of the Moment
phenomenon had the question been posed directly to each one of them. In other words, it
is believed by the researcher that most of the respondents, if not all of them, would have
admitted to practicing unprotected sex, at one point in their sexual history, because of
being in the “heat of the moment.” Though this is an unwelcome response, it is,
nonetheless, a reality that requires further investigation, and certainly needs to be
incorporated in the HIV/AIDS messages for women of all age groups.

Getting Tested was discussed by three African-American females and one Latina
participant, La Chingona, as the explanation for not using condoms. Many of the
participants believed that by the mere act of talking about getting tested they assumed
safety, and that getting tested is a form of prevention from contracting a sexually
transmitted disease, even though a person can apparently become infected after getting
tested. La Chingona stated, “Try to go get tested right away because I’m not really into
using condoms. As long as you get tested, it would be okay.” In addition, for those who
believed that their partner has been tested without proof or certainty, they were again
relying on the concept of trust. A case in point is with La Chingona who admitted to
having a positive STD test, but failed to inform her partner of the results.

Conversely, concerns regarding Condom Availability and Adversity were evident
among the Latina group, but were briefly mentioned by only one African-American
female. Issues regarding condom availability were an expected response, but adversity to
condoms was an unexpected theme that occurred among the Latina females in how they
viewed condoms as being a foreign object, as improperly fitting on the male partner, or as

decreasing sexual performance. Perhaps Adversity to Condom Use is a cultural

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phenomenon that is unique to the Latino group. A future research implication is an
assessment of the Latino male perception on the use of condoms.

Essentially, this sample, as a whole, identified Condoms as a form of safe sex; yet,
Myths in Practicing Safe Sex continue to prevail in many of the participants’ perceptions,
attitudes, thoughts, and behaviors. More perplexing are the reasons that were provided as
to their motivation in not using condoms. The four most visible themes—Monogamous,
Mutually-Exclusive Relationship, Spur of the Moment phenomenon, Getting Tested, and
Condom Availability and Adversity—seem to be build on two intrapersonal constructs of
trust and impulsivity that lay dormant until the opportunity arises and becomes
manifested in interpersonal relationships. Implicit in these themes of being in a mutually-
exclusive relationship and getting tested is an underlying sense of trust that these
participants seem to place on their partners. Specifically, the notion of infidelity does not
occur after getting tested or of being in a presumably monogamous relationship is
misleading. The impulsivity is also evident in the other two themes of being in the spur
of the moment and accessibility to a condom. Being impulsive prevents considering the
consequences associated with sexually risky behavior. Rather than resorting to the
popular adage incorporated in the present prevention campaigns of “use a condom, ” the
intrapsychic-oriented root, trust and fear of thinking about the adverse, long-term
consequences (impulsivity), is undoubtedly associated with risky behavior and, therefore,
needs to be integrated into the HIV/AIDS messages and prevention campaigns.

A future research implication in this area is to examine a possible relationship
between family dynamics among African-American and Latino families, and adolescent

behavior. African-American and Latino cultures tend to possess more conservative

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values, whereby an authoritarian style (Baumrind, 1991) that is typically dictated by a
male figure, and who is seen as head of the household, can have an oppressive-style
effect. Since this family dynamic, where rules are automatically adhered without
question, indirectly and unwittingly evoke a sense of trust in male-dominating figures
among the female adolescents in the family. This is a habitually learned, albeit implicit,
tendency to trust and may be carried over to the adolescent’s sexual relationships. In
other words, is there a relationship between being raised by a domineering male figure
and the adolescent’s sexual conduct with her sex partner?

Hypothesizing that the relationship between specific types of culturally-driven
family dynamics and an adolescent’s sexual behavior, this will direct the type of
HIV/AIDS prevention campaign. Psychoeducating the Latino and Afiican-American
parents about various parenting styles, and the effect it may have on their children, will
aid in increased communication with their children and develop sensitivity to their
emotional development.

Summary of Communication Patterns with Sex Partners

Direct and poignant conversations that solely centered on HIV/AIDS failed to
materialize among this sample of females. It seems that HIV/AIDS is disguised in
several contexts. Two of the more prominent contexts included Getting Tested and
Newly Acquired Information about HIV/AIDS. There are several assumptions operating
under this theme of Getting Tested, one of which is the act of getting tested. The mere
behavior of obtaining a STD test presupposes a form of safety measure that neither
partner will be susceptible to being HIV-infected after receiving their supposedly

negative HIV results. This is simply untrue in that transmission of HIV, or any other

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STD, is possible whenever condoms are not used because of the possibility that either
partner may be engaging in at-risk behaviors (e.g., engaging in sexual encounters with
another partner or using contaminated intravenous needles). Another erroneous thought
is that “getting tested” or getting “annual check ups” or simply getting blood drawn
because of other related medical concerns assumes that antibody HIV ELISA test is
included. However, a typical “annual check up” includes a breast exam, a pelvic exam,
and a Pap Smear test to rule out cervical cancer, gonorrhea, chlamydia, and human
papillomavirus (HPV), but it does not include testing for treponema pallidum that causes
syphilis, herpes simplex virus that causes herpes genitalis, HIV, and hepatitis B and C.
Goddess, for example, was under the assumption that she was aware of her HIV-status,
but in fact, she remained ignorant. A third, yet more subtle, assumption is that even when
STD tests have been sought, and then briefly discussed with their partners, talking about
the actual, or being truthful in disclosing, results of the tests are separate social constructs
that are invisible to the partner. In essence, HIV/AIDS is not necessarily addressed
directly, but it is implied when Getting Tested is mentioned, but the act or the discussion
of Getting Tested as in the cases of many of the participants is wrought with erroneous
assumptions that have led them to believe that they are safe from infection, that annual
gynecological check-ups include all STD tests, including HIV, and that the truth of the
results would be disclosed.

Other contexts, specifically cheating and the notion of Perception of
Relationships as being Insignificant, were the other derived themes. Discussion of

HIV/AIDS or STDs, in general, is connected with the notion of infidelity. Vixen’s

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narrative regarding her former partner who admitted to “cheating” on her on two different
occasions is not only disconcerting, but it is also deeply flawed:
Vixen: “If I knew he was cheating on me, then I would be like, ‘Hey.

Who have you been with, and did you use condoms or any type of

protection?’ I just went through that recently. I found out that the guy

that I was talking to had slept with somebody else. I was hurt, really

shocked. He had told me, ‘Yes, I used a condom.’ I said, ‘Oh, did it

happen only once?’ ‘No, it happened twice.’ ‘Did you use it both

times?’ ‘Yes,’ because I guess he knew the girl but really didn’t know

her. I was like, ‘Oh. It’s like that?’ I kind of got scared, but I was

happy in a way that he had the decency to actually use a condom

because he had been with me and he didn’t, we never used to, but that

didn’t last very much longer just because it was on my mind.”
Vixen’s thought processes are wrought with assumptions. The first, and most obvious, is
that she assumed her former partner disclosed the truth regarding the use of condoms on
those “two” occasions. There is a possibility that he may have been dishonest in regard
to using condoms, given that he did “cheat” on her. The other supposition is that her
partner had used a condom at the immediate onset of engaging in all sexual activities.
Condom use, however, is rarely considered when engaging in oral sex, and yet were
condoms used at this time? Condoms are employed at various stages of sexual
intercourse and during different kinds of sexual acts. For example, the male partner may
penetrate his partner without the condom at the onset of penile-vaginal intercourse, but
then decide to put a condom on during mid-session, or he may use a condom for vaginal
intercourse or anal sex, but not one for oral sex. It seems that this level of detail
regarding his sexual encounters was not revealed to her.

In addition, Cheating and Perception of Relationships as being Insignificant seem

to correlate with the construct of trust. In other words, the degree of trust established in

the relationship seems to be correlated with when or if the topic of HIV/AIDS occurs. In

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one instance, “one-night stands” that evoke meaningless, emotionally detached sexual
encounters is not a sufficient motivation to initiate a discussion that is emotionally-laden
and content-loaded like HIV/AIDS. In another instance, however, once the relationship
has been established in the context of monogamy, the idea of infidelity ignites
conversations centering on topics including STDS, getting tested, and HIV/AIDS.
Essentially, communication patterns among this sample of female participants are more
complex than expected, suggesting that more in-depth studies that focus on the concept of
trust and HIV/AIDS are needed in order to ascertain the art of communication in these
target populations.

Three themes were identified for the motivation to increase communication with
partners: (1) Forums that are Dialogue-Oriented, Personal, and Candid, (2) the Need to
Increase Feelings of Comfort and Safety, and (3) a Personalized Scare Tactics. These
themes, at first glance, seem contradictory, but on further examination, these themes give
a more complex response about the ways to increase communication skills. The
seemingly competing themes between Personalized Scare Tactics and the Need to
Increase Feelings of Comfort and Safety are comprised of a fundamental emotion of fear
that is going in diametrically opposing directions and is highly integrated in these
participants’ perceptions and experiences. Interestingly, extant research on anxiety and
performance show that moderate levels of anxiety are needed to attain optimal
performance. Could the same principle be applied to generating meaningful messages
that have a greater utilitarian impact on communities at risk of infection? Could the
messages have a component of content that elicits fear, such as, HIV does lead to death,

but yet also include it with a sense of hope that prevention is the key to preventing death?

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Furthermore, when delivering these messages, the participants are informing the research
communities of the need to be honest and candid in the delivery of knowledge. Lastly, an
important research implication based on this study is in the area of assessing and
determining what types of HIV/AIDS-related messages produce fear and to what extent.
Messages that evoke moderate levels of anxiety can then be added to the prevention
campaigns.

Bertrand, O’Reilly, Denison, Anhang, and Sweat (2006) recognized that there is a
call for more evidence-based communication programs as it is at the heart of the
HIV/AIDS response. Though there are extensive studies on parent-child communication
(Bertrand et al., 2006; Durant, Wolfson, LaFrance, Balkrishnan, & Altman, 2006; Fasula
& Miller, 2006), there is a lack on the studies about the ways adolescents communicate
with each other about safe sex practices, including methods and reasons to prevent STDS,
including HIV. Three participants, in particular, described ways they address sensitive
sex-related topics with their partners, and perhaps can be applied to communication-skill
building programs in practicing safer sex. Poet explained her approach in addressing her
STD status to prospective partners by using a “screening” technique.

Poet: “It’s uncomfortable for me as a person that has herpes, especially, if

I haven’t told the person yet. If we are sitting there and were watching
TV and we’re cuddling and this woman comes rowing a boat and
talking about, ‘Before Valtrex, my herpes just took over my life. Now
it’s not such a big deal.’ That is some bullshit. It is still a big deal
even with the Valtrex. That is still some ‘88.” There’s no
lighthearted way to deal with it. Usually the way that I do it is, I talk
to the person and say, ‘Hey, you say you like me and you know all this
stuff. Think about this. This is a really great question. Don’t give me
any silly little answers. If there was one thing, not one thing, but what
things could you find out about me that would make you say, in spite
of all your good qualities, 1 just can’t mess with you?’ And usually

they’ll say, “If you jealous or if you are a liar.” I say, ‘No, I’m not
talking about this. I’m talking about real world wide stuff like if I was

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a psycho, if I was abusive, if I was a habitual liar, if I like to set stuff
on fire, if I liked to steal from people, if I just went crazy, if I had an
STD, and I would bring something after that so I wouldn’t leave it at
that.’ I let them pick out those things and I don’t leave it at just the
way I said it, ‘If there’s anything you can think of along those lines
like if I like women or stuff like that. Real life stuff that people
actually do but you really don’t think that happens to people that you
know but they may happen behind closed doors because if you find out
about these things, how would you feel? Which of these things or
anything else that you can think of have you not thought of in spite of
all of the good things that you know about me?’ And if they say the
herpes, then I know where to go. I know that’s the way of me, kind of
doing, kind of like doing an interview without them knowing.”

La Chingona illustrated the use of a “truth and dare” approach, even
though she was less than truthful to her partner.

La Chingona: “I would play a lot of truth or dare with this third boyfriend
I’m with, and that was just one of the questions, but we played this
game before we got tested for STD’s so after that I never really told
him, afierl found out, we were already talking as friends, but we
hadn’t had sex, sol was really happy. Thank God we hadn’t had sex
before I got checked. Sol told him, ‘I’m gonna go get checked or
whatever,’ and I never told him the results, it just never came up, he
just knew I was tested.” [Investigator: “Do you think that truth and
dare, that kind of game is a good idea in terms of a way to find out
information about another person.”] Yeah, it is cuz we were really
honest about each other when we were playing that truth or dare. It
was not until after I got tested that I decided not to tell him, to keep it
to myself. Anyways I told my roommate, ‘ It’s none of his business
anyways,’ It’s not like I’m going to give it to him. I’m gonna cure it,
make sure that I’m fine, use condoms until everything’s fine, but yeah
that worked out real good, that truth or dare game. We asked so many
daring questions, it worked out real good.”

La Chingona’s admission that she refrained from informing her partner the truth of her
STD status is indicative of the lapse in corrrrnunication. Furthermore, the way the late-
adolescents believe that their level of communication immediately implies honesty is

erroneous, and certainly is not a sufficient measure of protection again HIV infection.

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Tinay candidly admitted that directly addressing sensitive topics, such as STD, is
often masked under a quip comments and sarcasm.

Tinay: “Actually I haven’t talked to any of them, maybe except for the

guy that was my boyfriend. We would make jokes about other people,

not joke about them, but you know like, ‘Oh that would never happen

to me,’ kind of pushing it off to the side, make light of the situation.

Basically not joke about it if we ever talked about it which was pretty

much rare. We don’t usually get into it that deep of a STD, but we’ll

talk about syphilis and all that type of stuff. Even with my friends, we

would joke. If my friend had a cold sore, we would joke, ‘Ahh, you

got syphilis.’ We just make jokes about STD’s, but we don’t talk that

much about it. I don’t ask anybody, ‘Do you have anything like

that?”
Though Tinay’s comments seem less than effective in communicating topics on STDs
and HIV/AIDS, she was, nonetheless, able to discuss it with her friends in the form of
humor. Humor can be implemented in communication-skill building programs as a
method of breaching a seemingly “uncomfortable, content-heavy,” topics.

The use of a “screening” approach to assess whether or not the partner is willing
to discuss STDs by employing a “truth or dare” technique that allows for an honest, yet
non-threatening, conversation to ensue, or integration of age-appropriate humor are
techniques that could be included in future programs that focus on communication skills-

building.

Utility of Evaluating HIV/AIDS Message

The purpose in evaluating past and present HIV/AIDS messages is to ascertain the
kinds of, and the extent of, messages understood from the past, and grasped in the
present, as well as to determine its effectiveness over time. The examination of these
messages will aid in deciding more appropriate and effective prevention campaigns
geared to the populations, specifically the African-American and Latina female

communities, that are disproportionately at-risk of HIV infection.

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The HIV/AIDS messages have shifted focus in the past two decades. According
to Bertrand et at. (2006), previous efforts using mass media focused on increasing HIV-
awareness, modes of transmission, and means of prevention. Yet, another study cited
that these early prevention efforts that used knowledge-based sexuality education were
found to have little impact on adolescent sexual behaviors (Durant, Wolfson, LaFrance,
Balkrishnan, Pharrn, & Altman, 2006). In this sample, Promotion of Condom Use, has
been a continued theme, which five Afiican-American and five Latina females, while
only two African-American and six Latina females, mentioned this theme as a past and a
present HIV/AIDS message, respectively. A significant change is that there was no
discussion of Familiar Past Messages that emphasized HIV being a “gay, IV-drug
disease " as a present message. The participants’ perceptions are consistent with the
evaluation of early intervention and prevention efforts, which focused almost exclusively
on white gay men and injection use (Prather, Fuller, King, Brown, Moering, Little, &
Phillips, 2006).

Another significant shift in the types of messages is in the area of the fatality of
HIV. Six respondents asserted that HIV will, eventually, lead to death as a past
HIV/AIDS message, while five explained that being HIV-infected led to confusing
results in that mortality and quality of life were dependent on socioeconomic status and
access to health care. Promotion of abstinence and concerns of pregnancy were issues of
the past, but have less weight in the present day and age. Topics, Getting Tested and
Infidelity, were in the context of present HIV/AIDS message, but not in respect to the

past

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Upon evaluating the efficaciousness of HIV/AIDS messages over time, 47% of
the total number of participants reported that the HIV/AIDS Messages Increased in
Prevalence and in Relevance, but specific mention of HIV, as being relevant to the
targeted population, was discussed by only one Latina female participant, Butterfly, as
evident in the following excerpt:

Butterfly: “Yeah, they are very different. I think that they affect those

kind of messages affect you more when you know that it’s within your
community. If there’s things that you know that relate to your
community, I guess that’s because that article was on a Latina women,
who was married. I guess that’s why it affected me more because you
know, it was someone that was from my community, from my
background, from my cultural values.”
The other participants discussed how the messages occur with greater frequency and
convey that “everybody can get it.” Yet, there were more Latina females (16%),
compared to their African-American counterparts (l 1%), asserting that there was no
difference, while additional 1 1% of the total number of participants reported that there
was a decline in the effectiveness from past to present HIV/AIDS messages. Spirit, for
example, explained that the prevention efforts focused on the perception that those who
are HIV-infected are able to “live” with the disease, thereby implying a precedence of
complacency has been set in practicing safe sex.
Spirit: “And then look at some of the messages that they say now. It kind of
seems like you don’t even, I don’t even, think about it as much as I used
to.”
In total, approximately 36% of the sample explicitly stated that the effectiveness
of HIV/AIDS messages across time had little to no positive effect. The results from this

study were reiterated by Fasula and Miller (2006) who concluded from a meta-analysis of

intervention evaluations that current programs are often ineffective in encouraging

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adolescents to delay intercourse. Koenig and Clark (2004) argued that the general
population, at large, does not respond to prevention messages. They further asserted that
prevention messages and programs that emphasize standard communication and condom
skills-building interventions are less effective for those who have a history of child sexual
abuse (CSA). This begs the following question: What types of interventions or messages
would have a more meaningful impact on the attitudes and behaviors of populations at
risk of HIV-infection?

The next research topic for this study identified themes obtained from the
participants’ perceptions on ways they feel would have greater practical and functional
messages to increase consistent condom use and HIV-awareness. Overall, the themes
appeared similar, but the degree of emphasis varied, among the two racial/ethnic groups.
Approximately half of the total number of participants (53%) advocated for more
messages focusing on various issues surrounding Condom Use, but more Latina (37%)
compared to the African-American (16%) females placed emphasis on this issue. The
results suggested that the topic on condoms needed to be addressed in future prevention
messages. Both racial/ethnic groups, however, promoted increased access to free
condoms need to be part of prevention campaigns in both colleges and high school
settings. Another concern associated with condom use is the social stigma in purchasing
condoms and the physical aspects of condom use (e.g., irritation or the correct size of
condom). Prevention campaigns, therefore, need to incorporate the implicit problems
associated with access to, and the use of, condoms.

Another theme, Direct, F act-Based, and Honest HI V/AIDS Messages, were

mentioned by approximately half of the total number of participants (53%), an aggregate

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of 32% of the Latina and 21% of the African-American females. Several respondents
demanded that there is a need for more “in your face” messages that do not “sugar coat”
the long-term consequences of being HIV-infected, and be more explicit in detailing the
biological mechanism in the transmission of the virus and in the physiological impact on
the body (e.g., various forms of sex acts and how the virus transmitted). Furthermore, the
messages need to be more relevant to the populations at risk, which was echoed by many
of the participants. Bertrand et al., (2006) recognized that the mass media campaigns to
date have primarily focused on members of the general public, but not on other high-risk
populations. An implication drawn from the results of this study, as well as the literature,
is that prevention messages need to consider televising—in documentaries, public service
announcements, daytime talks shows (e.g., El Show de Christina, The Tyra Banks Show,
or The Opera Winfrey Show) that cater to specific ethnic groups (e.g., Black
Entertainment Television and Spanish-language television), evening news specials (e.g.,
20/20 and Dateline)—young females of African-American and Latino/Hispanic/Chicano
heritage who appear healthy, yet contend with the social, medical, and psychological
complications of being HIV-infected. Essentially, these images of young women
diagnosed with the virus must be visually present in various forms of mass media on a
continual basis, not just merely for a “one-night” television special. This specific
prevention campaign would effectively attend to the needs of the populations, specifically
late-adolescent African-American and Latina females.

Empowerment was an equally important theme that was mentioned by 47% of the
total number of participants. Furthermore, both racial/ethnic groups equally resonated

with this theme with an emphasis on the following areas: (1) the approval need not come

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from external sources, such as their female peers or male sex partners; (2) women should
not be faced with the double standard of carrying a condom, where they are perceived as
“sluts” or “whores;” (3) women of all ages have the intrinsic right to speak up when
sensing discomfort as in the case of Tinay or to ask questions without judgment; and ( 4)
young females must be more future-oriented with regard to their personal, vocational, and
educational goals, which will help them deliberate over the long consequences connected
with their impulsive behaviors. Generally, there is a call for HIV/AIDS prevention
campaigns to convey a clear message as Morning Star succinctly stated, “We care, you
deserve to live, you should care too.” An intrinsic assumption is that both intervention
and prevention efforts should incorporate self-esteem enhancement programs, but
empirical studies suggest otherwise.

Several studies have focused on understanding the relationship between self-
esteem and risky sexual behaviors among adolescents (Biro, Striegel-Moore, Franko,
Padgett, & Bean, 2006; Ethier, Kershaw, Lewis, Milan, Niccolai, & Ickovics, 2006;
Goodson, Buhi, & Dunsmore, 2006; and Upadhyay & Hindin, 2006). A common belief
is that self-esteem has been related to a host of sexuality-related factors (Goodson et al.,
2006). With regard to cultural variance, Biro et al., (2006) showed self-esteem in the
area of physical appearance declined by the age of 11 among Caucasian girls, but
stabilized at the age of nine through fourteen among African—American girls. Yet, there
seems to be contradictory evidence in the empirical association between psychological
factors (i.e., self-esteem, depression, stress, and anxiety) and sexual risk among
adolescents (Goodson et al., 2006). The study conducted by Goodson et al. (2006)

canvassed 38 studies that examined the relationship between self-esteem and adolescents’

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sexual behaviors, attitudes, and intentions. They found that self-esteem did not serve a
protective effect for various risky behaviors, which they attributed to inconsistent
operationalization and measurement of the self-esteem construct. Ethier et al. (2006)
concluded from their study that adolescent females with lower self-esteem are more
likely to have unprotected sex, while the same sample who reported as being emotionally
distressed are more likely to have more multiple partners. They concluded that there is a
significant relationship between self-esteem and unprotected sex risk behavior.
Irrespective of the research findings, a recommendation not to place a high premium in
incorporating self-esteem in the intervention and prevention programs were noted,
especially since there is a gamut of other psychological factors to consider (Ethier et al.,
2006; Goodson et al., 2006).

In reviewing the results of this study and the literature on self-esteem and risky
sexual behaviors among adolescents, instilling empowerment does not necessarily
correspond to having low self-esteem. They seem to be two different constructs that are
worth empirically investigating. Is the type of content associated with Empowerment
described by these participants similar to the wide-variety of measures attempting to tap
into the self-esteem construct? Irrespective of the future outcomes on such prospective
studies, these participants are clearly imparting a clear message that they need to feel
comfortable and empowered to voice their thoughts and concerns, to seek approval
internally, and be encouraged to contend thoughtfully with their long-term educational
and vocational aspirations.

Another theme, Getting Tested, seemed to garner extensive attention from this

sample, but little in the research community. Of the eight participants, five Latinas

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compared to three African-American females, addressed a range of issues underlying the
theme, Getting Tested. Specifically, both racial/ethnic groups explained that more
information is needed to address several areas, including the promotion of, normalization
of, and ways of getting tested. Health-related, medical-based tests geared for women
should be discussed in the health-education programs at an early age, as early as
elementary and middle school. The demystification of the assumptions underlying the
concept of getting testing needs to be clear and accurate. The fact is that gynecological
exams do not include all STD tests, or having blood drawn does not automatically screen
for STDs. Finally, a thoughtful message should also address infidelity and other potential
risks involved after obtaining the presumably negative results from the HIV-test.
Specifically, sexual or drug-related behaviors that place those at risk for infection is a
seemingly apparent issue once being tested, but it seems it is less apparent among this
sample of participants.
Conceptualization of the Themes: The Big Picture

The plethora of themes garnered from the following major areas of this study is
analogous to the pieces of a jigsaw puzzle. Curiosity intrinsically asks the next level of
inquiry: what big picture will emerge from the jigsaw pieces, that is, from the themes?
Figure 1 illustrates the configuration of the key themes in explaining how the
participants’ need for validation and acceptance is the primary root, which moves them to
engage in a variety of sexually risky behaviors. This primal need intrapsychically
triggers two cognitive-oriented defense mechanisms: 1) the trust mechanism in which the
individual will instill trust in several behavioral and cognitive domains, including

“getting tested”, being in a mutually-exclusive relationship, believing the partner’s

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disclosure of his sex history, and remaining monogamous, while relinquishing control of
one’s body and behaviors; and 2) the disconnect mechanism in which the individual
experiences disconnect between her emotional need to be validated and her internalized
familial values which are culturally-situated in a larger systemic sphere. There is also a
disconnect from the long-term consequences of her sexually risky behaviors and her
future outlook. This disconnect then activates impulsivity in the individual, which
accounts for such phenomena, including it “Just-Kind-of-Happened” when describing
how these participants engaged in a sexual encounter, and lack of condom availability
and the “Spur-of-the-Moment” to explain why these participants did not use a condom.
The need for validation essentially is the root that branches into the two limbs, or
cognitive defenses, and then into smaller branches, which is the analogy of various
sexually risky behaviors. These cognitive—oriented defense mechanisms serve to manage
discomforting feelings of anxiety, shame, and embarrassment, especially when the
individual’s primal need for validation and acceptance triumphs over external messages,

for example, to practice safe sex.

184

Figure l

Conceptualization of the Themes: The Primal Motive and Its Eflect

 

  

Infidelity Unprotected Sexual Encounter

Mutually-Exclusive
Relationship

Getting Tested

 
   
 
 

Partner’s Sexual History

  

Sex: “Just-Kind-
of-Happened”

   

Lack of Condom Availability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Impulsivity
L Trust j Disconnect between
No Condom: learned societal
“Spur-of-the- values and
Moment” physical/emotional
k needs j

 

 

 

The Root:
Need for Validation and Acceptance

 

 

 

185

In the Review of the Literature chapter, existing theoretical models, such as the
Theory of Planned Behavior and the Information-Motivation-Behavioral Skills Model,
were under assault primarily because they failed to account for the social and
environmental factors that impact young women’s lives and safety (Wingood &
DiClemente, 2000), while mainly attending to the cognitive-oriented, individually-driven,
and intrapsychic influences, such as the construct of self-efficacy. Ironically, the
conceptual figure derived from the data analysis of the females’ experiences and
perceptions in this study ostensibly aligns with cognitive-oriented, intrapsychic
framework, the very concepts that were under attack. However, upon greater scrutiny,
the intrapsychic and cognitive forces are not the same when comparing the models of the
past and with the present figure. In fact, the concept of self-efficacy is irrelevant in the
present model and instead addresses more salient concerns for these participants, which is
the their need for validation, ability to trust in others, and mechanism to detach
emotionally from her social environment, her long-term goals, and from the
consequences associated with risky sexual behaviors. The concepts that make up the
“intrapsychic” forces and “cognitive” mechanisms are conceptually different and may
better able to account for the wide variety of complex and intersecting antecedent factors
of sexually risky behaviors among adolescents, but also explicates the rationale and
motives for late-adolescent African-American and Latina females to place themselves at
risk of infection.

Furthermore, this conceptual model has been proposed to complement the Theory
of Gender and Power. Figure 1, for example, focuses on the intrapsychic forces that

operate within the individual and in relation with others, while the Theory of Gender and

186

Power account for the environmental context in how the cognitive and emotional
mechanisms operate within the individual as well as in the behavioral and interpersonal
domains (e.g., getting tested, being in a mutually-exclusive relationship). The Theory of
Gender and Power primarily focuses on the gender inequality manifesting itself in power
imbalances, and it consequently may affect women's ability to navigate through social
and sexual environments. The theme, External Pressures and Threats, experienced by
this sample of female adolescents as their explanation to engaging in often unwanted
sexual activity is a critical example that can be part of the Theory of Gender and Power.
Prather et al. (2006) summarizes the Theory of Gender and Power by illustrating the
construct of imbalance and how it can account for a woman's willingness to adopt and
maintain sexual risk reduction strategies within heterosexual relationships as it pertains to
her perception of power, her commitment to the relationship, and her role in the
relationship.

As previously cited, the extant literature on HIV/AIDS among adolescents and
minority women indicated a need for more gender-appropriate, age-specific, and
culturally-relevant HIV/AIDS prevention programs that have greater utilitarian impact on
such communities that are at high risk of HIV-infection. Practical implications that will
support in spearheading a more effective HIV/AIDS prevention program ensue in the
following section.

Practical Implications: New and Improved HIV/AIDS Prevention Campaign

To tackle the “What, When, and How” questions regarding HIV/AIDS prevention
programs, this section will identify the “what” of the messages by listing several new

content domains that should be considered, the “when” of the messages by addressing at

187

what grade level relevant information should be discussed, and the “how” of the
messages by explaining better ways of delivering the information. Concentrating on
these critical questions will create meaningful prevention messages that hopefully will
translate into positive behavioral changes.
”What ” of the Message: Content

Knowledge, alone, does not necessarily translate into safer behaviors as evidenced
by the majority of the respondents who had the knowledge of the various modes of HIV
transmission, and yet did not practice safe sex consistently. Furthermore, each one of
them has placed themselves at risk of a STD at some point in their sexual history. In
addition, approximately 37% of the total number of participants in this study stated that
HIV/AIDS prevention messages had little to no positive effect. Though inaccurate
perceptions of blood transfusion as a common mode of HIV-transmission may linger in
the minds of these participants, more current and accurate information on the modes of
transmission is needed by directly addressing that blood transfusion is no longer a threat
of transmission. The message needs to place greater emphasis on the fact that
heterosexual contact, especially among women and adolescents, is the primary means of
HIV transmission. Identifying and discussing discrete sexual acts (e.g., cunnilingus,
fellatio, and anal sex), another content area, needs to be addressed as studies show that
condoms are used inconsistently and during different sexual behaviors. As previously
stated in the literature review and in this study, condoms are used with less frequency
during oral sex than penile-vaginal penetration and anal sex. Cultural values regarding
sexual practices need to be incorporated when talking about the noncoital sexual

behaviors, as it may have negative connotations in the Latino culture.

188

The majority of the participants, even those who reported being sexually involved
with fewer than four partners, fell victim to engaging in sexual encounters under the
guise of the “Just-Kind-of-Happened,” phenomenon. In addition, being in the “Spur-of-
the-Moment ” and lack of condom availability were the participants’ explanation for not
using a condom during a sexual encounter. Underpinning these themes is the construct
impulsivity, which in turn, is triggered by the activation of disconnecting between their
emotional needs and family values that are situated in a culturally systemic set of norms
and that have been learned over time. Practical implications suggest that HIV/AIDS
prevention efforts need to impart a clear message that female adolescents need to be more
insightful and future-oriented about their vocational, educational, and personal goals.

Being in a mutually-exclusive relationship, getting tested, implicitly believing in
knowing the partner’s sexual history, and questioning the fidelity of a relationship are
subsumed under a broader category, Trust, whereby the participants entrust themselves
into these specific cognitive and behavioral domains while relinquishing personal control.
Greatly needed are future prevention campaigns that create skill-building programs that
focus on ways to increase more accurate levels of trust in a sex partner and on better
methods of appraising their own reasons for entrusting themselves to others.

Prevention efforts need place greater emphasis on the psychosocial construct of
Getting Tested. Sex-based curriculum must increase awareness in the following areas: 1)
demystifying the assumptions underlying Getting Tested, 2) obtaining medical facts
about each of the tests taken during an annual gynecological exam; 3) learning about
logistical aspects of getting tested such as accessing free HIV tests; 4) overcoming fears

and anxiety associated with getting tested; and 5) communicating to the partners the

189

results of the tests. Prevention programs, for instance, could include role-modeling ways
to discuss the topic of getting tested with friends and with sex partners, or promote
getting tested as a couple-oriented activity, in hopes of placating fears and anxieties of
getting tested. Lastly, prevention programs must convey a clear, yet succinct, message
that getting tested is not indicative of lacking trust in the relationship, and instead, can be
associated with a more neutral concept of being health conscious.

Lastly, the participants collectively stated that there is an urgency to address
topics associated with condoms: l) accessing, addressing the social stigma of purchasing,
and using condoms; and 2) increasing messages of empowerment for women and young
females by having them feel safe in speaking up, by not having a double standard in
carrying condoms, and by asking questions without the fear of being judged. Their
suggestions are congruent with the observations made by the researchers in that the
content, or the “what” of the prevention programs, must center on critical areas including
1) accurate and current information about transmission of HIV; 2) empowerment
messages that help them to be more future—oriented and to instill less trust in others while
having more trust in themselves; and 3) relevant topics associated with getting tested and
with accessing and using condoms.

“ When ” of the Message: Grade Level

Given that approximately half of the adolescents by the age of 14 engage in
penile-vaginal intercourse, sex-curricular programs directors and parents, alike, must
consider disseminating critical topics (e.g., the complex nature of sexual behaviors and
feelings, condom use, and HIV testing) as early as fourth grade and for each subsequent

year thereafter that is grade-appropriate. Essentially frank discussions offered by both

190

the public school systems and parents on socially-sensitive topics are one of the avenues
to halting the spread of HIV.
“How " of the Message: Ways to Deliver Relevant Information on HIV/AIDS

According to the participants, needing more “in your face” messages that do not
“sugar coat” the impact of the disease is needed in future prevention campaigns. They are
asserting that there are insufficient levels of fear to motivate them to practice safer sex.
The results of the data analysis also suggested that programs need to teach adolescent
females how to communicate with their partners on obstacles associated with addressing
HIV-topics. Specifically, perceiving a sexual relationship as being insignificant impeded
these participants to initiate a “heavy-loaded topic.”

Prevention efforts also need to attend to helping young women managing their
anxieties associated with carrying, purchasing, and using condoms as well as negotiating
more effectively the ever-present external pressures, while seeking a greater sense of
internal validation. Literature shows that one of the sequelae of child sexual abuse is
dissociating. The dissociative process occurs during the actual sexual experience and
continues into their adult lives in various behavioral and cognitive arenas, such as when
information on HIV is being imparted. Prevention efforts need to take a closer look at
how facilitators can assess for dissociation and to implement Gestalt-like techniques that
help the female adolescents to stay in the here-n-now so that they are able to make more
thoughtful, informed decisions. Perhaps to capture the targeted audience’s attention more
effectively, programs might also incorporate a gender-appropriate, age-specific,
culturally-relevant lexicon of colloquial terms with which they can identify (e.g., The

Wooed-Effect, Spur—of-the-Moment, Just-Kind—of-Happened).

I91

Finally, HIV/AIDS prevention programs need to instill more interactive,
dialogue-oriented discussions that allow for increased communication between female
teens and their parents as well as with their sexual partners and peers. Two respondents
suggested the use of a “screening” approach or a “truth and dare” technique that allows
for the initiation of sensitive, heavy-loaded topics in a cautious and non-threatening
manner. In addition, sex-based education programs should consider including both the
parent and the child in an open discussion, where fears are first discussed. Parents, for
example, are given the opportunity to voice their concerns regarding the discussion of sex
as a fearful topic, while the young teen among his/her peers simply listens. Conversely,
the young teen voices her wishes in the kind of knowledge she want to hear from her
parents regarding sex and information about sex-related topics. This open dialogue will
breakdown communication barriers as well as address many of the myths associated with

sex practices.

192

Limitations

Considering the limitations of a study is necessary. This research project is not
impervious to the assertions made by Gelso and F eltz (2001) in that no one study is
without its flaws. Employing a qualitative-based research design has three significant
limitations, one of which is the reliance on a demographically-narrowed, non-
representative, small sample size. Inherent in recruiting a small sample is the lack of
generalizabilty to the population being targeted. Another limitation is the difficulty in
replicating the results given that there is no set standard in analyzing the data. Also, the
wealth of data in several domains (e.g., HIV knowledge, sexual practices, condom use,
and HIV/AIDS messages) in an already complex, intricate subject matter (HIV/AIDS
epidemic) makes replication of the results a strenuous and time-consuming task. A third
limitation is the research-bias effect. This study relied solely on one researcher who was
fully immersed in the data and consequently could have fallen victim to biasing the data.
Though these limitations may have attenuated the merits of this study, this project at the
onset clearly indicated that its primary purpose was exploratory in nature in hopes of
providing a more fruitful direction in the application of HIV/AIDS prevention campaigns
and innovative research directions. In light of the limitations and the data reviewed, the
ensuing section details the direction of future research implications.

Future Research Implications: Where to Next?

There are approximately five research avenues that warrant further investigation.
The first is differentiating the term sex into discrete sexual acts (i.e., cunnilingus, fellatio,
and anal sex) in future research studies on HIV/AIDS and sexually risky behavior, given

that condom use may vary from one act to another. For example, this sample alone

193

illustrated that 67% of the those who did practice anal sex did not use a condom, while
89% of the those who engaged in oral sex did not use a condom and 100% of the sample
who engaged in penile-vaginal intercourse did not use a condom. Research may profit
from investigating into the reasons, as they may fluctuate, in deciding when to use a
condom during different sexual acts (Prinstein et al., 2003; Cornell & Halpem-Felscher,
2005). The data derived from this intricate level of inquiry would create more relevant
and practical prevention efforts.

The second recommendation focuses on ascertaining future participant’s child
sexual abuse (CSA) statuses as there is sufficient evidence in the correlation between
CSA and adult sequelae, specifically in having an increased number of sexual partners.
More research is needed in identifying women who have experienced CSA and how it
may have impacted their outlook, attitude, and behaviors regarding their sexual practices
and their sexual identity.

Another related future research topic is based on the conceptualization of the
themes (see Figure l) and the two cognitive-oriented defense mechanisms, disconnect
and trust, which serve to manage the individual’s feelings of anxiety. The themes of
dissociation and trust may speak to the literature on internal attributions and locus of
control constructs. Can these multifaceted cognitive processes intersect and moderate in
a way that may explain for the justification and rationalization of engaging in sexually
risky behavior among adolescents females? More specifically, is there a relationship
between external locus of control and risky sexual behavior? Could these findings help
create more effective prevention in gearing the prevention campaigns to assist the

disenfranchised and marginalized women to seek more internal locus of control?

194

Furthermore, these cognitive defense mechanisms may help account for approximately
half of the respondents in this sample who were unable to identify at a personal and
emotional level with the HIV/AIDS epidemic. Could these cognitive defenses be
employed as a means to dissociate themselves from the possibility of being HIV-
infected?

The fourth research topic continues in the area of trust. The construct of trust is a
learned behavior that seems to be passed from parent to child. In this sample, there is
evidence, based on this study, that traditional Latino families, where male-dominating
figures that place emphasis on compliance teach their children to intrinsically trust men.
Could this intrinsic tendency to trust men be translated into their sexual relationships,
where they are encouraged not to ask questions and simply comply? Cross-cultural
studies among various racial/ethnic groups that come from a wide range of parenting
styles may garner rich data in how compliance and trust are implicitly intertwined and
become manifested in risky sexual behaviors. Present research on the relationship
between self—esteem and associated behavioral problems are inconclusive. Perhaps the
underlying construct in explaining an adolescent’s behavior is not necessarily with
regards to self-esteem, but issues of the learned behavior of implicitly trusting older men.
This trust may account for the power and control issues in the female teen’s relationship
with her parents and in her sexual partners.

The fifth research recommendation is examining a potential relationship between
types of messages (e.g., One can live with AIDS versus one can die from AIDS) and the
degree of fear the messages elicit. Based on the data, participants suggested that there is

a need for more fear-enhanced messages to motivate them to discuss sensitive topics,

195

while simultaneously having a need to feel safe when addressing HIV/AIDS to the
prospective sexual partner. Given the conclusive results that moderate levels of anxiety
educe optimal performance, perhaps the same principle may be applied to ascertaining
the types of messages needed to evoke moderate levels of anxiety in order that positive
behavioral change (i.e., consistent condom use) ensues.

In summary, delving in the minds of African American and Latina late-adolescent
females was a complex journey in an already complex topic on HIV/AIDS prevention.
Creating and implementing more effective messages and recommending new avenues of
much needed research are equally complex. Though this study has contributed to the
body of HIV/AIDS prevention in providing concrete prevention messages and elucidating
the intricate, cognitive mechanisms that account for the reasons and behaviors of these
adolescents’ sexual behaviors, seemingly insurmountable obstacles continue to persist.
Behavioral change at the individual level, specifically having adolescents increase
consistent condom use, requires funding and intense levels of cooperation and
communication between and through several spheres including federally funded agencies,
policy-makers at both the state and the local levels, sex and health curriculum
committees, communities, parents, peers, and the individual. Tenacity, education,
collaboration, and funding at all levels are necessary components to halt the spread of

HIV/AIDS.

196

APPENDICES

197

APPENDIX A

F LYER

198

 

DID YOU KNOW? ]
I Heterosexuals who are between the ages of 15 and 24 are MOST AT RISK for
contracting HIV/AIDS infection
I Among 20- to 24-year-olds there were 19,997 AIDS cases and 11,818 others known
to be HIV-positive, most of whom probably contracted HIV as teenagers

 

I African-American adolescents are at a vastly disproportionate risk, as they currently
account for 37% of persons diagnosed with AIDS between the ages of 13 and 29
years

I AIDS incidence in 2000 for Latino people was 22.5 out of 100,000 people, a figure
that is approximately three times the rate for Caucasian people (i.e., 6.6/100,000)

I HIV is more likely to be transmitted from men to women than from women to men

 

[ll/HAT CAN WE DO ABOUT THIS EPIDEMIC? I
We are interested in finding more culturally appropriate and gender-specific prevention
campaigns against the spread of HIV/AIDS. Exploring your perceptions and
understanding on HIV/AIDS-related topics will guide us in creating a more relevant
prevention message uniquely geared toward African-American and Latino female late-
adolescents. Hence, you are invited to take part in this innovative research study to
explore your perceptions on several related topics concerning HIV/AIDS: meaning of
sex, protection against HIV/AIDS (e.g., use of condoms), communication barriers to
condom use, and your thoughts on existing HIV/AIDS prevention messages. The semi-
structure interview will be in a one-on-one, face-to-face setting.

 

 

 

[ WHO CAN PARTICIPATE & WHAT’S INVOLVED? J

I If you are:
/ African-American/Black or Hispanic/Latino/Chicana
/ Female
\/ Ages: 18—22
/ Heterosexual
You are eligible to participate in this project

I You will be asked a set of open-ended questions about your health, HIV testing, sex
practices, communication barriers to condom use, and your thoughts on existing
HIV/AIDS prevention messages. The interview will take about 90-120 minutes. The
interview will take place (time and location) that is convenient to you.

I Participants will be given $15.00 as a form of gratitude

I Privacy and confidentiality are insured.

 

 

 

[wrro TO CONTACT? ]
If you are interested in participating and/or inquiring more about this project please feel
free to contact me. Callie Bair, M.A., LLPC at baircall@msu.edu orl517-282-4297]

 

 

 

199

APPENDIX B
SCRIPT

200

SCRIPT

 

Untroduction and Purpose of the Study

 

Hi, my name is Callie Bair, and I’m a fourth year doctoral candidate in the Counseling
Psychology program.

You have been invited to participate in this research project that will explore YOUR
perceptions and YOUR experience on several topics related to HIV/AIDS

HIV/AIDS knowledge, Needs, and perceptions
Terms and Definitions to Sexual Behaviors, Safer Sex, and Barriers to safer sex

Communication Patterns with sex partner
HIV/AIDS messages

We are interested in finding more culturally appropriate and gender-specific prevention
campaigns against the spread of HIV/AIDS.

Exploring your perceptions on your understanding on HIV/AIDS-related topics will
guide us in creating a more relevant prevention message uniquely geared toward African-
American and Latino female late-adolescents. Do you have any questions so far?

 

] Protocol of the actual Interview:

 

This is a semi-structured interview that will consist of me asking you a series of open-
ended questions. You will then answer each of the questions accordingly to your own
understanding and personal experience.

I want to remind you that there are no RIGHT or WRONG answers.

In addition, some of the questions are personal in nature, but you are highly encouraged
to answer to the best of your ability.

However, you are free to reframe from answering any question that causes you
discomfort.

The interview should take up to 1-2 hours of your time and afterward you will be
provided $15.00 as a way to express our gratitude for your participation.

Please take the time to read the informed consent so that you will know your rights as a
research participant. (I will go through the consent form with each participant and
emphasize the points of confidentiality component of the study. They will sign and date
it if they agree to participate). (After reading it, I will ask. . .).

Do you have any questions?

I will also need to ask the following questions to ensure that you meet the criteria of
research participant: Are you. . .?

I African-American/Black or Hispanic/Latina/Chicana
I Female

Ages: 18 - 22
Heterosexual
Let’s begin.

201

 

APPENDIX C
INFORMED CONSENT

202

INFORMED CONSENT FORM , .

A Qualitative Approach in Examining HIV/AIDS Prevention Messages among African-
American and Latino Late-Adolescent Females

Purpose and Background

You are invited to participate in this research study to explore your perceptions on several
related topics concerning HIV/AIDS: meaning of sex, protection against HIV/AIDS
(e.g., use of condoms), communication barriers to condom use, and your thoughts on
existing HIV/AIDS prevention messages.

Procedures
If you agree to be in this study, the following will occur:

a. You will be asked a set of open-ended questions about your health, HIV testing,
sex practices, communication barriers to condom use, and your thoughts on
existing HIV/AIDS prevention messages. There are no right or wrong responses
to the questions; we are interested in personal perceptions and opinions.

b. The interview will take about 1-2 hour(s).

c. The interview will be audiotaped. The tapes will be used to ensure that your
responses have been properly recorded. Tapes will be labeled with an ID number
only. Any names or identifying information you use will be omitted from all
written transcripts of the tapes. I can refuse to be taped without affecting your
participating in the study. You can also change your mind about the taping any
time.

You agree to be taped: Yes: No:

 

 

(1. Your study interview will take place (time and location) that is convenient to you.
e. At the end of the study, if you want to know, you will be told the results of the
study.

Risks/Discomforts
There are no known risks involved in participating in the interview. Nonetheless, you
might find that there are interview questions and discussions that may make you
uncomfortable or upset. There are several ways to deal with these discomfort feelings, if
it were to arise:
a. You may consider speaking with the interviewer who may be able to help with
your concerns.
b. You may consider speaking with a counselor about your reactions (e.g., you could
contact the MSU Counseling Center at 355-8270).
c. You are free to decline to answer any questions you do not wish to answer or to
stop the discussion at any time.

203

Benefits

Though there is no direct benefit from participating in this study, you may gain an
increased awareness of important issues for yourself. Furthermore, the information that
you provide may help service providers better understand how to meet the needs of
people impacted by HIV as well as to contribute the need for a culturally-relevant,
gender-specific HIV/AIDS prevention campaign.

Confidentiality

The confidentiality of your responses during the interview will be protected to the
maximum extent permissible under the law. The following precautions will be taken to
protect your confidentiality. No individual names will be used in any reports or
publications that may result from this study, and your name will not be on any of the
surveys or tapes. Instead, any responses you provide will only be associated with subject
identification numbers.

Participation

Your participation in this study is voluntary; you may decline to participate without
penalty. If you decide to participate, you may withdraw from the study at anytime
without penalty and without loss of benefits to which you are otherwise entitled. If you
withdraw from the study before data collection is completed, your data will be destroyed.

Compensation
In return for your time and effort for participating in this study you will receive $15.00.
You will be reimbursed at the end of the interview.

 

Contact

If you have questions at any time about the study or the procedures, (or you experience
adverse effects as a result of participating in this study) you may contact the principal
investigator, Callie J. Bair, M.A., LLPC, at baircall@msu.edu; at 517-355-8502. If you
have questions about your rights as a participant, contact the chairperson of the
University Committee on Research Involving Human Subjects (Dr. Ashir Kumar at 517-
355-2180, email: ucrihs@msu.edu), or by writing: Committee on Human Research, 202
Olds Hall, East Lansing, MI 48824-1046. The office hours are from 8:00 am. to 12:00
noon. and from 1:00 pm. to 5:00 pm, Monday through Friday. Please make sure that
you have all your questions answered before you sign this consent form.

Consent

If you have read the information and consider yourself to be fully informed about this
research study, please print and sign your name below indicating your agreement to
participate in this research on a purely voluntary basis. Please give the signed form to the
interviewer and keep the other copy of the consent form for your records.

Participant's name (print)
Participant's signature
Date

 

 

 

204

APPENDIX D

SEMI-STRUCTURED INTERVIEW: QUESTIONNAIRE

205

SEMI—STRUCTURED INTERVIEW and HIV/AIDS QUESTIONNAIRE

777 = Does not Apply
888 = Declines to Answer

999 = Doesn’t Know

ID Number:
Today’s
Date:
—Il_/Ionth— —Day— -_Yea7_

206

 

Interviewer: (Read Aloud): Let me start with some basic questions about your

understanding of HIV/AIDS. Please keep in mind that there are no right nor wrong

responses; the study rs looking at your perceptions. ,.. _

HIV/AIDS: KNOWLEDGE, NEEDS, AND PERCEPTIONS , ‘ . .

1. Tell me what you know about how HIV IS passed on from one person to the next
person.

:SEX: DEFINITION, SAFER SEX, AND BARRIERS . .
Interviewer: (Read Aloud): I’ m going to ask you questions and some will be hard to
answer because they are very personal, but I want you to know I’m doing this to help
women in this community and so HIV/AIDS won’t affect them.

1. What types of acts constitute “sex”? In other words, how would you define sex?

2. A. Where do you get your description of sex from?
[For example, are you thinking about things you read, things on TV, people you
know. . .?]

B. When did you begin learning about this?

3. Do you think that oral or anal sex is considered “sex”?
[Depending on the previous question, follow up with “how or what helped you to
define that?”]

4. When you meet a guy that you are interested in, when do you decide to have sex with
that him for the first time?

5. When you meet a guy that you are interested in, when do you decide not to have sex
with that him?

Interviewer: (Read Aloud): This next question will be personal but it is important to be
honest and remember this information will be kept confidential; e.g., no one will know
you shared this information with me.

6. The question is, Have you met a guy and had sex with him on the same day you met

him?
Yes__
No
If Yes: What led you to this decision?
7. What does “safe sex” mean to you?
8. When using these methods, what do you think you are protecting yourself from?

9. When do you not use these protective methods, specifically condoms?

10. If you ever had anal sex, how do you protect yourself?

207

11. A. If you were to perform oral sex on him, how would you protect yourself?

B. If he were to perform oral sex on you, how would you protect yourself?

Interviewer: (Read Aloud): Those were tough questions and we really appreciate your
honest responses. I know this study and your responses will help the women in your
community from getting hurt.

E'OWUNICATION WITH SEX PARTNER .
1. Tell me how you talk to your sexual partner about HIV/AIDS?

2. What needs to happen for you and your sexual partner to talk more about practicing
sexual partner?

HIV/AIDS MESSAGES 2
1. What kinds of messages did you hear, WHILE GROWING UP, related to HIV/AIDS
prevention?

2. How effective were these messages for you to practice “Safe Sex.”

3. What types of messages do you hear NOW about HIV/AIDS prevention? Are these
messages different from the ones you heard growing up?

4. What type of messages do you think will get you to use condoms on a more
consistent basis?

208

Interviewer: (Read Aloud): Before we begin this survey, please remember the answers
you give me will be confidential, and this paper does not have your name on it. Try to be
accurate as you can. What gender do you consider yourself to be?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female
Male
What race/ethnicity do you consider yourself?
No Yes Don’t Decline To
Know Answer
a. Hispanic or Latino 0 1 8 9
b. Black or African-American 0 1 8 9
c. Asian or Pacific Islander 0 1 8 9
d. Caucasian or European
American 0 1 8 9
e. Native Alaskan or Native
American 0 1 8 9
f. Other (specify) 0 l 8 9
Whatis _ __ __ __/____ _
your Date Month Day Year
of Birth
That makes you how old?
Currently __ __ Years old

What is the highest grade in school you completed?
Grade Use
Codes No Formal Education = 00

GED = 13
Some College or Associates Degree = 14
Graduated College/Bachelor’s Degree = 15
Beyond Bachelor’s degree
(some/completed Graduate school) = 16
Decline to Answer = 99

Interviewer: (Read Aloud): Next I’d like to ask you a few questions about sex. Please
think about all the people you had sex with in the past 12 months. In the last 12 months,
how many men have you had sex with?
Male Use None = 000
_ partners Codes Don’t Know = 888
Decline to Answer = 999

209

 

 

In the last 12 months, how many times did you have vaginal sex? [Interviewer: if
respondent has trouble estimating, probe for the average number times a week, and then
multiply by 52]
Times Use None = 000
Codes Don’t Know = 888
Decline to Answer = 999

In the last 12 months, how many times did you use a condom while having vaginal sex?
[Interviewer: if respondent has trouble estimating, probe for the average number times a
week, and then multiply by 52]
Times Use None = 000
Codes Don’t Know = 888
Decline to Answer = 999

In the last 12 months, how many times did you have anal sex? [Interviewer: if
respondent has trouble estimating, probe for the average number times a week, and then
multiply by 52]
Times Use None = 000
Codes Don’t Know = 888
Decline to Answer = 999

In the last 12 months, how many times did you use a condom while having anal sex?
[Interviewer: if respondent has trouble estimating, probe for the average number times a
week, and then multiply by 52]
Times Use None = 000
Codes Don’t Know = 888
Decline to Answer = 999

In the last 12 months, how many times did you have oral sex? [Interviewer: if respondent
has trouble estimating, probe for the average number times a week, and then multiply by
52]
Times Use None = 000
Codes Don’t Know = 888
Decline to Answer = 999

210

In the last 12 months, how many times did you use a condom while having oral sex?
[Interviewer: if respondent has trouble estimating, probe for the average number times a
week, and then multiply by 52]
Times Use None = 000
Codes Don’t Know = 888
_ _ _ Decline to Answer = 999
Interviewer: (Read Aloud): Next I’m going to ask you some questions about HIV
Testing. How many in your lifetime have you been tested for HIV?
[Interviewer: if respondent has trouble remembering, ask her to estimate]
Times Use Never = 00
Codes Don’t Know = 88
Decline to Answer = 99

When was your Most Recent HIV test?

 

Tested
In: _ _ _ __ _ _
Month Day Year
Not Applicable = 7 7/ 7 7/7 7
Use Codes Don’t Know = 88/88/88
Decline to Answer = 99/99/99

Did you receive your results for that most recent test?
__ No
_ Yes
__ Not Applicable
__ Declines to answer

Why didn’t you get your results?
[Interviewer: Avoid Reading list. Prompt as needed. Check all that apply]

_ ( 1) F ear/Don’t want to know Serostatus

_ (2) Difficult to access test site (issues of transportation/location of test site)
__ (3) Dislike or distrust testing site/providers .
_ (4) Hours Inconvenient a;
__ (5) Other competing concerns (e.g., food, housing, money, drugs)

__ (6) Don’t want to be seen at test site (stigma)

_ (7) No need (perceive little risk)

__ (8) Test results not ready yet

__ (9) Test provider did not disclose results (e.g., hospital or jail)

__ (10) Arrest

__ (l 1) Other (Specify)

_ (77) Not applicable

 

211

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