“again, it’s abstinence until when?” unveiling meanings of sexual relationships and hiv risk...

“Again, it’s abstinence until when?” Unveiling Meanings of Sexual Relationships & HIV Risk in Young Black African Women Living in the USA

Presented by: Sithokozile Maposa (RN, PhD)www.usask.ca/nursing

BACKGROUND and Context o HIV rates in Africans six times more than the

general US population1

o Pre-immigration practices linked to HIV sexual risk:o Forced sexual intercourse2

o Sexual double standards3 overlookedo Increasing but separate literature on HIV risk and

abuse4 in Black women in the United States

Sithokozile Maposa 2April 2, 2014 Opportunities & Challenges for Women Empowerment Global Meeting

Sithokozile Maposa 3

STUDY AIMEvident in the preliminary analyses of narratives: Examine factors that either enhanced or undermined

the extent to which young Black African women participated in determining the outcomes of their sexual relationships.

April 2, 2014 Opportunities & Challenges for Women Empowerment Global Meeting

METHODOLOGYHeidegerian interpretive phenomenological approach5 as explicated by Benner6 accentuates: o Interpretations are situated in social practiceso Ways of coping are visible in everyday practicesThis approach brings out young Black African women’s cultural meanings and sexual practices




A purposive sample of English speaking:

o Young Black African women 20-25 yearso Annual Income ranged <$20, 000 to >$20,000o All participants had a high school educationo 2 to 10 years residing in the United States o Two had children, nine in dating throughout the study

SAMPLE Characteristics (N=12)

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Table 1: Data Collection Schedule Visit 1 Visit 2

4 -5 wks after Visit 1

Visit 34 - 7 wks after

Visit 2

Visit 44 - 5 wks after

Visit 3

Consent formEvaluation of consent form

Sexual History & Meaning Interview

Demographic form

Event History Calendar Coping with Sexual Relationships Interview

*Coping with Sexual Relationships

*Coping with Sexual RelationshipsSexual Risk Interview

*Women who were re-interviewed reported dating and/or sexual experiences since the previous interview. (were asked about meaningful and difficult sexual experiences in multiple interviews)

April 2, 2014 Opportunities & Challenges for Women Empowerment Global Meeting Sithokozile Maposa

Sexual Agency vs. Limited Sexual AgencySexual agency captures awareness of sexuality,ability to recognize one’s power in sexual situations7 o practical wisdom of HIV sexual risk an essential aspect

of sexual health and public health. o Gender and sexual agency seemed intertwinedo Figure 1 captures different levels of sexual agency

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Figure. 1: PATTERNS of Sexual Agency

Reality ChecksSusan, Dudu, Beauty

Missing DialoguePhilomena, Gloria, Jolene

Tradition of Self-silencingPatty, Sheila, Amina,

Lovejoy, Grace, Esther

April 2, 2014 Opportunities & Challenges for Women Empowerment Global Meeting Sithokozile Maposa

REALITY Checks: “The Scare of My Life”


Susan (graduate student, 25 years) learns from her scare:“I got my scare after I broke up with Larry for cheating, I

was freaking out, I thought I had AIDS. I lost weight, I knew something was wrong. I went to my doctor and said I want to know what I am dying from.”

“Again, it’s abstinence until when? It’s not always practical in committed relationships. Frankly, it discourages us from being honest or talking about these emotional issues. Sex is the one thing I don’t talk to my mother about.”

MISSING Dialogue vs. Pressure to become a wife


Philomena (supervisor, 25 years) says our elders fail us: “I started dating with trepidation: I learned never to trust

men, men are deceptive. Where I come from your world crumbles if you have a child out of wedlock.”

“I wanted a perfect men but I learned through our bad bad fights, precisely, Keith and I both have weaknesses. This is where our elders cheat us. I felt unprepared for the dating scene, we argued a lot. It was a huge learning curve for me.”

Traditions Silence: Lack of Skills in Relating to Men

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Patty (college student, 25 years, a history of rape): Concurs with pervasive practices: “Men roam, women wait.”Sense of disconnect, want others to express her feelings: “I

wish I had someone to convince him (to stop cheating) ... when its my own marriage I hope I will know what to do.”

Passivity: “I will put it in God’s hands, I ignore (videos of fiancé having sex with other women), and yet I know… I don’t want to shame my mother and remain unmarried.”

Non-disclosure of sensitive information: “I cannot tell ‘them’ (therapist) about rape, the soldiers destroyed my goals.”

IMPLICATIONS-Discussion


1. Cultural Implications• In-depth understanding cultural nuances stigmas

2. Gender and Public Health Implications• US cities prime areas, diverse cultural practices

3. Transition to the next life stage Implication• Challenges, pressures impervious to modification


CITED References1. Blanas D, Nichols K, Bekele M, Lugg A, Kerani R, Horowitz C. HIV/AIDS Among African-Born Residents in the

United States. Journal of Immigrant and Minority Health. 2012:1557-1912.2. Skinner J, Underwood C, Schwandt H, Magombo A. Transitions to adulthood: Examining the influence of

initiation rites on the HIV risk of adolescent girls in Mangochi and Thyolo districts of Malawi. AIDS Care. 2012/09/09 2012:1.

3. Maposa S. Practical understanding of HIV risk in young black African women living in the United States [Doctoral dissertation]: School of Nursing, Saint Louis University; 2010.

4. Colfax G, Rosenthal L. Addressing the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities. Washington, D. C.: Interagency Federal Working Group; 2013.

5. Heidegger M, Dahlstrom DO. Introduction to phenomenological research. Bloomington, Indiana: Indiana University Press; 2005.

6. Benner PE, Tanner CA, Chesla CA. Expertise in nursing practice : Caring, clinical judgment, and ethics. New York: Springer Pub. Co.; 1996.

7. Crown L, Roberts LJ. Against their will: Young women's nonagentic sexual experiences. Journal of Social and Personal Relationships. June 1, 2007 2007;24(3):385-405.

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“again, it’s abstinence until when?” unveiling meanings of sexual relationships and hiv risk...

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