The influence of father-son relationships on the situational context of HIV risk

among Black men

David J. MalebrancheEmory University Division of Medicine

HIV Prevention ConferenceAugust 15, 2011

DISCLOSURE STATEMENT

Speaker: David Malebranche

I have nothing to disclose.

Background

• HIV disproportionately affects Black men

• Psychological distress associated with high-risk sexual behavior

• Poor father-son relationships may cause psychological distress

• “Absentee father” narrative common when discussing Black men

• Few explorations of father-son relationships among Black men in context of HIV disparity

Study Details – Project Adofo

• R01 – National Institute of Nursing Research (NINR)

• Collaborators

– Lisa Bowleg - Drexel University

– Robert Agans/Bill Kalsbeek - University of North Carolina

– Matthew Hogben/ThurkaSangaramoorthy – CDC consultants

• Brandi Park – Project Coordinator

• Jeffery Roman – Senior Research Interviewer

• Bernard Owens – Research interviewer

• Leonard Moore – Research interviewer

• Alanna Stone – Research interviewer

Dedication – Dr. Robert Scott(1944 – 2009)

ADOFO = Ghanaian boy’s name meaning “one who loves” or “courageous warrior”

DEMOGRAPHIC FACTORS

Geography (MSA)Age

RISK PROTECTIVEBEHAVIOR

Consistent condom useRecent HIV testing

RISK PROMOTINGBEHAVIOR

Unprotected anal/vaginal sexMultiple sexual partners

MENTAL HEALTHDETERMINANTS

Perceived StressDepressionGender role conflict

SOCIAL FACTORSRacism experiencesSocioeconomic status

JOHN HENRYISM

COOL POSE

Figure 1. Proposed conceptual framework for HIV Protective and Promoting Behavior among Black Men

Objectives – Phase I

• Describe the social context of Black men’s lives residing in metropolitan and non-metropolitan areas in Georgia

• Explore reported structural influences on mental health and coping strategies among these men

• Identify how mental health (stress and depression) and other factors serve as facilitators of condom use

Methods

• Semi-structured qualitative interviews with 90 Black men in Georgia (30 in Atlanta/Columbus/Valdosta)

• Recruitment venues:– Community sites; Internet; Grady Hospital– Snowball sampling*

• Inclusion criteria:– Black male; Age 18-65; HIV negative/unknown

• $50 compensation• 4 Coders (> 85% agreement); Nvivo8 software• Sub-analysis of Atlanta sample (n = 30)

Descriptive stats – ATL cohortVariable Number (%)

AGE 44.4 (mean)

EDUCATIONDid not complete HSHS Diploma/GEDSome Higher EducationCollege DegreeTechnical school/Grad school

9(30)3(10)7(23)4(13)7(23)

SEXUAL ORIENTATIONHeterosexualHomosexual

28(93)2(7)

INCOME<$15000$15000-$30000>$3000No Response

23 (77)4 (13)2 (7)1 (3)

HIV TEST IN PAST YEAR? (n=23)YesNo

17 (74)6 (26)

Unprotected sex with female in past year (n=23) 13(57)

INTERVIEW GUIDE

• Domains:– Current life experiences

– Manhood expectations

– Life stressors and coping strategies

– Childhood experiences

– Healthcare utilization

– Condom use practices and HIV testing

• Emerging Father themes1. Trauma of father

absence

2. Disruptive presence of alcohol

3. Influence of incarceration

4. Full circle fatherhood

Poor or absent father-son relationships common*

Varying explanations:

1. Divorce/Separation

2. Illness/Death

3. Incarceration

4. “Left” mother

5. Custody/mother kept away

6. Father just “not there” for unknown reasons

* NOT ALL “DEADBEAT DADS”

Trauma of father absence

• “… I guess there was a longing to have him [biological father] tell somebody or say to me publicly, ‘You are my son.’ And so that went on and I had resentments against him most of my life.” Daniel, age 51

• “If my dad was around I wouldn’t have turned out the way I am now. I probably would have, who knows?” Jake, age 25

Perceived origin of negative life course

Trauma impact – seeking guidance

• “It’s stressful because when I was younger I made a lot of bad decisions because my father really wasn’t like all the way in my life like he’s supposed to be and it was just my mother raising two kids…She was strong enough to do it but …she couldn’t turn a boy into a man…it takes a man to raise a man, to show him things.”- Chris, age 29

• “[My father] left my momma when I was probably like 10 years old. So that’s how I ended up getting into the street. I can’t use that against him…but it did play a big part of me being out there because it was just too much stressbecause my momma she working and she got four kids; my brother always, before he got killed, he always been on the streets and making money on his own.” - Noah, age 30

Disruptive presence of alcohol

• “Slid my first shot of gin over to me and til this day I believe…I had a genetic predisposition for alcohol because my dad was an alcoholic…I took a little sip. It was like drinking a hot fire! He said, ‘Nah you got to throw it back.’ You know, I threw it back and boy I mean the feeling, the euphoria, I done had my first sexual experience and you know first drink with my dad, you know, I mean I was on Cloud Nine!” - Aiden, age 56

• “Sure he [father] was, he was abusive…whether it was mentally, physically, psychologically. An alcoholic in the family, man, can do nothing but tear it down…cause disruption.” - Cooper, age 50

Early exposure to alcohol and sex

Intersection with abuse

Disruptive presence of alcohol (cont’d)

• “My childhood I guess was normal for that time and that environment. Um, my dad is an alcoholic user… I guess society would say a weekend alcoholic. He went to work every day [laugh] we could hardly get two words out of him, but on the weekend he drank and raised plenty of hell, and uh, we consequently we caught the brunt of that…I was brought up, you know fearful, a lot of fear, and uh, with low self esteem.” – Sebastian, age 54

Influence on mental health

Influence of Incarceration

• “…At the time when I got home [my parents] were fighting and um one of the neighbors called the police so my dad went in jail and when he got out he never came back home and so from that time um I didn’t have a male figure in the home.” - Andrew, age 57

FULL CIRCLE FATHERHOOD

• “At first I said well I’ll never be like my father but consequently somehow I ended up being just like him, you know drinking and carrying on, acting out, you know I uh, never hit women or anything like that, but I wasn’t there for my kids, you know for a long time uh, I…verbally abused women that was in my life and…I wasn’t being a man, you know just wasn’t being a man.” -Sebastian, age 54

• “It affected me because it just makes me stronger because he wasn’t there in my life all of the time or when he needed to be so me being a father it makes me be there all of the time for everything. Every… every little thing; it don’t matter what it is, I’ll be there.” - Chris, age 29

LEARNING FROM FATHER’S MISTAKES

LIKE FATHER, LIKE SON

Fatherhood as HIV risk protective

• Interviewer: “What in your life makes you want to get tested for HIV?”

• “My kids…like for instance, my oldest son. When I was younger, we would play racket ball and we would play so hard; we’d look around and it would be like 50 people watching, you know, and I always thought to myself if I ever had any more kids, and now I do, that I’d want to do the same thing with my youngest kid.” – James, age 49

Encouraging HIV-testing

Conceptual Framework

Absent/Poor Father-son relationship

TraumaDepression

Anger/StressLow self-esteem

Alcohol/Sex exposure

Situational HIV Risk- “Streets”

- Incarceration- High HIV prevalence- Low condom access

HIV Risk behavior- Drugs/alcohol

- Multiple partners- Reduced condom use

FATHERHOOD

Limitations

• Convenience sampling

• Not generalizable– Small sample, older men

– All men living in South

– Half of ATL sample from Gateway Center

• No analysis of other racial/ethnic groups

• Only Atlanta analysis

Conclusions• Father-son relationships described as large influence

on participants’ lives

• Both quantity and quality of interactions important

– Absence as trauma

– Early exposure to alcohol/sex

– Few positive narratives

• Oversimplified depiction of “absentee Black fathers”

• Cyclical nature of father-son relationships

• High risk HIV situational contexts may emerge from absent or poor father-son relationships

Future Directions• Research

– Analysis of entire sample/comparison of ATL, COL & VAL

– Father/son relationship as variable in probability samples

– Facilitators of positive father son relationships

– More studies among Black MSM samples

• Interventions– Mental health to address father/son relationships

– Fatherhood interventions – FIP (Philadelphia)

– Manhood development initiatives

– Merging of fatherhood initiatives and HIV prevention programs

Acknowlegements

• The men who allowed us to interview them

• Columbus Wellness Center: Luella Rhodes

• The Boyz Salon Barbershop : Shannon Buckner

• Valdosta Department of Health: January Smith, MPH and Brenda Mims, RN

• Dixon Transcription Services

• Our Community Advisory Board

THANK YOU!