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Review
. 2020 Aug;49(6):1939-1964.
doi: 10.1007/s10508-019-01609-6. Epub 2020 Mar 10.

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Devin E Banks  1 , Devon J Hensel  2 , Tamika C B Zapolski  3
Affiliations
Review

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Devin E Banks et al. Arch Sex Behav. 2020 Aug.

Abstract

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Keywords: African American; HIV risk; Risky sexual behavior; STI; Youth.

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Conflict of interest statement

Disclosure Statement: The authors have no conflict of interest to disclose.

Figures

Fig 1.
Fig 1.
Selection of studies based on searches of three databases and inclusion/exclusion criteria.
Fig 2.
Fig 2.
Customized social ecological model of HIV/STI risk for heterosexual African American youth. Straight arrows represent downward effects of structural and individual factors to risk. Asterisks indicate a factor that is likely to differ by gender.
See this image and copyright information in PMC

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