Safer sex knowledge, behavior, and attitudes of inner-city women

Abstract

Sexual behavior, knowledge of HIV transmission and prevention, perceived risk of AIDS, and safer sex behavior were studied in a sample of 289 single, pregnant, inner-city women. African-American and European-American women were equally represented. Women had poor AIDS knowledge. Sexual behavior placed women at risk for HIV infection due to the lack of condom or spermicide use. Women did not perceive themselves at risk for the AIDS virus, although they did recognize that heterosexuals were at risk. Their lack of risk perception was partly based on their having a single sexual partner. They did not regard their partner's current or past behavior as placing them at risk. Recommendations for intervention and cultural differences were discussed.

PIP: In order to establish suitable prevention goals, a study was undertaken of low-income, inner-city US women to determine their sexual activity in the prior year, knowledge of HIV transmission, knowledge of HIV prevention, perceived risk of infection, and current safer sex behavior. 2 samples of pregnant, single women were recruited from an obstetrics clinic in a mid-sized city. Data were gathered from October 1990 to September 1991 on 280 women and were analyzed for the 44% White and 53% Black participants. Age ranged from 16 to 29 years, 12% were previously married, 19% lived with their current partner, 53% had children, 63% had a previous pregnancy, 39% had some high school, 37% completed high school, 23% had some post-high school experience. 67% had less than $10,000/year income. The 2 ethnic groups were similar in age, parity, previous pregnancy, level of education, and income. While more Whites were previously married or lived with their partner, this number was very small (21 and 37, respectively). The women were found to be sexually active during the prior year, with most having intercourse more than 3 times a month, and a large group having sex once a month or less. White women were more likely to participate in risky behavior (16.7% had anal sex, 28.7% had multiple partners, and 66% participated in fellatio). Knowledge of HIV transmission and prevention was poor, except that most women knew that abstinence and condoms were means to prevent HIV transfer. Most women, although knowledgeable about heterosexual risk, believed themselves at low or moderate risk as a result of their own behavior. Most of the women were concerned about AIDS and wanted to know more about it. It was found that the woman were not adopting safer sex behavior, although a significant group reported altering their behavior because of AIDS. Few women bought or intended to buy condoms or spermicides and their partners did not provide condoms. Most of the women sought monogamous relationships and almost all considered AIDS when choosing a partner, but most did not broach the subject of AIDS with their partner. An important implication for intervention in this population is the fact that most woman appeared to believe that their risk was low because they had one or few partners despite the fact that many were involved with men who had been in jail, used IV drugs, or had several sex partners. A first intervention step would be to emphasize the fallacy of believing that one's own monogamy kept risk low, but this intervention would ideally require the cooperation of both woman and their partners. Since access to partners is limited, women need to be empowered through the improvement of their negotiation skills. Possible limitations of the current study are its self-report nature, which may lead to presentation of what would be perceived as a socially acceptable message, its limited generalizability to nonpregnant women, and time as it relates to the progress of the epidemic. It was concluded that women are not sufficiently changing their sexual behavior to compensate for the ever-increasing risk accompanying the predicted rapid rise in infection among this population. Knowledge and safer sex behavior must increase to offset this trend.