title: Low prospects and high risk: structural determinants of health associated with sexual risk among young African American women residing in resource-poor communities in the south.
abstract: African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-37, Atlanta, GA, 30333, USA, jraiford@cdc.gov.
authors.forename: Jerris L
authors.initials: JL
authors.lastname: Raiford
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Herbst
authors.forename: Monique
authors.initials: M
authors.lastname: Carry
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Browne
authors.forename: Irene
authors.initials: I
authors.lastname: Doherty
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009657:North Carolina / Q000453:epidemiology; D011204:Poverty Areas; D012309:Risk-Taking; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult