There is a high prevalence of HIV/AIDS in certain groups, such as prisoners and the African American community. Therefore, it is important to examine behavioral strategies which can reduce the transmission of HIV in these groups. In this study, we examined racial differences in interpersonal communication strategies to discuss HIV/AIDS. This is an important line of research given that previous findings have demonstrated that discussing HIV/AIDS triggers the condom use (Catania et al. 1992
; Allen, Emmers-Sommer & Crowell 2002
). However, the majority of studies have examined college populations (Snell & Finney 1990
; Smith 2003
; Powell & Segrin 2004
; Dilorio et al. 2000
) and there are no known studies that examined racial differences in HIV/AIDS discussion strategies among female criminal offenders. Therefore, this study contributes to the criminal justice and HIV prevention literature by identifying which HIV/AIDS discussion approaches are associated with the use of condoms in both White and African American female offender populations.
Results revealed significant racial differences in socio-demographic characteristics, participation in HIV risk behaviors, and HIV/AIDS discussion strategies. Consistent with previous literature (Wilson 1990
), African American women were significantly more likely than White women to have never been married. This socio-cultural phenomenon may be the result of unequal sex ratios in the African American community. Specifically, African American men have high rates of premature mortality and incarceration (Wilson 1990
; Mayer 1999
). The higher prevalence of unmarried African American women could be attributed to the lack of eligible marriage partners because African American women are the least likely racial group to engage in interracial dating and marriage (Staple 1981
There were also noteworthy racial differences in self-reported HIV risk behaviors including drug preferences, infectious diseases, and unprotected sexual behaviors. African American female inmates were significantly more likely to report using crack and marijuana on a daily basis, whereas White female inmates were more likely to report the daily use of prescription opioids in the six months prior to incarceration. These racial differences could in part be due to geographic differences. For example, the majority of the sample was recruited from Kentucky, which is a state that has fewer African Americans (7.4%) than the national average (12.4%) (U.S. Census Bureau 2000b
). Moreover, there is a high prevalence of prescription opioid use in the rural state of Kentucky (Havens, Oser, & Leukefeld 2007
; Havens et al. 2007
). Whites’ preference to use prescription opioid on a daily basis could also partially explain the higher prevalence of lifetime injection drug use among Whites because research suggests that prescription opioids are injected (Havens, Walker & Leukefeld 2007
). Conversely, crack is widely available in African American communities and is a key risk factor for the sexual transmission of HIV (Fullilove et al. 1990
; Edlin et al. 1994
). As such, there have been several HIV interventions that have been developed for African American crack-involved women which have demonstrated reductions in HIV risk behaviors (Weschsberg et al. 2004; Sterk, Theall & Elifson 2003
It is also important to examine racial disparities in infections diseases, especially those that are sexually transmitted because STIs increase HIV risk from 2 to 5 times (Kraut-Becher et al. 2008
). Consistent with data from the Centers for Disease Control and Prevention (CDC), there was a higher prevalence of infectious diseases (including HIV, syphilis, gonorrhea, trichomoniasis, and Chlamydia) in African American female inmates as compared to their White counterparts (CDC, 2004b
). However, this study did not support the CDC’s finding that the prevalence of HCV infection is substantially higher among African Americans than Whites (CDC, 1998
). On the contrary, White women reported more hepatitis C, which could be the result of the higher prevalence of injection drug use among White female offenders in this study. A meta-analysis by Vescio and colleagues (2008)
found that incarcerated injection drug users were about 24 times more likely than non-injectors to be HCV positive.
It is disconcerting that the majority of female offenders in the current study reported engaging in unprotected sex in the 30 days prior to incarceration. Furthermore, racial inequalities emerged in both the prevalence and mean number of unprotected sexual encounters. White women reported engaging in more were more likely to report having sex with an injecting drug user or a stimulant user in the 30 days before their incarceration. Again, this could be related to racial differences in drug preferences with Whites reporting more daily use of prescription opioids, which is also a significant public health concern because HIV is primarily transmitted via heterosexual contact with a high risk person, which includes injection drug users and stimulant users (CDC, 2006
). Moreover, African American females were more likely to engage in unprotected sex when trading sex for money, drugs, or gifts in the 30 days prior to incarceration. Our findings support previous studies which found that African Americans are more likely than Whites to engage in sex work (Wright et al. 2007
; Kraut-Becher et al. 2008
) and less likely to consistently use condoms (Gilbert 2003
; Catania et al. 1992
Besides abstinence, condom use is the best protection against the sexual transmission of HIV, and effective communication strategies are one of the best predictors of condom use (Catania et al. 1992
). This study found racial differences in the use of discussion strategies to talk about HIV/AIDS with a sexual partner. Of particular interest is the rational HIV/AIDS discussion strategy which is a direct way of talking about HIV/AIDS. The rational strategy has been incorporated into HIV risk-reduction interventions such as the National Institute on Drug Abuse (NIDA) Standard HIV intervention (Wechsberg et al. 1997
; Coyle 1993
) and is considered to be the approach that is mostly likely to produce a risk behavior change (e.g., condom use) (Snell & Finney 1990
). Our findings are encouraging since the rational strategy was the most frequently used approach by all female offenders. However, contrary to our expectations, African Americans female inmates were more likely to use rational approaches to discuss AIDS with an intimate partner than incarcerated White women. It is interesting to note, however, that the rational communication strategy was only associated with fewer unprotected sexual encounters among White women. Among African American women, the rational AIDS discussion strategy was not a significant correlate of the number of unprotected vaginal sex encounters in the 30 days before their incarceration. The racial disparity in the relationship between using a rational approach to discuss HIV/AIDS and engaging in fewer unprotected vaginal sex acts suggests the need for culturally-tailored HIV interventions. Specifically, for African American female offenders, using rational discussion “tactics” with an intimate sexual partner was not associated with unprotected vaginal sex. Therefore, HIV interventions for African American women must focus on more than just communication by addressing social-cultural issues, HIV knowledge, motivation for condom use, and behavioral skills (e.g., condom self-efficacy and correct condom use).
There are several limitations that must be acknowledged. This study is based upon self-reported data which could be impacted by recall bias and social desirability bias; however, it should be noted that previous research supports the validity of self-report data among drug users (Harrison & Hughes 1997
; Darke 1998
). These findings are limited to drug abusing criminal offenders in KY, CT, and DE. In addition, cross-sectional data which does not allow for the examination of the causal mechanisms underlying unprotected vaginal sex among African American and White women. Future studies should capitalize upon longitudinal study designs to identify which HIV/AIDS discussion strategies are predictors of condom use among both African American and White female offenders. Moreover, future research could focus on the socio-cultural context of relationships. For example, additional research is needed to examine the context of sexual relationships (e.g., monogamous, homosexual, etc.), relationship dynamics (e.g., power and abuse), and racial differences in the use of various HIV/AIDS discussion strategies immediately before sexual encounters to better disentangle the relationships between communication styles and unprotected sex.
These limitations notwithstanding, the results from this study have several contributions to the literature. Primarily, there are racial differences in interpersonal strategies used to discuss HIV/AIDS with an intimate sexual partner, with African American female offenders being significantly more likely to use rational, withdrawal, and persistent approaches to facilitate a discussion on the topic of HIV/AIDS. Moreover, the rational HIV/AIDS discussion strategy was associated with fewer unprotected vaginal sex encounters among White women in the 30 days before incarceration; however, this relationship was not significant in the same multivariate model for African American females. In sum, this research suggests the driving force seems to be higher prevalence rates of HIV in African American communities and that each risky encounter for African American women has a higher likelihood of infection transmission. Therefore, more comprehensive culturally-specific HIV risk-reduction interventions are critical for African American female offenders to effectively produce sexual behavioral changes.