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HIV-Associated Histories, Perceptions, and Practices Among Low-Income African American Women: Does Rural Residence Matter?

April 11, 2002

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

In the United States, the incidence of HIV infection and AIDS is increasing most rapidly among African American women. The geographic distribution of AIDS among women in the United States indicates that a vast majority of cases occur in urban epicenters and their surrounding communities. However, the diffusion of HIV to rural areas is an increasingly important issue. This study compared HIV-associated sexual health history, risk perceptions and sexual risk behavior of low-income and rural and nonrural African American women in a cross-sectional survey (n=571) of women attending federally funded Special Supplemental Nutrition Program for Women, Infants and Children clinics in Missouri. More than 90 percent of Missouri counties are rural.

Using a stratified random sampling scheme for the choices of counties, 21 counties were selected: 17 were rural and 4 were suburban. The state's only two urban counties were also included. The 23 counties contained 29 WIC clinics. Twenty-seven of the 29 clinics agreed to participate. Women receiving WIC benefits were eligible to participate in the study if they were 18 or older and consented to participation. Data collection was every two months when women received their WIC vouchers. They were given a self-administered survey and a preaddressed, postage-paid envelope for the return of the survey. Surveys were anonymous and focused upon reasons why low-income women do not always use condoms for the prevention of HIV infection. However, the current analysis sought to compare HIV-associated sexual health histories, risk perceptions and sexual risk behaviors of low-income rural and nonrural African American women.

Twelve measures relevant to sexual health, perceptions of risk and sexual behavior, as well as items to assess whether women were currently infected with HIV, were utilized. Women who indicated HIV infection (n=5) were not included in the analyses. About 90 percent (4,117) of women agreed to participate in the study, and 58 percent of these women returned a survey (n=2,391).

Of the 2,391 women returning the survey, 25 percent self- identified as African American. Among the African American women, the majority (72%) was from urban counties, with 4 percent and 24 percent coming from suburban and rural counties, respectively.

Adjusted odds ratios indicated that rural women were about 2 times more likely than urban women to report (1) a lack of HIV counseling during their pregnancy, (2) that a sex partner had been tested for HIV infection, (3) no preferred HIV prevention methods because they did not worry about becoming infected by STDs (4) never using condoms, and (5) not using condoms because they believed that their current partner was HIV negative. Rural women were about 50 percent less likely to report (1) ever having gonorrhea or syphilis and (2) not using condoms because the current partner had tested negative for HIV.

A recent study cited by the authors indicated that rural minority and low-income women living with HIV or AIDS typically had believed, before their diagnosis, that they could not get infected or that their partners were not infected. In another study, predominantly African American adults living with HIV or AIDS reported they had acquired HIV in a rural as opposed to a nonrural area.

According to the authors, the study provides initial evidence suggesting that low-income rural African American women are less engaged than their nonrural counterparts by the threat of HIV infection. They believe themselves less susceptible to HIV infection. "Given the potential diffusion of HIV from high-concentration epicenters to rural areas, these perceptions may be highly problematic in regard to the adoption of protective practices such as condom use," the authors noted. Further research is critical to guiding development and implementation of HIV prevention programs for this population.

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Adapted from:
American Journal of Public Health
04.02; Vol. 92; No. 4: P. 655-659; Richard A. Crosby, Ph.D.; William L. Yarber, H.S.D.; Ralph J. DiClemente, Ph.D.; Gina M. Wingood, Sc.D., M.P.H.; Beth Meyerson, M.Div.

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
See Also
More Statistics on Women Living With HIV/AIDS in the U.S. and Canada


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