The Rising HIV Rates Among Young Women and Girls of Color: What's Going On? Part One
January 25, 2011
Kellee Terrell: Jennifer, earlier you made some really great points about younger women sleeping with older men, and the power dynamic that happens: not being able to negotiate condom use; self-esteem and media messages. Can we talk a little bit more about that?
Jennifer Irwin: Issues around power and control, whether it's with our clients who are HIV negative or positive, I think are some of the biggest issues that the bulk of our young girls face. Whether they're conscious of it fully or not, their behaviors definitely point to a huge lack of self-esteem and a lot of powerlessness in relationships that they're currently in. And that's even if they are with young guys who are around their age, although the bulk of our girls are with men that are considerably older, sometimes double their age.
I think one of the biggest ways that we see the negative impact of this is with our HIV-positive girls and disclosure of their status. A large portion of our girls do not disclose their HIV status to their partners, for several reasons. I think one of the biggest ones is the fear of rejection by their partner. There's concern around being rejected by their partner. A lot of our girls have faced a lot of trauma and violence in their history and their past; everything from sexual assault, molestation to rape. So on one hand, there's an inherent worry about violence.
I also think that a lot of these young girls spend a lot of energy on what they feel is trying to find a good man, or a good guy, to be with, and the concern that there are not a lot of good men out there for them. So when they've got one, they need to do whatever it takes to protect that. And so I think a big piece of that is the feeling that they're scared, or don't want to disclose their status.
Now tie mental health issues into it. When we talk about what's affecting these young women, a large bulk of the girls in our program suffer from major depression and post-traumatic stress syndrome due to the trauma of their past.
In terms of condom use, I think some of our girls think that if they don't wear a condom then it will give their boyfriend the impression that they've got nothing, that they don't have any diseases, that they're "clean." They are worried that if they ask their boyfriend to use a condom, suspicions will come into his mind that she's got something.
It's that really kind of scary, warped way of viewing it. It's not him saying, "Oh, I want to protect you. I want to protect myself." It's the absolute opposite. It's: "Why do you need to wear a condom? Is something wrong? I thought you were clean. You told me you were clean."
There's almost this kind of rite of passage of girls: By not using condoms, they are proving to the men that they're with that they don't have anything. Because they're scared that by using a condom, a red flag will be triggered, and they are going to be asked a lot of questions they don't want to have to answer, particularly our positive girls.
Claire Simon: As I listen to Jen talking, I'm like, "OK; these are some of the same issues that grown women face." Is it learned behavior? Is there a manual that we got that got input in our brain at birth, to say that this is how we're supposed to behave, and these are the issues? And how much of it is media sensation around black women, or women of color, not finding partners or not having adequate partners?
We haven't addressed this heterosexual epidemic in any way, other than the fact that we're telling girls to use a condom; negotiate condom use. And we're not talking about sexuality. We're not talking about power dynamics.
Again, this is about the social factors that we talk about, that are fueling the epidemic. Because if we have young women who feel like: Once I enter a relationship with a guy, I have no power. And I have to relinquish whatever power I have because I don't want to lose him --
Kellee Terrell: And you don't want to lose him because everyone keeps telling you, "You have got a good man. What are you doing? Why can't you keep a man?" It's a very Steve Harvey-esque mentality.
Claire Simon: Yes, it is.
Jennifer Irwin: A lot of our girls are very economically dependent on these older men.
Tracie Gardner: Right.
Jennifer Irwin: These older men are the ones who buy them the clothes they need, buy the cute purse, pay for them to get their nails done and pay for them to get their hair done. They cannot get that from anywhere else. They can't get that kind of money at home; it doesn't exist. They're young. They may not have their own job and so it's very attractive when you have some guy handing you all this stuff. And essentially the payback is, you're having sex with him.
Tracie Gardner: Right.
Jennifer Irwin: And so they're willing to give that up to get what they can get absolutely nowhere else.
Tracie Gardner: So let's look at what is power, really? We talk about power in terms of girls and women being able to negotiate safer sex, being able to negotiate condom use. That means you have to negotiate putting a condom onto somebody else's organ. It's not that you're negotiating condom use for yourself; you have to quote-unquote try to convince somebody to put a sheath onto his penis. And I'm not even going to talk about the female condom.
Kellee Terrell: That's a whole other conversation. [Laughs.]
Tracie Gardner: A whole other discussion. But in terms of the power discussion, what if, in fact, you are powerful, in that you feel like you make the decisions about the man that you're going to sleep with, and whether you're going to use a condom with him? What if you've got the power in deciding? But we know this is not the case for so many of our young women, and yet we've grown up with prevention that presumes and assumes, and that incorporates the idea of giving women power. We're asking -- we're needing -- power over primarily an organ that we don't even have attached to our body.
The other piece of the discussion, of course, that's always been missing, long been missing, is: AIDS, Inc., does not know what to do with heterosexually identified men.
Kellee Terrell: Which was my next question.
Tracie Gardner: AIDS, Inc., does not know what to do with sexually active men who are not exclusively gay -- let me put it like that. Unless you are exclusively gay, out, or even a little bit kind of halfway what society labels as "down low," AIDS, Inc., doesn't know what to do with black men's sexuality. It just doesn't. We don't have the right studies for it. We don't have the right access for it. We don't have any idea, except prison -- which is my whole other issue -- of where you can have an opportunity to engage men around health literacy, right? Sexuality addiction that plays into factors; sex that happens with men that does not mean, or does not reflect, an orientation. We don't have the places to have those discussions. The good thing about what we're doing with the girls is that we're able to have those venues to have that discussion.
But as long as we're able to access health care, mostly around our reproductive organs, and men don't have a similar place where they even ever have to come into care, unless they're coming into care for prostate cancer -- and that's a sure sign that they've come too late -- we've been doing one-hand clapping for a long time. So it's not even about what works, or what doesn't work; we're still trying to figure it out.