In the United States, HIV diagnosis rates are six times higher in African-born immigrants than any other demographic. This number is disproportionately higher in African-born women. Olihe Okoro, Ph.D., M.P.H., M.Pharm., assistant professor in the College of Pharmacy, Duluth, designed a study to find out why.
The study aimed to gain insight on strategies to limit the spread of HIV and enhance care of African-born (AB) women. 30 AB participants with different roles in the community, ranging from clinicians to community advocates, answered a series of opinion-based questions which were later analyzed thematically. The findings were published in the International Journal of Women’s Health.
Results from the study suggest gender and culture-specific factors drive HIV transmission and create barriers to HIV treatment for AB women. The main factors highlighted in the study are domestic and intimate partner violence, gender-biased stigma, discriminatory cultural beliefs and norms, unprotected sex with MSM husbands, gender discordance in health care and sexual health illiteracy.
Sexual health is not typically discussed with AB women in their youth. This absence of education can have an adverse effect later in life, as they do not have an adequate risk perception of HIV and other sexually transmitted diseases. As these same women grow up and have families, they are unfamiliar with sexual health education and cannot pass on the knowledge to other girls. Generally, an open discussion on sex is seen as taboo, especially in women. Women are raised to not talk about any aspects of sex and are discouraged from discussing sex even with a husband or significant other.
Deeply-rooted cultural perceptions and social norms about gender roles foster domestic violence towards AB women. Participants said cultural norms instill an expectation that women be subordinate to men. Leaving a marriage is seen as a women’s failure, so they often accept their situation as fate. As a result, women may not feel comfortable negotiating condom use or demanding faithfulness in fear of being left.
Okoro says even if the woman is the clear victim in the transmission of HIV – most often seen in abusive relationships – she is still stigmatized. As a result, she may not seek proper care due to fear of others in the community finding out. Even if she does receive treatment, her internalized stigma may result in a loss of follow-up treatment.
With all of these factors in mind, Okoro is working on a unique curriculum aimed for AB women to aid in sexual health awareness.
“One unique feature of this curriculum is that it incorporates the cultural perspective of the African woman, and harnesses the positive attributes to promote healthier sexual behaviors,” Okoro said.
Created by African women, the curriculum focuses on incorporating the cultural perspective and the positives to promote healthier sexual behaviors. The curriculum will take a holistic approach and broadly address sexual and reproductive health in addition to HIV. Additionally, the sessions will take place in a more social environment, such as a community center, rather than a typical classroom.
“The key message here is that interventions for prevention of health issues like HIV needs to be tailored and culturally-responsive to specific groups to be more effective,” Okoro said.
Additional studies assessing the effectiveness of the proposed curriculum will be underway when sessions begin.