Revista de SIDA e investigación clínica

Predictors of Sexual Scripts Among Young, Sexually-Active, Substance-Using African American Women

Abstract

Mandy J Hill, Misha Granado, Yolanda Villarreal, Jamie Fuega, David J Robinson and Angela L Stotts

Background: The HIV epidemic in the US continues to disproportionately affect the health of young, African American women. The focus here is on predictors of sexual scripts, which are roadmaps to sexual decision making. The objective is to examine life experiences, normative beliefs and cultural predictors of sexual scripts that place young, sexually-active, substance-using, African American women (YSSAAW), a population with significant vulnerability to HIV, at even greater risk of becoming HIV positive. Methods: Face-to-face, tablet-assisted, semi-structured interviews were conducted with 30 YSSAAW in a private or public emergency department in Houston, TX, USA. Interviews were professionally transcribed, then coded by a trained 3-member coding team. One interview was used to create the codebook. Codes were organized into primary themes during face-to-face meetings. Inter-coder reliability was assessed and confirmed using Cohen's Kappa statistics, demonstrating a nearly perfect agreement between coders 1 and 2 (K=0.93). Results: Three primary themes were described as predictors of sexual scripts: emotional wounds, norms and decision making. Prevalent codes among YSSAAW within the emotional wounds theme included infidelity (43.33%) and parental dynamics (56.67%). Under the norms theme, we found 66.7% of YSSAAW discussed their communication norms and 30% disclosed cultural norms. Within the sexual decision making theme, we gained relevant information and implications on relationship longevity and having an STI history among 46.67% of the sample. Conclusion: Primary predictors of high risk sex revealed sexual scripts that demonstrated gender-based power differentials; thereby, supporting utility of a theoretical framework that includes the Sexual Script Theory and the Theory of Gender and Power. The logic model illustrates how emotional wounds from life experiences (i.e., trauma, abuse, abandonment) and socially acceptable norms establishes the sexual script of YSSAAW; whereby, high risk sex is the most likely outcome relative to prevention strategies.