Street Myths As Cultural Barriers to Reduction of HIV Risk Behavior: Implications for Policy and Practice

Background and Purpose: Understanding the contexts and social processes of norms and scripts of heterosexual African American males who have multiple sex partners is essential to informing program and policy efforts aimed at reducing HIV/AIDS risk. According to CDC, African Americans face the most severe burden of HIV infection in the US. In 2009, blacks accounted for 46% of people living with HIV and 45% of new infections with black males accounting for 65% among all blacks. Like other communities, African Americans face challenges that contribute to higher rates of HIV infection such as unprotected sex with multiple partners, and injection drug use. This National Institute on Drug Abuse (NIDA)-funded qualitative study used Sexual Scripts Theory to examine how black males are socialized into multiple sexual partnering and how they negotiate intercourse and condom use with multiple female partners. This information is critical to the successful development of HIV risk reduction policy and programs. Methods: Seventy-two heterosexual (self-identified) African American men age 18-50 were recruited in a large metropolitan city by trained ethnographers. Participant mean age was 24.5 years, 20% were married, and 78% had two or more female sexual partners in the prior 6 months. Demographic data were collected and in-depth interviews were conducted using structured qualitative protocols covering three areas: 1) sexual socialization; 2) sexual scripts and practices; and 3) HIV-related sexual risk behaviors and condom use. Using File Maker Pro, interview content was analyzed for themes reflecting conduct norms, preferred sexual scripts, and patterned sexual practices. Findings present thematic myths that serve as barriers to safe sex practices and include: 1) multiple partners as normative- parents of participants had multiple partners, both open and clandestine; 2) condoms used all the time –participants initially indicated condom use but described not using condoms when high on drugs or alcohol; 3) not wearing condoms is a relationship test—condoms were not used because a partner would know that she was not the only one—a trust issue; 4) a previous negative HIV test means you can't get infected—because participants had tested HIV negative in the past they felt protected from the virus; and 5) you can tell if someone is HIV-infected by looking at them—simply looking at someone “you would know” if they had HIV. Conclusions and Implications: Even after 25 years of campaigns promoting HIV-related health information and education significant myths about prevention and transmission of HIV are prevalent and serve as barriers to safer sex. Participants describe having multiple partners, avoiding condom use, liberally using alcohol and drugs, and seeing HIV testing as preventative. Recently, CDC removed confidential counseling from the HIV testing protocol yet; data from this study strongly suggest that this policy decision is detrimental. Both social policy changes in the form of reinstating HIV counseling to the testing protocol and practice improvement where social workers intervene at an individual and small group level to directly address the myths still prevalent in the community need to be employed to stem the continued spread of HIV.