Condomless Sex, Binge Drinking, and Mental Health: Assessing Risk and Sexual Decision-Making Skills Among Young Black College Students at Risk for HIV

Background: Over the past decade, there has been a rise in sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) among people aged 15-29. In 2018, the Black community represented 13% of the U.S. population yet accounted for 42% of new HIV cases (CDC, 2019). People who have poor self-image or experience mental health challenges are vulnerable to health disparities and other negative health outcomes such as HIV. There is a critical need to understand how the intersection of mental and physical health plays a part in Black college students’ sexual decision-making skills and behaviors that can position them at risk for health disparities. The purpose of this study was to pilot test the CDC Healthy Love HIV Prevention Intervention in a sample of Black College students. Previously, this intervention had only been marketed to Black Women who engaged in “high risk” behaviors and had never been tested with men.

Methods: Data were collected using a Triangulated Mixed Methods Exploratory Research Design. Convenience and snowball sampling were used to recruit participants in the study. The total sample (N=381) comprised four HBCU’s and one MSI, all located in the South. There were seven single gender focus groups (Four Female and Three Male) completed across three schools (Two HBCU’s and One MSI) for a total N=40. The data collection tools included a 70-item online survey (Women and Men), individual interviews (Women Only), and focus groups (Women and Men). Further, this project implemented Healthy Love, a single session, CDC evidence-based behavioral and biomedical intervention that was designed to increase safer sex or protective behaviors for STD and HIV among Black women.

Results: Fifty one percent of the sample were women followed by 48% who identified as men and 1% who identified as other. Participants were given pre-and post-tests before the delivery of the intervention that measured: STD knowledge, attitudes towards condom use, Black Masculinity, Women of Color Self-Efficacy, PrEP knowledge, and sexual risk. The findings from the pre and post-test indicated that students’ knowledge about sexually transmitted diseases increased (mean difference -2.89) and the endorsement of high-risk sexual behavior decreased (mean difference 4.66). The study participants endorsed high risk sexual behaviors including the use of an illicit substance at the time of intercourse, unprotected sexual encounters, and ambiguity as it relates to HIV testing and knowing their status.

Implications: The findings from this study indicate the importance of understanding how science contributes to social change and the need for culturally tailored and gender specific biomedical behavioral HIV prevention interventions that directly target the unique sexual health needs of Black College Students. The findings of this study indicate that poor decision-making resulted in low to no condom use, lack of assertiveness to refuse unwanted sex, binge drinking and use illicit drugs, and having multiple sexual partners, that increased subsequent risk for STIs and HIV. These findings are critical to advancing social change by prioritizing mental health screening and care when approaching HIV prevention and Black College Students.