Background African Americans (AAs) make up 12% of the US population, yet they account for about half of all reported chlamydia and syphilis cases, and 70% of gonorrhoea cases. Targeted, culturally sensitive interventions are needed to address these disparities. This study sought to explore how AAs perceive STIs in their communities, and what they feel should be done to address the problem.
Methods Triads (n=31) and individual interviews (n=64) were conducted with sexually active, heterosexual AA adults, ages 18-45, in four communities with high STI incidence. Triads were segmented by age, gender, and urban/rural residence. Interviewers (gender/race-matched) used a semi-structured guide to explore awareness and importance of the STI problem in AA communities, perceptions of contributing factors and high-risk groups, and suggested solutions. Discussions were audio-taped and transcribed. A team of three analysts coded transcripts using QSR NVivo8, based on a codebook developed from identified themes.
Results A total of 158 adults participated. Overall, STDs were believed or presumed to be very common in AA communities. Many had heard about the disparate STD/HIV rates on the news/TV or in school. Men were more likely to challenge this, reasoning that AAs are heterogeneous and that STIs are more likely influenced by socioeconomic status (SES) than race. Participants identified youth, low SES groups, drug addicts, Sex workers, homosexuals, and men on the down low as highest-risk groups. Promiscuity and a lack of sexual-health education, care for self/others/future, and health-care access were seen as major causes. Other contributing factors were teen pregnancy/family disintegration, gangs, drugs, school dropouts, unemployment, poverty, boredom, hopelessness, male/female ratio, partner concurrency, and the media. Overall, STIs were seen as a relatively low priority. Yet most felt that change is critical and could be promoted through music, mass media, faith-based/community/organizational, electronic and interpersonal channels. Increasing information, education, and healthcare access; and developing parenting, self-esteem boosting, and mentoring programs were suggested.
Conclusions STDs among AAs are recognised as a likely consequence of many underlying social, structural and community ills, which must be addressed to reduce STD disparities. Traditional STD prevention efforts must be supported by non-traditional social/structural interventions.