We continue to provide HIV/AIDS prevention education targeting particularly African American women of childbearing age (15 to 44 years of age), in an effort to reduce the number of new HIV infections reported year to year. Each week, at a certain site in the city, I am speaking with 15-25 women in this targeted group as part of the Behavioral Counseling Model intervention that we use. I will do an introduction then a Pre-Knowledge Assessment Test, an American Red Cross certified HIV Education presentation and then a Post-Knowledge Assessment Test, which is the same as the Pre-Knowledge Assessment Test. In conjunction with the University Of Memphis Department Of Psychology, we use this pre and post knowledge assessment tool as a way of measuring the amount of change in an individual’s knowledge and awareness of HIV/AIDS. The purpose is to evaluate the learning process of individuals after being presented with the facts about HIV and AIDS. Measuring against current perceptions, myths, and other miss-information that guide individual responses and reactions to the disease, our effort is to cause one to assess the behaviors that put them at risk for HIV infection, leading to a diagnosis of AIDS.
I have found that many women lack the knowledge needed in order to facilitate change in risky behaviors and that this lack of knowledge leads them in a direct path to HIV infection. Knowing that HIV is spread primarily be having unprotected sex with an HIV infected sex partner, the question is ‘how would you know if your sex partner has HIV or not?’ Well, let’s imagine that you don’t know. Then the question becomes, ‘why would you have unprotected sex with that sex partner?’ As you begin to conjure an answer to those questions there is the point that most men do not like to use condoms when having sex anyway. So there is the first of many barriers to be confronted. How do you make him use a condom?
There is a wide-ranging discussion about this very thing and it is mentioned that some women do not possess the skill to negotiate condom-use with a man and this could be the sticking point in the risk-taking behavior; being almost forced to have sex without a condom.
Whereas statistics and anecdotal evidence portrays that 1) many men do not know their HIV/STI status 2) have multiple sex partners 3) do not always use condoms with these sex partners and 4) will have had HIV infection for at least two to three years before finding out, women will invariably be placed in conflict with their own values when involved with a man who does not “want” to wear a condom when having sex with them.
Then when you look at the social-economic implications of why a woman would participate in unprotected sex with a particular man, we will see where the complication of possible infidelity exists resulting in possible domestic partner violence occurring. A woman who would ask a man to suddenly start using a condom when engaged in sex with him “obviously” has caught something from some other man or she thinks that he has something; creating a situation that will threaten her economic survival or pose a threat against her very life.
So, there are a myriad of determinants to the behavior that places women at risk for HIV infection and unless these determinants are addressed we will continue to see women of childbearing age becoming infected at such an alarming rate.
When speaking with especially women of African descent I have had to confront attitudes that are consistent with the information received from women who have become infected with HIV; they trust their sex partner who happens to be a husband or long-termed boyfriend, a chance meeting with an attractive man who may fit the profile of the potential HIV infected man, cannot dictate condom use in sexual relations or is the victim of intimate partner violence. Among these women it can be said that many do not understand how HIV is transmitted or believe themselves not to be at risk because the man they are with is not a homosexual man, which is not a subject that they can even discuss with a man. Though there have been numerous reports of men in jail being raped by another man and becoming infected and even the stories of men who have sex with other men and women does not cause consistent thought or imaginings that this somehow would affect their relationships with men.
Many women categorically deny that there is even a remote chance that their man or men is actually having sex with another man on a regular basis. More times than not this topic will illicit strong and sometimes animated reactions from some Black women, to the point where I am careful not to agitate in my effort to be informative. But this is part of the educational process if for no other reason as to ignite thought along those lines among women who are obviously at bit stubborn when it comes to addressing extraneous reasoning with men who provide them with something more than…sex.
I continue to challenge women to be more conscientious in choosing who they have sex with and the choice in providing protection against HIV infection.. I always suggest the use of the polyurethane female condom as an empowering solution to male non-condom use. Though almost 6 out of 10 Black females have not tried the female condom, just about 8 out of 10 of them have not even heard of the female condom, which says that there is little discussion of condom use among females. As it were, the numbers of unwanted or unplanned pregnancies is continuous and it is so likely that the female condom would reduce many of these numbers. The question becomes ‘why isn’t the female condom promoted among these females by other females or even their health care providers?’
This is the week-to-week challenge of the HIV educator. Sometimes it becomes such a challenge that I have nightmares about HIV/AIDS becoming “just another condition that Black folk face”. This is still a 100% preventable infection and until there is a cure there will be a need for continued education in prevention of HIV which is the virus that causes AIDS!
Ernest A. Donelson II
Ernest Donelson is an HIV Education Specialist & Prevention Case Manager at an AIDS Awareness Program in Memphis, TN. Contact Ernest at firstname.lastname@example.org.