1. African American Adolescent Women’s Sexual Socialization and the Sexual Double Standard: Implications for Heterosexual Risk Reduction
Amy M. Fasula, PhD, MPH, ORISE Fellow
Kim S. Miller, PhD
Jeffrey Wiener, MS
Presented by Lari Warren-Jeanpiere, PhD ORISE Fellow
Division of HIV/AIDS Prevention, CDC
November 7, 2007
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

2. Presentation Objectives
Background
Study objectives and methodology
Themes from qualitative analyses
Application of themes
Implications for multi-level interventions

3. Young African American Women and HIV Risk
Rate of new AIDS cases approximately 23 times higher for African American than for white women (CDC, 2004)
AIDS leading cause of death, African American women ages (Anderson & Smith, 2005)
13 to 19 year olds have the highest proportion of AIDS cases among females (43%) (CDC, 2004)
Unprotected heterosexual contact primary mode of transmission.

4. Intervention Approaches
Address multiple social levels
Begin early, prior to establishing sexual scripts
Speak to African American women’s lived experiences of their intimate relationships with men

5. In This Study Qualitative approach
African American mother-adolescent discussions about sexual risk reduction
Sexual double standard (SDS)
Present at multiple social levels
Affords males more freedom and power than females to engage in and direct heterosexual interactions

6. Methodology: Sample
Convenience sample 129 African American mother-adolescent dyads
Reported SDS attitudes
35% The Bronx, NY; 65% Montgomery, AL
Adolescents years old
53% Female
40% Sexually active

7. Methodology: Analyses
Follow-up, open-ended responses from structured interviews
Mother’s sexual risk reduction messages
Why sex discussions came up
Topics of reoccurring arguments
Constant comparative method
Adolescents’ gender
Adolescent sexual behavior

8. Results: Key Themes “Good”/ “bad” girl dichotomy
“Clean”/“dirty” girl dichotomy
Sexual guidance for sons, conflict and control for daughters
Discouraging daughter’s sexual risk reduction preparedness
Challenges to passive condom preparation for daughters
Proactive condom preparation for sons

9. Results: Clean and Dirty Girl Dichotomy
Intersection between Good and Bad Girl dichotomy and STDs
Mothers’ messages to sons about avoiding STDs/HIV
“[I told my son to use condoms] whether or not he thought the girl was clean…”
“[My mother told me that to prevent HIV] … use a condom if you’re gonna have sex. Don’t bring a slutty girl into the house…”
“I told him that appearance says nothing, she can be the prettiest girl in school and infect everyone on the football team….”

10. Results: Sexual Guidance for Sons, Conflict and Control for Daughters
Daughters: consistent theme of conflict and control over sex, pregnancy, dating, and contact with boys.
Sons: rare conflict over sexual issues. Son’s interest in girls often used as impetus for sexual guidance discussions.

11. Results: Discouraging Daughter’s Sexual Risk Reduction Preparedness
Some daughters (but no sons) discouraged from obtaining safe sex methods
“[I told my daughter that] no birth control method is foolproof…. I told her that she did not need it and not to participate in the school programs where birth control is distributed…”
“[My mother said] that if I wanted to be on birth control it was for people that slept around. She says the best way to prevent pregnancy is not to have sex.”

12. Results: Challenges to Passive Condom Preparation for Daughters
“… [I told my daughter] not to be ashamed to provide her own condoms.”
“[I told my daughter]…Don’t depend on the man [for condoms]….”

13. Results: Proactive Condom Preparation for Sons
Mothers provided sons (but no daughters) with condoms.
Condoms part of pubertal guidance and skills
“[My son and I have] talked about condoms. I gave him packages of them that told how to use them on the back. I told him he need to use them to ask me and I’ll get them for him.”

14. Effects on Young Women’s Sexual Risk Reduction: Good/Bad Girl Dichotomy
Limits sexual-self development
Barriers to developing strong attitudes about their own sexual decisions
Promotes romance script with active male and passive female

15. Effects on Young Women’s Sexual Risk Reduction: Clean/Dirty Girl Dichotomy
Additional layer of stigma to Good/Bad Girl Dichotomy – not only deviant, but dangerous and diseased
Condoms run counter to the good or clean girl image, due to meanings of disease, promiscuity, and non-monogamy

16. Effects on Daughters’ Sexual Socialization for Risk Reduction
Prohibitive approach promotes environment of conflict, secrecy, and missed opportunities
Neutral approach leaves critical gaps in daughters’ sexual risk reduction skills and access to resources

17. Proactive Sexual Risk Reduction for Sons
“Teachable moments”
Condoms introduced early in pubertal development
Provided access to condoms

18. Directions for Intervention: Individual-Level
Young African American women
Develop ability to identify and communicate sexual needs
Promote attitudes of empowerment (not shame) for being in command of their own sexuality
Young African American men and women
Illuminate and challenge SDS expectations
Encourage heterosexual scripts that emphasize open communication, and mutual respect and responsibility

19. Directions for Intervention: Familial-Level
Group-level interventions with parents
Provide supportive environment
Explore SDS attitudes
Identify negative effects of SDS
Develop confidence and tools for sexual risk reduction socialization without reinforcing SDS

20. Directions for Intervention: Community-Level
Fill gaps for sexual risk reduction behaviors
Information
Encouragement
Resources