Lisa Bowleg

The Problem With the Phrase Women and Minorities: Intersectionality—an Important Theoretical Framework for Public Health

Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public healths commitment to social justice makes it a natural fit with intersectionalitys focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.

“The Ball Was Always In His Court”: An Exploratory Analysis Of Relationship Scripts, Sexual Scripts, And Condom Use Among African American Women

This qualitative study explored the association between African American womens interpersonal relationship and sexual scripts and condom use with primary partners. Participants were 14 lower to middle-income women between the ages of 22 and 39 involved in emotionally and sexually intimate heterosexual relationships. Relationship types included those that were: stable, emotionally committed; casual, primarily sexual; and unstable, emotionally imbalanced and/or conflict-ridden. Respondents completed a semi-structured interview and a questionnaire about their relationships, sexual, and condom use behaviors. Data analyses identified 3 interpersonal relationship scripts (i.e., men control relationships, women sustain relationships, infidelity is normative) and 2 interpersonal sexual scripts (i.e., men control sexual activity; women want to use condoms, but men control condom use) that may indirectly or directly decrease African American womens condom use with primary partners, and in turn increase their HIV risk. We discuss these interpersonal scripts within the context of sociocultural factors relevant to African American women, heterosexual relationships, and communities.

Gender Roles, Power Strategies, and Precautionary Sexual Self-Efficacy: Implications for Black and Latina Women's HIV/AIDS Protective Behaviors

This cross-sectional study tested a conceptual model of womens HIV/AIDS protective behaviors using gender roles, relationship power strategies, and precautionary sexual self-efficacy as predictors in a predominantly Black and Latina community sample of heterosexual women (N = 125). Results revealed no support for the full model, but partial confirmation for several components of the model. Education significantly predicted gender roles, and gender roles and use of direct power strategies were significant predictors of sexual self-efficacy. Most of the participants were married or partnered and were unconcerned about contracting HIV, suggesting that if women perceive that they are at low or no risk, their gender roles, power strategies, and precautionary sexual self-efficacy will be inconsequential to their HIV/AIDS risk reduction practices.

‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men

Research documents the link between traditional ideologies of masculinity and sexual risk among multi-ethnic male adolescents and White male college students, but similar research with Black heterosexual men is scarce. This exploratory study addressed this gap through six focus groups with 41 Black, low- to middle-income heterosexual men aged 19 to 51 years in Philadelphia, PA. Analyses highlighted two explicit ideologies of masculinity: that Black men should have sex with multiple women, often concurrently, and that Black men should not be gay or bisexual. Analyses also identified two implicit masculinity ideologies: the perception that Black heterosexual men cannot decline sex, even risky sex, and that women should be responsible for condom use. The studys implications for HIV prevention with Black heterosexual men are discussed.

Racial discrimination, social support, and sexual HIV risk among Black heterosexual men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination.ResumenNumerosos estudios documentan los efectos negativos de la discriminación racial en la salud de los afroamericanos, pero pocos se han centrado en el riesgo de VIH. Examinamos la relación entre la discriminación racial y el riesgo sexual en una muestra de 526 hombres negros heterosexuales para probar la hipótesis que el apoyo social mitigaria esta relación. Los participantes en una muestra predominantemente urbana de bajos ingresos tenían edades comprendidas entre 18 a 45. Alto apoyo social tuvo un impacto amortiguador sobre la relación entre la discriminación racial y el riesgo sexual. Entre los hombres que reportaron una alta discriminación racial, aquellos con más apoyo social indicaron tener menos riesgos sexuales que los con bajo apoyo social. Hombres que reportaron una alta discriminación racial y bajo apoyo social reportaron más riesgos sexuales que aquellos en cualquiera de los otros grupos. El estudio pone de manifiesto el apoyo social como un factor de protección importante poco estudiado que puede reducir el riesgo sexual para hombres negros heterosexuales que reportan altos niveles de discriminación racial.

“I’m a Keep Rising. I’m a Keep Going Forward, Regardless”: Exploring Black Men’s Resilience Amid Sociostructural Challenges and Stressors

A growing number of health and social science research findings document Black men’s adversities, but far less is known about their strengths. The purpose of this study was to explore resilience among low-income, urban, Black men. Semistructured interviews produced rich narratives, which uncovered numerous sociostructural stressors in men’s lives, such as racism, incarceration, and unemployment. Most men were resilient despite these challenges, however, and described five main forms of resilience: (a) perseverance; (b) a commitment to learning from hardship; (c) reflecting and refocusing to address difficulties; (d) creating a supportive environment; and (e) drawing support from religion/spirituality. Analysis of men’s challenge and resilience narratives revealed the need to understand and promote low-income, urban, Black men’s resilience via a broader ecosocial perspective which acknowledges the importance of social and community-level protective factors to support individual men’s efforts to survive and thrive amid their adversities.

A mixed methods evaluation of the effect of the protect and respect intervention on the condom use and disclosure practices of women living with HIV/AIDS.

This mixed methods study evaluated the efficacy of an intervention to increase HIV status disclosure and condom use among 184 women living with HIV/AIDS (WLH/A). Participants were recruited from an HIV clinic and randomly assigned to: (1) a comparison group, who received brief messages from their health care providers (HCPs), or; (2) an intervention group, who received messages from HCPs, a group-level intervention, and peer-led support groups. Participants completed risk surveys at baseline, 6-, 12-, and 18-months. Quantitative analyses using hierarchical generalized linear models within a repeated measures framework indicated that intervention participants had significantly higher odds of reporting condom use with sexual partners in months 6 and 18. Grounded Theory-based qualitative analyses suggested that the opportunity to discuss the social context of their lives in addition to HIV/AIDS, including continued stigma and fear related to disclosure, are also essential components of a prevention strategy for WLH/A.

Heterosexual Risk for HIV Among Black Men in the United States A Call to Action Against a Neglected Crisis in Black Communities

Recent data from the Centers for Disease Control and Prevention demonstrate that 1 in 16 Black men in the United States will be infected with HIV in their lifetime. Furthermore, the long-standing HIV disparity in Black communities is actually increasing for Black men. National efforts to curb the epidemic among U.S. Black men focus primarily on men who have sex with men and injection drug users. Black men at heterosexual risk for HIV have largely been neglected by research, program, and policy. This article presents epidemiologic data documenting that heterosexual risk for HIV among Black men is a major concern for Black communities and is likely additional evidence among growing indications of a generalized epidemic in low-income and urban Black communities. The authors offer a call to action to increase support for research, program, and policies that can improve HIV prevention and testing among heterosexual Black men in the United States, as part of the national agenda to reduce rates of HIV in Black communities.

Parents, peers and pornography: the influence of formative sexual scripts on adult HIV sexual risk behaviour among Black men in the USA

Black men in the USA experience disproportionately high rates of HIV infection, particularly in the Southeastern part of the country. We conducted 90 qualitative in-depth interviews with Black men living in the state of Georgia and analysed the transcripts using Sexual Script Theory to: (1) characterise the sources and content of sexual scripts that Black men were exposed to during their childhood and adolescence and (2) describe the potential influence of formative scripts on adult HIV sexual risk behaviour. Our analyses highlighted salient sources of cultural scenarios (parents, peers, pornography, sexual education and television), interpersonal scripts (early sex- play, older female partners, experiences of child abuse) and intrapsychic scripts that participants described. Stratification of participant responses based on sexual-risk behaviour revealed that lower- and higher-risk men described exposure to similar scripts during their formative years; however, lower-risk men reported an ability to cognitively process and challenge the validity of risk-promoting scripts that they encountered. Implications for future research are discussed.

‘Pain on Top of Pain, Hurtness on Top of Hurtness’: Social Discrimination, Psychological Well-Being, and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than