Abstract
Background:Pregnancy coercion (PC), defined as a restriction of women's reproductive autonomy, may be associated with increased HIV and sexually transmitted infection (STI) risk. However, there are few empirical studies defining the association between PC and HIV risk, particularly among vulnerable African American women.Setting and Methods:African American women (N = 560), ages 17–24, completed an audio computer-assisted self-interview assessing PC prevalence and its association with HIV/STI risk. Women were screened for prevalent STIs using polymerase chain reaction assays. Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes.Results:Women who had experienced PC in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]. Among women who experienced PC, odds of noncondom use in their last sexual encounter were 3.45-fold greater relative to women not experiencing PC (95% CI = 1.55 to 7.85). Women who experienced PC had lower condom use intentions (coefficient, −1.31, P = 0.002), greater fear of condom negotiation, and perceived more barriers to condom use (coefficients, 3.89 and 5.74, respectively, both P < 0.001). Women who experienced PC had 1.98 (95% CI = 1.22 to 3.21) and 1.82 (95% CI = 1.09 to 3.04) odds of depression and HIV worry relative to women not experiencing PC.Conclusion:Among African American women, PC was associated with a range of adverse sexual health outcomes and HIV/STI-related behaviors and attitudes. The findings underscore the need for promoting gender-equitable social norms in HIV prevention interventions.
Highlights
African American women are disproportionately affected by HIV and othiker sexually transmitted infections (STIs)
Women who had experienced Pregnancy coercion (PC) in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]
Women who experienced PC had 1.98 and 1.82 odds of depression and HIV worry relative to women not experiencing PC
Summary
African American women are disproportionately affected by HIV and othiker sexually transmitted infections (STIs). In 2017, 24.9/100,000 African American women were diagnosed with HIV compared with 1.7/100,000 white women,[1] with heterosexual transmission accounting for 95.2% of new HIV infections.[2] Similar racial disparities are observed in the distribution of STIs, such as chlamydia, gonorrhea, and trichomoniasis.[3,4,5] Noncondom-protected heterosexual contact is associated with acquisition and transmission of HIV and other STIs,[6,7,8] with extensive empirical evidence demonstrating a robust association between bacterial, viral, and parasitic STIs and risk of HIV seroconversion.[5,9,10,11,12] A recent meta-analysis concluded that STIs confer a 2- to 3-fold increase in HIV-1 susceptibility.[11] In addition to biological factors, numerous individuallevel cognitive and behavioral factors are associated with increased HIV/STI risk, such as number of sexual partners, depression, and substance use.[13] there is considerable empirical data describing the association between myriad individual-level determinants and HIV/ STIs, one area that remains understudied is the association of relational-level factors to HIV/STI acquisition One such relational factor is pregnancy coercion (PC). Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes
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