Abstract
While Black girls and women are disproportionately impacted by sexual health disparities, there continues to be an overwhelming focus on individual risk behaviors within prevention initiatives, which offers a fragmented narrative of the multidimensional nature of risk and plausibly limits effectiveness of prevention programs and attenuates reductions in disparities. Because sexual health is experienced within an individual’s beliefs/values, interpersonal relationships, and behaviors and reflects larger social and cultural systems, it is important to critically examine common theories used to inform HIV/STI prevention interventions for Black women and girls. To fill this gap in the literature, we critique two commonly used theories in HIV/STI prevention interventions, namely the social cognitive theory and the theory of gender and power, by highlighting theoretical and practical strengths and weaknesses. We propose research implications that incorporate key strengths of the two theories while adding new concepts grounded in the intersectionality theory. The overall goal is to introduce a more comprehensive conceptual model that is reflective of and applicable to the multidimensional sexual experiences of Black girls and women within the evolving definition of sexual health and behavior.
Highlights
Sexual health refers to the social, psychological, interpersonal, and intrapersonal functions of sex as a core element of health across the life span from adolescence through to later adulthood [1]
Studies have found that the perceived power difference between the two sexes due to the assumed gender ratio imbalance can impact whether Black women engage in behaviors that put their sexual health as a priority
Critique: theory of gender and power (TGP) discusses the power imbalance between men and women in heterosexual relationships, it does not account for the historical degradation of Black women and girls that has contributed to the HIV/AIDS epidemic
Summary
Sexual health refers to the social, psychological, interpersonal, and intrapersonal functions of sex as a core element of health across the life span from adolescence through to later adulthood [1]. There has been an overwhelmingly focus on individual-level risk behaviors as a factor in high incidence rates of STIs among Black girls and high HIV rates among Black women [2]. The data is concerning, yet prevention programs have not fully addressed the factors that continue to place Black girls and women at risk, which may continue to widen the disparity gaps in their health outcomes. Because STI and HIV prevention research tends to place focus on individual risk behaviors as opposed to structural factors, such as systemic racism, sexism, stigma, medical mistrust, and homophobia, the full lived experiences of. Black girls and women in the U.S have not been fully taken into account in theoretical frameworks that ground the most commonly used HIV and STI prevention programs. Theories used to develop interventions for Black girls and women should first highlight the historical context of how the relationship between sexual and romantic relationships involving Black girls and women are conceptualized, how stereotypes have impacted their views and expected behaviors, and the continued medical mistrust that is experienced by this group
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