Stigma as a Barrier to STI Care among Older African Americans

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Stigma as a Barrier to STI Care among Older
African Americans
Bronwen Lichtenstein PhD Department of Criminal
Justice University of Alabama ___________________
_____________ The research for this study was
funded, in part, by the Applied Gerontology
Program, the Department of Psychology, and the
College of Arts and Sciences at the University of
Alabama
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Background

• STI/HIV rates in the United States are highest
  among African Americans in the southeast
• Sexual activity is primary mode of transmission
  in the Southeast not IV use
• Older African Americans are more at risk of
  STI/HIV than other elders
• Elders are often unaware of STI/HIV risk

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Theoretical framework

• Cultural perceptions of old age for African
  Americans often center on assumptions that elders
  have higher social status, lead exemplary moral
  lives, provide community leadership, and are
  church-minded. Bourdieu (1977) framed these
  cultural dispositions in terms of habitus.
• Research question Are the effects of STI-related
  stigma greater for African Americans than for
  whites?

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Stigma context
Social Conservatism and Stigma Measures for the
South Compared to All U.S. States ________________
___ South United
States Religious Conservatism church
attendance 49 38 youth in church
weekly 43 35 religious conservative 21 19
pro life 10 8 ______________________ Sour
ce Laumann et al. (1994)
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Sample and Method

• Hypothesis STI-related stigma will be greater
  for older African Americans than for older whites
• Sample African Americans and whites aged 50 and
  older in Alabama (N190)
• Method 15-minute telephone survey, random digit
  dialing

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Questionnaire

• Eleven main items (30 sub-items). Yes/no or 5
  point Likert scale items
• Topics included
• Knowledge of STIs It is possible to cure
  sexually transmitted diseases not HIV/AIDS.
• Sex education It is important to teach
  abstinence
• Fear of STIs I am worried about catching STIs
  from public restrooms
• Enacted Stigma I would seek revenge if someone
  infected me
• Felt stigma I would be too embarrassed to see a
  doctor

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Four elements of STI control

• Prevention (e.g. sex education)
• Treatment the earlier the better
• Contact tracing for notifiable infections
• Partner notification for all infections

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Table 1. Social Demographics ____
A-A (N81) W (N109) Age
Range 50-84 50-83
Mean 62.4 62.9 Gender Male 41
40 Female 59
60 Income Low (lt20,000) 46
15 Medium (20-49,000) 35
43 High (gt50,000) 19
42 Education lt12th grade 23
7 High
school 35 31 gtHigh
school 42
62 Marital status Married 35 56
Never married 7 3 Sep/Div/Widowed 58
41 Church attendance Rare 5
20 Regular 73 53 Often 22
27 Location Urban 32
47 Rural 68 53

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Fear of STIs (1)
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Fear of STIs (2) Age comparisons from two surveys
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Figure. 3 Treatment and Contact Tracing
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Figure 4. Age comparisons from two surveys
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Figure 5. Partner Notification

• If infected I would

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Figure 6. Stigma and Blame
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Figure 7. Gender and STIs
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Figure 8. Fear of STIs Urban/Rural



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Figure 9. Stigma Urban/Rural

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Table 2. Attitudes towards STIs rural
African Americans
versus others
__________________________ Rural A-A
Others p _________________________________

STIs are like other diseases 49
28 lt.01 Fear being in same room
with infected person 27 4
lt.01 Afraid to hug infected person
39 11 lt.02 Afraid to get STI
from public restroom 56
27 lt.01 Women get more STIs than men
39 17 lt.01 Men
are to blame for spreading STIs 61
62 ns __________________________
__________________________________________________
__
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Table 3. Contact tracing and treatment for STIs
by ethnicity and location

• ___________________
• Rural A-A Others p
• ___________________
• Refuse to name partner 42 24 lt.05
• Seek revenge against partner 59 32 lt.01
• Delay treatment 71 54 lt.02
• No treatment at all 49 32 lt.05

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Conclusions

• Stigma is a barrier for all three arms of STIs
  control (partner notification, contact tracing,
  treatment)
• Stigma Dispositions African American elders were
  more fearful of STIs and of infected people than
  whites
• Likely actions African American elders were more
  likely to delay or forgo treatment than whites
  because of stigma
• Bourdieus (1977) habitus is useful for
  explaining the importance of cultural context
• The exemplary elder construct is useful for
  explaining cultural differences between elders

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The Exemplary Elder and STI Control

• Exemplary elders are opinion leaders. They exert
  considerable influence over younger people as
  teachers, authority figures, and church leaders.
• The challenge for public health policy is how to
  protect the exemplary elder construct within the
  traditions of local habitus, while harnessing the
  moral authority of older adults for STI control.
• The stigma dispositions of older African
  Americans should be examined more fully for the
  role of habitus in modes of resistance or
  motivations for action.