Choosing Unsafe Sex

Choosing Unsafe Sex: AIDS-Risk Denial Among Disadvantaged Women

Elisa J. Sobo
Copyright Date: 1995
Pages: 256
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  • Book Info
    Choosing Unsafe Sex
    Book Description:

    Choosing Unsafe Sex focuses on the ways in which condom refusal and beliefs regarding HIV testing reflect women's hopes for their relationships and their desires to preserve status and self-esteem. Many of the inner-city women who participated in Dr. Sobo's research were seriously involved with one man, and they had heavy emotional and social investments in believing or maintaining that their partners were faithful to them. Uninvolved women had similarly heavy investments in their abilities to identify or choose potential partners who were HIV-negative. Women did not see themselves as being at risk for HIV infection, and so they saw no need for condoms. But they did recommend that other women, whom they saw as quite likely to be involved with sexually unfaithful men, use them.

    eISBN: 978-0-8122-0037-9
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-x)
  4. Chapter 1 Introduction
    (pp. 1-7)

    The popular and scientific media often describe people who are at risk for human immunodeficiency virus (HIV) infection but fail to use condoms as being “in denial.” Unfortunately, most authors, clinicians, and health officials — indeed, most people — take the specifics of the denial process for granted. Denial has become a blanket term in the most literal sense, tossed about freely, covering up or hiding away the broad range of complex factors that contribute to Acquired Immunodeficiency Syndrome (AIDS) risk misperceptions and unprotected (e.g., condomless penetrative-receptive) sex. Until we examine these factors and arrive at an understanding of the mechanisms of...

  5. Chapter 2 Women and AIDS in the United States
    (pp. 8-24)

    As I write, the cumulative total number of reported AIDS cases in the United States hovers at about 400,000. By the end of 1993, about 61 percent of all individuals who had been diagnosed with AIDS since its biomedical identification were dead (CDC 1994a). AIDS is the third leading cause of death among U.S. men and women aged twenty-five to forty-four; it is the ninth leading cause overall (CDC 1993d).

    Most of the people who are now suffering from AIDS were infected years ago with Human Immunodeficiency Virus (HIV), the virus associated with AIDS. Today, between 550,000 and 1,000,000 U.S....

  6. Chapter 3 AIDS Education and the Perception of Risk
    (pp. 25-50)

    The research for this book grew out of the concern that Cleveland’s Maternity and Infant Health Care Program (M&I) clinic clients were not heeding the M&I safer sex message. There was nothing unique about the relative failure of the M&I AIDS education mission, which focused on the dissemination of factual information. Most studies conclude that no significant relation exists between safer sex and the degree of AIDS or HIV knowledge people have (e.g., Farmer and Kim 1991; Geringer et al. 1993; Johnson 1993; Linden et al. 1990; Mays and Cochran 1988; Prohaska et al. 1990); behavioral changes made by homosexual...

  7. Chapter 4 Seropositivity Self-Disclosure and Concealment
    (pp. 51-62)

    People who have tested negative for HIV or who have not been tested at all often fear being lied to or manipulated by unethical seropositive individuals. This fear, in turn, affects risk-related behavior. Urban legends abound warning of beautiful HIV-positive charmers who enchant and then have unprotected sex with unsuspecting seronegative¹ people in order to spread the virus (regarding the social construction of AIDS and the further ramifications of myths such as this one, see Abelove 1994; cf. Farmer 1992; Turner 1993). Moreover, several cases in which HIV-positive individuals had unprotected sex with others while concealing their seropositivity have received...

  8. Chapter 5 The Condom Use Project
    (pp. 63-74)

    My original research mission involved investigating the low efficacy of AIDS education in Cleveland’s M&I clinics in order to improve it. My main aims were to find out why most clients neglected to comply with the safer-sex guidelines provided, and to identify the factors distinguishing the non-users from the few who did use condoms.¹

    It is folly to believe that education alone can halt the spread of AIDS (see Chapter 3). The constraints that sexism, racism, and other oppressions place on people’s perception of AIDS risks and on their abilities to reduce these risks are immense. Vast social, cultural, and...

  9. Chapter 6 Romance and Finance
    (pp. 75-105)

    The common assumption that impoverished women engage in unprotected sex because of financial coercion and a lack of empowerment pervades a great deal of both popular and academic thinking about lower-income minority women and AIDS (cf. Kline et al. 1992; for examples of models that give economics a prime role see Carovano 1991; De La Cancela 1989; Ward 1993a; see also Campbell 1990; Worth 1989; regarding the political economy of STDs in general see Jones 1991). Deployed in certain contexts, assumption reveals and perpetuates racism and classism: it would never be used to explain sexual risk taking among white women...

  10. Chapter 7 The Psychosocial Benefits of Unsafe Sex
    (pp. 106-139)

    This chapter uses study findings to show that unsafe sex is part of a psychosocial strategy for maintaining one’s status and sense of self — a strategy that involves telling patterned narratives (as regarding a partner’s faithfulness) and acting out scripts (as by engaging in unsafe sex) that optimistically confirm the quality of one’s choice of a partner and so of one’s relationship with him. Economic motives do, in some cases, play a role in encouraging some women’s unsafe sex (e.g., Campbell 1990; Ward 1993a; Worth 1989) but, as Chapter 6 showed, purely materialist or economic approaches to urban minority women’s...

  11. Chapter 8 HIV Testing and Wishful Thinking
    (pp. 140-156)

    Condomless sex supports the Monogamy Narratives women tell about themselves and their relationships. A positive HIV test leads a woman to replace this narrative with another: as Martha Ward (1993b) shows, many HIV-positive women tell of broken trust and partners that must not have really loved them. I call this narrative the “Betrayal Narrative.”¹

    Even prior to and without positive diagnoses, women fear betrayal. A woman may believe in her own wisdom and skill in choosing safe partners, and she may trust her man when he says that he is faithfully monogamous. But, for reasons connected to risk perception (see...

  12. Chapter 9 Self-Disclosure Self-Described
    (pp. 157-179)

    The need for safer sex practice does not end with a negative HIV test; neither does it end with a positive diagnosis. Indeed, safer sex is as imperative for HIV-positive individuals as it is for HIV-negative individuals, not only because the former might otherwise pass the virus on but also because they are at risk for reinfection and for infection with other kinds of pathogens. While this project did not originally concern the experiences of individuals who know themselves to be HIV-positive, it soon became clear that, in addition to self-esteem and status-related concerns, the riskrelated behavior of seronegative and...

  13. Chapter 10 Circumventing Denial
    (pp. 180-196)

    Neither the Midwesterners that Chapters 5–8 were expressly concerned with nor the Southwesterners who spoke through Chapter 9 thought that AIDS would affect them. But denial alone cannot hold HIV and AIDS at bay; indeed, denial sometimes acts as a catalyst that enables HIV to spread because denial keeps people from acting to reduce their risk for infection. In light of this, a keen understanding of the mechanisms underlying denial is essential, and this book has been expressly concerned with exposing and describing them to that end.

    AIDS-risk denial in the United States is tied to monogamy ideals and...

  14. Appendix A: Interviewee Profiles
    (pp. 197-203)
  15. Appendix B: Further Quantitative Findings
    (pp. 204-208)
  16. References Cited
    (pp. 209-226)
  17. Index
    (pp. 227-232)
  18. Back Matter
    (pp. 233-233)