Gender and Power Issues Among Male and Female Adolescents with Repeat STIs:

What Works for Girls May Not Work for Guys.

Sharleen H. Simpson, PhD1, Cheryl McGhan, PhD2 and Karla Schmitt, PhD, MPH3

1 University of Florida, 2Northeast Florida State Hospital, 3Florida Dept. of Health Bureau of STD Prevention and

Control

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Acknowledgements 

Contract Number COA7V from the Florida Department of Health, Bureau of STD Prevention and Control in collaboration with Centers for Disease Control and

Prevention, Division of STD Prevention and Control supported this research.

 

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Purpose of the Study

The purpose of this study was to explore, through qualitative methodology, psychological, social, and contextual factors that may contribute to re-infection with gonorrhea or chlamydia among adolescents who attend Duval County STD Clinic.

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Background

• Sexually active adolescents are the highest risk group for STIs.

• Duval County (Jacksonville) reported twice as

many cases of GC and Chlamydia in adolescents compared to the average case rate in Florida

• Inclusion criteria—at least two episodes of GC or chlamydia within 24 months

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Research Questions• What was going on in the lives of these teens

that led to continued re-infections?

• What were their perspectives and motivations as told in their own words and through their own experiences?

• How can these narratives help formulate more effective prevention strategies?

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Research Design

• Sample: 5 Black Males and 11 Black females and 1 White female 14-19 years of age who attended an STD clinic.

•In-depth interviews to elicit the “stories” or

narratives of these teen’s experiences.

•Analysis of narratives used to identify

recurring themes within and across interviews.

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Findings

• Many had poor parenting• Absent fathers• Mothers who had to work two or three jobs• Fathers and other family members in jail• Those who did have more stable homes did

better.• All knew about the need to use condoms.

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Findings--Parenting

CoolCat: “My dad locked up, and my mom Daytona. Um, I knew it was going to happen, it was just a matter of time. So, I wasn’t too angry. Cause I had my momma there, but (sigh) ain’t trying to go down his road.”

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James: Father and older brother are in prison: “…my brother, he locked up currently right now. (He) … my father figure anyway…I pretty much ain’t never known my daddy. He locked up for life…out in California State Penitentary. …I raised myself after I got twelve…everything I know now and everything I done seen and done I showed myself …I had to teach myself cause there wasn’t nobody there to show me nothing, you know.”

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James was a star athlete in swimming, got awards but had no one there to support him:

“…one year I get nominated as the MVP and team captain…when I go to accept my trophy, everybody moms there, and…my mom ain’t even much there. I didn’t…accept my trophy cause the way I felt then, …ain’t nobody even really give a damn what I did…so that’s what really caused me to start dropping out of school…”

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James hangs out with a group of young men that he calls his “little brothers.”

“…all of us from out of this group ain’t got no father figure. That’s the reason why I hang with them…cause we all going through the same shit…”

“…right now…I’m trying to keep most of them in school…three of them graduating…three more still in school…five of us that didn’t graduate because we got kicked out…stuff that could have been avoided…we just trying to keep it together.”

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Findings--Parenting

Keisha, aged 19:

“…my mom, she, like always like, she always put her men before us, her children…I just like basically raised myself…she wasn’t no mother-figure to me. I was like…basically everything I learned, I learned on my own.”

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Findings--Parenting

• Mike (BM) and Poo (BF) age 16, both had more stable family arrangements with a mother and a stepfather

• They were both still in school and seemed to be staying out of trouble.

• Even with this increased stability they both had had several STIs.

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First Sexual Experience

• Boys usually had sex with an older, more experienced girl, usually by 12 or 13 years.

• Girls had first had sex with an older boy and sometimes with an older man.

• Several girls reported being raped as their first sexual experience.

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First Sexual Experience cont.

• Most girls reported being “curious” or that they did it because of peer pressure.

• Alcohol was involved with most of the rape cases.

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Failure to Use Condoms• Boys

– Didn’t have condoms or the girls told them not to use the condoms.

• Girls – Did not use condoms because they “hurt”,

the boy did not like it or they wanted to get pregnant.

• Both reported sometimes being too high on drugs and alcohol to use condoms.

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Knowledge of STD Risk

• Girls– Aware of the risks but willing to ignore them

in order to develop and maintain a relationship.

• Keisha: (Explaining why she stays with a boyfriend who has given her several STIs), “I love him. I mean, I’m just, I’m a, I’m a settling down type,…but … I always stay with him cause I love him so much.”

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Knowledge of STD Risk

• Boys – Knew they should use condoms but many

thought they could tell by how a girl looked whether she had an STD.

Mike:“…she’s real nice, and real clean, wore nice

clothes, had her hair done all the time, …a good student…wouldn’t a thought she

would have a STD.”

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Social Environment• Mike thinks it is dangerous for a young

Black male to spend a lot of time with friends. He wants to graduate and go to college on a football scholarship

Mike: “…I have one friend…and that’s about all the friends…I don’t really do the hanging out…cause it’s trouble so easy to get into…”

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Discussion

• Double standard—Boys had girls they had sex with and “girlfriends” they really cared about.

• Boys expected their “girlfriends” to be faithful

even though they were not.

• Some girls expected that their boyfriends would see other people but others expected fidelity.

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Discussion cont.

• Absence of a father was a major influence for both young men and young women.

• It may be related to the strong focus young women had on forming and maintaining a relationship with a young man.

• In young men it may be related to the anger and hostility they feel.

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Discussion cont.

• The single parent was usually the mother and young women were more likely to have conflicts with their mothers.

• Lack of knowledge does not seem to be the reason adolescents in this study had repeated STIs.

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Conclusions

1. Need to know the community context to understand the behaviors of these adolescents.

2. Duval County has a history of problems with race relations.

3. The Jacksonville Community Council Inc. has done several studies on race relations, particularly the situation with young black males (JCCI, 1992; 2002).

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According to the JCCI, 2002:

• Intervention programs more likely to serve white youth.

• Black youth more likely to serve time

• A disproportionate number of black men are removed from the workplace, decreasing family stability

• Public policy decisions made by white males

• Duval County schools do not enable teachers to effectively educate children from diverse cultural backgrounds.

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Conclusions cont.

1. “Young black males who are not personally involved in crime or violence run a disproportionately high risk of becoming victims or being mistaken for perpetrators” (JCCI, 1992 and echoed in JCCI, 2002)

2. “The prevalence of female heads-of-household and absent

fathers contributes to a lack of husband/father role models for young black males and to the perpetuation of this pattern in the next generation” (JCCI, 1992).

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Practice Implications

• Social and psychological problems must be dealt with before adolescents can hear prevention messages.

• Current services more oriented to needs of young women.What works for young women may not work for young men. Tailor programs to meet gender-specific needs.

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Implications cont.

• Knowledge deficits about STIs greater in young men.

• Racial disparities, particularly those that affect young black men must be addressed.

• Keeping young black males in school and ensuring they have life goals may be more effective than simple preventive education.

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References:

McGhan, C. (2005). Repeated Acquisition of Sexually Transmitted Infections: Feelings, Perceptions and Explanations of Adolescent Girls. Dissertation, University of Florida, Gainesville, FL.

Jacksonville Community Council, Inc. (JCCI) (1992). Young Black Males Study. Available at http://www.jcci.org/projects/projectreports.aspx

Jacksonville Community Council, Inc. (JCCI) (2002). Beyond the Talk: Improving Race Relations. Available at http://www.jcci.org/projects/projectreports.aspx