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Crooks explores higher STI, HIV rates among Black women

UIC Nursing’s Natasha Crooks finds that sociocultural conditions of protecting Black men, silence, cultural messaging, and societal expectations and stereotypes contribute to these higher rates.

Natasha Crooks

In her clinical experiences, UIC Nursing assistant professor Natasha Crooks, PhD, RN, saw young Black women with sexually transmitted infections and heard their stories about early pregnancies and sexual engagement.

She knew from prior studies that Black girls and women were disproportionately affected by sexually transmitted infections (STIs) and HIV but noted a gap in the literature when it came to understanding why.

“There was no framework or theories specific to Black women,” she says. “That’s huge: You can’t work to reduce STIs and HIV in this population if you don’t understand their experiences. As a Black woman myself, I’ve really seen disparities and inequities play out with my own friends and family, which drew me to this area of Black female sexuality and STI/HIV prevention.”

As lead author in a paper published in the journal of Social Science and Medicine, Crooks explores sociocultural conditions in which Black women are silenced about their sexuality, protect Black men who may be transmitting infections, and face cultural norms, stereotypes and messaging about sexuality. She and her co-authors find that these are contributing factors to higher rates of HIV and STIs among Black women.

“Our findings demonstrate the need for STI/HIV prevention programs to address these sociocultural conditions to improve Black female sexual health,” Crooks and her co-authors wrote in the paper, titled, “Addressing sexually transmitted infections in the sociocultural context of Black heterosexual relationships in the United States.”

Despite the fact that Black women have fewer sex partners and are less likely to engage in unprotected sex, their chlamydia rates were five times those of white women, and gonorrhea rates were 8.8 times higher, according to CDC data for 2018. Among women diagnosed with HIV in 2016, 61% were Black, compared with 19% who were white, according to the CDC.

Crooks interviewed 20 Black women between the ages of 19 and 62 years old about their experiences with sexuality and sexual health.

She and her co-authors found that Black women were socialized to protect Black men but often did this “at the expense of their own sexual health.” Black heterosexual women’s partners tend to be Black men, whose STI rates are higher compared to non-Black men, according to the paper. Women in the study said they found it empowering to protect Black men, even if this meant enduring hardship or forgiving men who betrayed them.

“I think part of this goes back to history, and the structural violence we experience with incarceration and lack of economic opportunities,” Crooks said in an interview. “The Black man is the pillar of the Black family, but they’re often taken away, whether due to incarceration or being killed. That’s where the protection comes in. We stand up for them; we protect them; we help them; we give them grace.”

The paper’s authors also found a historically rooted culture of silence among Black girls and women around sex and sexuality, which impacts STI/HIV risk by making it difficult for girls and women to protect themselves or advocate for condom use. Participants in the study shared personal stories of sexual assaults when they were younger, saying they stayed silent because they feared no one would believe them. Older participants described growing up with social norms that discussion of sex was not “ladylike” or not something a family discussed.

Study participants also talked about underage Black girls engaging in sexual relationships with older Black men, describing this as a cultural norm. Girls whose bodies developed at an early age may have been pursued by men who viewed them as grown and capable of engaging in sex.

“Having an older sexual partner can be associated with intimate partner violence, which has been linked to [lack of] condom use and STI/HIV risk,” the authors write. “Differences in age could contribute to communication and power dynamics in sexual relationships that disadvantage young girls.”

Further, societal expectations and stereotypes to fulfill the sexual needs of men may prevent Black women from communicating about sex or advocating for condom use, the authors write.

Crooks says an intervention to help them protect themselves at the “girl phase of sexual development” is needed. Among her study participants, the mean age for first intercourse was 11 years old and the median was 14 years old.

“As a Black girl, there are so many messages coming at you, whether cultural, historical, or from the media,” Crooks says. “Our main goal should be to protect Black girls at that ‘girl phase’ when they’re particularly vulnerable to STIs, sexual trauma and early sexual engagement.”