Mandy J Hill is a trained Clinical Researcher. She has advanced a prevention-based public health agenda within a clinical environment. Her academic portfolio to date has demonstrated feasibility of HIV prevention through formative intervention work that is designed to meet the people where they are, including the emergency department. Her current research agenda is to adapt efficacious interventions to varied settings where vulnerable populations at especially high risk for HIV infection can be accessed. She has published 22 peer reviewed manuscripts, 10 she first authored in diverse areas addressing health disparities among minority populations, coupled national and international presentations and extramural funding support from the CDC and the NIH through the American Psychological Association and Centers for AIDS Research, as well as industry sponsored research. In summary, her expertise includes randomized clinical trial development and implementation, and integrating public health-based prevention research into varied settings that include the emergency department.
Statement of the Problem: The HIV epidemic in the US continues to disproportionately affect the health of young, African American women. The focus here is on predictors of sexual scripts, which are roadmaps to sexual decision making. The objective is to examine life experiences, normative beliefs, and cultural predictors of sexual scripts that place young, sexuallyactive, substance-using, African American women (YSSAAW), a population with significant vulnerability to HIV, at even greater risk of becoming HIV positive.
Methodology & Theoretical Orientation: Face-to-face, tablet-assisted, semi-structured interviews were conducted with 30 YSSAAW in a private or public emergency department in Houston, TX, USA. Interviews were professionally transcribed,
then coded by a trained 3-member coding team. One interview was used to create the codebook. Codes were organized into primary themes during face-to-face meetings. Inter-coder reliability was assessed and confirmed using Cohen’s Kappa statistics, demonstrating a nearly perfect agreement between coders 1 and 2 (K=0.93).
Findings: Three primary themes were described as predictors of sexual scripts: emotional wounds, norms and decision making. Prevalent codes among YSSAAW within the emotional wounds theme included infidelity (43.33%) and parental dynamics (56.67%). Under the norms theme, we found 66.7% of YSSAAW discussed their communication norms and 30% disclosed cultural norms. Within the sexual decision making theme, we gained relevant information and implications on relationship longevity and having an STI history among 46.67% of the sample.
Conclusion & Significance: Primary predictors of high risk sex revealed sexual scripts that demonstrated gender-based power differentials; thereby, supporting utility of a theoretical framework that includes the Sexual Script Theory and the Theory of Gender and Power. The logic model illustrates how emotional wounds from life experiences (i.e., trauma, abuse, abandonment) and socially acceptable norms establishes the sexual script of YSSAAW; whereby, high risk sex is the most likely outcome relative to prevention strategies.