Correspondence regarding the manuscript may be addressed to:
Schenita D. Randolph, Ph.D.
School of Nursing
North Carolina A&T State University
1601 East Market Street
Greensboro, NC 27411
Phone: (919) 334-7750 FAX: (919) 334-7300
E-mail: sadavis@ncat.edu
Abstract
African Americans face the most severe burden of HIV among other racial and ethnic groups in the United States. One group warranting attention in North Carolina has been African American male college students. Between 2000 and 2003, 11% of new HIV infections among men ages 18-30 were enrolled in college at the time of their diagnosis, with 87% of those college students being African American. Another examination of HIV transmission among men ages 18-30 in North Carolina revealed that 15% of the men reported sexual contact with both men and women in the year prior to their diagnosis, and that these individuals were more likely than men who exclusively have sex with men to be African American and enrolled in college.
Sexual identity is a complex and multidimensional construct. Many factors surrounding sexual identity have yet to be sufficiently explored in the context of sexual transmission and HIV. To more fully understand the role that sexual identity may play in the lives of African American men, we interviewed African American male college students within a historically Black college and university in North Carolina. Our aim was to address a gap in the literature by exploring what shapes sexual identity and its development among African American men. This could lead to future research that could explain sexual behavior within the context of the HIV epidemic for this population. Interviews were used to assess experiences, attitudes, and beliefs about sexual identity development and sexual activity held by African American male college students. A total of 31 African American male students took part in this investigation. Researchers developed interview questions based on The Measure of Sexual Identity Exploration and Commitment survey instrument. Results from this qualitative exploratory study revealed that the language, meaning, and dimensions of sexual identity development were consistently related to peer and family influences, sexual physicality, importance of sexual reputations, safe sexual practices, full disclosure from sexual partners, and heterosexuality.
Introduction
African Americans face the most severe burden of HIV among other racial and ethnic groups in the United States. Despite representing only 14% of the US population in 2009, African Americans accounted for 44% of all new HIV infections in that year (Center for Disease Control, 2011). While the overall incidence of HIV in the US did not change significantly from 2006-2009, there was a 21% increase in people 13-29 years of age and a 34% increase in men who have sex with men. Among the 13-29 age groups, only MSM experienced an increase, and among MSM aged 13-29, there was a significantly greater increase among African American MSM. Overall, there was a 48% increase in African-American men who have sex with men (Prejean, Song, Hernandex, Ziebell, Green & Walker, 2011).
Furthermore, in 2009, 57% of the 11,200 new HIV infections among women occurred in African American women and the vast majority (80%) of the new cases were due to heterosexual transmission (Prejean, et al., 2011). Research has suggested that there are some African-American men who do not self-identify as gay or bisexual, but do in fact have sex with both men and women (Millet, Malebranche, Mason & Spikes, 2005). This phenomenon may be one explanation for the increased rates of HIV transmission to African- American women (Millet,et al., 2005). Black men appear more likely to be behaviorally bisexual than men of other racial groups (Montgomery, Mokotoff, Gentry & Blair, 2003). However, despite attention to this phenomenon of African American males, there is no empirical evidence that this is uniquely African American or responsible for increased HIV infection among African Americans (Millet, et al., 2005; Bond, Wheeler, Millett, LaPollo, Carson & Liau, 2009).
Male African-American college students are at particularly high risk for HIV infection. Between 2000 and 2003, 11% of men ages 18-30 years who were newly infected were enrolled in college at the time of their diagnosis, and 87% of those college students were African American (Hightow, MacDonald, Pilcher, Kaplan, Foust, Nguyen & Leone, 2005). An examination of HIV transmission among men ages 18-30 years in North Carolina found that 15% of the men reported sexual contact with both men and women in the year prior to their diagnosis. Bisexual men were more likely than men who exclusively had sex with men to be African American and enrolled in college (Hightow, Leone, MacDonald, McCoy, Sampson & Kaplan, 2006).
Although all men and women, regardless of sexual orientation, race and ethnicity have a process for sexual identity, this study focuses on African Americans because they are disproportionately affected by the disease and it is essential to implement culturally appropriate interventions to address this disparity. It is important to understand African American men’s sexuality and views of homosexuality in order to implement the best strategies that will assist them in protecting themselves and their partners. Therefore, a first step in addressing the spread of HIV in African American college students is to gain insight into African American male sexuality and sexual identity development. Such information could shed light on the factors that drive sexual risk behaviors among young, college-aged African-American men. Research on the sexual experiences of African-American men, however, has typically focused primarily on their behaviors; little work has been done to understand how these men develop their sexual identities (Wyatt, Williams & Myers, 2008). Furthermore, most of the work on the sexuality of African-American men has ignored heterogeneity, developmental change, and the context in which sexual behaviors occur (Lewis & Kertzner, 2002).
Finally, little research has been done with African-American college men despite the importance of understanding the context of their sexual behaviors (Hightow, et al., 2006).
Method
To gain insight into the role that sexual identity may play in the lives of African-American men, we interviewed African-American male college students in a historically Black college and university (HBCU) located in the central Piedmont region of North Carolina in one of the largest cities in the state. Specifically, we explored the language, meaning and dimensions of sexual identity and factors influencing the sexual identity development process. The study had two goals: 1) to assess men’s ideas about gender, sexuality, and sexual behavior, and 2) to identify ways in which an understanding of sexual identity development might inform appropriate and effective sexual health interventions.
This exploratory study used a qualitative design to investigate the sexual identity development of African-American college men. We conducted semi-structured interviews with African-American male college students to solicit information about their experiences, attitudes, and beliefs about sexual identity development and sexual activity. The interviews took place during November 2010. The undergraduate population at this HBCU is 89% African-American and 46% male.
Thirty-one African-American male undergraduate students participated in one-on-one interviews. Participants were recruited through fliers, texting, and Twitter communications sent by recruiting assistants as well as by word of mouth. To be eligible, participants had to 1) be enrolled in the university as a part-time or full-time student; 2) self-identify as a black and/or African-American male; 3) be between the ages of 18 and 25; 4) be conversant in English; and 5) be able to provide consent. Participants received a $40 gift card for their participation in the study.
Given the study’s focus on participants’ subjective experiences and views of sexual behaviors, a qualitative method was chosen. A qualitative approach explores individual experiences by using dialogue and emergent themes that delve beneath the surface of aggregate data. Qualitative methods are particularly relevant when the issues under investigation are relatively new and questions have yet to be clearly and completely explicated, as is the case with sexual identity development among African American males.
Researchers developed interview questions based on The Measure of Sexual Identity Exploration and Commitment (MoSIEC) survey instrument (Worthington, Navarro, Savoy & Hampton, 2008). The MoSIEC survey instrument views sexual identity as comprised of six dimensions: modes of sexual expression, sexual values, sexual needs, sexual orientation, characteristics of a sexual partner, and sexual activities. The interview questions explored each of these components.
Pilot cognitive testing of the interview guide was conducted with a sample of six African Americans who were studying public health and were recent graduates of the HBCU. We asked them for feedback on their understanding of the meaning of the questions as they were responding to the instrument. Based on the feedback some modifications were made to specific questions to increase the clarity of the questionnaire.
Semi-structured interviews were conducted over 3 days using an interview guide developed by the first author, who had a faculty affiliation with the HBCU, and an African-American male graduate research assistant who was not affiliated with the HBCU. The University Institutional Review Board approved the study. Informed consent was obtained before each interview, and all interviews were audio recorded. Each interview began with an introduction to the study, and allowed time for participants to ask any questions.
Interviewers probed participant responses for clarification or to collect additional detailed information. Participants could choose not to answer any question, and they were also permitted to terminate the interview at any time and receive partial compensation (a $10 gift card). The interviews lasted approximately 45 minutes. Upon completion of the interview, demographic data were collected by self-report. The data included age, religion, academic classification, location of permanent residence, and sexual orientation. All interviews were transcribed verbatim.
Qualitative analysis was conducted by the first author and two research staff members using Atlas.ti. The analysis was guided by a master code book that consisted of the six dimensions listed in Table 2. The initial analysis took a grounded theory approach. The approach followed a traditional recursive and iterative process in which earlier interviews were referenced in order to inform and shape future interviews. This approach is appropriate for discovery oriented research and is most often used in under–theorized areas of research.
Results
Characteristics of the study sample are presented in Table 1. The mean age of the sample was approximately 20 years. Men in the second, third, and fourth years of college at the time of interviews were equally represented. Respondents were primarily from North Carolina. All but two participants identified their religion as Christian, and all reported their sexual orientation as heterosexual.
There were consistent perceptions and values related to sexuality among these African-American male college students. Although there were 31 interviews conducted, only the themes that emerged as salient for participants are described below under each of the six dimensions of sexual identity development (Worthington, et al., 2008). Table 2 presents a summary of qualitative codes with their corresponding conclusions.
Characteristics of Sexual Partners
Participants in this study sought differing types of sexual relationships with women depending on the woman’s characteristics. The participants described two different ways of characterizing women; one approach was based on physical attractiveness and other aspects of compatibility, and the other on sexual reputation. Participants all said that one type of girl had “relationship potential” and had positive physical attributes while the other type had a reputation of being “easy” in that she would have sex with them. One participant stated: “Because with my girlfriend, I love her, I feel like it’s a connection between me and her, physically and spiritually. Anybody else it’s just sex. No feelings attached.”
Another participant said: “So if she’s dumb, then we can still have sex, it’s just not going no further. And if you’re a ho, we can still have sex, but it’s never going any further. That’s even worse than being dumb.” The kinds of characteristics men sought in their partners varied not only by the type of relationship they wanted, but also from man to man. The participant quoted above identified reputation, intelligence, and absence of sexual promiscuity as important characteristics in a partner with whom he would like to have a relationship that went beyond simply having sex. These sentiments, however, were not echoed in the statements of others.
Modes of Sexual Expression
Participants reported that being sensitive to the concerns of the women they were involved with sexually was important. They also acted respectfully towards women while they were in a sexual relationship, including actually having sex. Oral, vaginal, and spontaneous sex were ways that the participants expressed themselves sexually. It was generally viewed that expressions of sex were demonstrated physically and spiritually, however, having an emotional commitment could be disassociated from sexual activities with certain partners. One participant describes: “Sex for me in the emotional sense it gives me another way that I can show my emotions in a physical way that is both healthy and pleasurable to my partner. But without emotions, it fulfills a physical desire of mine and of my partner's that I'm with…”
Sexual Activities
Oral and vaginal sex was the most frequently reported sexual activities, with few participants reporting experiences with anal sex. They also reported that performing oral sex on a woman depended on the number of partners that the woman had been with. The more partners a woman had, the less likely the participants were to perform oral sex.
Participants reported that having a greater number of sexual partners had been more important to them when they were younger. One senior participant said, “When I was in high school, I think I had four sex partners. But now I’m at 30, and that’s when I first came to college.” This participant said that upon entering college it was very important to have multiple sex partners, however, over time it had become less important for him to have sex with a lot of women. Sexual
Needs
The sexual needs of participants ranged from needing sex on a regular basis to sex as something that they could go without. Most referred to sex as being a good stress releaser. Most also said that men have sex because it feels good, makes them feel manly, and gives them a sense of being in control. A number of things influenced these individuals’ need to engage in sexual activities. One participant stated, “I have a drive if I just see the girl come up to me and she has no clothes or she’s revealing so much that it should drive an old man. Okay, but more or less, TV drives me, the Internet drives me, just seeing stuff like that on TV and the computer and all that stuff makes you just want to think about it, like yah I got to go, I want to have some sex.”
Sexual Orientation/Identity
All participants self-identified as heterosexual with only two even mentioning another man with whom they had been friends or having had any homosexual thoughts. Participants described sexual-identity as their personal preferences, likes, dislikes, and habits. They believed that they generally had developed their sexual orientation and identity from the influences of their peers, parents, and other family members. It was important for participants to have a sexual identity that made them feel like a man who is dominant. Masculinity was important, and not having a strong, masculine identity was looked upon negatively. For example, one participant stated, “All right. So if you have a gay person, and then other people are looking at him as being gay, so if you have a gay person next to a straight person, the gay person is the negative person out of the group. So nobody wants to be looked at as being negative. And growing up, that’s all you hear about is Oh he’s gay, Oh he’s gay. It s a bad thing to be associated with. So I wouldn’t want to associate myself with that.”
Sexual Values
Values related to sex varied among participants. A majority felt that having sex alone does not make you a man, while others stated that society has informed them that there is a direct link between manhood and sex. Therefore, it is a popular thing for men to discuss and brag about the number of sex partners they have encountered. Many participants say that sex is a physical act that does not have to have emotions attached to it. For example, one participant stated, “Sex on its own is a physical act, and as a physical act, it's okay for that physical act to go on between two people regardless of whether there's any emotions at all. And with my experiences, I was able to take the emotion out of sex, so that way I didn't equate love and sex.” Although many participants had heard that sex should be kept for marriage, many stated that doing this would be a challenge and don’t feel that many young males their age actually wait to have sex.
Discussion
Study limitations include the small sample size. The perceptions and values of only 31 students were included in the results. This study was also limited to one HBCU. It is not for certain that the same study results would have been obtained at other HBCUs or other colleges and universities. Finally, the sensitivity of the subjects is also a potential limitation in that all responses were based on subjective data collected.
Sexuality for African American men has a major impact on their health. It is important for public health professionals working with this population to have an understanding of their language and the meaning of sex and sexuality for them. Interventions aimed at influencing sexual behavior in isolation from issues of sexual identity may not be effective. Having forums for conversations about sexuality to take place with this group on college campuses may be one opportunity for implementing HIV/STD prevention interventions. Having insight into the contextualization of African American male college students’ sexual identity development can inform programs to promote the sexual health of African- American men and ensure that strategies are culturally and socially appropriate.
This study showed that the perceptions and values of this specific population can potentially have some negative influences on their sexual behaviors. Participants commonly reported having a “main girl” to whom they were emotionally committed, but identified other women that they were only interested in for sex. The general theme of having multiple, often concurrent partners, but having at least one partner that they classified as “significant” has been cited by others as a potentially important HIV risk factor among African American heterosexuals (Adimore, Schoenback, & Floris-Moore, 2009) and should be recognized when planning interventions for African American college students as well. The women who engage in sexual activities with college men who have multiple partners, particularly concurrent partners, are placing themselves at a higher risk for sexually transmitted diseases and HIV and should be made aware of the perceptions, thoughts, and values of their potential sex partners (Adimore, et.al., 2009).
A common theme that was evident across all six aspects of sexual identity development was that sexuality and sexual orientation are private. Many of the men in this study felt that sexuality was a personal issue, and not all things surrounding it should be disclosed. This increases the possibilities of risky sex behaviors that could lead to STDs and HIV. It was also evident that being “gay” was not accepted by this group of participants. If it is found to be pervasive, these stigmatizing attitudes could potentially influence the number of men who will engage in same sex activities, but not disclose it to others.
While some men reported that values from family and church promoted monogamy and abstinence, most participants felt a greater influence by peers to have multiple sexual partners to booster their reputations. Prevention programs should explore involvement from family structures and the faith community to reach this group even before they reach college age. More involvement from these entities could potentially have an influence in decision making about sex.
While this study did not look at specific groups based on sexual orientation, future studies should explore sexual identity development of men who have sex with men exclusively and men who have sex with both men and women. Although studies have compared sexual behaviors of these two groups, few studies have compared the sexual identity of these two groups or looked at how identity development may impact their sexual decisions and behaviors.
In conclusion, the language, meaning, and dimensions of sexual identity that were reported by these participants were consistently related to issues of peer and family influences; sexual physicality and the importance of sexual reputations; emphasis on safe sexual practices and full disclosure from sexual partners; and heterosexuality. While the sexual values among this population were similar, the specifics of the contextual aspects of their sexual identity varied, suggesting that these issues warrant further, more in-depth investigation. Research should explore the meaning of the sexual identity development process for young, Black men to provide culturally and socially relevant prevention strategies and messages about HIV and other STDs. Media campaigns, stigma reduction programs, individual level computer-based sexual communication skills training, and individual level counseling programs are all approaches that could be potentially effective with college students at HBCUs to reduce their HIV/STD risk.
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