Date of Degree


Document Type


Degree Name



Social Welfare


Willie Tolliver

Subject Categories

African American Studies | Social Work


African American; Black; HIV/AIDS; Latino; Social Determinants; Social Work


More than thirty years into the HIV/AIDS epidemic, Black, African American, and Latina/o communities continue to demonstrate the highest rates of HIV/AIDS in the US, accounting for 64% of all new infections and 58% of all AIDS diagnoses in 2009. Despite the longevity of this public health crisis, individually-based behavioral change approaches to HIV/AIDS prevention continue to be the most widely used and funded methods of combating HIV risk in Black, African American and Latina/o communities. These methods have been proven to lower the risk of HIV transmission, but HIV incidence in the US remains high at approximately 50, 000 new infections each year. These stubbornly high new HIV infections reflect a limitation in individual and group-level HIV prevention interventions with regard to enduring behavior change.

This dissertation used secondary data analysis to investigate if the structural level factors of homelessness, incarceration, and poverty predisposed Blacks, African Americans, and Latinas/os to engaging in unprotected vaginal or anal sex. Baseline data collected for a NIDA-funded randomized controlled trial that tested the efficacy of a four-session, cognitive-behavioral skills-building HIV prevention intervention with HIV-seronegative non-injection drug users and their network members in Harlem and the South Bronx, was used to assess the relationship between macro-level structural factors and micro-level individual sex risk behaviors. The baseline dataset consisted of a sample of 270 study participants between the ages of 18-59.

Sex-risk behavior was measured by the Vaginal Equivalent Episode (VEE), a weighted index of each episode of unprotected oral, vaginal and anal intercourse. Univariate analyses revealed that 74% of the study participants had a history of incarceration, 54% had been homeless in the past three months, and 74% were in receipt of public assistance. Chi-square values for bivariate analyses between the three structural-level variables and unprotected sex were all statistically significant. The final model in stepwise multiple regression illustrated that for every unit increase in income from selling sex, VEE scores increased (â = .155), and for every unit increase in incarceration, VEE scores increased (â = .148) as well. An increase in income from selling sex significantly predicted more episodes of unprotected anal, vaginal and oral sex (p = .033), and an increase in the number of times in jail, prison or a detention center significantly predicted more episodes of unprotected anal, vaginal and oral sex (p = .012). These research findings illustrate a direct relationship between macro-level structures and micro-level sex risk behaviors.