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The popular and scientific media often describe people who are at risk for human immunodeficiencyvirus (HIV) infection but fail to usecondoms as being "in denial." Unfortunately, most authors, clinicians, and health officials —indeed, most people —take the specifics of the denial process for granted. Denial has become a blanket term in the most literal sense, tossed about freely, covering up or hiding away the broad range of complex factors that contribute to Acquired ImmunodeficiencySyndrome (AIDS) risk misperceptions and unprotected (e.g., condomless penetrative-receptive) sex.Until we examine these factors and arrive at an understanding of the mechanisms of AIDS-risk denial, we will be unable to suggest effective ways to lessen the denial, and wewill continue to be limited in our ability to decrease the high rates of unsafe sexit entails. The research described in this book takes a critical approach to AIDSrisk denial, providing insight into how and whyit occurs. Findings suggest that women who hold certain expectations for heterosexual unions actually need to practice unsafe sex in order to support their beliefs that their own unions meet these expectations. Women seem to have a related tendency to assume that they have themselves been tested for HIV seropositivity (antibodies to the human immunodeficiencyvirus) when they have not.Both unsafe sexual practice and the tendency to assume testing stem from wishful thinking engendered bywomen's hopes for their relationships and their desires to preserve status and self-esteem. AIDS is on the rise among women—especially among poor Black and Latina inner-citywomen. Regular condom use can help stop the spread of HIV, but public response to warnings about the consequences of unprotected or unsafe (condomless) penetrative-receptive sexhas not been enthusiastic. Most of us do not see ourselves as people at risk for AIDS. Fewof us use condoms on a regular basiseven though having condomless penetrative-receptive sex with an HIV-positivepartner could lead to HIV infection. In the followingchapters, I askhow and whywefail to acknowlChapter 1 Introduction edge our own risk behaviors. I examine the mechanisms of heterosexual female AIDS-risk denial by exploring the reasons behind condom use rates and byinvestigating the cultural meanings and socialramifications that condom use and AIDS carry. I focus in particular on the condomrelated practices and understandings of impoverished Black inner-city women. Most of the data discussed in this book were collected at the instigation of Dr. Philip Toltzis, who directs and oversees health education for women seeking pregnancy-related care at the five urban health care centers associated with Cleveland's Maternity and Infant Health Care Program (M&I). Distressed by the rising rate of HIV infection among the poor inner-city minority women who use the M&I clinics, Dr. Toltzis asked me to design and carry out an anthropological study with clinic clients. The goal for the project was to identify and qualitatively explore enablers of and barriers to safer-sex behavior among the clinic clients. What factors made it easier for women to get their male sex partners to use condoms? Were certain groups of women more likely than others to forgo condoms? If so, why? What were the differences between users and non-users? Figuring that actions which have costsalso can have benefits,I elicited, described, and analyzed participants' perceptions of the social, economic, emotional, and other benefits of unsafe sex. I also explored women's perceptions of risk, power, and persecution, their social and economic situations, and their health-related cultural knowledge and explanatory models or ideas about AIDSand HIVinfection. The project was designed expressly for collecting data to be used in adjusting the M&IAIDSeducation curriculum to make it more effective. M&I records from 1991 showed that 90 percent of clients were impoverished and that 25 percent had some history of substance use (which, as defined by M&I, includes the use of alcohol as well as crack cocaine, heroin, or other drugs). About one-fourth of the clients werefirst-time mothers, and almost all clients had some characteristics—nutritional deficits, income limitations, drug habits—placing them in the "at risk" category.1 Such information is important, because it gives us some ideas about clients' objective situations, but it reveals nothing about clients' subjective understandings of personal life experiences. It reveals nothing about their sex-related, condom-related, or AIDS-related beliefs and attitudes , nor does it tell us about the culture that encourages these beliefs and attitudes. In the course of the research, I found that most of the participants usually chose to forgo condoms. They did so because they...

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