Choosing Unsafe Sex: AIDS-Risk Denial Among Disadvantaged Women

3. AIDS Education and the Perception of Risk

The research for this book grew out of the concern that Cleveland's Maternity and Infant Health Care Program (M&I) clinic clients were not heeding the M&Isafer sexmessage. There wasnothing unique about the relative failure of the M&I AIDSeducation mission,which focused on the dissemination of factual information. Most studies conclude that no significant relation exists between safer sex and the degree of AIDS or HIV knowledge people have (e.g.,Farmer and Kim 1991; Geringer et al. 1993; Johnson 1993; Linden et al. 1990; Mays and Cochran 1988; Prohaska et al. 1990); behavioral changes made by homosexual men (Turner et al. 1989, 136) living in areas with firmly established gay social and political structures are the exception (see Winkelstein et al. 1987). But even among this group patterns of relapse have been documented (Milleret al. 1990, 109; Stall et al. 1990). Factual information is necessary,but it is certainly not sufficient to drive and sustainbehavioral change. This chapter askswhynot, and investigates the keyrole riskperception playsin motivating (or obstructing) health-protecting behavior such as condom use. The Failure of Education AIDS "Facts/'AIDS "Myths" Findings from the 1992 National Health Interview Survey (Schoenborn et al. 1994) indicate that 96 percent of U.S. adults knowthat HIV can be transmitted through sexual intercourse and 94 percent know that it can pass from pregnant women to their babies perinatally; 96 percent know that it is "very likely"1 that an individual will contract HIV if sharing needles with an infected person. Among BlackAmericans the respective percentages are lower, but only byone to twopercentage points (regarding AIDS knowledge levelsof Blacksin particular, see also Flaskerud and Chapter 3 AIDS Education and the Perception of Risk Rush 1989; Hardy and Biddlecom 1991; Harrison et al. 1991; Jemmott andjemmott 1991;Johnson 1993). People do have the facts, but they do very little with them. One of the most common problems in prevention education is that the facts about HIV and AIDS are disembodied —they are not presented in relation to the health ideas clients already hold. Asa result, people often have done little more than memorize the "AIDSfacts" theyare taught. Once memorized , thisinformation iseasilyregurgitated in response to questions such as those posed on surveysmeant to measure AIDS knowledge levels. As Irving Zola points out in relation to health surveysin general, We may be comforted by the scientific terminology if not the accuracy of [the respondent's] answers. Yetifwe follow this questioning with the probe: "Why did you get X now?" or "Of all the people in your community, family etc. who were exposed to X, whydid you get . . . ?" then the rational scientificveneer ispierced and the concern with personal and moral responsibility emerges quite strikingly. Indeed, the issue "why me?" becomes of great concern and isgenerally expressed in quite moral terms of what they did wrong. (1972; ellipses in the original) The masked beliefs can concern more thanjust morality (asdiscussed later). Often, old health beliefs have not been set aside or replaced but instead simply have been augmented. Accordingly, while AIDS knowledge levels among Blacks,for example, are generally high, many stillfear doorknobs and public toilets because "you never know" (Flaskerud and Rush 1989, 212; see also Hardy and Biddlecom 1991; Schoenborn et al. 1994). The educatees memorize the scientific explanations of the AIDS educators, but traditional means of contagion still operate in many people 's minds as science and tradition co-exist. In a study ofAIDS knowledge and risk behavior among women from a range of ethnic groups, Harrison et al. (1991) found that, while the majority of participants possessed reasonably accurate AIDS information, many still believed that casual contact can spreadAIDS (cf.Becker andJoseph 1988; Kimmel and Keefer 1991). For example, when asked whether one could contract AIDS through shaking hands or kissing cheeks, or through insect bites, manywomen answered incorrectly. Eleven percent of the Hispanics, 28 percent of the whites,32 percent of the U.S. Blacks, and 36 percent of the Haitians thought that kissing and shaking hands could spread HIV infection. Twenty-threepercent of the whites,32 percent of the Hispanics, 34percent of the U.S.Blacks, and 42 percent of the Haitians thought that insects such as mosquitoes could transmit HIV as they went from person to person. Harrison et al. (1991) attributed the latter belief among Haitians to traditional beliefs concerning illnessescaused by spirits (the researchers 26 Chapter 3 did not discuss the possible causes of the existence of the...