Social Theory & Health, 2007, 5, (245–266)
r 2007 Palgrave Macmillan Ltd All rights reserved. 1477-8211/07 $30.00
www.palgrave-journals.com/sth
Tapping the Core: Behavioral
Characteristics of the Low-Income,
African-American Male Core Group
LEIGH A WILLIS
Department of Sociology, Institute for African-American Studies, 315 Baldwin Hall, The University of Georgia, Georgia, USA. E-mail: LAWILLIS@UGA.EDU
African-Americans (AA) have been among the hardest hit by the hidden epidemic of sexually transmitted diseases (STDs) in the US. One potential means of reversing this epidemiological trend is to identify groups responsible for the sustained prevalence of STD in the AA community, who are commonly known as ‘core groups’. However, there is a lack of specific information about characteristics and attitudes of this group as researchers have yet to empirically define this ‘core group’. The primary purposes of this study are to define and confirm the existence of the social epidemiological concept known as the core group among AAs and to determine the sexual beliefs and practices of AA male core group using habitus. Data from 266 low-income, AA males between the ages of 16 and 78 recruited from an inner-city STD clinic in the southeast are analyzed. Findings indicate differences between core and non-core men in sexual activity, STDs, age and age of sexual initiation, monogamy, trading money or drugs for sex, sexual preoccupation, and beliefs and attitudes.
Social Theory & Health (2007) 5, 245–266. doi:10.1057/palgrave.sth.8700089
Keywords: epidemiology; STI/STD; habitus; sexual risk; African-Americans; men
INTRODUCTION
In the last 25 years, the incidence of HIV and sexually transmitted disease (STD) among African-Americans (AA) has dramatically increased (Centers for Disease Control and Prevention, 2004). Currently AAs constitute 12.5% of the population, while they accounted for over 54% of all new HIV diagnosis and 56% of new AIDS cases reported in 2002 (Centers for Disease Control and Prevention, 2003). As of 2003, HIV was the ninth leading cause of death for all
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
246
AAs (Centers for Disease Control and Prevention, 2005). Furthermore, the rate of adult and adolescent cases among AA has been seven to 11 times the rate for whites for the last 6 years (Centers for Disease Control and Prevention, 2004). AAs also have higher rates of gonorrhea, syphilis and chlamydia (McNeil and Williams, 2004).
The increasing rate of HIV and STDs among AAs is alarming for a variety of reasons. First, this increase is occurring as the rate of HIV is decreasing in other segments of the population. For example, from 1985 to 2001, the proportion of AIDS cases among AA increased from 23% to 49%, while among whites decreased from 62% to 31% (Centers for Disease Control and Prevention, 2001). Second, if left unaddressed the spread of HIV and STDs will continue to have a significant impact on the reproductive health and generation of human capital of AAs. As of 2003, HIV/AIDS is the fourth leading cause of death among AA women during the child-bearing years (20–40) (Centers for Disease Control and Prevention, 2004). Similarly, AA children bear a high burden of disease as evidenced by AA children having the highest rate of pediatric AIDS cases in 2002, 58.7 per 100,000 compared to 5.9 per 100,000 for whites (Centers for Disease Control and Prevention, 2003). Also, when left untreated STDs influence reproductive health through sterility in men and women and birth defects in children (Brunham et al., 1990).
Third, this phenomenon indicates a shift in the means of transmission of HIV/AIDS among AA men who have sex with men to the heterosexual population. Specifically, heterosexual sexual contact is now the primary means of transmission among AA women (Centers for Disease Control and Prevention, 2004). Fourth, perhaps even more disturbing is that the increase is occurring at a time when there has been considerable research and intervention development devoted to preventing HIV and STDs in the general population and among AAs in particular. The limited effectiveness of prevention activities may be the result of previous efforts focusing on changing attitudes and risk behaviors among AA women and MSMs, while ignoring a key group, AA men who identify as heterosexual (Millett et al., 2006). Understanding the behaviors and beliefs of this group, in particular, is a critical and overlooked step in STD prevention.
In light of the consistent increase in HIV, sustained prevalence of STD and lack of a clear definition of the core group, the primary purpose of this study is to explore and confirm the existence of the social epidemiological concept known as the core group among AAs. The secondary purpose of this study is to explore the sexual beliefs and practices of AA male core group.
Many epidemiological studies focusing on STD and HIV have attempted to explain the spread and persistence of STDs through the core group concept; that is, those individuals who are responsible for sustaining HIV and STDs in
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
247
a given population over time (Rothenberg, 1983; Yorke et al., 1978). Although epidemiological research has sought to refine this critical concept, an empirical definition has proven to be nebulous, thus limiting its application for three basic reasons. First, while the core group is accepted as a valid theoretical and practical construct, at present research seeking to define and verify characteristics of a core group has been inconsistent (Thomas and Tucker, 1996). Next, few if any of these studies examine psychosocial and relationship factors that influence behaviors leading to transmission. Lastly, most epidemiological studies do not place these factors in the proper social, economic and environmental contexts necessary to ensure the effectiveness of prevention activities among AAs. Given the consistent prevalence of STDs and recent increase of HIV in the AA community coupled with the shortfall of prevention efforts, there is a need for research that defines and explores the AA core group.
In order to define, confirm and explore the core group this paper will draw on several literatures. First, this paper begins with a discussion of the ‘sexual habitus’ of inner-city AA men as it relates to the spread of STDs. Immediately following the discussion of the sexual habitus, the core group concept is reviewed. Third, methods and plan of analysis are described. Finally, the results and discussion are presented along with suggestions for future research.
Habitus
In an attempt to discern the origins of sexual behavior of heterosexual AA men, it is necessary to explicate the forces affecting this behavior. Given sexual behavior is usually determined by expectations of society, community, family, peer group and situational opportunities, sexual behaviors are largely the function of the internalization of social structure. The concept of habitus is particularly applicable to understanding the sexual behavior of low-income, urban, AA men because it focuses on the influence of socialization, class-rooted behavior and the environmental context of such behavior. Thus, habitus is useful in understanding the sexual behavior of AA men.
Habitus, as described by Bourdieu (1984), is the internalization of external social structures and conditions by individuals, which produce enduring orientations toward actions that consistently channel behavior in particular, habitual ways as opposed to others. It is an acquired set of social views encoded in early socialization, realized through praxis (social actions). Habitus starts to form in childhood socialization and life experiences reflected through the individual’s class circumstances. Bourdieu believed that early experiences are important to the habitus because it becomes fixed and resists change. Early experiences in particular become fixed in an individual’s mind
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
248
as a ‘habit-forming force’ and ‘set of deeply interiorized master patterns’ (Bourdieu, 1984, 23), which resist change.
As every group has views and theories about their role in the world, consequently each group develops its own habitus, which is internalized by members. According to the theory, this is true because people in the same groups, classes and societies are likely to share the same habitus due to shared experience (Swartz, 1997). The mores and norms of a group or class, along with its position in the world and society, influence the development of a specific habitus or dispositions to act in a given way. Thus, habitus influences individual actors’ interpretations by placing actions within the context of a larger framework. For the most part people are unaware of their use of habitus, therefore we can think of it as routine, prescriptive, unthinking and habitual. Similarly, people are passive in the construction of their own habitus. Conceptualized, habitus is a set of practical thoughts and actions people as well as groups use habitually and unconsciously when faced with given situations to resolve matters in a predictable manner.
In sum, the living conditions of a society, group or class, its position in the world and society, spawn a specific habitus or dispositions to act in a given situation. Simply put, habitus gives us multiple paths for our actions by providing us with categories of what is possible. Habitus is not innate and must be constructed and internalized from social activities such as school, family or the workplace. Therefore, it is safe to reason that habitus is often encoded unconsciously during socialization. Class and living conditions also shape the construction of habitus. As a result, classes and groups within societies will develop a unique habitus of their own. This implies that habitus is developed and reinforced through social interactions with one’s own social group and society as a whole. Overall, habitus is what is responsible for an individuals’ disposition to act in a particular manner in a given situation. In short, we learn various roles in society or group and then we have the ability to make the right move at the right time.
Formation of sexual habitus of low-income AA men
Habitus is a crucial concept to this study because it takes into account the class, social and economic factors in society that affect individual behavior. The concept of habitus is particularly applicable to understanding the sexual behavior of low-income, AA men because it explains the effect of social structure on the behavior of classes and groups. Since class, history and environment influence habitus, it strengthens the argument made by many researchers regarding the sexual behavior of low-income AA men. For instance, Staples and others have argued that historically the community regulated sexuality through monitoring the dating patterns of children and
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
249
young adults (Staples, 1999). This was particularly true when AA commu-nities were more cohesive. It was common for dating behavior to be organized in the context of the neighborhood, church and school. For the most part, dating was a very casual process in which attachments were formed which led to marriage. During this time, the community had powerful sanctioning and monitoring functions regarding dating. Consequently, young people were made aware that they had reputations to uphold, so they were not blatantly promiscuous due to the social control enacted by the community at large (ie, church, family and peers). As the communities declined due to economic and social changes, the monitoring function of the community did as well. Simply, due to social mobility middle-class blacks left the inner cities taking with them critical social and economic capital.
Anderson (1990), Wilson (1987, 1996) and others have argued that changes in economic and social structure in the AA community have significantly impacted in the lives of low-income men. Specifically, the combined changes in the economy coupled with low levels of education reduced the number of marriageable AA men (Bowman and Sanders, 1998; Staples, 1999). Also, stipulations put on family assistance removed the physical and symbolic presence of the father from the home (Jewell, 2003). As a result, this created a social environment in many low-income, AA communities where growing up fatherless became the rule rather than the exception (Anderson, 1999; Billson, 1996; Johnson and Staples, 2005; Wilson, 1996). Now the ‘fatherless’ generation is entering its sexual prime, leading to the construction of a risky sexual habitus. This habitus arises because many young males have not been able to observe a meaningful male/female relationship. Instead, it is commonplace for a man to have several partners, while he remains unattached.
There are several key ingredients in the construction of this habitus. First, young men in low-income areas are aware of the limited opportunities available to them. As a result, many decide against forming stable unions with partners as they enter adulthood (Anderson, 1999; Johnson and Staples, 2005; South, 1993; South and Lloyd, 1992; Staples and Johnson, 1993). Owing to the perception of future inability to support a family, marriage is seen as unattainable or undesirable (Bowman and Sanders, 1998; Darity and Myers, 1987; Laumann et al., 2004; Wilson and Neckerman, 1986).
Second, excess mortality coupled with high rates of incarceration of AA men, has caused a sex ratio imbalance among AAs (Johnson and Staples, 2005; South, 1993; South and Lloyd, 1992). The imbalance is problematic because it causes many women to unknowingly or unwittingly share partners unless they choose to date and marry with those outside of their racial and ethnic group (Laumann et al., 2004; Wyatt et al., 1999). Furthermore, AA men
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
250
and women are aware of the implications of the imbalance. AA men realize they have advantage in relationships because it is easier for them acquire another partner. This influences the likelihood of preventive behaviors such as condom use. For example, if a woman insists on wearing a condom during intercourse and her male partner refuses for whatever reason, he may terminate the relationship and search for a partner who will not insist on wearing one (Harvey and Bird, 2004). Overall, the sex ratio imbalance has created a sexual relationship market which caters to the needs of men (sellers) rather than women (buyers) (Ferguson et al., 2006). The imbalance is a structural factor that influences the development of the risky habitus among AA men.
Third, there is the social myth that AA men are hypersexual, which some may internalize or may view this as a source of pride or self-esteem that they feel the need to live up to (Collins, 2004; Majors and Gordon, 1994). Often, young AA men may see this hypersexual behavior played out in the community or in the popular media. Fourth, given the decrease in social control and monitoring by the community there is often the expectation of the peer group, that one become a ‘player’ and have as many sexual partners as possible to prove their manhood and increase their social standing (Harper et al., 2004; Majors and Gordon, 1994; Staples, 1982; Youm and Laumann, 2002). The norm is to prove manhood sexually due to an inability to attain it economically. Fifth, there appears to be a disdain of condom use given that the STD and fertility rates remain relatively high (Crosby et al., 2005; Essien et al., 2005b; Grimley et al., 2004; Ross et al., 2003). The current structure of low-income AA communities fosters attitudes, practices and patterns of risky sexual behavior.
After reviewing the literature regarding the social and economic structure of low-income, AA communities, it is clear that some heterosexual, low-income, AA men have developed a distinct sexually risky habitus. This habitus promotes widespread promiscuity and a lack of emotional attachment to sexual partners particularly in low-income communities. However, it is important to remember that not every member of a group internalizes the surrounding structure the same way; as such, some men do not adopt the ‘promiscuous’ habitus. Still, the characteristic promiscuity that is a part of the habitus of many low-income AA men places them in a high-risk category for STD known as the ‘core group’.
Core group concept
Yorke et al., 1978 first conceptualized and used the term ‘core group’ as they speculated about the dynamics that led to the transmission of STDs specifically gonorrhea. Following the principle that most STDs are easily
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
251
curable thus making the individual susceptible to disease again, there was a need to explain how such diseases maintain background prevalence. They deduced that a subset of the at-risk segment of the population was indirectly or directly responsible for all cases of the disease in a population and in fact, may be integral in the re-emergence and spread of STDs throughout the general population in recent years (Eng and William, 1997). Some have speculated that if the core were treated and somehow prevented from infecting others, STDs would be eliminated (Blower et al., 2004; Boily et al., 2002; Rothenberg, 1983; Yorke et al., 1978). While initially this term was epidemiological, Potterat (1992, 16) gave the core a more behavioral definition, ‘ygroups of people whose sexual and health behaviors are such that microorganisms find many opportunities for sustained transmission.’ Some have conceptualized the core as ‘people who change sexual partners frequently’ (Garnett et al., 1992, 189).
Since its conceptualization, researchers have sought to define character-istics of the core, but a review of literature demonstrates that empirically defining core characteristics has been a formidable challenge. As a result, there is no consensus among researchers as to the definition of the core group. The uncertainty of the term has caused many to be frustrated and unsure of how to use the concept in research, with some calling for a new concept and others moving toward ‘sexual networks’ as a means of understanding the transmis-sion of STD (Potterat and Muth, 1996; Rothenburg and Narramore, 1996; Wasserheit, 1995). Still, as Wasserheit points out the utility of the concept cannot be shortchanged,‘The core group concept cannot be ignored when one considers the effectiveness of STD prevention programs rather than simply the effectiveness of individual interventions’ (Wasserheit, 1995,165).
Although research on characteristics of the core has had limited success, one area which has shown promise is the confirmation of core groups in geographic areas (eg, neighborhoods, zip codes, streets) (Potterat, 1992; Potterat et al., 1985; Rothenberg, 1983; Zenilman et al., 1999). As Thomas and Tucker (1996) point out, characteristics and definitions of the non-spatial approaches to the core group vary by study. Furthermore, Laumann and Youm (1996, 1999) have attempted to provide clear definitions and characteristics of the core group.
In an effort to better understand the core group and its relationship to the rest of the population, Laumann and Youm (1996, 1999) reduced the concepts of the ‘core’, ‘peripheral’ and ‘adjacent’ subgroups originally described by Rothenberg (1983) to the individual level. They defined the core as those individuals, who have had four or more partners in the past 12 months, some of which were concurrent. The adjacent group were defined as ‘those who had one or two partners who were concurrent or had been paid for sex’ (1996,
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
252
22). The adjacent group includes those who had three partners that may have been concurrent and people who had four or more non-concurrent partners. Finally, Laumann and Youm defined the peripheral group as people ‘who had only one or two partners, none of whom were concurrent or paid.’ (1996, 22).
Laumann and Youm (1996) describe a core group as encompassing three types of individuals: lifetime members, current members and newcomers. Lifetime members of the core are men and women who report having 11 or more sex partners in their lifetime (since the age of 18) and described some of those partnerships as having overlapped in time (non-monogamous). Current core members are men and women who have had more than more four sexual partners in the last 12 months and describe some of those partnerships as having overlapped in time. Newcomers to the core are those potential core members in their mid-twenties who have not acquired more than 11 partners, but are well on their way to doing so. It is important to note every ethnic/ racial group features each of the subgroups including a current core. Furthermore, these distinctions concerning the core are important because they provide insight about the spread of STDs in the AA community. Laumann and Youm hold that the high rate of infection among AAs in comparison to other groups may be the result of a larger core.
It seems that the traditional exchange of sex appeal from women for the economic support men is declining in low-income communities, given the high rate of AA male incarceration, unemployment and female-headed households. Consequently, AA women are better able to define their own status and are becoming more economically independent of men. Further-more, given the circumstances many women now only seek to have their emotional and physical needs met by men, rather than their financial ones. Staples (1999) points out, ‘While men must confront this new reality, women must realize that emotional needs can be taken care of by men in all social classes.’ ‘Although similar education and income can mean greater compat-ibility in values and interests, there are no guarantees of this compatibility or of personal happiness’ (p. 43). Therefore, it follows that women would have relationships and sexual contact with men of lower socioeconomic status who may be members of the core. It is likely that high incidence of STDs among AAs is due to the increased ‘sexual mobility’ of this core. The spread of disease from core to periphery is diagrammed in Figures 1 and 2. In addition, Laumann and associates found that AA men demonstrate stronger racial homophily in their mating patterns, than other groups (Laumann et al., 2004). This strong in-group preference may serve as a catalyst in the prevalence of STDs within the AA community.
Given the importance of the core group concept, the lack of a consensus definition of the core group, lack of information on potential AA men in the
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
253
Core Adjacent Peripheral
Figure 1: Traditional core group model of STI/STD transmission.
Core Adjacent Peripheral
Figure 2: Core Group model of STI/STD transmission among AA.
core this study has three goals. The first is to confirm the existence of the core group by testing a core group definition. Second, this study attempts to discern if there are attitudinal differences among AAs within and outside of the core. The following hypotheses will be tested:
Core versus non-core membership
H1: Core group members will be younger and have a lower age at first intercourse than non-core members.
H2: Core group members will have higher mean indicators of sexual risk than non-core members. (Lifetime number of sexual partners, number of partners in the last 3 months, sex partner ratio and total lifetime number of STDs.)
Behavioral and attitudinal differences
H3: Core group member will be less likely to have ever engaged in monogamy than non-core members.
H4: Core group members will be more likely to think about sex and to have engaged in the sex trade than non-core members.
H5: Core group members will be more likely to hold attitudes that oppose regular condom usage.
H6: Core members will be more likely to hold traditional beliefs regarding sex.
Cross-sectional, self-reported, behavioral and attitudinal data will be used in concert with longitudinal medical record data to test hypotheses.
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
254
METHOD
Participants
The initial data were collected during the summer of 1996 from a county STD clinic in a major metropolitan area in the southeast. The sample contained 266 men of ages 16–70. Respondents were recruited while waiting to be voluntarily examined. It is safe to assume that the sample drawn from this population is low income because typically county publicly funded clinics serve the lower and under-classes (Cockerham, 2007). Respondents were compensated six dollars for participating and were made aware of their right to terminate the interview at any time with compensation. Participants did not lose their place in line while they waited to see a doctor using a computer system that kept their place. The study had a 97% recruitment rate, so the sample bias is small.
Survey instrument
AA male college students administered the 25-min questionnaire. Topics included in the survey were sex-role attitudes, nature of the relationship with sexual partners, and measures of sexual risk taking behavior.
Medical record data
The medical data were collected during the spring and fall of 1998 such as to give each respondent in the study a 2-year follow-up period based on the date of their interview. Data were abstracted using the County Department of Health computer records. There were some limitations in the patient records; patients were allowed to keep their visits anonymous, so their records were discarded and their names were removed for the system. As a result, only 271 out of 336 (80.7 %) respondents had medical records in the system and were able to be fully analyzed.
Variables
Core group predictors
To verify the existence of and to explore the core group concept the following measures were used:
Age: The respondent’s age was obtained from clinic records.
Sexual orientation: Response options were women, men or both. If a respondent indicated they had sex with men or both they were not included in the study.
Age at first sex: The age at which the respondents of first had intercourse.
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
255
Number of partners in the last 3 months: The number of sexual partners the respondent had in the last 3 months.
Lifetime number of sexual partners: The number of sexual partners the individual has acquired represents the total number of sexual partners an individual has had throughout the course of their life. This number starts with the first person they had intercourse with and continues up to the time the respondent agreed to participate in the study.
Sex partner ratio: To approximate the rate at which the respondent acquires partners a ratio was created by dividing the lifetime number of sexual partners reported by the number of years since they first became sexually active. The number of years sexually active was calculated by subtracting the age at which they first had sex by their current age.
Number of STDs: The number of STDs for each respondent was obtained from information provided by the County Department of Health. The number represents the total number of STDs the respondent acquired from the time they first came to the clinic, to the end of the 2-year follow-up period created by the interview. The information concerning STDs included the total number of STDs as well as the name. Still, it is possible the number of STDs is underrepresented because the men may choose to have their symptoms treated in another clinic.
Behavioral characteristics and attitudes
Sexual preoccupation: Sexual preoccupation has been listed as a potential characteristic of the core group. The response options were (1) never or seldom,
(2) occasionally, (3) frequently and (4) all the time. This item was orthogonally recoded (0) never seldom/occasionally and (1) frequently/all the time.
Sexual bartering: This statement sought to determine if respondent engaged in sexual bartering using drugs or money. The response options to this question were coded Yes (1) or No (0).
Sexual knowledge: These items measured general knowledge about sexual practices and risk for disease. These items were rated on a four-point Likert scale, (4) strongly agree, (3) agree, (2) disagree, (1) strongly disagree. Some items were reverse coded. This item was orthogonally recoded (0) disagree and (1) agree.
Traditional masculine sexual beliefs. These items measured traditional beliefs of how men and women ‘should’ act regarding sex. These items were rated on a four-point Likert scale, (4) strongly agree, (3) agree, (2) disagree and (1) strongly disagree. This item was orthogonally coded (0) disagree and
(1) agree.
Monogamy: Monogamy is relevant because it indicates whether the respondent has ever had multiple partners in the course of a relationship.
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
256
This variable acknowledges if the respondent has ever been in a monogamous relationship in the past. The response options to this question were coded Yes (1) or No (0).
Dependent core group variables
Given the measures available in the present study, core group men were considered a core member if they met any of the criteria which are derived from Laumann and Youm (1996):
(1) Men over the age of 25 years, reporting 11 or more sex partners in their lifetime and a sexual partner ratio greater than 1.
(2) Men who have had more than two sexual partners in the last 3 months and have a sexual partner ratio greater than 1.
(3) Men younger than 25 years of age, having less than 11 lifetime partners, and a sexual partner ratio greater than 1.
Men who do not meet any of these criteria will be considered non core.
RESULTS
Analysis
To determine the validity of these group definitions and explore the possibility of meaningful differences demographic differences between proposed groups, t-tests will be performed. To determine, attitudinal differences logistic regression were executed. The data were analyzed using SAS using age of the respondent as a control. Given the high standard error, skewed distribution of data and the exploratory nature of this research the level of statistical significance at 0.10.
Descriptive statistics
Table 1 shows that the sample is relatively young (M ¼ 28.32 years) and started having sex slightly earlier than the current national average of 16
Table 1. Selected descriptive statistics
Variable Mean Mode STD deviation Missing
Age 28.32 23.61a 8.49 2
Age first sex 14.71 16 2.28 1
Lifetime no. of partners 36.01 20.00 87.01 14
No. of partners in the last 3 months 2.29 1 2.07 0
Sex partner ratio 2.75 N/A 4.69 17
Total no. of STDS 3.69 1 4.14 0
N 268
a=multimodal.
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
257
years (M ¼ 14.71 years) (CDC 2006), although the mode indicates that many men are at the national average. Given the high mean number of sexual partners (M ¼ 36.01), it is safe to say the sample is sexually active although the mode is lower (20.00) thus, indicating that some individuals in the sample are less sexually active. The sample has a mean number of partners in the last 3 months over 2 (M ¼ 2.29), although the mode indicates a number of men only have had one partner during that period. The sex partner ratio of the sample is almost three per year (2.75), with no true mode. Finally, while the sample has an average lifetime number of almost four STDs (M ¼ 3.69), the mode (1) indicates that some in the sample have not had quite as many.
Core versus non-core membership
As Table 2 indicates the t-tests revealed several key differences between core and non-core members. As a group, core members have a lower mean age and age of first sexual intercourse. Core members have a higher mean number of lifetime partners and partners in the last 3 months, sex partner ratio and total numbers of STDs.
Behavioral and attitudinal differences
Odds ratios in Table 3 indicate that controlling for age, core members were less likely to have had a monogamous relationship for a year or longer. Core members were over two times more likely to engage in the sex trade and were one and a half times as likely to have thought about sex. In regard to condom use, core members were more likely to hold the following views: it is hard to use condoms with a steady sex partner; it is difficult to start using condoms with a steady sex partner; condoms are not needed due to other forms of birth control; it is acceptable to stop using condoms once you are familiar with your partner than were non-core members. Similarly, core group members were over one and a half times more likely to feel that men need sex more often than women and that they are always ready for sex.
Table 2. Comparison of demographic variables core group sample characteristics
Variable Core group Non-core group Difference
****
Age 26.80 31.00 ₃4.20****
Age first sex 14.55 16.24 ₃1.69**
Lifetime no. of partners 47.17 14.51 32.66
No. of partners in the last 3 months 2.62 1.50 1.12****
Sex partner ratio 3.54 1.20 2.34****
Total no. of STDs 3.75 1.50 2.25***
N 166 86
****Po0.001, ***Po0.01, **Po0.05.
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
258
Table 3. Logistic regression model of behavioral and attitudinal variables predicting core and non-core membership
Variable b OR 95% CI
****
Age ₃0.330*** 0.928 0.890, 0.968
Monogamy ₃0.219** 0.434 0.215, 0.874
Sexual bartering 0.187 2.311 1.011, 5.283
Thinking about sex 0.195** 1.567 1.049, 2.340
Women use other birth control so condoms are unnecessary 0.147* 1.460 0.418, 1.123
Men should feel free to have sex with other men 0.100 1.330 0.855, 1.968
Safe to have sex w/o condom if you know partner ₃0.160* 1.458 0.926, 2.296
It’s really hard to start using condoms with a steady sex ₃0.044 0.913 0.605, 1.379
partner 0.163*
It’s okay to stop using condoms once you get to know your 1.510 0.911, 2.502
partner
Men can not get AIDS from a woman ₃0.035 0.907 0.518, 1.586
Aids is a gay men’s disease ₃0.023** 0.936 0.532, 1.644
Men need sex more than women 0.205 1.588 1.006, 2.507
Men are always ready for sex 0.223*** 1.692 1.106, 2.588
Its better if a woman is a Virgin when she marries 0.004 1.009 0.694, 1.467
w2 47.14****
DF 14
N Core: 161;
non-core: 84
****Po 0.001, ***Po0.01, **Po0.05, *Po0.10.
DISCUSSION
Overall, the results confirmed all of the hypotheses.
H1: Core group members will be younger and have a lower age at first intercourse than non-core members.
As predicted, core group members had a younger mean age and lower age of sexual initiation than non-core members did.
H2: Core group members will have higher mean indicators of sexual risk than non-core members. (Lifetime number of sexual partners, number of partners in the last 3 months, sex partner ratio and total lifetime number of STDs.)
As hypothesized, core group members had higher mean number of lifetime number of sexual partners, number of partners in the last 3 months, sex partner ratio and total lifetime number of STDs compared to non-core members.
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
259
H3: Core group member will be less likely to have ever engaged in monogamy than non-core members will.
Consistent with the literature and hypotheses, core group members were less likely to have ever been in a monogamous relationship for a year or less than non-core members were.
H4: Core group members will be more likely to think about sex and to have engaged in the sex trade than non-core members will.
As predicted, core group members were more likely to be sexually preoccupied and to have traded money or drugs for sex than non-core members were.
H5: Core group members will be more likely to hold attitudes that oppose regular condom usage.
As predicted condom core, group members were more likely to hold beliefs and attitudes, which opposed condom usage in some instances. Specifically, core members were more likely to agree with the statements that did not favor sustained condom use than non-core members. In particular, core group members were more likely to agree that condoms were not necessary due to other forms of birth control, that it safe to have sex without a condom if you know your partner and it is acceptable to stop using condoms once you are familiar with your partner.
H6: Core members will be more likely to hold traditional beliefs regarding sex.
Consistent with the hypothesis core members were more likely to have traditional beliefs regarding masculinity and sex than non-core members. Specifically, core members were more likely than non-core members to agree that men need sex more than women do and men are always ready for sex.
These results have important theoretical and practical significance. Theoretically, these results provide a clearer definition of a core group and evidence of the sexual habitus of low-income, AA men. Defining core groups is important given its utility in epidemiology and the inability of prior research to do so. Despite, the limitations of the data it is reasonable to conclude that this study identified distinct core and non-core groups in this population. Simply put, these results provide quantitative support for the
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
260
definitions of the core offered by Potterat (1992) and Garnett et al. (1992), as core men were more sexually active than non-core men. Specifically, core men had a higher number lifetime number of partners, partners in the last 3 months and sex partner ratio. Therefore, it is not surprising that core men had a higher mean number of STDs. Contrastingly, as the study identified an empirically valid, non-core group, this research demonstrates that the cultural myth of all low-income AA men being ‘oversexed’ and members of the core is erroneous. This finding is explained by the theory of habitus because as Bourdieu posited not every member in a group adopts the group habitus.
While the findings uncovered more definitive core characteristics, they also demonstrate the presence of a sexual habitus of low-income, AA men. This particular sexual habitus is rooted in the economic and social conditions of low-income AAs. Specifically, the finding that core men were less likely to have ever been in a monogamous relationship highlights the effect of the sex ratio imbalance among AA on this particular habitus. It is likely the relationship market, lack of economic prospects and peer group expectations contribute to a lack of monogamy among this group.
The findings that core members were more likely to endorse statements that it is acceptable to taper condom use once you know your partner is consistent with the habitus. These attitudes highlight the reproductive health risk of this group to women; given core men have a higher number of partners and more STDs. Simply put, the notion that by ‘knowing’ their partner they can somehow tell whether they have a STD is problematic because if they are not monogamous and not using condoms they put their partner at risk for an STD. After all the men and their partners may not be aware that they have an STD given that many STDs are asymptomatic (Eng and William, 1997). Other studies have found that increasing partner familiarity is associated with decreased condom usage (Essien et al., 2005a; Geringer et al., 1993; Grimley et al., 2004; Maxwell and Bastani, 1999; Ross et al., 2003; Thorburn et al., 2005). Also, given a man has a degree of leverage due to the sex ratio imbalance and women being aware of it and not wanting to lose their partner, it is likely that once he feels a condom is not necessary then they are not used (Ferguson et al., 2006; Harvey and Bird, 2004; Wyatt et al., 1999).
Another means by which habitus influences condom use is through its new view of manhood. In this definition of manhood, the number of partners and children serve as a measure of masculinity rather than the traditional concept manhood (economic provision). Although core group men were more likely to feel condoms are not necessary given women’s use of other forms of birth control, it is likely given the sex ratio imbalance, women may
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
261
opt not to use any birth control in the hopes of getting pregnant to ensuring a lasting relationship with the father or to raise their self-esteem (Gibbs, 1984; Staples, 1999). Still, this result does not definitively indicate that these men do not want to father a child given that it barely attained statistical significance and findings of similar studies indicate that although pregnancy is to be avoided, it is not entirely undesirable outcome (Davies et al., 2004; Jenkins, 2002).
The finding that core members were more likely to engage in sexual bartering further underscores the risk behavior found in the core. In the same way, the finding that core men were more likely to be sexually preoccupied paired with the traditional beliefs, men are always ready for and need sex more than women further demonstrate the influence of the habitus, which holds more traditional sex beliefs. From the endorsement of these attitudes in addition to sexual preoccupation, it seems likely core men actively create, seek out and capitalize on opportunities to have sex as their group habitus dictates. These beliefs are interrelated because if a man is sexually preoccupied, feels men need sex and are always ready for sex then it seems likely that he would have no objection to trading drugs or money for sex if the opportunity presents itself.
Practically, these results are important because they provide key information health practitioners and researchers can use to fight the hidden epidemic of STDs. Specifically, this study provides insight into the psyche of core members, which is critical given lack of understanding about male motivations for condom usage. The beliefs that it is acceptable for men not to use condoms once they feel they ‘know their partner’ and because ‘women use other means of birth control’ are the type of attitudes that need to be changed if STDs are to be prevented. Especially, since men in the core were found to be less likely to practice monogamy. So this information can inform scientists as they plan health education and promotion campaigns and interventions which target heterosexual, AA, core men.
LIMITATIONS
While this research has theoretical and practical utility, it has limitations regarding external and internal validity. First, in reference to external validity, this sample is from one region of the country, the south. The south has higher rates of STD than other regions. Given the unique nature of the south, it is difficult to generalize to the rest of nation. Second, since the sample is from a publicly funded STD clinic, it is not representative of all AA men. However, the study population is appropriate, since the goal of the study
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
262
was to confirm a core group among low-income, sexually active, AA men. Third, the sample is all AA, which potentially reduces the studies applicability to the general population. Fourth, the sampling frame for recruitment, a STD clinic, reduces the ability to make meaningful distinctions beyond the core/non-core dichotomy. Simply, the collection of data from an STD clinic may have reduced the likelihood of recruiting ‘true’ peripherals into the sample.
There were also were three challenges to the internal validity. First, some of the questions asked may require a different metric of time. For instance, monogamy may have needed a shorter length of time than a year given the higher relationship turn over of core men. Second, given some of the data is based on memory, it is prone to recall bias. Third, the data may contain self-presentational bias due to respondents being deceptive about their sexual activities. Fourth, in the same way, while the men claimed to heterosexual, it is possible that the men included in sample had engaged in sex with men.
CONCLUSION
By finding support for hypotheses, this study provides a clearer definition of the core, as well as insight as to the type of low-income men who make up the AA core. Compared to non-core men, core men on average, were younger, initiated sex earlier, reported more sex partners (lifetime and in the last 3 months), as well as had a higher number of STDs. In the same way, characteristically, core men were more likely to not have been in monogamous relationship for a year or more, trade money or drugs for sex and be sexually preoccupied.
In addition, this study was successful in identifying beliefs and attitudes unique to the AA core, which influence sexual and health behaviors. To reiterate, core men were more likely to hold attitudes such that they will stop using condoms once they are familiar with their partner. In addition, core men are likely to be more traditional (hyper-masculine) in their expectations of how a man should behave sexually in sexual appetite and readiness. It is likely these behaviors and dispositions are the product of the sexual of habitus, which is a reflection of the social and economic conditions of low-income AA men.
In closing, given that these findings are only exploratory, it is imperative that research on core groups continues to advance. In particular, future research should continue to focus on further empirical verification and definition of the core group concept including studies of adjacent and peripheral groups. In the same way, since this study focused on making
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
263
distinctions between core and non-core, going forward research should address the other groups that make up the epidemiological model, adjacent and peripheral. Once more, further exploration of the core in other racial and ethnic groups is necessary in order to determine if there are any differences or similarities between groups. Moreover, it is important to investigate the beliefs and attitudes of the core group in the future. Given its utility in the current study, habitus may emerge as a key theory in explaining the actions, practices and beliefs of the core men and their impact on health. Finally, it is critical that research in this area continues because the more definitive information researchers have about core groups they can construct more effective interventions to help eliminate the hidden epidemic of STDs.
REFERENCES
Anderson E (1990). Streetwise: Race, Class, and Change in an Urban Community. University of Chicago Press: Chicago.
Anderson E (1999). Code of the Street: Decency, Violence, and the Moral Life of the Inner City. W.W Norton: New York.
Billson JM (1996). Pathways to Manhood: Young Black Males Struggle for Identity Expanded 2nd edn. Transaction Publishers: New Brunswick, NJ.
Blower S, Wald A, Gershengorn H, Wang F, Correy L (2004). Targeting virological core groups: a new paradigm for controlling herpes simplex virus type 2 epidemics. Journal of Infectious Diseases 190: 1610–1617.
Boily MC, Lowndes C, Alary M (2002). The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models. Sexually Transmitted Infections 78: 78–90.
Bourdieu P (1984). Distinction: A Social Critique of the Judgment of Taste. Harvard University Press: Cambridge, MA.
Bowman PJ, Sanders R (1998). Unmarried African American fathers: a comparative life span analysis. Journal of Comparative Family Studies 29: 39–56.
Brunham RC, Laga M, Simonsen JN, Cameron DW, Peeling R, McDowell J, Pamba H, Ndinya-Achola JO, Maitha G, Plummer FA (1990). The prevalence of Chlamydia trachomatis infection among mothers of children with trachoma. American Journal of Epidemiology 132: 946–952.
Centers for Disease Control and Prevention, (CDC) (2001). HIV/AIDS Surveillance Report, 2001. US Department of Health and Human Services: Atlanta, GA.
Centers for Disease Control and Prevention, (CDC) (2003). HIV/AIDS Surveillance Report, 2003. US Department of Health and Human Services: Atlanta, GA.
Centers for Disease Control and Prevention, (CDC) (2004). HIV/AIDS Surveillance Report, 2004. US Department of Health and Human Services: Atlanta, GA.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2005). WISQARS Leading Causes of Death Reports, 1999–2003. In: Web-based Injury Statistics Query and Reporting System (WISQARS) (online).
Centers for Disease Control and Prevention, (CDC) (2006). YRBSS: Youth Risk Behavior Surveillance System. In Youth Online: Comprehensive Results, Accessed July 26, 2006, http://www.cdc.gov/ healthyyouth/yrbs/index.htm.
Cockerham WC (2007). Medical Sociology. Pearson: Upper Saddle River, NJ.
Collins PH (2004). Black Sexual Politics: African Americans, Gender, and the New Racism. Routledge: London.
Social Theory & Health
Leigh A Willis
Behavioral Characteristics of the Low-Income, African-American Male Core Group
264
Crosby RA, Diclemente RJ, Wingood GM, Salazar LF, Rose E, Levine D, Brown L, Lescano C, Pugatch D, Flanigan T, Fernandez I, Schlenger W, Silver BJ (2005). Correlates of condom failure among adolescent males: an exploratory study. Preventive Medicine 41: 873–876.
Darity WA, Myers SL (1987). Public police trends and the fate of the black family. Humbolde Journal of Social Relations 14: 134–164.
Davies SL, Dix ES, Rhodes SD, Harrington KF, Frison S, Willis L (2004). Attitudes of young African American fathers toward early childbearing. American Journal of Health Behavior 28: 418–425.
Eng TR, William T, Corp Author Institute of Medicine Committee on Prevention and Control of Sexually Transmitted Diseases Butler, and Inc NetLibrary (1997). The Hidden Epidemic Confronting Sexually Transmitted Diseases. National Academy Press: Washington, DC.
Essien EJ, Meshack AF, Peters RJ, Ogungbade GO, Osemene NI (2005a). Strategies to prevent HIV transmission among heterosexual African-American men. BMC Public Health (Electronic Resource) 5: 3.
Essien EJ, Ross MW, Ferna´ndez-Esquer ME, Williams ML (2005b). Reported condom use and condom use difficulties in street outreach samples of men of four racial and ethnic backgrounds.
International Journal of STD & AIDS 16: 739–743.
Ferguson YO, Crouse Quinn S, Eng E, Sandelowski M (2006). The gender ratio imbalance and its relationship to risk of HIV/AIDS among African American women at historically black colleges and universities. AIDS Care 18: 323–331.
Garnett GP, Brunham RC, Anderson RM (1992). Gonococcal infection, infertility, and population growth: the influence of heterogeneity in sexual behavior. IMA Journal of Mathematics Applied in Medicine and Biology 9: 127–144.
Geringer WM, Marks S, Allen WJ, Armstrong KA (1993). Knowledge, attitudes, and behavior related to condom use and STDs in a high risk population. Journal of Sex Research 30: 75–83.
Gibbs JT (1984). Black adolescents and youth: an endangered species. American Journal of Orthopsychiatry 54: 6–21.
Grimley DM, Hook III EW, DiClemente RJ, Lee PA (2004). Condom use among low-income African American males attending an STD clinic. American Journal Of Health Behavior 28: 33–42.
Harper GW, Gannon C, Watson SG, Catania JA, Dolcini MM (2004). The role of close friends in African American adolescents’ dating and sexual behavior. Journal of Sex Research 41: 351–362.
Harvey SM, Bird ST (2004). What makes women feel powerful? An exploratory study of relationship power and sexual decision-making with African Americans at risk for HIV/STDs. Women & Health 39: 1–18.
Jenkins RR (2002). Sex, pregnancy, and contraception-related motivators and barriers among Latino and African-American Youth in Washington, DC. Sex Education 2: 5.
Jewell KS (2003). Survival of the African American Family: The Institutional Impact of US Social Policy. Praeger: Westport, CT.
Johnson LB, Staples R (2005). Black Families at the Crossroads: Challenges and Prospects. Jossey-Bass: San Francisco, CA.
Laumann EO, Ellingson S, Mahay J, Paik A, Youm Y (eds) (2004). The Sexual Organization of the City. University of Chicago Press: Chicago.
Laumann EO, Youm Y (1996).‘Social attitudinal and behavioral determinants of sexually transmitted infection: in search of the core’ Presented at Social Determinants of Sexually Transmitted Diseases, 13 June 1996. UAB Center for Social Medicine and Sexually Transmitted Diseases: Birmingham, AL.
Laumann EO, Youm Y (1999). Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sexually Transmitted Diseases 26: 250–261.
Majors R, Gordon JU (1994). The American Black Male: His Present Status and His Future. Nelson-Hall Publishers: Chicago.
Maxwell AE, Bastani R (1999). Condom use in young Blacks and Hispanics in public STD clinics.
Sexually Transmitted Diseases 26: 463.
Social Theory & Health
Leigh A Willis Behavioral Characteristics of the Low-Income, African-American Male Core Group
265
McNeil JI, Williams KM (2004). HIV/AIDS and sexually transmitted diseases. In: Lensworth I. (ed).
Praeger Handbook of Black American Health: Policies and Issues Behind Disparities in Health. Praeger: Livingston. pp 238–260.
Millett GA, Richard J, Stall WR, Peterson JL (2006). Greater risk for HIV infection of black men who have sex with men: a critical literature review. American Journal of Public Health 96: 1007–1019.
Potterat JJ (1992). Socio-geographic space and sexually transmissible diseases in the 1990’s. Today’s Life Science 16: 22–31.
Potterat JJ, Muth JB (1996). Core groups by any other name? Sexually Transmitted Diseases 23: 164–165. Potterat JJ, Rothenberg RB, Woodhouse DE, Muth JB, Pratts CI, Fogle 2nd JS (1985). Gonorrhea as a
social disease. Sexually Transmitted Diseases 12: 25–32.
Ross L, Kohler CL, Grimley DM, Bellis J (2003). Intention to use condoms among three low-income, urban African American subgroups: cocaine users, noncocaine drug users, and non-drug users.
Journal of Urban Health: Bulletin of The New York Academy of Medicine 80: 147–160. Rothenberg RB (1983). The geography of gonorrhea. Empirical demonstration of core group
transmission. American Journal of Epidemiology 117: 688–694.
Rothenburg RB, Narramore JB (1996). Commentary: the relevance of social network concepts to sexually transmitted disease control. Sexually Transmitted Diseases 23: 24–29.
South SJ (1993). Racial and ethnic differences in the desire to marry. Journal of Marriage & Family 55: 357–370.
South SJ, Lloyd KM (1992). Marriage opportunities and family formation: further implications of imbalanced sex ratios. Journal of Marriage & Family 54: 440–451.
Staples R (1982). Black Masculinity: The Black Male’s Role in American Society. Black Scholar Press: San Francisco, CA.
Staples R (1999). The Black Family: Essays and Studies. Wadsworth Pub. Co: Belmont, CA. Staples R, Johnson LB (1993). Black families at the crossroads: challenges and prospects. In: The
Jossey-Bass Social and Behavioral Science Series. Jossey-Bass Publishers.
Swartz D (1997). Culture & Power: The Sociology of Pierre Bourdieu. University of Chicago Press: Chicago.
Thomas JC, Tucker MJ (1996). The development and use of the concept of a sexually transmitted disease core. The Journal Of Infectious Diseases 174(Suppl 2): S134–S143.
Thorburn S, Harvey SM, Ryan EA (2005). HIV prevention heuristics and condom use among African-Americans at risk for HIV. AIDS Care 17: 335–344.
Wasserheit JN (1995). Response to the editor: core groups by any other name? Sexually Transmitted Diseases 22: 164–165.
Wilson WJ (1987). The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. University of Chicago Press: Chicago.
Wilson WJ (1996). When Work Disappears: The World of The New Urban Poor. Knopf Distributed by Random House Inc: New York.
Wilson WJ, Neckerman KW (1986). Povery and family structure: the widening gap between evidence and public policy issues. In: Danziger S.H., Weinberg D.H. (eds). Fighting Povery: What works and What Doesn’t. Harvard University Press: Cambridge, MA. pp 232–259.
Wyatt GE, Myers HF, Ashing-Giwa K, Durvasula R (1999). Sociocultural factors affecting sexual risk-taking in African-American men and women: results from two empirical studies. In: Robert S. (ed). The Black Family: Essays and Studies. Wadsworth: Belmont, CA. pp 45–58.
Yorke JA, Hethcote HW, Nold A (1978). Dynamics and control of the transmission of gonorrhea.
Sexually Transmitted Diseases 5: 51–56.
Youm Y, Laumann EO (2002). Social network effects on the transmission of sexually transmitted diseases. Sexually Transmitted Diseases 29: 689–697.
Zenilman JM, Nancy E, Anne F, Gregory G (1999). The gregory of sexually partnetships in Baltimore: applications of core theory dynamics using a geographic information system. Sexually Transmitted Diseases 26: 75–81.
Social Theory & Health
