Reducing the Impact of Discrimination on HIV-Risk Behaviors Family-Based Prevention for Rural African American Adolescents

Racism continues to be a major source of stress for African Americans, especially in the rural South, where vestiges of slavery and Jim Crow laws produce unequal distribution of economic, educational, and health resources. Discrimination predicts HIV risk behaviors for both heterosexual and MSM adults, however, research with adolescents is much more limited. Racism can impair adolescent psychological functioning, producing hopelessness, anger, and depression. Consequently, adolescents may engage in self-soothing, but risky sexual behavior and substance use, as a “quick fix” coping strategy. Despite the negative effects of racism, it is important to recognize individual differences. Racial identity has been identified as a key factor in explaining how some youth thrive despite exposure to discrimination. Racial socialization is key in nurturing resilience for African American adolescents and is thus an important target for universal family-based prevention programs.

The current study tests a set of hypotheses regarding the link between discrimination and HIV risk behavior, as well as the effectiveness of a family-based program in preventing risk among rural African American adolescents. We hypothesize: 1) exposure to racism will negatively affect HIV risk behaviors and associated outcomes (substance abuse, teen parenthood); and 2) a culturally tailored family based prevention program can facilitate positive racial identity, through the enhancement of adaptive racial socialization, that will buffer adolescents from engaging in risky behaviors in response to racism-related stress.

Six waves of data from the Strong African American Families (SAAF) efficacy trial, with 667 African American families in rural Georgia, were used for this study. Adolescents were 11 at Pretest and 16 at W6. Adolescent gender was 47% male and 53% female. There was minimal attrition across waves, with 571 families at W6. Intent to treat analyses using Structural Equation Modeling in Mplus were employed to test study hypotheses. Models testing both hypotheses demonstrated good model fit.

Discrimination at age 15 predicted concurrent psychological functioning and HIV risk behavior at age 16. Psychological functioning was a significant mediator of these relations. The SAAF program was associated with parents’ gains in racial socialization practices, which in turn fostered gains in children’s racial identity. Racial identity and racist hassles independently predicted adolescents’ psychological functioning, which in turn predicted HIV risk. Moderation analyses demonstrated that the negative effect of discrimination on psychological functioning was less for children with higher racial identity.