Factors that influence HIV testing among non-marginalized African American women.
Abstract: This study assesses socio-behavioral influence on HIV testing among non-marginalized African American women (N = 432African-American women). Participants were drawn from a major Midwestern university. Over half tested for HIV at least once (63.6%). HIV tested women were more likely to report aprior STD (45%), sexual relations with someone previously jailed (30%), more sexual partners (6.8%) and endorse anti-HIV conspiracy beliefs (p<.05). Those not tested expressed stronger commitments to condom use and barriers to getting tested. Each additional sex partner was significantly associated with greater odds of getting tested (p<. 05). However, risk perception (p<.10), perceived barriers (p<.05) and positive attitudes towards condoms (p<.05) was significantly associated with decreased odds of getting tested.
Subject: Women (Sexual behavior)
African Americans (Sexual behavior)
HIV testing (African American market)
Condoms (African American market)
Conspiracy
HIV (Viruses)
Author: Norwood, Carolette
Pub Date: 09/22/2011
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Fall, 2011 Source Volume: 26 Source Issue: 4
Topic: Event Code: 240 Marketing procedures Advertising Code: 80 Targets & Markets
Product: Product Code: 3069770 Prophylactics & Diaphragms NAICS Code: 326299 All Other Rubber Product Manufacturing SIC Code: 3069 Fabricated rubber products, not elsewhere classified
Accession Number: 308741493
Full Text: INTRODUCTION

African American women are facing a health emergency in regards to new HIV infection rates and AIDS mortality. While composing only 12 percent of the US female population, they account for nearly 70% of new AIDS diagnoses among women (Kaiser Foundation, 2007). According to surveillance statistics from the Centers for Disease Control (CDC, 2010), African American women are 15 and 4 times more likely to be newly infected with HIV than are White and Hispanic women, respectively. Equally salient, AIDS mortality is now a leading cause of death for Black women of reproductive age (CDC, 2006). Despite this crisis, only a handful of studies has focused exclusively on African American women and HIV prevention. Even fewer have examined US Black women in non-marginalized groups. In response to the lack of research, this study examines factors that undermine African American women's sexual health and create barriers to HIV testing.

Prior research suggests that people who self-select to test for HIV are motivated by several factors, such as having recently engaged in risky sex, being pregnant, having recently used drugs with needles, having had multiple sexual partners, having had a sexually transmitted disease (STD), or knowing someone who is infected with HIV or AIDS. Likewise, deterrents of getting tested for HIV are low perception of risk, fear of receiving positive results, concerns about confidentiality and test affordability, lack of transportation to a testing facility, and simply not being offered a test (see Kakoko, et al, 2006; Spielberg, et al, 2003; Herdon, et al, 2003 Fernandez, et al, 2005; Peralta, et al, 2007). Other research has noted that in addition to risk perception and knowledge of HIV, self-efficacy plays an important role in HIV testing (Basen-Engquist, et al, 1999). Having the confidence to get tested as well as ask a partner to get tested for HIV is an important tool for prevention.

Community-specific barriers to HIV testing are also important. Several researchers have argued that the legacy of mistrust and suspicion of health-care providers, validated by the infamous Tuskegee experiment, Jim Crow segregation policies, and centuries of institutionalized racism, has been driving HIV conspiracy beliefs in the Black community (Thomas and Quinn 1991; Jones 1992; Bogart et al. 2010). An increasing number of studies have explored the extent to which HIV conspiracy beliefs influenced condom use at last sex, as well as having had an HIV test, but the results have been mixed. For instance, Bogart and Thorburn (2005) found that conspiracy beliefs are salient in the Black community, particularly among Black men, and that these conspiracy beliefs negatively impacted condom use at last sex. In contrast, Bohnert and Latkin's (2009) research on conspiracy beliefs and HIV testing among African Americans in low-income neighborhoods with high rates of drug use found that education (having less than a high-school degree), being male, and being older increased the likelihood of endorsing conspiracy beliefs. Yet, these factors positively influenced the odds of having been tested for HIV.

Racial-identity salience may also influence the likelihood of having had an HIV test. Racial-identity salience refers to the extent to which individuals normatively define themselves in racial terms. High racial-identity salience is therefore the extent to which race is a relevant aspect of one's self-concept. Since African Americans tend to be more racialized than other groups in the United States, racial identity is believed to play an important role in their everyday lives (Sellers, et al, 1997). Recognizing the importance of racial-identity salience in HIV prevention, Bogart and Thorburn (2005) employed Seller's (1997) Multidimensional Model of Racial Identity in their study on regular condom use among African Americans, but because of low internal consistency reliability and Guttmann split-half reliability, the scale could not be used.

The current study's rational for utilizing the racial-identity salience scale is predicated on prior research but also the ongoing and widely held perception that AIDS is a White, male, and or gay "disease" and therefore, one that neither affects nor infects Blacks women heterosexuals. Despite the fact that Black women (and men) are significantly more likely to die of AIDS than any other racial or ethnic group in United States, research shows that their perception of risk differs only slightly from other groups (Young, et al, 2010). The perception of AIDS as a disease for socially "deviant" groups such as "the gays," bisexuals, and those on down-low (DL)1; a disease for straight men who have been imprisoned or jailed; or a disease for sexually "loose" Black women and "crack whores" might mislead some Blacks with high racial-identity salience into thinking that AIDS is not a disease that infects "ordinary," non-marginalized Black people. Given the above discussion, the purpose of this research is to understand and identify tangible factors that undermine African-American women's sexual health as it relates to HIV and AIDS testing.

RESEARCH SIGNIFICANCE

This research is important for a number of reasons. First, the focal group is non-marginalized African American women. As aforementioned, existing research on African American women and HIV tends to focus on low-income substance abusers and sex traders, usually women already infected with AIDS (see Friedman, et al, 1999; Thomas and Quinn, 1993; Sterk, Theall and Elifson, 2003; Barkan, et al, 1998). This bias in the literature homogenizes Black women into a narrow and even pathological category. The reality is that Black women who are not involved in sex trading or recreational drugs are also being infected with HIV. The heavy focus on marginalized groups is important, but should not eclipse the entire narrative in the literature. In this respect, this research is informed by Black feminist thought, which encourages scholars to produce knowledge, empower women, and challenge stereotypes about Black women (see Pat Hill Collins, 1990). An important goal of this research is to broaden the perspective and diversify the literature on Black women and HIV in the US.

Second, other research on Black women and HIV are either needs assessment studies of community intervention efforts or qualitative inquires (see Prathers, et al, 2006; Wingood and DiClemente, 2006; Robinson, et al, 2002; Dworkin, et al, 2006 Simoni, et al, 2000; Jarama, et al, 2007). The current study employs large-scale data on a population for which very little data exist.

Third, this research fills in some of the gaps in the literature. In doing so, this study: 1) examines the influence of HIV conspiracy beliefs on having had an HIV test using a non-marginalized population of African American women; 2) explores the influence of racial-identity salience on being tested for HIV; and 3) introduces and employs a culturally relevant scale to assess self-efficacy in getting tested for HIV.

Given the increasing prevalence of HIV infections and AIDS-related mortality among African American women, this study addresses the following research questions:

1) Is there a meaningful difference between Black women who have tested for HIV and those who have not?

2) Do prior STDs, sexual relations with someone previously imprisoned or jailed, a higher number of sexual partners, high perception of risk, and high self-efficacy increase Black women's odds of having had an HIV test?

3) Do perceived barriers, weak attitudes about condom use, high endorsement in HIV conspiracy beliefs, and racial-identity salience decrease Black women's odds of having had an HIV test?

METHODS

Cross-sectional data were collected at a large Midwestern university between Fall 2008 and Spring 2010. The research questionnaire was composed of 129 items that inquired about respondents' demographic characteristics, risk perception, prior and current sexual partnerships and prior STDs. Four-hundred and thirty-two African American women college students completed the survey which represents about one-quarter of the total population in this demographic. Access to the sample was obtained through the University's registrar's office, which provided a comprehensive list of currently enrolled students in this demographic. Students were initially solicited from African American Studies classes, then university wide via a Blackboard survey page with restricted access. All female students who self-identified as African American were enrolled in the Blackboard survey page and were invited to participate. Students were encouraged to complete the survey for the sake of advancing scientific knowledge, as well as for extra credit in courses that encourage an experimental learning component. Approval for the study was obtained from the University of Cincinnati's Institutional Review Board. Students were given an informed consent form before the study commenced. All interviewees were 18 years and older and matriculating students.

VARIABLES

The dependent variable was a single-item indicator that asked, "How many times have been tested for HIV/AIDS?" This variable is dichotomous, where "0" indicates "no" for not having been tested for HIV and "1" indicates "yes" for having been tested >1 times.

Control Variables

Four control variables were included. First is a dummy variable on "prior STDs." Respondents were asked, "Have you ever had a sexual transmitted disease (STD)?" The second control variable is also a dummy variable that asked respondents if they had "ever had sexual relations with someone previously jailed or imprisoned." Third is "the number of sexual partners" the respondent has had to date. This is an interval ratio variable that ranged between 0 and > 20. And fourth is the risk perception variable (Basen-Engquist, et al, 1999). Respondents were asked "Do you think you have no risk, a small risk, a moderate risk or a great risk of becoming infected with HIV?" The response options ranged from 1 = no risk to 4 = great risk and were collapsed into a dichotomous one where 0 = no risk and 1 = small to great risk.

Other Predictor Variables in Scales

Attitudes about condom use

The attitude about condom use scale borrowed from Basen-Engquist et al. (1999) consisted of the following three statements that gauged the respondents' beliefs about regular condoms use: 1) "I believe condoms should always be used if a person has sex"; 2) "I believe condoms should always be used if a person has sex, even if the girl uses birth control"; and 3) "I believe condoms should always be used if a person has sex, even if the two people know each other very well." A four-point Likert scale ranged from 1 = strongly disagree to 4 = strongly agree. This scale was validated and had an alpha reliability score of .92 (see Table 1).

Self-efficacy in getting tested for HIV

Inspired by Basen-Engquist et al.'s (1999) self-efficacy scales (to refuse sex, in communication, and in using condoms), a self-efficacy scale in getting tested for HIV was created specifically with African American women in mind. The scale items were based on theory and findings from prior qualitative research on HIV in the Black community. Respondents were asked five questions inquiring about their confidence in asking their partners to get tested. Each question asked the respondent to imagine a situation with a partner and whether she would feel confident asking the partner to get tested for HIV. Using a 4-point scale, respondents reported their level of confidence where 1 = not at all confident and 4 = very confident (see Table 1 for a complete list of items in the scale). The questionnaire included scenarios like dating someone that might be on the DL or someone she knew had spent time in jail or prison. Alpha reliability tests yielded a robust score of .87.

Barriers to getting tested for HIV

The barriers to getting tested for HIV scale (Peralta, et al, 2007) consists of nine statements to explain why the respondent might delay getting tested. Reasons include: 1) not having time to get tested, 2) feeling uncomfortable calling for an appointment for an HIVAIDS test, 3) not having transportation, 4) feeling embarrassed to buy HIVAID home test kit, 5) feeling afraid to collect results, 6) having concerns about being infected with HIV while getting tested, 7) having doubt about the accuracy of the test, 8) worry about what friend, and 9) family would think if tested and having general fear to get an HIV test (see Table 1). A five-point Likert scale was used whereby 1 = strongly disagree and 5 = strongly agree. Alpha reliability tests of this scale yielded a score of .78.

HIV conspiracy beliefs

The HIV conspiracy beliefs scale was replicated from a study by Bogart and Thorburn (2005). The scale consisted of 14 questions on a 5-point Likert scale where 1 = strongly disagree and 5 = strongly agree (see Table 1 for a complete list of questions in this scale). The questions inquired about respondents' endorsement of an HIV conspiracy in the Black community. The final HIV conspiracy beliefs scale consisted of 14 questions taken from the original scale, with an alpha reliability score of .87.

Black-identity salience

Borrowed from Sellers, et al (1997), the Black-identity salience scale measures three dimensions of African American identity (Centrality, Ideology, and Regard). The centrality dimension is theoretically most relevant to this study, because it measures the extent to which respondents normatively define themselves in racial terms. Five out of the 8 items (see Table 1 for items) were used for the present study, with an alpha reliability score of .80.

Data Analysis

Data were analyzed using the Statistical Package for the Social Science (SPSS) version 19. Respondents' demographic characteristics were analyzed with range, means, standard deviations, and valid N's presented in Table 1. Difference-in-means tests were performed to evaluate any meaningful differences between those who have been tested for HIV and those who have not (see Table 1). Logistic regression tests were performed to assess the relationship of background characteristic variables and socio-psychological factors on having ever been tested for HIV. The selections of the variables in the logistic regression model is based on prior research (afore-discussed) and is informed by black sexual politics (see Collins 2005) which identifies cultural peculiarities facing the black community such as the "down-low" phenomenon and the ways in which racial authenticity is tied to sexual identity.

RESULTS

DESCRIPTIVE STATISTICAL TESTS

The mean age of the sample was 23.92 years, with a range of 17 to 46. Six percent of respondents had sexual relations with a partner they suspected might be on the DL. More than one quarter (26%) reported having had sexual relations with someone previously imprisoned or jailed, and two fifths (40%) reported having had a prior STD. In terms of risk perception, over half (59%) felt they had no risk, over a third (35.2 %) felt they had a small risk, 4.8% felt a moderate risk, and only 1% thought they had a great risk of getting infected with HIV.

As shown in Table 1, difference-in-means tests confirmed several statistically meaningful differences between those who had been tested and those who had not. In regards to background and demographic variables, tests showed that respondents who had been tested were more likely to report having had a prior STD (p < .01), had relations with someone who had been previously imprisoned or jailed (p < .05), and had more sex partners (p < .001). On attitudes about condoms and self-efficacy in getting tested for HIV, women who had not been tested were more likely to express higher efficacy on condom use but were less likely to ask their partner to get tested for HIV (see Table 1).

Regarding barriers to getting tested for HIV, several items proved significant. Women who had not been tested were more likely to express: 1) not having enough time to get tested (p < .001), 2) feeling uncomfortable making an appointment (p < .001), 3) not having transportation (p < .01), 4) having concerns about the test's accuracy (p < .05), 5) having concerns about being infected while being tested (p < .05), and 6) having a general fear of being tested (p < .01).

HIV conspiracy beliefs were also statistically significant. Compared to women who had not been tested, women who had been tested were significantly less likely to be distrustful of the government telling the truth about AIDS (p < .05), as well as medical and public health institutions' attempts to stop the spread of AIDS (p < .05).

LOGISTIC REGRESSION RESULTS

Adjusted Odds Ratios (AOR) are presented in Table 2. As shown in Table 2, prior STDs and sexual relations with someone previously imprisoned, jailed, or on the DL were not significant predictors of having been tested. Controlling for other variables in the model, the odds of having had an HIV test were about 1.1 times higher ((AOR) = 1.088, p < .05) with each additional sexual partner. Unfavorable attitudes about condom use and the perception of many barriers to HIV testing, however, were significantly related to decreased odds of having been tested (both p < .05 with AOR = .948, and .853, respectively). Women who thought they were at risk for getting HIV/AIDS were less likely to have had an HIV test than women who thought they had no risk of getting HIV/AIDS (p < .10, AOR = .651). Neither HIV conspiracy beliefs nor racial-identity salience significantly affected whether respondents had been tested for HIV.

DISCUSSION

To my knowledge, this is the first research study to examine HIV conspiracy beliefs, racial identity salience, and self-efficacy in getting tested for HIV on a non-marginalized population of African Americans; however, none were significant indicators of having been tested. Prior research on HIV conspiracy belief among African Americans found that African American men had a higher propensity for endorsing conspiracy beliefs than African American women. This study found that non-marginalized African American women generally did not adhere to such beliefs. In fact, women who had not been tested were significantly more likely to believe that the government was telling the truth about AIDS and that health officials were trying earnestly to eradicate the rapid spread of AIDS in the Black community.

The fact that college women students were less distrustful and less likely to endorse HIV conspiracy belief is unsurprising. Prior research that found a link between Blacks and the endorsement of HIV conspiracy beliefs were mostly among poor, men with less education. This study finding gives us important perspectives on how gender and social class (indicated by education) might influence the endorsement of conspiracy beliefs in the Black community.

The first goal of this study was to assess whether there were any significant differences between women who had been tested and those who had not. Similar to findings from prior research, the number of sexual partners was a significant indicator of having been tested. The more sexual partners a woman had, the more likely she had been tested. Likewise, having had a prior STD also proved significant. Nearly half of HIV tested women (45%) had a prior STD.

Consistent with other research findings, perceiving a barrier to HIV testing was a significant indicator of testing status. Women who had not been tested were more likely to feel concern and fear about the testing process and expressed restrictions on time and mobility.

An unexpected finding was that 40% of respondents indicated having had a partner that had been jailed or imprisoned. To my knowledge, this is first HIV prevention study to inquire about Black women's sexual relations with a partner previously incarcerated. In the Black community, the disproportionate representation of young Black men in jails and prisons has important implications for Black women's sexual health and well being. Some have argued same-sex relations in jails and prisons has led to the DL phenomenon, which is believed to be directly related to the rising number of new HIV infections among heterosexual Black women.

A second goal of the study was to determine what factors increase the odds of having been tested. Results from the current study indicate that there are two salient factors that are related to increased odds of having been tested: 1) having had a greater number of sexual partners and 2) low perception of risk. The latter finding is perplexing and counterintuitive. Recall that nearly two thirds of the sample (59%) believed they had zero risk of becoming infected with HIV. This finding is consistent with other studies on African American college women students (Roberts and Kennedy 2006). The implication of this finding is great as knowing one's status is the first important step in behavior prevention. If African American women do not recognize the potential for becoming infected based on current trends, this suggests that health officials need to make stronger efforts to raise awareness.

A third goal of the study was to test whether racial-identity salience and conspiracy beliefs affected non-marginalized African American women's odds of having been tested. Neither factor had an influence. Bogart and Thorburn's (2005) study attempted to use Seller's racial-identity scale, but could not because of low alpha reliability. In this study, racial-identity salience was robust, but not a significant indicator of testing status for women. Future studies should consider the effect of this variable on a more representative sample that includes men. Last, perceived barriers and attitudes about condoms were considered to decrease the odds of being tested. These hypotheses were confirmed.

LIMITATIONS AND CONCLUSION

The epidemic of HIV and AIDS in the Black community has reached crisis levels, but an understanding of risk among African American women remains low despite exceedingly high new infection and AIDS mortality rates. From the analysis presented in this study, we now have a better understanding of how race (via conspiracy beliefs and identity salience) might influence African American women's prevention choices. Additionally, we now have insight on how Black women's sexual experiences with partners previously jailed, imprisoned and or on the DL might influence their decision to get tested. Despite the above strengths, this study has several limitations. First, the sample (although large and comprises 25% of the target population,) is non-random and is exclusively comprised of women college students from a Midwestern university, thus restricting our ability to generalize these result beyond this demographic. Additionally, these data are self reported which can compromise validity as subjects might under report or exaggerate their experiences. Efforts were taken to minimize this potential effect by assuring participant's confidentiality and anonymity. Third, given the cross-sectional research design of this study, causal inferences cannot be established. Instead, odd ratios are used to evaluate the probabilities of being tested or not. Future studies might consider utilizing qualitative techniques, in addition to quantitative methods, to deepen and contextualize our understanding of factors that might enhance and or inhibit Black women's action to get tested for HIV. Finally, future studies should also consider examining non-marginalized black men, as well as broader samples of African Americans, to determine the best possible means of generating awareness of this social and medical issue.

Acknowledgments:

I would like to express a great debt of thanks to my friend Yuan-ting Zhang for her invaluable comments and suggestions. Additionally, I would like to acknowledge the love and support from my special flowers that grow north of the woods, west of the river.

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Caroletter Norwood, PhD

(1) Down Low refers to men who have sex with other men as well as women but do not self-identify as gay or bisexual (CDC 2005).

Carolette Norwood, PhD, is affiliated with the University of Cincinnati. Mailing Address: Department of Africana Studies, University of Cincinnati, P.O. Box 210370, Cincinnati, OH 45221-0370, Phone. (513) 556.0358, Fax (513) 556-4446, Email: Carolette.Norwood@uc.edu
Table 1a. Descriptive Statistics (Range, Mean, and Standard
Deviation) and Parametric and Non-Parametric Significance Tests,
N = 432

                                             Tested   Not Tested

                                   Min-Max   Mean     Mean (SD)
                                             (SD)     Sig.

Variables

Characteristics about
  respondents
Age                                 17-46    24.86      22.35
Sexual relations with someone                (7.15)     (5.92)
  you suspect might be on the
  "DL"                               0-1      .07        .05
                                             (.25)      (.23)
Prior STD                            0-1      .45        .31
                                             (.50)     (.47) **
Sexual relations with someone        0-1      .30        .19
  previously imprisoned or                   (.46)     (.39) *
  jailed
Number of sexual partners           0-20      6.85       4.57
                                             (5.66)   (4.97) ***
Risk perception                      0-1      1.43       1.48
                                             (.63)      (.63)
Attitudes about condom use          3-12      9.91      10.55
  scale (1 = Strongly Disagree,              (2.19)     (1.99)
  Alpha Reliability = .92)
I believe condoms should             1-4      3.31       3.50
  always be used if a person                 (.77)     (.77) *
  has sex.
I believe condoms should             1-4      3.34       3.56
  always be used if a person                 (.76)     (.68) **
  has sex, even if the girl
  uses birth control
Very well.                           1-4      3.27       3.50
                                             (.80)     (.71) *
Self efficacy in getting tested
  for HIV scale (1 = Strongly
  Disagree, Alpha Reliability
  = .871)                           5-20     17.40      16.60
Imagine your partner really                  (3.19)     (3.81)
  wants to have sex and you
  know he or she has had
  other partners. If you wanted
  to have sex, how confident
  are you in asking him or her
  to take an HIV/AIDS Test?          1-4      3.21       3.05
Imagine you have been having                 (.95)      (1.03)
  sex without condoms. You
  heard that using a condom is
  a good way to avoid getting
  infected with HIV/AIDS.
  However, your partner does
  not like condoms. If you do
  not want to have sex without
  a condom anymore, how
  confident are you that you
  could delay sexual relations
  until learning your HIV/AIDS
  status?                            1-4      3.45       3.39
Imagine you have been dating                 (.77)      (.85)
  someone you suspect might be
  on the "DL"". If you wanted
  to have sex, how confident
  are you in asking your
  partner to have an HIV Test?       1-4      3.55       3.27
Imagine you have been dating                 (.73)    (1.02) **
  someone you know has spent
  some time in jail or prison.
  If you wanted to have sex,
  how confident are you in
  asking your partner to have
  an HIV Test?                       1-4      3.47       3.40
Imagine you have been dating                 (.84)      (.88)
  someone you know has
  experimented with
  intravenous drugs. If you
  wanted to have sex, how
  confident are you in
  asking your partner to
  have an HIV Test?                  1-4      3.70       3.53
                                             (.65)     (.78) *
Barrier HIV Test scale
  (1 = Strongly Disagree,
  Alpha Reliability = .786)         9-45     15.69      17.64
I don't have enough time to                  (5.91)     (5.88)
  get tested.                        1-5      1.29       1.67
I would be uncomfortable                     (.57)      (.90)
  calling for an appointment
  for an HIV/AIDS test.              1-5      1.88       1.94
I don't have transportation                  (1.22)     (1.02)
  to get to a testing site.          1-5      1.37       1.53
I would be embarrassed to                    (.77)     (.86) **
  buy an HIV/AIDS home
  testing kit.                       1-5      1.95       2.18
I would be afraid to collect                 (1.23)     (1.28)
  the result of my HIV/AIDS
  test.                              1-5      2.11       2.40
I have concerns about the                    (1.30)     (1.31)
  accuracy of an HIV/Test.           1-5      1.94       1.99
I have concerned about being                 (1.07)    (1.08) *
  infected with HIV/AIDS
  while getting tested for
  HIV/AIDS.                          1-5      1.79       1.94
I worry what my friends and                  (1.06)    (1.08) *
  family would think if
  they knew I got tested
  for HIV/AIDS.                      1-5      1.78       2.04
In general I am afraid to                    (1.08)     (1.18)
  get an HIV test.                   1-5      1.65       2.02
                                             (1.04)     (1.23) **
Conspiracy Belief scale
  (1= Strongly Disagree,
  Alpha Reliability =
  .878)                             14-70    34.65      34.58
The medicines used to                        (8.85)     (8.50)
  treat HIV are saving
  lives in the black
  community. [Reverse]               1-5       2.80      2.83
A lot of information                         (.97)       (.83)
  about AIDS is being
  held back from the
  public.                            1-5       3.25      3.24
HIV is a man-made virus.                      (1.25)    (1.18)
There is a cure for
  AIDS, but it is being
  withheld from the poor.            1-5       2.87      2.86
The government is telling                     (1.14)    (1.02)
  the truth about AIDS.
  [Reverse]                          1-5       2.76      2.59
The medicine used to                          (1.24)    (1.17)
  treat HIV causes
  people to get AIDS.                1-5       3.08      3.01
HIV was created and                           (1.00)     (.85) *
  spread by the CIA.                 1-5       2.06      2.20
AIDS is a form of                              (.78)     (.81)
  genocide against
  blacks.                            1-5       2.21      2.32
The medicine that                              (.92)    (1.04)
  doctors prescribe to
  treat HIV is poison.               1-5       2.37      2.41
AIDS was created by the                       (1.08)    (1.14)
  government to control
  the black population.              1-5       2.18      2.19
Doctors put HIV into                          (1.02)    (1.04)
  condoms.                           1-5
People who take the new
  medicines for HIV are
  human guinea pigs for
  the government.                    1-5       1.55      1.69
Medical and public health                      (.70)     (.80)
  institutions are trying
to stop the spread of HIV
  in the black communities.          1-5       2.54      2.56
[Reverse]                                     (1.00)    (1.03)
AIDS was produced in a
  government laboratory.             1-5       2.33      2.29
                                              (1.02)     (.96) *
Black Identity Salience
  Scale (1 = Very Strongly
  Disagree, Alpha
  Reliability = .80)                 5-35      2.07      2.05
In general, being Black is                     (.81)     (.84)
  an important part of my
  self-image.                        1-5       2.18      2.19
My destiny is tied to the                     (1.02)    (1.04)
  destiny of other Black
  people.                            1-5       1.55      1.69
I have a strong sense of                       (.70)     (.80)
  belonging to Black people.         1-5       2.54      2.56
I have a strong attachment                    (1.00)    (1.03)
  to other Black people.             1-5       2.33      2.29
Being Black is an important                   (1.02)     (.96)
  reflection of who I am.            1-5       2.41      2.38
                                              (1.00)    (1.00)

(1) Not Tested was assigned the value 0

Parametric T-tests for contineous variables and Non-Parametric
Chi-Square tests for categorical variables.

* P [less than or equal to] .05,
** P [less than or equal to] .01,
*** P [less than or equal to] .001

Table 2. Logistic Regression analysis of having been
tested for HIV by demographic and
socio-phychological factors, N = 432

Variable                 [beta]           AOR     95% CI

Constant                 2.53 ([dagger])
Prior STD                .26              1.30   .671-2.52
Sexual relations with    -0.00            1.00   .997-1.00
someone previously
imprisoned or
jailed
Number of sexual         09 **            1.09   1.01-1.16
partners
Sexual relations with    .00              1.00   1.00-1.00
someone you suspect
might be on
the 'DL"
Risk perception          -.38 ([dagger])   .65   .417-1.02
Self efficacy in         .02              1.02   .938-1.10
getting tested for HIV
Barrier to getting       -.053 *           .95   .902-.997
tested for HIV
Attitudes about          -.16 *            .85   .743-.978
condom use
HIV conspiricacy scale    .01             1.01   .982-1.04
Black Identity            .00             1.00   .954-1.05
Salience Scale

Chi square              32.76
Pseudo [R.sup.2]          .15

([dagger]) p < .10, * p [less than or equal to] .05,
** p [less than or equal to] .01,
*** p [less than or equal to] .001

AOR = Adjusted Odd Ratio

CI = Confidence Interval
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