Elevating Black Women in Contextually Relevant Ways: A Top Priority in Violence and HIV Prevention Work

Paralleling national conversations focused on the widespread problem of violence against women (e.g., Dominican writer and activist, Zahira Kelly's #MaybeHeDoesntHitYou hashtag ¹ ), in this issue of the Journal of Women's Health, Montgomery et al. ² shine an important light on associations between high-risk sexual behavior and violence victimization in a longitudinal cohort of primarily black women (86%) residing in high-poverty and HIV-risk areas. The study is salient in its focus on black women, who suffer disproportionately high HIV sex risk behavior, intimate partner violence, and related death rates, ^{3 –7} and who have been historically under-represented in research and in larger societal conversations about violence against women. ⁸

Women in the study reported high rates of emotional (23%), physical (12%), and sexual abuse (4%) for the prior 6 months. Women who exchanged sex (i.e., had sex with a man in exchange for food, shelter, housing, drugs, or money) were at increased risk of both physical abuse (adjusted odds ratio [AOR]: 1.71) and emotional abuse (AOR: 1.60). As well, women who reported partner incarceration and partner concurrency suffered higher risk of emotional abuse (AOR: 1.34, 1.59, respectively), and those with sexually transmitted infection and binge drinking were at risk of physical abuse (AOR: 1.62, 1.47). Although the study design precluded definitive isolation of violence perpetrated by intimate partners, the authors maintain that since having a male intimate partner was the main study inclusion criterion, women were likely reporting intimate violence.

The findings by Montgomery et al. serve as an important call to action to prioritize black women in violence, sex risk, and HIV prevention programming across healthcare, public health, and broader societal settings, and to elevate their voices more broadly.

In this regard, the study findings remind us of our critical role in clinic-based screening for violence and related sexual risk behaviors. The U.S. Preventive Services Task Force supports clinic-based screening for intimate partner violence in women of reproductive age, ⁹ with referral to community-based advocates. ¹⁰ However, such screening and referral programs must attend to the economic, power, and gender-related contextual factors that are salient in black women's lives and may reduce their agency and ability to be independent from male intimate partners. ¹¹ For example, the reality of poverty in the lives of women in Montgomery et al.'s study may influence their partnering with men to relieve economic stress, but subject them to pressure to engage in unprotected sex and bear children. Thus, it is critical that screening and referral programs ensure women's robust connection to community-based advocates with training in assisting in buffering against these stressors and dynamics.

Second, evidence-based public health prevention and support programs aimed at reducing sex risk behaviors and led by black women and conducted in supportive settings to build agency and skills in other black women and girls should be prioritized, ¹¹ along with telephone-based interventions delivered over time to reach black girls within high-risk contexts. ¹² Yet, since intimate partner violence victimization among black women reduces the effectiveness of prevention programs intended to reduce sex risk behaviors, ¹³ concomitant prevention strategies to reduce intimate partner violence should be prioritized.

Third, on the broadest societal level, the study by Montgomery et al. ² highlights the critical need for the voices and needs of black women to be prioritized and to be taken seriously. Although social media movements, such as Zahira Kelly's #MaybeHeDoesntHitYou hashtag, ¹ are not controlled scientific experiments, they are, in effect, broader societal interventions and necessary vehicles that direct our attention to the largely tolerated reality of violence against women and have the potential to raise black women's historically under-represented voices in these societal conversations.

Finally, societal policies and programming must continue to be developed and implemented to reduce inequalities at the intersection of gender, race, and poverty, which result in unfair and less than optimal conditions for black women.

Through our collective pledge and promise to these multiple overlapping actions, we will together contribute to supporting and elevating black women's agency, health, well-being, and voices in contextually relevant ways.