HIV prevention and African American youth: examination of individual-level behaviour is not the only answer.

African American youth continue to be disproportionately represented in the incidence and prevalence of HIV despite numerous prevention efforts that target adolescent populations and declines in sexual risk behaviour among youth in general during the last decade. Several studies examining individual-level behavioural factors have failed to explain the health disparity in HIV prevalence. African American youth experience higher rates of HIV and other STIs, even when their sexual behaviour is normative. These findings suggest the need to expand beyond the examination of individual-level factors and to consider contextual issues such as economic, geographic and cultural influences. This paper reviews the relationship between contextual factors and HIV risk and prevalence and the implication for prevention for African American youth.