Gender Differences in Condom Use Behavior? The Role of Power and Partner-Type

Risky relationships: targeting HIV prevention for women offenders

HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.

Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya

Using samples of reproductive aged men and women from rural Ethiopia and Kenya, this study examines the associations between two scales measuring balances of power and equitable attitudes within relationships and modern contraceptive use. The scales are developed from the Sexual and Reproductive Power Scale (SRPS) and Gender Equitable Male (GEM) scale, which were originally developed to measure relationship power (SRPS) among women and gender equitable attitudes (GEM) among men. With the exception of Ethiopian women, a higher score on the balance of power scale was associated with significantly higher odds of reporting modern contraceptive use. For men and women in both countries, a higher score on the equitable attitudes scale was associated with significantly higher odds of reporting modern contraceptive use. However, only the highest categories of the scales are associated with contraceptive use, suggesting a threshold effect in the relationships between power, equity and contraceptive use. The results presented here demonstrate how elements of the GEM and SRPS scales can be used to create scales measuring balances of power and equitable attitudes within relationships that are associated with self-reporting of modern contraceptive use in two resource-poor settings. However, further work with larger sample sizes is needed to confirm these findings, and to examine the extent to which these scales can be applied to other social and cultural contexts.

Spousal communication about HIV prevention in Kenya

High HIV rates among cohabiting couples in many African countries have led to greater programmatic emphasis on spousal communication in HIV prevention. This study examines how demographic and socioeconomic characteristics of cohabiting adults influence their dyadic communication about HIV. A central focus of this research is on how the position of women relative to their male partners influences spousal communication about HIV prevention. The authors analyze gaps in spousal age and education and females' participation in household decision making as key factors influencing spousal communication about HIV, while controlling for sexual behaviors of both partners as well as other individual and contextual factors. Data were obtained from the 2003 Kenya Demographic and Health Survey for 1,388 cohabiting couples. Information regarding spousal communication was self-reported, assessing whether both, either, or neither partner ever discussed HIV prevention with the other. Analyses showed higher levels of education for the female partner and participation in household decision making are positively associated with spousal communication about HIV prevention. With females' education and other factors controlled, couples with more educated male partners were more likely to have discussed HIV prevention than couples in which both partners have the same level of education. Spousal communication was also positively associated with household wealth status and exposure to the mass media, but couples in which male partners reported having nonspousal sex in the past year were less likely to have discussed HIV prevention with their spouses. Findings suggest HIV prevention programs should promote female empowerment and encourage male participation in sexual health discussion.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

Sex without desire: characteristics of occasions of sexual compliance in young adults' committed relationships

Sexual compliance (i.e., willingly engaging in sexual activity that one does not desire) is a common behavior among young people. Little is known about the characteristics of occasions of sexual compliance in the context of a committed relationship. This study used both a diary method and in-depth interviews to assess occasions of sexual compliance, as well as types of sexual activity, condom use, pleasure, and feelings of pressure and control. Participants included 63 young adults (18-24 years old) in committed, heterosexual relationships. Seventeen percent of all sexual activity was rated as sexually compliant. Occasions of sexual compliance were rated as less enjoyable and more unexpected. In-depth interviews revealed four key themes including endorsement of an implicit contract between partners, partner awareness of low desire, past experience of pressure, and justification for reporting low desire. Future research should evaluate the long-term impact of sexual compliance on a relationship.

Partner relationships and HIV risk behaviors among women offenders

The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationships and HIV risk behaviors.