Rejection Sensitivity, Perceived Power, and HIV Risk in the Relationships of Low-Income Urban Women

An Integrative Review of the Literature Examining Sexual Relationship Power, Depressive Symptoms, Silencing the Self, and HIV Vulnerability for Women in the United States

ABSTRACT

The purpose of our integrative review was to synthesize the literature examining relationships between depressive symptoms, silencing the self (STS), sexual relationship power (SRP), and HIV vulnerability among women in the United States. Literature searches were conducted through CINAHL, MEDLINE, PsycINFO, SCOPUS, Sociological Abstracts, and SocINDEX. Integrative review methodology of Whittemore and Knafl guided the review process, and 37 articles met inclusion criteria. The Theory of Gender and Power, modified by Wingood and DiClemente, was the guiding framework to organize and synthesize findings. Primary findings suggest that depressive symptoms, STS, and SRP in relationships may individually influence women's vulnerability for acquiring HIV, yet research lags behind. Evidence documenting relationships between these factors is insufficient to draw generalizable conclusions. Findings suggest that the current literature on this topic does not reflect those women most highly affected by HIV and those who identify as African American or Black in the Southeast region of the United States.

A Preliminary Experimental Study of Self-Objectification and Risky Sex Behavior Among a University Sample of Cisgender Women in the U.S

Self-objectification is associated with a number of negative mental and behavioral outcomes. Though previous research has established associations between self-objectification and risky sex, no study to date has examined whether self-objectification affects propensity to engage in risky sex. The current research employed an experimental design to examine the effect of heightened self-objectification on a laboratory analog of risky sex (n = 181). We observed that when college-attending women experienced a heightened state of self-objectification, they were more likely to engage in sex without a condom and less likely to wait to use a condom with a highly desirable partner. Given the frequency of intended and unintended objectifying messages that young women face, this increase in willingness to engage in risky sex behavior represents a consequential health concern.

Does Self-Silencing Behavior Mediate the Relation Between Rejection Sensitivity and Sexual Violence Victimization?

Previous research reveals that rejection sensitivity is associated with both sexual violence victimization and self-silencing behavior, yet the association among these variables has not been examined. As the foundation for this study, we propose a theoretical model that integrates these constructs. Using mediational analyses with bootstrapping, the results from a sample of 241 heterosexual college women revealed that consistent with the proposed model, self-silencing mediated the link between rejection sensitivity and reports of unwanted sexual contact and rape. The implications of the findings for the prevention of victimization/revictimization and interventions with victimized women are discussed.

The Relationships Among Social Capital, HIV Self-Management, and Substance Use in Women

Women living with HIV (WLHIV) face unique challenges to successfully self-manage HIV including substance use and limited social capital. We conducted a 6-month mixed-methods study to describe how social capital influences HIV self-management and substance use among WLHIV. Participants completed a self-report survey and in-depth interview at baseline, and 3 and 6 months. Descriptive statistics, t-tests, and generalized estimating equations (GEEs) were used to examine quantitative relationships. Qualitative data were analyzed using qualitative description. Current substance users reported lower social capital compared with past substance users (2.63 vs. 2.80; p = .34). Over time, substance use and social capital were associated with HIV self-management (Wald χ² = 28.43; p < .001). Qualitative data suggest that HIV self-management is influenced by overlapping experiences with social capital, including influential trust, community, and value of self can be complicated by ongoing substance use. Social capital can facilitate improved HIV self-management; however, substance use and trauma can weaken this relationship.

Partner Relationships and Injection Sharing Practices among Rural Appalachian Women

BACKGROUND

The role of relationships in initiating and maintaining women's risk behaviors has been established. However, understanding factors that may underlie partner relationships and women's risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women's risky injection practices as a function of relationship power perception.

METHODS

Female participants were recruited from three rural jails in the Appalachian region. Women were selected randomly, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs during the year before entering jail (n = 199).

MAIN FINDINGS

Approximately three-quarters (76%) reported having a recent main male sexual partner with a history of injection drug use. Although having a risky partner independently increased the likelihood of women reporting shared injection practices, perceptions of relationship power significantly moderated the effect on shared needle (adjusted odds ratio, 0.02; 95% CI, 0.003-0.23; p = .001) and shared works (adjusted odds ratio, 0.17; 95% CI, 0.03-0.95; p = .04) use.

CONCLUSIONS

This interaction indicated that, for women who inject drugs with a recent injecting male partner, greater perception of relationship power was associated with a decreased likelihood of shared injection practices. Implications for clinical assessment and intervention are discussed.

History of abuse and risky sex among substance users: The role of rejection sensitivity and the need to belong

This study investigates abuse and rejection sensitivity as important correlates of risky sexual behavior in the context of substance use. Victims of abuse may experience heightened sensitivity to acute social rejection and consequently engage in risky sexual behavior in an attempt to restore belonging. Data were collected from 258 patients at a substance use treatment facility in Washington, D.C. Participants' history of abuse and risky sexual behavior were assessed via self-report. To test the mediating role of rejection sensitivity, participants completed a social rejection task (Cyberball) and responded to a questionnaire assessing their reaction to the rejection experience. General risk-taking propensity was assessed using a computerized lab measure. Abuse was associated with increased rejection sensitivity (B=0.124, SE=0.040, p=0.002), which was in turn associated with increased risky sex (B=0.06, SE=0.028, p=0.03) (indirect effect=0.0075, SE=0.0043; 95% CI [0.0006, 0.0178]), but not with other indices of risk-taking. These findings suggest that rejection sensitivity may be an important mechanism underlying the relationship between abuse and risky sexual behavior among substance users. These effects do not extend to other risk behaviors, supporting the notion that risky sex associated with abuse represents a means to interpersonal connection rather than a general tendency toward self-defeating behavior.