Power communication and condom use: patterns of HIV-relevant sexual risk management in heterosexual relationships

The impact of COVID-19-related anti-Asian discrimination on sexual communication and relationships among Asian individuals in the United States

Asian individuals in the United States have experienced heightened racial discrimination during the COVID-19 pandemic, which may reduce positive relationship processes and damage intimate relationships, including their sexual behaviors and quality. Guided by the chilling effect and Interpersonal Exchange Model of Sexual Satisfaction, this study explores how COVID-19-related anti-Asian discrimination moderates the relationships between sexual relationship power, sexual self-disclosure, and sexual satisfaction. Results (N = 294 partnered Asian adults) showed that as racial discrimination increased, the positive relationship between sexual relationship power and sexual self-disclosure decreased. As people experienced more racial discrimination, the positive effects of sexual self-disclosure on sexual satisfaction also decreased. Sexual power positively predicted sexual satisfaction via sexual communication, only when COVID-19-related discrimination was low or moderate. This study demonstrates how racial discrimination interacts with relational factors to predict Asian individuals' sexual communication and, in turn, sexual satisfaction. More public attention and efforts should be devoted to combating anti-Asian discrimination during the pandemic and beyond.

HIV-serodifferent couples' perspectives and practices regarding HIV prevention strategies: A mixed methods study

A substantial proportion of heterosexually acquired HIV infections in the U.S. occur between partners in primary relationships characterized by mixed HIV status. The U.S. Centers for Disease Control and Prevention have issued guidelines prioritizing HIV-serodifferent couples for primary HIV prevention, including treatment-as-prevention and pre-exposure prophylaxis (PrEP). Yet, very little research has been conducted to understand the perspectives and practices of HIV-serodifferent couples regarding HIV prevention strategies in the U.S. To help fill this gap, we conducted a mixed methods study with 27 mostly Black/African American and Latinx HIV-serodifferent heterosexual couples residing in New York City to explore their knowledge, attitudes, practices, and perspectives regarding combination HIV prevention, including condoms, PrEP and viral control. All couples expressed the desire to maintain viral suppression in the HIV-positive partner, which was not always achieved. There was considerable heterogeneity in the use of HIV prevention methods by couples; and several patterns emerged that were largely driven by gender and relationship dynamics. Female partners, in particular, expressed high levels of anxiety around transmission of HIV and thus desired multiple methods of protection. Healthcare providers should consider couples' psychosocial well-being, relationship quality, and other motivational factors when helping to tailor HIV preventative care for mixed-status couples.

Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power

The theory of gender and power provides a unique framework for understanding condom use by accounting for distinct challenges faced by minority women in particular. This study examined whether self-efficacy about condom use communication (SECC) and perceived partner's beliefs about condom (PPBC) use had an influence on condom use frequency; and whether these associations varied by gender. A sample of 252 African-American college students (101 males and 151 females) completed a confidential online survey assessing SECC, PPBC, and condom use behavior. SECC and PPBC showed significant associations with condom use behavior. Furthermore, there was a gender interaction effect with PPBC on condom use behavior. As PPBC increases toward positive associations about condom use, condom use behavior increased significantly more for females (B = 0.42; p = .02) as compared to males (B = 0.26; p = .19). This study supports the need to teach young women effective communication skills in order for them to accurately assess what their partner thinks about condom-related behaviors; and ultimately not allow partner discouragement to influence their decisions to use condoms. Interventions aimed at reducing risky sexual behavior on predominantly Black college campuses, in particular, may benefit from directly addressing relationship power and focusing on building self-efficacy in communicating condom use.

Perceptions and Definitions of Power Within the Context of HIV-Negative Male Couples' Relationships

Examining dynamics within relationships is critical for development of effective HIV prevention interventions for male couples. The dynamic of power has received little attention in research with male couples, though power has been reported to affect HIV risk among heterosexual couples. To help address this knowledge gap, the present cross-sectional analysis used mixed methods with dyadic data from 142 HIV-negative male couples to (1) assess partnered men's perception of who has the most power in their relationship and why, (2) examine whether partners concur about who has the most power and their reasoning for this selection, and (3) assess whether male couples' concurrence about who has the most power is associated with their engagement of condomless anal sex within and/or outside the relationship, type of relationship, and aspects of their sexual agreement. Individual- and couple-level responses about who has the most power were quantitatively assessed, whereas for why, their responses were coded qualitatively. Fifty-six percent of couples concurred about who has the most power in their relationship and of these, many said it was equal. Regarding why, themes of responses ranged from "compromise" and "shared responsibility" for those who concurred about who has the most power versus "dominant/compliant personality" and "money" among the couples who disagreed about who has the most power in their relationship. Concordance about who has the most power was only associated with condomless anal sex within the relationship. Further research is warranted to examine how power may affect other dynamics of male couples' relationships and risk-related behaviors.

Tackling sexually transmitted infection burden in Ugandan communities living in the United Kingdom: a qualitative analysis of the socio-cultural interpretation of disease and condom use

BACKGROUND

Despite being in a different country and social environment, Ugandans living in the UK still reportedly have the lowest rates of condom usage and one of the highest incidences of STIs in UK. In Uganda, STIs and HIV prevalence has been reported to be on the increase. Understanding peoples' beliefs and the attitudes that influence their behavior is a key factor to effectively designing control programs.

METHODS

A qualitative study that interviewed 37 purposively selected Ugandans living in the UK was conducted. Lay theories and interpretations were derived using thematic analysis.

RESULTS

Condoms generally carried a lot of stigma and were perceived for use primarily in extramarital affairs and pregnancy control. HIV/AIDS was most feared due to its perceived socio-psychological or physical effects unlike other STIs described as "non-threatening" due to wide availability of "quality" treatment in UK. Notions of trust, the purpose of relationships, symptom recognition and partner selection greatly influenced decisions to undertake consistent condom use.

CONCLUSIONS

The socio-cultural understanding of STIs, sex, trust and relationships are symbolic in influencing consistent condom use among Ugandans. This indicates a need to acknowledge community beliefs and values about sexual health and design messages about STIs and condoms that would help eliminate these serious condom-related misconceptions.

Alcohol use, sexual relationship power, and unprotected sex among patrons in bars and taverns in rural areas of North West province, South Africa

We examined the relative importance of alcohol consumption and sexual relationship power (SRP) in predicting unprotected sex among 406 bar patrons in North West province, South Africa. We assessed participants' demographic characteristics, alcohol consumption, SRP, and number of unprotected sexual episodes in the past 6 months. In correlational analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP was significantly associated with frequency of unprotected sex for males and marginally associated for females. In multivariate regression analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP's association was marginally significant for females and not significant for males. Alcohol consumption is more strongly associated with unprotected sex than is SRP among bar patrons. Combination HIV prevention approaches to curb problem drinking and increase condom accessibility, and regular and effective use are needed in tavern settings. SRP needs further examination among tavern populations.

Men's attitudes on gender equality and their contraceptive use in Uttar Pradesh India

BACKGROUND

Men play crucial role in contraceptive decision-making, particularly in highly gender-stratified populations. Past research examined men's attitudes toward fertility and contraception and the association with actual contraceptive practices. More research is needed on whether men's attitudes on gender equality are associated with contraceptive behaviors; this is the objective of this study.

METHODS

This study uses baseline data of the Measurement, Learning, and Evaluation (MLE) Project for the Urban Health Initiative in Uttar Pradesh, India. Data were collected from a representative sample of 6,431 currently married men in four cities of the state. Outcomes are current use of contraception and contraceptive method choice. Key independent variables are three gender measures: men's attitudes toward gender equality, gender sensitive decision making, and restrictions on wife's mobility. Multivariate analyses are used to identify the association between the gender measures and contraceptive use.

RESULTS

Most men have high or moderate levels of gender sensitive decision-making, have low to moderate levels of restrictions on wife's mobility, and have moderate to high levels of gender equitable attitudes in all four cities. Gender sensitive decision making and equitable attitudes show significant positive association and restrictions on wife's mobility showed significant negative relationship with current contraceptive use.

CONCLUSION

The study demonstrates that contraceptive programs need to engage men and address gender equitable attitudes; this can be done through peer outreach (interpersonal communication) or via mass media. Engaging men to be more gender equal may have an influence beyond contraceptive use in contexts where men play a crucial role in household decision-making.

Emotional intimacy power predicts different sexual experiences for men and women

Those who are more emotionally invested in relationships have less power than their partners. Furthermore, less powerful individuals may attempt to equalize power imbalances by offering rewards to their partner and using sex and condom use as exchange resources. Australian young adults reported their condom use and pressured sex experiences in both romantic (n = 708) and casual (n = 118) relationships. Results showed that greater power (lower relative emotional investment) predicted more condom use among those wanting to use condoms. In casual relationships, an interaction with gender showed that women in particular used condoms more when they had more power. Power also interacted with gender for pressured sex and, unexpectedly, men who had more power experienced more pressured sex. The possibility that condom use and pressured sex have different meanings for men and women is explored.

When do condom use intentions lead to actions? Examining the role of sexual communication on safer sexual behavior among people living with HIV

This study investigated the moderating role of sexual communication in the association between intentions to use condoms and unprotected sex in a sample of 358 individuals living with HIV (233 men, 125 women, M age = 43). Longitudinal analyses revealed a significant interaction between condom intentions and sexual communication: individuals who were high in both condom intentions and safer sex communication engaged in less unprotected sex with all partners and with partners of HIV negative or unknown serostatus over six months of follow-up. Among individuals low in communication, intentions were not associated with unprotected sex. Implications for interventions are discussed.

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.

Dangerous subtlety: relationship-related determinants of consistency of condom use among female sex workers and their regular, non-commercial partners in Hai Phong, Viet Nam

Research indicates female sex workers use condoms more consistently with their clients than with regular, non-commercial partners (partners). The purpose of this study was to better understand the relationship between couple communication and HIV risk behavior by examining (1) sex worker-partner divergence on communication measures and (2) the association between intra-couple communication divergence and consistent condom use. In this cross-sectional study, 50 sex workers and their partners in Hai Phong, Viet Nam were separately asked about their relationships and condom use. When asked about HIV risk communication in their relationship, sex workers reported significantly higher HIV communication content than their partners (p < 0.001). Higher communication divergence between partners was associated with a decreased likelihood of consistent condom use (OR 0.54 95% CI 0.30, 0.97). Sex workers urgently need interventions that build their communication skills and address their risk behavior in non-commercial relationships.

Considerations in HIV prevention for women affected by the criminal justice system

Within the national dialogue of HIV prevention strategies, relatively little consideration is given to the millions of women and girls affected by the criminal justice system, either through their own incarceration or that of their partners. Statistics indicate that these women and girls are disproportionately infected or at risk for HIV and other sexually transmitted infections and much of this risk is directly related to the dynamics and circumstances that led to their incarceration or relationships with incarcerated men. As we look for the link between public health and correctional health within our National HIV/AIDS Strategy, it is imperative that the risks, obstacles, and opportunities facing women and girls affected by incarceration are brought into the discussion. Gender-responsive HIV prevention policies and practices must be developed to address the unique risks and opportunities for these women and girls. This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts.

Sexual cognitive predictors of sexual communication in junior college adolescents: medical student perspectives

BACKGROUND

Further understanding the relationship between sexual cognition and sexual communication in adolescents may facilitate sexual health promotion in this population.

PURPOSE

This study was designed to investigate associations between sexual cognitive variables and sexual communication in adolescents.

METHODS

This study used a cross-sectional research design with conventional sampling. Data were collected from one medical college in central Taiwan. A total of 900 questionnaires were dispatched, with 748 copies returned, giving a response rate of 83.1%. Structural questionnaires were designed to collect demographic data, sexual self-concept inventory, sexual risk cognition, sexual self-efficacy, and sexual communication scale. This study applied statistical methods, including descriptive statistics, Pearson product-moment correlation, and multiple regression analysis.

RESULTS

Major findings revealed that (a) adolescents talked about sexual activity and sexual issues with their parents at a moderate level (mean = 2.52, SD = 1.24), (b) all sexual cognitive variables (sexual self-concept, sexual risk cognitions, and sexual self-efficacy) correlated positively with sexual communication, and (c) predictors of sexual communication were supported by demographic data (having heterosexual friends, satisfaction with heterosexual friends, and duration of relationships with heterosexual friends) and sexual cognitive variables, which accounted for 62.0% of variance.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Study results can contribute to the development of safe sexual health programs and improve healthcare provider knowledge of sexual communication among adolescents. More sexual communication between adolescents and their parents is encouraged. Moreover, sexual health programs must give increased focus on the issue of adolescent sexual cognition to help encourage increased discussion between adolescents and their parents regarding sexual activity and issues.

Older sexual partners during adolescence: links to reproductive health outcomes in young adulthood

CONTEXT

Sex at a young age with an older partner has been linked to poor reproductive health outcomes during adolescence, but minimal research has examined the influence of teenagers' having an older sexual partner on reproductive health outcomes during the transition to young adulthood.

METHODS

Logistic regression and contrast analyses of three waves of data from the National Longitudinal Study of Adolescent Health were used to examine whether individuals who had had sex before age 16 with a partner at least three years their senior were at increased risk of becoming teenage or unmarried parents or of contracting an STD by young adulthood.

RESULTS

Ten percent of females and 2% of males had had early sex with an older partner. These females were more likely to acquire an STD as young adults than were those whose riskiest relationship was before age 16 with a similar-aged partner (odds ratio, 2.1) or at age 16 or later with a similar-aged or older partner (2.4 and 2.6, respectively). For males, having sex before 16, regardless of partner age, was associated with an elevated STD risk (odds ratio, 1.9), although controlling for relationship history characteristics attenuated the association.

CONCLUSIONS

Adolescents, particularly young adolescents, should be made aware of the potential risks associated with having older sexual partners. In particular, program providers should be alerted that females who engage in early sexual activity with older partners are at especially high risk of experiencing adverse reproductive health consequences.

Men, multiple sexual partners, and young adults' sexual relationships: understanding the role of gender in the study of risk

Heterosexual transmission of HIV and other sexually transmitted infections has become a primary health concern worldwide. Gender roles for heterosexual interactions appear to sanction men's sexual risk-taking, especially the pursuit of multiple sexual partners. Using measures developed in this study, the current study assessed the associations between men's and women's relationship attitudes and experiences and their sexual risk encounters. Participants were 104 men and 103 women (18-24 years) from a large, urban college located in a high HIV risk neighborhood of New York City. All completed a survey assessing HIV risk and the battery of relationship measures assessing traditional sexual roles, sexual conflicts, significance of sex, relationship investment, need for relationship, and unwanted sex. For men, greater sexual conflict in their primary relationships was associated with more sexual partners and fewer unprotected vaginal intercourse encounters with a primary partner and across sex partners overall. In addition, men's endorsement of more traditional sexual roles and lower relationship investment were associated with higher numbers of sexual partners. Among women, compliance with men to engage in unwanted sex was associated with higher levels of participation in unprotected sex. For both men and women, greater significance given to sex in a relationship was associated with fewer extradyadic partners. This study demonstrates the utility of measures of relationship attitudes and experiences to characterize sexual risk, especially among men. Findings are discussed in terms of implications for prevention program targeting young urban adults.

Deconstructing the relationship between intimate partner violence and sexual HIV risk among drug-involved men and their female partners

This study, based on data from a random sample of 322 men on methadone, examines whether traditional male gender role beliefs, male substance use, and couple drug-involvement lead to male psychological dominance, which in turn leads to perpetration of intimate partner violence (IPV) and sexual HIV risk behavior. Structural equation modeling indicated that male psychological dominance is directly associated with perpetrating both physical IPV and sexual HIV risk; however, physical IPV did not lead to sexual HIV risk as predicted originally. Stronger endorsement of traditional male gender role beliefs was associated with male psychological dominance. Couple drug-involvement was also directly associated with male psychological dominance as well as sexual HIV risk. Male substance use led to couple drug-involvement, but not to physical or sexual HIV risk as hypothesized. Study findings highlight the significance of couple drug-involvement and male psychological dominance as pathways leading to physical IPV and sexual HIV risk behavior. Implications for HIV prevention efforts targeting drug-involved men and their sexual partners are discussed.