Safer sexual practices among African American women: intersectional socialisation and sexual assertiveness

The measurement of racism in health inequities research

There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.

Black Women's Sexual Communication: Retrospective Accounts of Messages from Male and Female Family Members

The study used Black feminist theory and methods to examine messages about the composition of, and potential differences in the sexual health that Black women received from male and female loved ones. Black feminist theory grounded the study by ensuring Black women were involved in research team composition, design, recruitment, and data analysis. Our inductive thematic analysis of focus group data from 24 Black women revealed seven themes: Indirect Communication, Absence of Communication, Messages to Shield, and Prepare from male figures. The themes from female figures included: Absence of Communication, Open Communication, and Empowerment, Pleasure, and Judgment-Free Communication. A seventh theme that connected across gender focused on Objectification and Gender Stereotypes. Findings of the study suggest that there is a need for greater focus on improving family communication about sex for Black women and the need to center communication that empowers Black women to engage in healthy sexual practices.

Black Women’s Sexual Assertiveness and Satisfaction: The Role of the Superwoman Schema

Although extant research highlights the detrimental effects of the Superwoman Schema (SWS) on Black women’s physical and psychological well-being, researchers have yet to examine the implications of SWS endorsement on Black women’s sexual attitudes and behaviors. As a culturally salient racialized gender schema that reifies Black women’s supposed superhuman emotional and physical strength, to what extent does endorsement of the SWS contribute to Black women’s reported sexual assertiveness and satisfaction? In the present work, 406 Black women completed an online survey measuring their endorsement of the SWS, as well as their sexual assertiveness and sexual satisfaction. SWS dimensions moderated the association between sexual assertiveness and sexual satisfaction. Findings from the present study highlight the importance of considering culturally salient racialized gender schemas when examining Black women’s sexual attitudes and behaviors.

The Strong, Silent (Gender) Type: The Strong Black Woman Ideal, Self-Silencing, and Sexual Assertiveness in Black College Women

Women are socialized to endorse femininity scripts mandating that they prioritize others' needs and engage in self-silencing behaviors. Further, Black women may also endorse the strong Black woman (SBW) ideal, by which they are expected to selflessly meet the needs of their family and community and, as such, may embrace self-silencing in their interpersonal relationships. In a sample of 597 Black undergraduate and graduate college women, we tested whether: (1) self-silencing and SBW ideal endorsement would be independently, inversely associated with three dimensions of sexual assertiveness-communication assertiveness, refusal assertiveness, and pleasure-focused assertiveness; and (2) the association between self-silencing and sexual assertiveness would be stronger among Black women who endorse the SBW ideal. Correlational and regression analyses revealed that self-silencing was negatively linked to all dimensions of sexual assertiveness; SBW ideal endorsement was associated with lower levels of communication and pleasure-focused assertiveness. As expected, SBW ideal endorsement moderated the association between Black women's engagement in self-silencing and two dimensions of sexual assertiveness. Self-silencing was associated with less communication and pleasure-focused assertiveness regardless of their level of SBW endorsement. Findings highlight the complexities of Black women's desire to fulfill expectations to be strong, assertive, and/or compliant and silent. Interventions to promote Black women's sexual health should address sexual assertiveness and feminine silencing norms.

Latent variable and clustering methods in intersectionality research: systematic review of methods applications

PURPOSE

An intersectionality framework has been increasingly incorporated into quantitative study of health inequity, to incorporate social power in meaningful ways. Researchers have identified "person-centered" methods that cluster within-individual characteristics as appropriate to intersectionality. We aimed to review their use and match with theory.

METHODS

We conducted a multidisciplinary systematic review of English-language quantitative studies wherein authors explicitly stated an intersectional approach, and used clustering methods. We extracted study characteristics and applications of intersectionality.

RESULTS

782 studies with quantitative applications of intersectionality were identified, of which 16 were eligible: eight using latent class analysis, two latent profile analysis, and six clustering methods. Papers used cross-sectional data (100.0%) primarily had U.S. lead authors (68.8%) and were published within psychology, social sciences, and health journals. While 87.5% of papers defined intersectionality and 93.8% cited foundational authors, engagement with intersectionality method literature was more limited. Clustering variables were based on social identities/positions (e.g., gender), dimensions of identity (e.g., race centrality), or processes (e.g., stigma). Results most commonly included four classes/clusters (60.0%), which were frequently used in additional analyses. These described sociodemographic differences across classes/clusters, or used classes/clusters as an exposure variable to predict outcomes in regression analysis, structural equation modeling, mediation, or survival analysis. Author rationales for method choice included both theoretical/intersectional and statistical arguments.

CONCLUSION

Latent variable and clustering methods were used in varied ways in intersectional approaches, and reflected differing matches between theory and methods. We highlight situations in which these methods may be advantageous, and missed opportunities for additional uses.

Balancing the sexology scales: a content analysis of Black women's sexuality research

Existing research adopting a sex positive and intersectional framework for investigating Black women's sexualities is scarce. We conducted a 46-year (1972-2018) content analysis of sexualities research focussed on Black women. It sought to examine which sexualities topics were published most; whether the publications aligned with sex-positive, neutral or negative discourse; what methodologies were used; and differences in how various identities were investigated among Black women. Using human coding, we applied an integrative approach to the content analysis. Results found 245 articles meeting criteria. Approximately one-third of articles within the analysis focussed on the topic of sexually transmitted infections (STIs), HIV and sexual risk behaviours among Black women. Only 6.5% of articles utilised a sex-positive discourse. Quantitative articles were the most published methodology, and publications disproportionately overlooked Black women's intersectional identities. Implications for future research and practice are discussed.

"It Had a Lot of Cultural Stuff in It": HIV-Serodiscordant African American Couples' Experiences of a Culturally Congruent Sexual Health Intervention

Objective

The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention.

Participants

Participants (n=17) who completed at least half of the eight intervention sessions.

Methods

Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains.

Results

Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Participants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the sessions, including the emphasis on learning from one another as couples.

Conclusions

Couples at risk for HIV transmission benefit from strengthening skills and knowledge related to healthy sexuality. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also reducing risk.

Development and validity evidence of the multidimensional scale of sexual self-concept in a Spanish-speaking context

BACKGROUND/OBJECTIVE

STIs and HIV/AIDS are an important public health problem, transmitted by risky sex behaviours. In this context, it is necessary to identify protective factors, of those behaviours, as sexual self-concept. Sexual self-concept is a multidimensional trait (i.e. sexual self-esteem; sexual self-efficacy; and sexual assertiveness), but, in an extensive review, we did not find any measure to assess this multidimensional construct in a Spanish-speaking context. The objective of this research is development a scale to assess sexual self-concept in young people and adults.

METHOD

Time-space sampling with a total size of 792 participants, coming from the two Chilean cities (i.e. Arica and Iquique) with the highest HIV rates, aged between 17 and 53 years old (ME = 23.42; SD = 6.33), with 66.2% women (N = 500), 33.6% men (N = 258).

RESULTS

Final scale has 16 items and 4 dimensions: sexual self-esteem, sexual self-efficacy, assertive sexual communication, and assertive sexual behaviour. The identified structure provides satisfactory levels of reliability (ω > .8) and presents robust evidence of validity, based on the internal structure of the test, using ESEM (RMSEA = .060; CFI = .99; TLI = .98), evidence of validity based on relationship to other variables (i.e. risky sexual behaviour) and measurement invariance between men and women.

CONCLUSIONS

The multidimensional scale of sexual self-concept has adequate psychometric properties to assess sexual self-concept in equivalent samples.