The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors

The pandemic and social experience: For whom did discrimination and social isolation increase?

OBJECTIVE

The objective of this study was to examine whether experiences of discrimination have increased during the pandemic, particularly among negatively stigmatized racial/ethnic groups, and whether such experiences have exacerbated feelings of social isolation.

METHOD

Discrimination and social isolation were assessed before and during the pandemic in a sample of 263 Black and White young adults attending a large, predominantly White 4-year research university in the Southeastern region of the United States (52% Black, 48% White, 53% female, mean age = 19.2).

RESULTS

Increases in discrimination were evident among Black but not White participants. Black participants also reported greater increases in social isolation than White participants, and changes in discrimination partially mediated the emergent racial disparity in social isolation.

CONCLUSIONS

Findings are consistent with theoretical perspectives on discrimination during times of stress and suggest the need for broader attention to the impact of the pandemic on unfair treatment of stigmatized groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors Associated with Planned Future Use of PrEP in the Next 3 Months and Likelihood to Use PrEP Among Black Cisgender HIV-negative Women in Texas

Identifying and then addressing barriers and leveraging facilitators is important to help increase pre-exposure prophylaxis (PrEP) use among Black women vulnerable to HIV acquisition. The present cross-sectional study examined what factors were associated with future plans to use PrEP, and general likelihood to use it among a convenience sample of 152 adult, Black cisgender women from three metropolitan areas in Texas. The final multivariable logistic regression model revealed that relationship status (aOR = 0.20, 95% CI: 0.05-0.73, p < 0.05), PrEP anticipated stigma (aOR = 0.29, 95% CI: 0.10-0.78, p < 0.05), perceived discrimination (aOR = 0.40, 95% CI: 0.21-0.78, p < 0.01) and interest in learning more about PrEP (aOR = 5.32, 95% CI: 2.60-10.9, p < 0.001) were associated with future plans to use PrEP. The final multivariable linear regression model with maximum likelihood estimation identified that perceived discrimination (β=-0.24, SE: -0.38 - -0.10, p < 0.01), perceived HIV risk (β = 0.33, SE: 0.18-0.49, p < 0.001), willingness to use PrEP with condoms (β = 1.26, SE: 0.94-1.60, p < 0.001), and comfort communicating about PrEP with a provider (β = 0.23, SE: 0.06-0.41, p < 0.01) were associated with general likelihood to use PrEP. Findings reveal key factors that warrant further attention and examination toward improving PrEP use within this population.

Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles

BACKGROUND

Preliminary evidence indicates that acute and chronic psychological stress affect sexual arousal and satisfaction. African American women, in particular, are vulnerable to the impacts of gender- and race-related stress, given their socially constructed identities as African Americans and as women.

AIM

We examined associations between minority stress and sexual function using data from 248 African American women.

METHODS

Surveys were conducted with 248 African American women in South LA with male partners at risk for acquiring HIV. We analyzed self-reports on (i) stress indicators: chronic burden, perceived racism/sexism, and histories of trauma/sexual abuse; (ii) Female Sexual Function Index domains: desire, arousal, and satisfaction; and (iii) potential moderators: social support and spirituality. We used multiple regression, adjusting for potential confounding factors, to examine the relationships between stress indictors, potential moderators, and sexual function domains.

OUTCOMES

The outcomes were the female sexual function index domains of desire, arousal, and satisfaction.

RESULTS

This largely low-income sample experienced significant chronic and acute stressors, was highly spiritual and reported strong social support. Moderate-high chronic burden and increasing sexism scores were independently associated with decreased arousal (B = -0.38, 95%CI = -0.75, -0.02) and satisfaction (B = -0.03, 95%CI = -0.06, 0.00) scores, respectively.

CLINICAL IMPLICATIONS

Providers may want to explore chronic burden in patients who complain about low sexual arousal. Additionally, to develop effective HIV- and other STI-related interventions that impact behaviors that can confer sexual risk, prevention strategies are needed that either reduce contextual stressors or mitigate their impact.

STRENGTHS

Strengths of this research are that it focuses on sexual function among previously under-studied, low-income African American women and that it takes into account the unique set of stressors faced by these women.

LIMITATIONS

A limitation is that the sample size may have been too small to capture the effects of potential moderators.

CONCLUSIONS

Low-income African American women accumulate life stressors that may harm sexual function. Schrode K, Poareo E, Li M, et al. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022;19:603-612.

“I do the she and her”: A qualitative exploration of HIV care providers’ considerations of trans women in gender-specific HIV care

Objectives:

Women of all genders, including cisgender (cis) and transgender (trans) women, experience social and structural drivers of HIV inequities and pervasive barriers to HIV care. Yet, little is known about how HIV care providers address gender diversity in health care. Through a critical feminist lens informed by intersectionality theory, medical anthropology, and critical sociology, we explored (1) how do HIV care providers describe women living with HIV’s care needs and barriers; (2) what are their perspectives on optimal HIV care for women; and (3) to what extent do these conceptualizations include/exclude trans women.

Methods:

Utilizing a community-based exploratory qualitative study design, we conducted 60–90 minute semi-structured individual interviews from March 2019–April 2020 with eight HIV care providers (n = 4 social service providers; n = 4 physicians) practicing across seven counties representative of rural, suburban, and urban Michigan, United States. Data were analyzed utilizing a reflexive thematic approach.

Results:

Three overarching themes emerged: (1) Emphasis on (different) clinical needs: key considerations in cis and trans women’s HIV care; (2) Recognition of the structural: barriers to HIV care affecting women of all genders; and (3) Proposed solutions: piecing together individual, social, and organizational interventions to increase access to HIV care that may benefit women living with HIV of all genders but are disproportionately framed as being for cis women. While HIV care providers recognized both cis and trans women living with HIV’s clinical care needs and structural barriers to care, they rarely envisioned optimal HIV care inclusive of gender affirmation and structural interventions.

Conclusions:

Findings suggest that HIV care providers can avoid reducing gender to biology and making assumptions about reproductive care needs, endocrinological care needs, caregiving responsibilities, and other life circumstances; provide gender-affirming medical care; and address structural barriers to HIV care to enhance intersectional and structurally focused gender-affirming—that is, trans-inclusive—women-centered HIV care.

The Role of Objectification in College Women's Substance Misuse and Sexual Risk

Sexism and objectification present major challenges for mental and physical health among women. Scholars have called for research to identify mechanisms that underlie these associations as well as to delineate factors to target in prevention and intervention efforts. This study aimed to build on central tenets of objectification theory through its examination of sexist experiences in relation to body surveillance, body shame, depressive symptoms, and the health risk behaviors of substance use (i.e., alcohol and drug misuse) and sexual risk (i.e., condom use and number of sexual partners) among a large sample of college student women. We also examined whether body surveillance, body shame, and depressive symptoms would mediate theorized pathways extended to substance use and sexual risk. A sample of 505 full-time college student women ages 18-26 completed an online survey that assessed their health and behaviors. We used structural equation modeling to test mediation hypotheses. Results largely supported hypotheses, extended objectification theory to sexual risk, and expanded upon past research on objectification in relation to substance use. Notably, results of this study provided a more nuanced knowledge of how objectification may lead to increases in sexual risk when assessed by number of sexual partners (but not condom use). Further research is warranted to understand potential explanatory pathways between sexism, objectification, and sexual risk. Findings can inform prevention and intervention efforts to target body surveillance, body shame, and depressive symptoms to attempt to reduce the burden of sexist experiences on women's health.

Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services

BACKGROUND

Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice.

SETTING

We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties.

METHOD

Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her.

RESULTS

We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors.

CONCLUSIONS

Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.

Examining the association between sexism, self-objectification, empowerment, and alcohol-related problems: Pathways through drinking to cope

While research suggests that sexism is associated with college women's hazardous alcohol use, few studies have investigated the psychological factors that underlie the association between sexism and alcohol-related problems. Thus, the purpose of the present study was to examine the direct and indirect effect of gender-relevant sociocultural factors, including sexism, self-objectification, and empowerment, on college women's alcohol-related problems through drinking to cope. 450 women attending a large public university completed a cross-sectional survey that assessed these gender-relevant sociocultural factors and alcohol-related outcomes. Controlling for Greek membership, perceived drinking norms, and alcohol use, sexism and empowerment were both directly associated with alcohol-related problems, while sexism, self-objectification, and empowerment were indirectly associated with alcohol-related problems through the mechanism of drinking to cope. The results of this study highlight the importance of taking into account gender-relevant risk factors for women's alcohol-related problems, as well as the role of psychological processes such as drinking to cope. Pathways for intervention on both individual and systemic levels are discussed.

The target/perpetrator brief-implicit association test (B-IAT): an implicit instrument for efficiently measuring discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age

BACKGROUND

To date, research assessing discrimination has employed primarily explicit measures (i.e., self-reports), which can be subject to intentional and social desirability processes. Only a few studies, focusing on sex and race/ethnicity discrimination, have relied on implicit measures (i.e., Implicit Association Test, IAT), which permit assessing mental representations that are outside of conscious control. This study aims to advance measurement of discrimination by extending the application of implicit measures to multiple types of discrimination and optimizing the time required for the administration of these instruments.

METHODS

Between September 27th 2019 and February 9th 2020, we conducted six experiments (984 participants) to assess implicit and explicit discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age. Implicit discrimination was measured by using the Brief-Implicit Association Test (B-IAT), a new validated version of the IAT developed to shorten the time needed (from ≈15 to ≈2 min) to assess implicit mental representations, while explicit discrimination was assessed using self-reported items.

RESULTS

Among participants (mean age = 37.8), 68.6% were White Non-Hispanic; 69% were females; 76.1% were heterosexual; 90.7% were gender conforming; 52.8% were medium weight; and 41.5% had an advanced level of education. Overall, we found implicit and explicit recognition of discrimination towards all the target groups (stronger for members of the target than dominant groups). Some exceptions emerged in experiments investigating race/ethnicity and weight discrimination. In the racism experiment, only people of Color showed an implicit recognition of discrimination towards the target group, while White people were neutral. In the fatphobia experiment, participants who were not heavy showed a slight implicit recognition of discrimination towards the dominant group, while heavy participants were neutral.

CONCLUSIONS

This study provides evidence that the B-IAT is a valuable tool for quickly assessing multiple types of implicit discrimination. It shows also that implicit and explicit measures can display diverging results, thus indicating that research would benefit from the use of both these instruments. These results have important implications for the assessment of discrimination in health research as well as in social and psychological science.

Perceived Discrimination and Risk Behaviors in African American Students: the Potential Moderating Roles of Emotion Regulation and Ethnic Socialization

Prior research has identified perceived discrimination as being a contributing factor in health and mental health disparities. However, there is little research on the relationship between perceived discrimination and behaviors such as hazardous alcohol and illicit substance use and risky sexual behaviors that put people at risk for negative health consequences including HIV. The current research explores the role that cultural factors may play in a tendency for individuals to engage in unhealthy behaviors or an ability to avoid them. A total of 266 college students who self-identified as Black or African American were surveyed on measures of familial ethnic socialization, perceived discrimination, emotion regulation, substance use, and risky sexual behaviors. Findings indicate that perceived discrimination and emotion regulation-suppression were associated with higher levels of hazardous alcohol use, and that emotion regulation-cognitive reappraisal was associated with lower levels of illicit substance use. Implications for intervention and prevention in African American college students are discussed.

Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis

Racism. Sexism. Heterosexism. Gender binarism. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified "isms" and provide a measurement schema, informed by research from both the Global North and the Global South. Metrics discussed include (a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures; and (b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Recommendations include (a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures; (b) analyzing exposure in relation to both life course and historical generation; (c) developing measures of anti-isms; and (d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.

Externalizing Behaviors Exacerbate the Link between Discrimination and Adolescent Health Risk Behaviors

Discrimination based on race/ethnicity, sexual minority status, and gender is associated with higher rates of drinking, drug use and risky sexual behavior during adolescence. The current study explored variation in the link between these three types of discrimination and health risk behaviors by focusing on how this association differed according to externalizing problem behavior status. Participants in the Study of Early Child Care and Youth Development were asked about discrimination and their drinking, drug use and risky sexual behavior (age 15; 50% female, 82% White, n = 939). The association between discrimination and health risk behaviors varied according to both externalizing problem status and the type of discrimination, suggesting that individual-level characteristics (i.e., externalizing behaviors) shape variation in the consequences of discrimination for adolescent health outcomes. Ultimately, these findings point to the need for future research to better understand which adolescents are the most vulnerable to the consequences of discrimination, and when these vulnerabilities are most likely to occur.

Sexism and sexual risk behavior in adolescents: Gender differences

Background/Objective: This study examines whether there are differences in the maintenance of ambivalent sexist beliefs on the basis of gender and sexual experience in adolescents. The study also investigates whether the sexist beliefs themselves are linked to sexual risk behaviors. Method: A representative sample of 2,703 Spanish adolescents was carried out in public and private secondary schools, with an age range of 14 to 20 years old (M = 15.89; SD = 1.29). Results: Males maintain more hostile, benevolent and ambivalent sexist beliefs compared to females. Sexual experience (both coital and non-coital) is linked to a greater degree of hostile and benevolent sexist beliefs, but only within the male group. In males, greater benevolent sexism is linked to vaginal sex initiation at an earlier age, while greater hostile sexism is linked to a lower proportion of condom use. In females, greater hostile sexism is linked to a greater number of sex partners. Conclusions: It is necessary to include specific actions on sexist beliefs in programs for the prevention of sexually transmitted infections and HIV.

The impact of environmental, parental and child factors on health-related behaviors among low-income children

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S.

SAMPLE

This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (β: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (β: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (β: -0.19, 95% CI: -0.29; -0.10). More parental covert control (β: 0.44, 95% CI: 0.35; 0.54), more parental overt control (β: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (β: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Reverberations of Racism and Sexism Through the Subjective Sexualities of Undergraduate Women of Color

Young women of color (among others) face both subtle and overt discrimination on a regular basis, but few studies have examined relations between discrimination and sexual outcomes using quantitative tools. We surveyed 154 self-identified undergraduate women of color to examine connections between race- and sex-based discrimination and subjective sexual well-being (i.e., condom use self-efficacy and sexual life satisfaction) and also tested whether sexual autonomy mediated these relations. When examined individually, each form of discrimination was related negatively to condom use self-efficacy and sexual life satisfaction, such that as women reported more discrimination, they reported poorer sexual well-being. However, when examining both racism and sexism as joint predictors, only racism remained significant and there were no racism × sexism interaction effects. In a path model, sexual autonomy mediated the relation between racism and each measure of subjective sexual well-being; racism was negatively related to sexual autonomy, which in turn was positively related to both condom use self-efficacy and sexual life satisfaction. These findings are consistent with the broader literature on the negative impact of discrimination on various aspects of mental and physical health. They also reinforce the position that redressing social inequality is a vital component of promoting individual health.

Everyday exposure to benevolent sexism and condom use among college women

Understanding factors related to condom use is critical in reducing the spread of sexually transmitted infections (STIs), especially for women, who are disproportionately affected by many STIs. Extant work has shown that perceived sexism is one such factor associated with lower levels of condom use among women, but has yet to explore whether benevolent sexism in particular-a subtle form of sexism that often goes unnoticed and increases cognitions and behaviors consistent with traditional female gender roles (e.g., sexual submissiveness)-relates negatively to this safer-sex practice. The present research tested this possibility and, in addition, examined whether relational sex motives, which reflect a desire to engage in sex as a means to foster partners' sexual satisfaction, mediated the relation between benevolent sexism and condom use. During the spring of 2011, female college students (N = 158) reported how often they experienced benevolent sexism in their daily lives and, 2 weeks later, their relational sex motives and condom use. Supporting hypotheses results indicated that greater exposure to benevolent sexism was associated significantly with lower condom use, and that relational sex motives mediated this relationship. We discuss implications for women's well-being, including ways to promote safer sex in the face of sexism.

Self-reported sexually transmitted infections and sexual risk behaviors in the U.S. Military: how sex influences risk

BACKGROUND

Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes.

METHODS

We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members.

RESULTS

There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners).

CONCLUSIONS

Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.

A multilevel understanding of HIV/AIDS disease burden among African American women

Disproportionate HIV/AIDS rates among African American women have been examined extensively, primarily from an individual-centered focus. Beyond individual behaviors, factors such as the hyperincarceration of African American men and geographically concentrated disadvantage may better explain inequitable disease burden. In this article I propose a conceptual model of individual, social, and structural factors that influence HIV transmission among African American women. The model can be used to develop comprehensive assessments and guide prevention programs in African American communities.

Transitions in latent classes of sexual risk behavior among young injection drug users following HIV prevention intervention

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.

Feminist With Benefits

Perceived sexism has been linked to poorer sexual health among women. However, research has yet to examine whether protective factors, specifically liberal feminist beliefs (i.e., support for women’s empowerment and equity), moderate the relation between perceived sexism and precursors to risky sexual behavior. The present studies tested this possibility. In Study 1, 161 female undergraduates reported their liberal feminist beliefs, perceived sexism, and sexual self-efficacy. For women with weaker feminist beliefs, perceived sexism was related to lower sexual self-efficacy. For women with stronger feminist beliefs, perceived sexism was uncorrelated with sexual self-efficacy. In Study 2, 85 women with weaker or stronger liberal feminist beliefs were exposed to either hostile or benevolent sexism and subsequently reported their expectations to initiate condom use during sex. Participants with strong feminist beliefs reported greater anticipated condom use than those with weak feminist beliefs, but only in the hostile sexism condition; in the benevolent sexism condition, women with strong feminist beliefs reported condom use intentions that were similar to those reported by women with weak feminist beliefs. Results suggest women’s attitudes and social environment work together to shape sexual well-being and that liberal feminist beliefs may be a powerful tool women can employ to combat hostile, but not benevolent, sexism.