Relationship Power, Acculturation, and Sexual Risk Behavior Among Low-Income Latinas of Mexican or Puerto Rican Ethnicity

Alcohol intoxication and sexual risk intentions: Exploring cultural factors among heavy drinking women

INTRODUCTION

Sexually Transmitted Infections (STI) rates are the highest of the last 20 years, with people of color and women particularly affected. Ongoing research has identified risk factors (e.g., alcohol intoxication) and protective factors (e.g., risk perception) for sexual risk behaviors, such as inconsistent condom use. Depending on behavioral norms within a group, ethnic identity (EI) - the exploration and sense of belonging to one's ethnicity - may be a risk or protective factor. This study examined the relations between EI, alcohol intoxication, and STI risk perception on sexual risk intentions among women of color (WOC) and white women (WW).

METHODS

Cisgender women (N = 390; 35% WOC; 65% WW) completed measures and were randomly assigned to an alcohol condition (0.10% BrAC vs control). They projected themselves into an eroticized scenario and self-reported two aspects of STI risk perception (personal, partner) and two sexual risk behaviors (condomless sex intentions, condom decision abdication intentions).

RESULTS

Path analysis indicated that intoxicated women endorsed higher sexual risk intentions compared to women in the control group. Personal STI risk perception was negatively associated with sexual risk intentions. Indirect effects indicated that race was indirectly associated with both indicators of sexual risk, such that WOC reported higher perceived personal STI risk and subsequently endorsed lower sexual risk intentions compared to WW. Surprisingly, EI was associated with higher perceived partner risk for WW only.

CONCLUSIONS

Prevention initiatives that address STI risk perception, condom assertion behaviors, and alcohol may be effective for mitigating women's sexual risk behaviors.

Social Support, Relationship Power, and Knowledge of HIV+ Serostatus in Sexual Risk Behavior Among Women in Psychiatric Treatment

This study examined social support, perceived relationship power, and knowledge of HIV+ serostatus in relation to frequency of unprotected sex acts and number of partners among women with comorbid psychiatric illness receiving treatment. Data were drawn from an initial assessment of participants enrolled in an HIV risk reduction intervention (N = 284), and two generalized linear models were used to examine the potential associations. Relationship power was significantly associated with fewer unprotected sex acts. This relationship was stronger among those with greater social support. Knowledge of HIV+ serostatus was linked with fewer sexual partners and less unprotected sex. Findings also revealed that the protective nature of support varies by level of perceived relationship power, with higher power indicative of a stronger protective relationship. Study findings suggest that the potential protective benefits of social support may depend on one's perceived relationship power. Implications for HIV prevention intervention for this at-risk group are discussed.

Trauma, Power, and Intimate Relationships Among Women in Prison

The present study, which included four focus groups of women (n = 21) in four New England prisons, aimed to understand how power impacted women's relationships, exposure to violence, and health. Women described power in three ways: (a) power as control over their sexuality and their sexual partners, (b) power emerging from emotional strength, and (c) power referring to a process of empowerment. Women's perceptions and experiences of power were informed by their trauma histories and influenced their sexual behavior and health. Our findings provide a framework for considering incarcerated women's experiences of power in trauma-informed interventions for this marginalized population.

Associations of Self-Silencing and Egalitarian Attitudes with HIV Prevention Behaviors Among Latina Immigrant Farmworkers

Latinas in farmworker communities are at particularly higher risk for human immunodeficiency virus (HIV) due to the vulnerable circumstances they experience. However, little is known about the factors influencing HIV prevention behaviors in this population. The aim of this study was to examine the associations of self-silencing behaviors and egalitarian attitudes toward women in relation to three HIV prevention behaviors: self-efficacy for HIV prevention, intentions to negotiate safe sex, and HIV-related knowledge. This study is a cross-sectional analysis that used hierarchical multiple regression models to examine these previously mentioned associations, among Latina immigrant farmworkers from Miami-Dade County, Florida (n = 232). Findings indicated that self-silencing behaviors were adversely associated with the three HIV preventive behaviors whereas egalitarian attitudes were positively associated. Findings from this study may help to advance the understanding of sociocultural determinants of HIV prevention behaviors among Latina immigrants.

Self-Silencing, but Not Sexual Relationship Power Associated with Condom Use for Black College-Aged Women

Black adolescent and young adult women in the United States experience a disproportionately higher rate of HIV infections than White and Hispanic adolescent and young adult women. Heterosexual sexual activity is the main route of infection for women, regardless of race or ethnicity. We examined two potential barriers to reducing Black adolescent and young adult women's HIV risk: high levels of self-silencing and low levels of sexual relationship power. Data were collected on a small convenience sample of sexually active Black college-aged women (N = 57, Mage = 19.6, SD = 1.4) who answered questions about their current or most recent dating relationship. We found that higher levels of self-silencing were significantly related to lower condom use frequency and to a lower likelihood of reporting condom use at last sex. No significant associations were found between sexual relationship power and condom use (frequency or at last sex). Data from this study suggest that self-silencing, which involves putting the needs of others ahead of one's own in order to avoid conflict in relationships, is an important variable to consider when examining potential risk factors for sexually transmitted HIV among Black college-aged women. Implications for future studies on HIV risk are reviewed.

Dependency Traits, Relationship Power, and Health Risks in Women Receiving Sexually-Transmitted Infection Clinic Services

In prior research, having traits consistent with a personality disorder has been shown to be related to substance use and high-risk sexual activity; however, few studies have examined relationships between dependency traits and health-jeopardizing behaviors. Individuals with traits consistent with dependent personality disorder may be more likely to be in a primary relationship characterized by unhealthy conditions, including physical abuse from a partner, low assertiveness in sexual situations, and partner infidelity. In addition, dependency traits may be associated with unhealthy coping (e.g., through substance use). To examine associations between dependent personality traits and these types of health-related behaviors, 198 women seeking sexually transmitted infection clinic services completed a computer-assisted assessment of dependent personality traits, substance use, unhealthy conditions in primary relationships, perceived sexual and relationship power, and sexual risk related to condom use. Dependency trait scores were correlated with the use of cocaine, heroin, and methamphetamine. Participants high in dependency traits reported low perceived power within their relationships and less say in sexual behaviors, including condom use. In a series of multivariate analyses, dependency traits significantly predicted having been hit by a partner, staying with a partner after he cheated, having sex because of threats, and fear of asking a partner to use a condom. Dependency traits were also associated with lower past condom use and lower future condom use intentions. Results suggest that dependent personality traits may place women at higher risk for physical abuse and harmful health behaviors.

Sociocultural Determinants of Risky Sexual Behaviors among Adult Latinas: A Longitudinal Study of a Community-Based Sample

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother-daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.

Gender, Generational Status, and Parent-Adolescent Sexual Communication: Implications for Latino/a Adolescent Sexual Behavior

There is little research on how specific parent-adolescent sexual communication topics influence Latino/a youth's sexual behaviors, and how gender and generational status may moderate effects. This study examined effects of three different messages on intercourse and condom use among 1944 Latino/as from the National Longitudinal Study of Adolescent Health (T1 mean age=15.46; sd=1.50). Results indicated discussing health consequences predicted higher odds of intercourse one year later across gender and generation groups. Birth control recommendation effects on subsequent intercourse and condom use differed by generational status and gender. Results indicated that message content is important for understanding effects of parent-adolescent sex communication on adolescents' behavior, and underscored the need to consider gender and generational status in Latino/a parent-adolescent sexual communication studies.

Relationship Power in the Context of Heterosexual Intimate Relationships: A Conceptual Development

Various theoretical frameworks have been utilized while examining the concept of relationship power. In addition, the conceptual definition and operational use are inconsistent throughout literature. A concept analysis was conducted on the basis of the guidelines provided by Walker and Avant. The proposed definition of relationship power is the relative, perceived, and actual ability to influence a relationship partner. Antecedents, attributes, and consequences are presented. Because of the various adverse outcomes related to relationship power (eg, intimate partner violence, depression), an understanding of this concept is essential. Furthermore, a clear understanding is needed to advance nursing knowledge, leading to future research and theory development.

Storytelling for Empowerment for Latino Teens

Latino adolescents are disproportionately impacted by HIV, but researchers have documented few programs to prevent and reduce HIV risk. The Storytelling for Empowerment (SFE) HIV StoryBook was designed with an innovative ecodevelopment approach combining empowerment, family communication, and positive cultural identity. A mixed method design used both a randomized control group design, as well as grounded theory coding of semi-structured focus group interviews. For the quantitative method, a total of 96 adolescents (85% Latino, M age = 12.2) were randomized to either the SFE HIV StoryBook condition or a control condition and then tested at baseline and at 4 months post-baseline. Study findings indicated that teens who participated in the HIV StoryBook condition maintained sexual abstinence, increased their ability to communicate about sex, increased their intention to stop sexual advances, and increased their HIV prevention knowledge. For the qualitative method, seven focus groups of 38 participants, including staff, madres, teen participants, and graduates created rich description. Axial coding produced emergent themes, including an appreciation for the culturally affirming curriculum, increased family communication, and the embodiment by teens resulting in restraint and integrity. Results indicate that SFE has promise to stem HIV infections.

Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos

Interviews were conducted with 480 sexually active Latino young adults from four rural counties in Oregon. We examined relationships between three levels of power (individual, interpersonal, and structural) and consistent condom use. Condom use self-efficacy and sexual decision-making, examples of individual and interpersonal measures of power, respectively, were associated with increased odds of consistent condom use among both men and women. Among men only, increasing relationship control, an interpersonal measure of power, was associated with lower odds of consistent condom use. Among women only, increasing medical mistrust, a structural measure of power, was associated with increased odds of consistent condom use.

Attachment and associated sexual health behaviors of heterosexual Mexican housewives

Sexually transmitted infections including human immunodeficiency virus are international public health concerns. Heterosexual women who are in steady relationships have been described as a particularly vulnerable population at risk for sexually transmitted infections acquired from their male partners. In this pilot study, we describe associations identified via cross-sectional survey among demographic variables, attachment style, and condom use in Mexican heterosexual women (ages 20-44 years, n  =  50) who self-reported current steady partner relationships. Descriptive, bivariate, and correlation analyses were conducted. Secure attachment and condom use were positively correlated with education level. Limited sexual risk prevention knowledge and contraception use, low risk perception within male partner relationships and misconception about proper condom use were identified as sources of elevated risk for sexually transmitted infections via male partners. Implications of findings include sexual health intervention modification to include dialogue concerning the context of steady relationship and sexual risk among Mexican heterosexual women.

A systematic review of the psychometric properties of the Sexual Relationship Power Scale in HIV/AIDS research

The Sexual Relationship Power Scale (SRPS) was developed over a decade ago to address the lack of reliable and valid measures of relationship power in social, behavioral and medical research. The SRPS and its two subscales (relationship control [RC], decision-making dominance [DMD]) have been used extensively in the field of HIV prevention and sexual risk behavior. We performed a systematic review of the psychometric properties of the SRPS and subscales as reported in the HIV/AIDS literature from 2000 to 2012. A total of 54 published articles were identified, which reported reliability or construct validity estimates of the scales. Description of the psychometric properties of the SRPS and subscales is reported according to study population, and several cross-population trends were identified. In general, the SRPS and RC subscale exhibited sound psychometric properties across multiple study populations and research settings. By contrast, the DMD subscale had relatively weak psychometric properties, especially when used with specific populations and research settings. Factors that influenced the psychometric properties of the various scales and subscales included the study population, mean age of the sample, number of items retained in the scale, and modifications to the original scales. We conclude with recommendations for (1) the application and use of the SRPS and subscales, (2) reporting of psychometric properties of the scales in the literature, and (3) areas for future research.

Acculturation and HIV-related sexual behaviours among international migrants: a systematic review and meta-analysis

This review examines the global literature regarding the relationship between acculturation and HIV-related sexual behaviours among international migrants. Seventy-nine articles published in English-language journals prior to July 2012 met the criteria for inclusion. We conducted a systematic review and subset meta-analysis of correlations between acculturation and five types of sexual behaviours including condom use, multiple partnerships, early sexual initiation, sexually transmitted diseases (STDs) and other unsafe sexual practices. Immigrants high in mainstream acculturation were more likely to have multiple partnerships, early sexual initiation, STDs and unsafe sex (rs ranged from 0.10 to 0.16), but acculturation was not associated with condom use (r = 0.02). Gender moderated the relationships between acculturation and multiple partnerships, STDs and unsafe sex. The relationship between acculturation and unsafe sex also varied across ethnicity. These findings suggest that acculturation may serve as a risk factor towards immigrants' HIV-related sexual health. We offered a theoretical framework and suggested applying cross-cultural and longitudinal designs in future research on acculturation and health behaviours.