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

The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and, therefore, may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women’s sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001–2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and, in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention.     

Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV

Abstract

It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners’ HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants’ experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support.     

Poverty-related stressors and HIV/AIDS transmission risks in two South African communities

Community stress associated with poverty is related to health risks and poor health outcomes. Perceived community stress is specifically related to HIV transmission risk behaviors in the United States, but research bas not examined these relationships in southern Africa, the region of the world with the highest rates of HIV infection and among the greatest poverty. Men (N=464) and women (N=531) living in impoverished adjacent communities distinguished by race (e.g., indigenous African and Coloured) completed anonymous surveys of perceptions of 10 poverty-related community stressors and measures of HIV risk-related behaviors. Indigenous African and Coloured communities differed in their perceptions of stressors, with Africans consistently viewing the 10 community stressors as more serious problems. In addition, perceived seriousness of lacking basic living resources was related to higher risk for HIV among Africans. Perceived community stress was also related to alcohol and drug use, but substance use did not mediate the association between perceived community stress and HIV risks. In the Coloured community, perceived community stressors were related to drug use, but percived community stressors were not associated with HIV risks. These findings extend the findings of previous research to show that povertyrelated stressors are associated with HIV transmission risks in some poverty-stricken communities and that these associations are not mediated by substance use.     

Sexual power and HIV risk, South Africa

Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women's power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman's experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17-3.78), and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently (95% CI 1.86-17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10-2.27).     

Associations Between Neighborhood Characteristics,Social Cohesion,and Perceived Sex Partner Risk and Non-Monogamy Among HIV-Seropositive and HIV-Seronegative Women in the Southern U.S.

Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women’s Interagency HIV Study’s sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women’s HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06–1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51–0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69–1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics.     

Sexual culture in low-income older adult housing: norms,behaviours and risks

Abstract

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings.     

What Girls Won't Do for Love: Human Immunodeficiency Virus/Sexually Transmitted Infections Risk Among Young African-American Women Driven by a Relationship Imperative

PurposeRates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors.MethodsParticipants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing.ResultsMultivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive.ConclusionThese results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk.     

'If I buy the Kellogg's then he should [buy] the milk': young women's perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa

Ideals of masculinity and femininity may limit South African women's decision making power in relationships and increase their risk of HIV infection. We conducted 30 in-depth interviews with 18-24-year-old women in inner-city Johannesburg with the aim of understanding young women's expectations of intimate relationships with men, their perceptions of gender and power and how this influences HIV risk. We found that the majority of young women reported expectations of power in relationships that conform to a model of femininity marked by financial independence, freedom to make decisions, including over sexuality, and equality (resistant femininity). The majority of young women, however, were in relationships marked by intimate partner violence, infidelity or lack of condom use. In spite of this, more young women who subscribed to a resistant model of femininity were in less risky relationships than young women who subscribed to acquiescent models, in which power was vested in their male partners. Further, young women who subscribed to resistant femininity had more education than women who subscribed to an acquiescent model. The disconnect between expectations of relationships and young women's lived realities emphasises the need for structural changes that afford women greater economic and thus decision making power.     

Alcohol misuse,depressive symptoms,and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study’s objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR?=?2.15) and better HIV/STI knowledge (β?=??.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR?=?1.76) and worse HIV/STI knowledge (β?=?.37).

Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women’s health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.     

The Influence of Relationship Power and Partner Communication on the Syndemic Factor among Hispanic Women

BackgroundThis study expands research on the substance abuse, intimate partner violence, human immunodeficiency virus (HIV), and depression syndemic theory for Hispanic women. We hypothesized relationship power and partner communication would be related to the syndemic.MethodsData were used from the baseline assessment of an effectiveness trial of SEPA (Salud/Health, Educación/Education, Prevención/Prevention, and Autocuidado/Self-care), an HIV/sexually transmitted infection risk reduction program for Hispanic women. Hispanic adult women (n = 320) completed measures (in Spanish or English) of relationship power, partner communication about HIV, and acculturation. The syndemic was defined with a factor model of substance abuse, intimate partner violence, risk for HIV/sexually transmitted infection, and depression using structural equation modeling.ResultsControlling for acculturation and education, relationship power was inversely related to the syndemic factor (β = −0.49, p < .001), but partner communication was not (β = 0.14, p = .054). Acculturation and education were also related to the syndemic factor. These variables combined accounted for more than one-half (53%) of the variance in the syndemic factor.ConclusionsFindings suggest the need to develop and test interventions that address the power dynamics of intimate relationships as a means of reducing health disparities among Hispanic women.     

‘If I buy the Kellogg's then he should [buy] the milk’: young women's perspectives on relationship dynamics,gender power and HIV risk in Johannesburg,South Africa

Ideals of masculinity and femininity may limit South African women's decision making power in relationships and increase their risk of HIV infection. We conducted 30 in-depth interviews with 18–24-year-old women in inner-city Johannesburg with the aim of understanding young women's expectations of intimate relationships with men, their perceptions of gender and power and how this influences HIV risk. We found that the majority of young women reported expectations of power in relationships that conform to a model of femininity marked by financial independence, freedom to make decisions, including over sexuality, and equality (resistant femininity). The majority of young women, however, were in relationships marked by intimate partner violence, infidelity or lack of condom use. In spite of this, more young women who subscribed to a resistant model of femininity were in less risky relationships than young women who subscribed to acquiescent models, in which power was vested in their male partners. Further, young women who subscribed to resistant femininity had more education than women who subscribed to an acquiescent model. The disconnect between expectations of relationships and young women's lived realities emphasises the need for structural changes that afford women greater economic and thus decision making power.     

Parental investment, club membership, and youth sexual risk behavior in Cape Town.

This study examines whether parental investment and membership in social clubs are associated with safer sexual behaviors among South African youth. Participants comprised 4,800 randomly selected adolescents age 14 to 22 living in the Cape Town area in 2002. Logistic regression was used to examine associations between measures of parental investment and associational membership with reported condom use at first and most recent sexual intercourse, net of effects of HIV knowledge, age, education, population group, parental co-residence, and household income. Interaction terms were used to examine gender differences in associations between risk behavior and parental investment and between risk behavior and group membership. Participation in clubs and community groups is associated with safer behaviors. A mother's financial support (for clothing, school fees and uniforms, and pocket money) is negatively associated with condom use, particularly among young women, suggesting that material need impels vulnerability to higher risk behaviors. Social resources in households and communities mediate HIV risk behaviors among youth in Cape Town.     

Exploring the Relationships Among Food Insecurity,Alcohol Use,and Sexual Risk Taking Among Men and Women Living in South African Townships

South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol’s role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (n = 1,137) and women (n = 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women’s alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.     

Incarcerated women’s relationship-based strategies to avoid drug use after community re-entry

ABSTRACT

While recent research has stressed the supportive role that family and friends play for incarcerated persons as they re-enter the community, drug-using incarcerated women re-entering the community often have to rely on family, community, and intimate relationships that have played a role in their substance abuse and criminalization. In this study the authors conducted qualitative analysis of clinical sessions with rural, drug-using women (N = 20) in a larger prison-based HIV risk reduction intervention in Kentucky during 2012–2014 to examine incarcerated women’s perceptions of the role of their family, community, and intimate relationships in their plans to decrease their substance abuse upon community re-entry. Women stressed the obstacles to receiving support in many of their family and drug-using relationships after community re-entry. Nonetheless, they asserted that changes in their relationships could support their desires to end their substance abuse by setting limits on and using their positive relationships, particularly with their children, to motivate them to change. Interventions to promote incarcerated women’s health behavior changes—including substance abuse—must acknowledge the complex social environments in which they live.     

Psychosocial Problems and Coping Patterns of HIV Seropositive Wives of Men with HIV/AIDS

Abstract

The sociocultural milieu provides HIV positive women with fewer resources and more role responsibilities. The present research aimed at studying the psychosocial problems encountered in living, post HIV infection, and the coping patterns adopted by HIV seropositive wives of men with HIV/AIDS. In the background of an exploratory research design, thirty (n = 30) HIV positive women, attending Counseling Clinics in Bangalore (South India), selected through purposive sampling, were assessed using an interview schedule and a standardized coping scale. Majority of the respondents were the primary caregivers for their infected spouse and/or children. Content analysis of the problems revealed increased financial difficulties; problems in child care and support; compromised help-seeking due to stigma; problems in sexual interactions and communication in their marital relationship; role strain in caregiving; gender discriminatory and inadequate care; and increased concerns about parenting efficacy, post HIV infection. Escape avoidance was the most preferred coping strategy adopted by them. Situating the illness in a socio-familial context is indicated, and implications for social work and mental health practice follow from the findings.     

Locus of control and HIV risk among a sample of Mexican and Puerto Rican women

The disproportionate impact of HIV/AIDS on Hispanic women in the United States has been variously attributed to a failure to utilize protective measures due to low levels of HIV knowledge, a denial or minimization of risk, and conflicts with cultural norms. It has been hypothesized that women's relative lack of power in relationships may be associated with higher risk sexual behavior. We examined the relationship between higher risk sexual behavior and perceived locus of control in sexual relationships among a sample of Puerto Rican and Mexican women. We interviewed 71 women of self-reported Mexican ethnicity in San Diego, California, and 79 women of self-reported Puerto Rican ethnicity in Cleveland, Ohio, to examine the relationship between HIV risk, HIV knowledge, and locus of control. Univariate logistic regression indicates that among Puerto Rican women, the perception that locus of control in a sexual relationship resides in the male partner was significantly associated with increased HIV risk, while younger age was significantly associated with increased risk among Mexican women only. In a combined sample of both Puerto Rican and Mexican women, multiple logistic regression analysis indicates that younger age, increased length of residence in the United States, and an other-focused locus of control are significantly associated with increased HIV risk. Women who have been in the United States for relatively longer periods of time may be more likely to integrate U.S. sexual norms into their own behavior and may, as a consequence, be at higher risk of HIV infection. Increased HIV prevention efforts must be made available to Mexican and Puerto Rican women born outside of the United States. These prevention efforts must necessarily focus not only on HIV prevention strategies, but also on the dynamics within male-female intimate relations. Increased attention to younger Puerto Rican and Mexican women is also needed.     

Protective Parenting,Relationship Power Equity,and Condom Use Among Rural African American Emerging Adult Women

Sexually transmitted infections disproportionately affect African Americans, particularly young women. The influence of a set of interrelated protective parenting processes—instrumental and emotional support, sexual risk communication, and encouragement of goals for employment or education—on emerging adult women was examined. Parenting was hypothesized to affect consistent condom use through its association with women's reports of power equity in their intimate relationships. Hypotheses were tested with 135 sexually active women 18 to 21 years of age living in rural southern communities. Structural equation modeling indicated that (a) parenting processes predicted women's self‐reported relationship power equity and consistent condom use and (b) relationship power equity predicted consistent condom use. Limited support emerged for a mediational role of relationship power equity in explaining the influence of parenting on consistent condom use. Parental involvement and young women's establishment of personal control in their intimate relationships are important goals for sexual risk reduction programs.     

A Comparison of the Occurrence and Perceived Stress of Major Life Events in Black and White Women

Purpose: To describe the occurrence and perceived stress of major life events, and to investigate whether adjusting for socioeconomic status reduced race/ethnicity differences.

Methods: Black (n = 639) and white (n = 419) women aged 35–49 years responded to 14 major life event questions within the domains of employment, health, relationship, finance, residential change, and crime.

Main Findings: The total number of life events did not differ by race/ethnicity, but black women reported significantly more events in the domains of relationship, financial, and residential change than white women. White women generally reported higher stress for a given event than black women, although for “residential change” black women reported more severe stress than the white women.

Conclusions: Inclusion of both the occurrence and perceived stress of major life events can improve our understanding of how this stressor may affect health.     

Gender,power and intimate relationships over the life course among Ethiopian female peer educators living with HIV

Historically, Ethiopian women have faced numerous challenges to gender equity at the individual, relational and community levels; such inequalities can lead to increased risk of HIV acquisition. Over the past two decades, some progress has been made towards changing policies and norms to reduce gender inequality. We sought to understand the ways in which marriage and other romantic/sexual relationships of a group of Ethiopian women living with HIV had been impacted by gender norms, relational power dynamics and HIV status over the life course. We conducted in-depth interviews with 19 women living with HIV who were working as peer educators at a large clinic in Addis Ababa, Ethiopia. Reflecting on their early lives, participants often described traumatic prior relationships characterised by rape, forced marriage and HIV nondisclosure. In the aftermath of being diagnosed with HIV, participants’ more recent relationships embodied a more egalitarian dynamic characterised by mutual support for HIV care engagement and open communication. Participants’ narratives illustrate encouraging examples of ways in which HIV-positive women can form and maintain equitable and satisfying personal relationships even in the context of obstacles at multiple levels.     

Milking the cow: Young women's construction of identity and risk in age-disparate transactional sexual relationships in Maputo,Mozambique

Abstract

Sexual relationships between young women and older men involving economic transactions have been offered as a likely explanation for gender differences in HIV prevalence in many parts of sub-Saharan Africa. This study employed peer ethnography to explore young women's construction of social identity and risk within age-disparate transactional sexual relationships in Maputo, Mozambique. Peer ethnography, a rapid approach derived from the anthropological method and based upon training members of the target group to carry out in-depth qualitative interviews with their peers, was adopted in order to gather ethnographic data within a short timeframe to produce actionable results for the design of a communications intervention. The study highlights young women's perception of agency and power in these relationships. Through a strategy of extracting financial and material resources from men based on the power of their sexuality, young women construct a positive identity and esteem linked to perceptions of modernity and consumption and their ability to access consumer goods. Current behaviour change HIV prevention messages have little meaning in relation to young women's perceived goals, in a context in which structural conditions offer few opportunities and limited hope for a secure economic future.