Perceived relationship power, relationship characteristics and sexual risk taking among adult black women. Open Access

Oakley, Lisa Paige (2015)

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HIV/AIDS rates continue to be substantially higher among Blacks than among Hispanics or Whites. Additionally, women are at a higher risk of HIV infection than are men. Black women carry a "double jeopardy" when it comes to HIV as they are at increased risk because of both race and gender. Gender-based power, relationship dynamics, and relationship context are important social factors in women's sexual health choices and safer sex negotiations and, yet, there is a lack of understanding of power dynamics among midlife and older adults and the impact these relationships have on women, especially black women. A mixed-methods study was undertaken to examine the association of age with sexual health, including psychosocial risk factors, relationship characteristics, relationship-specific behaviors, and personal and relationship power dynamics among black women, to inform interventions that can be targeted for black women across adulthood, but more specifically, for black women entering middle age (35-55 years old) and later life. Main themes from this dissertation include midlife black women's relationship empowerment built through personal power and life experiences, women's high sexual self-efficacy for sexual communication and condom use, and women's reported low condom use with main or primary partners. Findings emphasize the need to explore characteristics (such as concurrency, peer norms, future orientation, and self-efficacy) among midlife women that have been mostly investigated among younger (adolescent and young adult) populations to better understand and intervene on beliefs and behaviors that are putting midlife women at an increased risk for HIV and STIs. Additionally, findings serve to inform efforts to increase personal and relationship power as well as self-efficacy through programs and intervention research for preventive behaviors in an attempt to reduce the rates of new HIV and STI infections among midlife black women.

Table of Contents

Chapter 1. Literature Review. 1

Epidemiology of HIV. 2

Reasons for Increased Risk. 6

Relationship Power. 13

Other Important Psychosocial Predictors. 19

Conceptual Frameworks. 20

Gaps and Limitations in the Current Research. 25

Aims of the Research. 26

References. 28

Chapter 2. The effect of age on psychosocial characteristics and risky sexual behaviors among black women. 42

Abstract. 42

Introduction. 45

Method. 52

Results. 57

Discussion. 62

References. 70

Chapter 3. Differences in sexual risk behavior and condom use among adult, black women in concurrent partnerships. 86

Abstract. 86

Introduction. 88

Method. 92

Results. 94

Discussion. 100

References. 108

Chapter 4. Associations of unmarried midlife black women's gender relationships and power dynamics with sexual health choices: A focus group study. 117

Abstract. 117

Introduction. 119

Method. 121

Findings. 123

Discussion. 134

Limitations and Strengths. 138

Conclusion. 139

References. 140

Chapter 5. Summary and Conclusion. 146

Evaluation of the Dissertation Research. 152

Implications for Research and Practice. 154

Conclusion. 158

References. 159

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