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AIDS and Behavior

, Volume 22, Issue 6, pp 1944–1954 | Cite as

Assessing the Theory of Gender and Power: HIV Risk Among Heterosexual Minority Dyads

  • Deborah J. Rinehart
  • Alia A. Al-Tayyib
  • Catlainn Sionean
  • Nancy Rumbaugh Whitesell
  • Susan Dreisbach
  • Sheana Bull
Behavioral Surveillance

Abstract

This study drew on the Theory of Gender and Power (TGP) as a framework to assess power inequalities within heterosexual dyads and their effects on women. Structural equation modeling was used to better understand the relationship between structural and interpersonal power and HIV sexual risk within African American and Latina women’s heterosexual dyads. The main outcome variable was women’s sexual HIV risk in the dyad and was created using women’s reports of condomless sex with their main male partners and partners’ reports of their HIV risk behaviors. Theoretical associations developed a priori yielded a well-fitting model that explained almost a quarter of the variance in women’s sexual HIV risk in main partner dyads. Women’s and partner structural power were indirectly associated with women’s sexual HIV risk through substance use and interpersonal power. Interpersonal power was directly associated with risk. In addition, this study found that not identifying as heterosexual was directly and indirectly associated with women’s heterosexual sex risk. This study provides further support for the utility of the TGP and the relevance of gender-related power dynamics for HIV prevention among heterosexually-active women.

Keywords

Theory of gender and power HIV risk Sexually transmitted infections (STI) Structural equation modeling (SEM) 

Notes

Acknowledgements

The authors would like to acknowledge the support of the Denver, CO NHBS Partner Study site Principal Investigator Mark Thrun and data analyst Theresa Mickiewicz as well as the following NHBS Partner Study sites and researchers: Dallas, TX: Shane Sheu, Sharon Melville, Richard Yeager, Jim Dyer, Nandita Chaudhuri, Alicia Novoa; Detroit, MI: Renee McCoy, Vivian Griffin, Eve Mokotoff; Houston, TX: Marcia Wolverton, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Sey; Miami & Ft. Lauderdale, FL: Marlene LaLota, Lisa Metsch, David Forrest., Dano Beck, Stefanie White; New York City, NY: Alan Neaigus, Chris Murrill, Samuel Jenness, Holly Hagan, and Travis Wendel; San Francisco CA: H Fisher Raymond, Willi McFarland, Hong-Ha Truong; Seattle, WA: Maria Courogen, Hanne Thiede, Nadine Snyder, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dean Klinkenberg, LaBraunna Friend. The authors would also like to acknowledge the support of the Center for Disease Control and Prevention’s Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, NHBS team: Teresa Finlayson, Nevin Krishna and Binh Le.

Disclaimer

The findings and conclusions of this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Funding

This study was funded in part of the Centers for Disease Control and Prevention (Grant #U62-PS000954-02). Data collection was based on CDC study protocols as part of the National HIV Behavioral Surveillance System.

Compliance with Ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The current data analysis was approved under the Colorado Multiple Institutional Review Board (Protocol # 06-0517).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol. 26. http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2015.
  2. 2.
    Amaro H. Love, sex, and power. Am Psychol. 1995;50(6):437–47.CrossRefPubMedGoogle Scholar
  3. 3.
    Amaro H, Raj A. On the margin: power and women’s HIV risk reduction strategies. Sex Roles. 2000;42(7/8):723–49.CrossRefGoogle Scholar
  4. 4.
    Pulerwitz J, Gortmaker S, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7/8):637–60.CrossRefGoogle Scholar
  5. 5.
    Pulerwitz J, Amaro H, DeJong W, Gortmaker S, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14(6):789–800.CrossRefPubMedGoogle Scholar
  6. 6.
    Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.CrossRefPubMedGoogle Scholar
  7. 7.
    Connell RW. Gender and power. Stanford: Stanford University Press; 1987.Google Scholar
  8. 8.
    Wingood GM, DiClemente RJ. The theory of gender and power: a social structural theory for guiding public health interventions. In: Di Clemente R, Crosby R, Kegeler M, editors. Emerging theories in health promotion practice and research. San Francisco: Jossey-Bass; 2002. p. 313–46.Google Scholar
  9. 9.
    Fenaughty AM. Perceptions of power equality among drug-using women. Women Health. 2003;37(1):91–107.CrossRefPubMedGoogle Scholar
  10. 10.
    Saul J, Norris F, Bartholow K, Dixon D, Peters M, Moore J. Heterosexual risk for HIV among Puerto Rican women: does power influence self-protective behaviors? AIDS Behav. 2000;4:361–71.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dinenno EA, Oster AM, Sionean C, Denning P, Lansky A. Piloting a system for behavioral surveillance among heterosexuals at increased risk of HIV in the United States. Open AIDS J. 2012;6:169–76.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Byrne BM. Structural equation modeling with Mplus: basic concepts, applications, and programming. New York: Routledge; 2012.Google Scholar
  13. 13.
    Schreiber JB, Amaury N, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: a Review. J Educ Res. 2006;99(6):323–37.CrossRefGoogle Scholar
  14. 14.
    Muthen L, Muthen B. Mplus User’s Guide. 6th ed. Los Angeles: Muthen & Muthen; 2010.Google Scholar
  15. 15.
    DePadilla L, Windle M, Wingood G, Cooper H, DiClemente R. Condom use among young women: modeling the theory of gender and power. Health Psychol. 2011;30(3):310–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kaestle CE, Waller MW. Bacterial STDs and perceived risk among minority young adults. Perspect Sex Reprod Health. 2011;43:158–63.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Marrazzo JM, Coffey P, Bingham A. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspect Sex Reprod Health. 2005;37(1):6–12.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Marshall BD, Wood E, Shoveller JA, Patterson TL, Montaner JS, Kerr T. Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis. BMC Public Health. 2011;11:20.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Operario D, Gamarel KE, Grin BM, Lee JH, Kahler CW, Marshall BD, et al. Sexual minority health disparities in adult men and women in the United States: national Health and Nutrition Examination Survey, 2001–2010. Am J Public Health. 2015;105(10):e27–34.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Austin SB, Roberts AL, Corliss HL, Molnar BE. Sexual violence victimization history and sexual risk indicators in a community-based urban cohort of “mostly heterosexual” and heterosexual young women. Am J Public Health. 2008;98(6):1015–20.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Koh AS, Gomez CA, Shade S, Rowley E. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis. 2005;32(9):563–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Misovch S, Fisher J, Fisher W. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1(1):72–107.CrossRefGoogle Scholar
  23. 23.
    Ellen JM, Vittinghoff E, Bolan G, Boyer CB, Padian NS. Individuals’ perceptions about their sex partners’ risk behaviors. J Sex Res. 1998;35(4):328–32.CrossRefGoogle Scholar
  24. 24.
    Tourangeau R, Yan T. Sensitive questions in surveys. Psychol Bull. 2007;133(5):859–83.CrossRefPubMedGoogle Scholar
  25. 25.
    Ong AD, Weiss DJ. The impact of anonymity of responses to sensitive questions. J Appl Soc Psychol. 2000;30(8):1691–708.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Center for Health Systems Research, Denver Health and Hospital AuthorityDenverUSA
  2. 2.Department of Medicine, School of MedicineUniversity of ColoradoAuroraUSA
  3. 3.Denver Public Health DepartmentDenver Health and Hospital AuthorityDenverUSA
  4. 4.Department of Epidemiology, School of Public HealthUniversity of ColoradoAuroraUSA
  5. 5.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  6. 6.Department of Community and Behavioral Health, Colorado School of Public HealthUniversity of ColoradoAuroraUSA
  7. 7.Department of Health and Behavioral Sciences, College of Liberal Arts and SciencesUniversity of Colorado DenverDenverUSA

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