Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

Abstract

Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research, however, has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a National Institute on Drug Abuse Clinical Trials Network multisite trial of a women's HIV prevention intervention in communitybased drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Possible explanations for these findings are discussed, and future research directions for examining power constructs and developing interventions targeting relationship power among drug-involved women are suggested.

Decisions, decisions: the importance of condom use decision making among HIV sero-discordant couples in a prospective cohort study in Uganda

“…Another study from South Africa observed a positive association between sexual power and consistent condom use, although these studies did not explicitly focus on the decision making dominance subscale of the SRPS, where our decision making variable was drawn 20. Campbell et al 32 argued that the decision making dominance subscale of the SRPS may be a more accurate predictor of condom use, as it captures women's relative power to her partner.…”

A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

“…The RC subscale is explained by Campbell et al to encompass the ability to “act as one desires,” in the context of a relationship (Campbell et al, 2009). The direction of the associations we observed between RC subscale scores and the sexual risk variables is consistent with other studies of heterosexual couples.…”

“…HIV prevention research has highlighted gender inequality and the resulting power differential found in relationships between women and men as contributing factors in heterosexual HIV transmission and disproportionate rates of HIV among women (Campbell et al, 2009; Campbell, Tross, Hu, Pavlicova, & Nunes, 2012; Knudsen et al, 2008; Pulerwitz, Gortmaker, & DeJong, 2000). Power dynamics (also referred to as “relationship power dynamics” or “gendered power”) is a concept that encompasses a range of individual (empowerment), interpersonal (dominance and control in relationships) and social and structural factors (gender norms, economic inequalities).…”

“…The SRPS has primarily been applied to nonsubstance using heterosexual partnerships in the field of HIV prevention research (Campbell et al, 2009; Conroy et al, 2016; Muldoon, Deering, Feng, Shoveller, & Shannon, 2015), in which lower SRPS scores have been associated with higher risk and inconsistent condom use and for HIV infection (Bonacquisti & Geller, 2013; Dunkle et al, 2004; Jewkes, Dunkle, Nduna, & Shai, 2010). However, we are unaware of any investigation of relationship dynamics in the intersecting injecting and sexual relationships of young WWID, or one that quantifies the impact of sexual relationship power on injecting or sexual risk behaviors in the context of WWID’s sexual relationships.…”

Homelessness & Health in Canada

“…Further, from a sociological perspective, it has been proposed that genderbased power imbalances play an important role in determining individuals' sexual behaviours (e.g., Amaro 1995). In several studies of non-homeless females from diverse ethnic backgrounds, individuals who were low in relationship power (e.g., decision-making abilities, assertiveness, control) demonstrated an increased risk of sexual risk behaviours and poor sexual health outcomes, including unprotected sex and hiv (e.g., Bralock and Koniak-Griffin 2007;Campbell et al 2009;Jewkes et al 2010). This power differential may make it difficult for girls and women to assert themselves sexually and to resist coercion in sexual situations (Tyler and Johnson 2006).…”