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RESEARCH ARTICLE

Sexual agency versus relational factors: a study of condom use antecedents among high-risk young African American women

Richard A. Crosby A B G , Ralph J. DiClemente C D E F , Gina M. Wingood C D , Laura F. Salazar C D , Sara Head A , Eve Rose C and Jessica McDermott-Sales C
+ Author Affiliations
- Author Affiliations

A College of Public Health, University of Kentucky, 121 Washington Avenue, Lexington, KY 40506, USA.

B Rural Center for AIDS/STD Prevention, Indiana University, 801 East 7th Street, Bloomington, IN 47405, USA.

C Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, 1516 Clifton Avenue, GA 30322, USA.

D Emory Center for AIDS Research, 1518 Clifton Avenue, Atlanta, GA 30322, USA.

E Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Epidemiology, and Immunology, 2015 Uppergate Drive, Atlanta, GA 30322, USA.

F Emory University School of Medicine, Department of Medicine, Infectious Diseases, 1440 Clifton Avenue, Atlanta, GA 30322, USA.

G Corresponding author. Email: crosby@uky.edu

Sexual Health 5(1) 41-47 https://doi.org/10.1071/SH07046
Submitted: 23 June 2007  Accepted: 30 October 2007   Published: 22 February 2008

Abstract

Background: The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. Methods: A cross sectional study of 713 young, African American women (aged 15–21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Results: Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. Conclusion: The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.

Additional keywords: adolescent females, sexual behaviour, sexually transmissible infection.


References


[1] Centers for Disease Control and Prevention. A heightened national response to the HIV/AIDS crisis among African Americans. Atlanta: Department of Health and Human Services; March 2007.

[2] Centers for Disease Control and Prevention. HIV/AIDS Among African Americans. Fact Sheet. Available online at http://www.cdc.gov/hiv/pubs/facts/afam.htm [verified 5 March 2006].

[3] Southern States AIDS/STD Directors Work Group. Southern States Manifesto: HIV/AIDS & STDs in the South – A call to action. Southern States AIDS/STD Directors Work Group; 2003.

[4] Wasserheit JN. Epidemilogical synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19 61–72.
PubMed |

[5] Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2005. Atlanta: US Department of Health and Human Services; November 2006.

[6] Berman SM , Hein K . Adolescents and STDs. In: KK Holmes, PF Sparling, P Mardh, et al. (eds). Sexually Transmitted Diseases. New York: McGraw Hill; 1999. pp. 129–42.

[7] Weinstock H,  Berman S,  Cates W. Sexually transmitted diseases among American youth: incidents and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36 6–10.
CrossRef | PubMed |

[8] DiClemente RJ,  Salazar LS,  Crosby RA. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective – a commentary. Public Health 2005; 119 825–36.
CrossRef | PubMed |

[9] DiClemente RJ , Crosby RA . Sexually transmitted diseases among adolescents: risk factors, antecedents, and prevention strategies. In: GR Adams, M Berzonsky (eds). Blackwell Handbook of Adolescence. Oxford: Blackwell Publishers Ltd; 2003. pp. 573–605.

[10] Crosby RA,  DiClemente RJ,  Wingood GM,  Sionéan C,  Cobb BK,  Harrington K, et al. Correlates of unprotected vaginal sex among African American female teens: the importance of relationship dynamics. Arch Pediatr Adolesc Med 2000; 154 893–9.
PubMed |

[11] Crosby RA,  Salazar LF,  DiClemente RJ,  Yarber WL. Correlates of having unprotected vaginal sex among detained adolescent females: an exploratory study of sexual factors. Sex Health 2004; 1 151–5.
CrossRef | PubMed |

[12] Wingood GM,  DiClemente RJ. Partner influences and gender-related factors associated with non-condom use among young adult African American women. Am J Community Psychol 1998; 26 29–51.
CrossRef | PubMed |

[13] Kalichman SC,  Rompa D. Sexual sensation seeking and sexual compulsivity scales: reliability, validity, and predicting HIV risk behavior. J Pers Assess 1995; 65 586–601.
CrossRef | PubMed |

[14] Cabral RJ,  Pulley L,  Artz LM,  Brill I,  Macaluso M. Women at risk of HIV/STD: the importance of male partners as barriers to condom use. AIDS Behav 1998; 2 75–85.
CrossRef |

[15] Turner CF,  Ku L,  Rogers SM,  Lindberg LD,  Pleck JH,  Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280 867–71.
CrossRef | PubMed |

[16] Pullerwitz J,  Gortmaker S,  DeJong W. Measuring sexual relationship power in HIV/STD research. Sex 2000; 42 637–60.


[17] DiClemente RJ,  Lodico M,  Grinstead OA,  Harper G,  Rickman RL,  Evans PE, et al. African-American adolescents residing in high-risk urban environments do use condoms: correlates and predictors of condom use among adolescents in public housing developments. Pediatrics 1996; 98 269–78.
PubMed |

[18] Wingood GM,  DiClemente RJ. Gender related correlates and predictors of consistent condom use among young adult African American women: a prospective analysis. Int J STD AIDS 1998; 9 139–45.
CrossRef | PubMed |

[19] Begley E,  Crosby RA,  DiClemente RJ,  Wingood GM,  Rose E. Older partners and STD prevalence among pregnant African American teens. Sex Transm Dis 2003; 30 211–3.
CrossRef | PubMed |

[20] DiClemente RJ,  Wingood GM,  Crosby RA,  Sionean C,  Cobb BK,  Harrington K, et al. Sexual risk behaviors associated with having older sex partners: A study of African American female adolescents. Sex Transm Dis 2002; 29 20–4.
CrossRef | PubMed |

[21] Miller KS,  Clark LF,  Moore JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Fam Plann Perspect 1997; 29 212–4.
CrossRef | PubMed |

[22] Crosby RA,  DiClemente RJ,  Holtgrave DR,  Wingood GM. Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non-viral STIs. Sex Transm Infect 2002; 78 228–31.
CrossRef | PubMed |

[23] Crosby RA,  Yarber WL,  Sanders SA,  Graham CA. Condom discomfort and associated problems with their use among university students. J Am Coll Health 2005; 54 143–8.
CrossRef | PubMed |

[24] Crosby RA,  Graham CA,  Yarber WL,  Sanders SA. If the condom fits, wear it: A qualitative study of young African American men. Sex Transm Infect 2004; 80 306–9.
CrossRef | PubMed |

[25] Weir SS,  Roddy RE,  Zekeng L,  Ryan KA. Association between condom use and HIV infection: a randomised study of self reported condom use measures. J Epidemiol Community Health 1999; 53 417–22.
PubMed |

[26] Crosby RA,  DiClemente RJ,  Holtgrave DR,  Wingood GM. Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non-viral STIs. Sex Transm Infect 2002; 78 228–31.
CrossRef | PubMed |

[27] Warner L,  Newman DR,  Austin HD,  Kamb ML,  Douglas JM,  Malotte CK, et al. Condom effectiveness for reducing transmission of gonorrhea and Chlamydia: the importance of assessing partner infection status. Am J Epidemiol 2004; 159 242–51.
CrossRef | PubMed |



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