Economic Dependence and Unprotected Sex: The Role of Sexual Assertiveness among Young Urban Mothers

Abstract

In the USA, sexual intercourse is the leading route of human immunodeficiency virus transmission among women, primarily through their main partner. Because male condom use is not directly under a woman's control, gender inequalities may help shape this sexual risk behavior. To examine this association, data came from follow-up interviews of young, primarily minority, pregnant women enrolled in a prospective, randomized controlled trial. Specifically, we aimed to determine the relationship between economic dependence on a male partner and condom use, and to establish whether this relationship was mediated by sexual assertiveness. Overall, 28% of women reported being economically dependent on a male partner. Young women dependent on a male partner were 1.6 times more likely to report not using a condom at last sex than women not dependent on their partner (95% confidence interval=1.11-2.32; p=0.01). Sexual assertiveness mediated the relationship between economic dependence and condom use (Sobel=2.05, p=0.04). Coupled with past research, this study supports the premise that sexual behaviors may be rooted in a complex web of social determinants. Addressing gender inequalities in contextual factors may promote healthier decisions within sexual relationships.

Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068)

“…Interestingly, only access to a banking account was significantly associated with consistent condom use, which provides the most protection from HIV apart from sexual abstinence. This may have reflected a level of assertiveness and autonomy among young women who were able to navigate the process of obtaining a banking account which they also applied in negotiating condom use with sex partners [19]. Young women with bank accounts may also have felt more financially secure and have been more inclined to focus on long-term planning, such as avoiding HIV.…”

“…One explanation is that limited income and economic control among poor women decreases their ability to negotiate condom use with sexual partners [15-18]. For example, economic dependence on a male partner has been shown to increase rates of unprotected sex among young women [14, 19, 20]. Another explanation is that poverty, as measured by unemployment or other forms of financial distress, constrains young women's livelihood options requiring many of them to resort to exchanging sex for money, housing, or other commodities [14, 21-25].…”

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

“…Indeed, economic dependence is one of the primary reasons women give for feeling compelled to stay in high-risk relationships (Newman, Williams, Massaquoi, Brown, & Logie, 2008). A recent study demonstrated an association between economic dependence and less frequent condom use that was mediated by the women less frequently requesting that their partner use condoms (Biello, Sipsma, Ickovics & Kershaw, 2010). …”

Attachment and Associated Sexual Health Behaviors of Heterosexual Mexican Housewives

“…Housewives with characteristics of avoidant attachment may have more misconceptions about HIV transmission. Biello, Sipsma, Ickovics, and Tershaw, 2010, found that young women who depended on a male partner were 1.6 times more likely to report not using a condom at last sex than women who were not dependent on their partners. In our study, more than half were economically dependent (66%).…”