Relationship Power, Sexual Decision Making, and HIV Risk Among Midlife and Older Women

Abstract

The number of midlife and older women with HIV/AIDS is high and increasing, especially among women of color. This article addresses these demographic realities by reporting on findings about self-esteem, relationship power, and HIV risk from a pilot study of midlife and older women. A purposive sample (N = 110) of ethnically, economically, and educationally diverse women 40 years and older from the Greater Los Angeles Area was surveyed to determine their levels of self-esteem, general relationship power, sexual decision-making power, safer sex behaviors, and HIV knowledge. Women with higher levels of self-esteem exercised greater power in their relationships with their partner. Women with higher levels of general relationship power and self-esteem tend to exercise greater power in sexual decision making, such as having sex and choosing sexual acts. Income and sexual decision-making power were statistically significant in predicting the use of condoms. Implications and recommendations for future HIV/AIDS research and intervention targeting midlife and older women are presented.

Factors Associated with African American Women’s Sexual Health and Risk Behavior: A Mixed Methods Study

“…Typically, SPRS total scores are reported when evaluating gender inequality in AAW, thus making accurate comparisons in this study difficult. However, in previous studies, middle aged AAW report having lower relationship and decision-making power (Altschuler & Rhee, 2015), unlike the women in the current study. Decreased levels of decision-making dominance were determined to predict improvement women's sexual health, despite these women perceiving their decision-making dominance as being high.…”

Safer Sex in Later Life: Qualitative Interviews With Older Australians on Their Understandings and Practices of Safer Sex

“…The limited research undertaken to date suggests that older people do not consistently practice safer sex (Altschuler & Rhee, 2015;Bourne & Minichiello, 2009;Dalrymple, Booth, Flowers, & Lorimer, 2016;de Visser et al, 2014;Foster, Clark, McDonnell Holstad, & Burgess, 2012;Grant & Ragsdale, 2008;Lindau et al, 2006;Reece et al, 2010;Schick et al, 2010), may lack effective condom use skills (Foster et al, 2012), and report low rates of testing for HIV and STIs (Bourne & Minichiello, 2009;Dalrymple et al, 2016;Grulich et al, 2014;Schick et al, 2010;Slinkard & Kazer, 2011).…”

“…Several authors have noted that older heterosexual women may face a higher susceptibility to HIV and STI transmission on account of the physiological and hormonal changes that typically accompany ageing, such as decreased estrogen production leading to thinning of the vaginal wall and subsequent greater susceptibility to tears and cuts (Altschuler & Rhee, 2015;Brooks, Buchacz, Gebo, & Mermin, 2012;Idso, 2009;Johnson, 2013), and the low rates of condom use of post-menopausal women who no longer fear unintended pregnancy (Altschuler & Rhee, 2015;Bateson et al, 2012;Idso, 2009;Johnson, 2013;Lindau et al, 2006). Older men can be reluctant or unable to use condoms as a result of erectile difficulties (Idso, 2009;Johnson, 2013), and older men who take erection-enhancing medications can face a higher likelihood of contracting an STI (Smith & Christakis, 2009).…”

“…Older people grew up in a time when discussions of sex and sexual health were largely taboo, comprehensive sexuality education was generally not available (Cook, 2012;May, 2006;Pilcher, 2005), and STIs were highly stigmatised (though this is arguably still the case in many respects) (Altschuler & Rhee, 2015;Bourne & Minichiello, 2009;Grant & Ragsdale, 2008;Idso, 2009;Nash et al, 2015;Slinkard & Kazer, 2011). Additionally, the dominant sexual and gendered sexual scripts that older people grew up with may restrain their ability to openly negotiate condom use or other safer sex practices in new sexual relationships (Altschuler & Rhee, 2015;Bateson et al, 2012;Nash et al, 2015;Zablotsky & Kennedy, 2003).…”

“…Additionally, the dominant sexual and gendered sexual scripts that older people grew up with may restrain their ability to openly negotiate condom use or other safer sex practices in new sexual relationships (Altschuler & Rhee, 2015;Bateson et al, 2012;Nash et al, 2015;Zablotsky & Kennedy, 2003). Further, safer-sex campaigns and policy are typically targeted towards younger people (Bateson et al, 2012;Bourne & Minichiello, 2009;European Expert Group on Sexuality Education, 2016;Gedin & Resnick, 2014;Kirkman, Kenny & Fox, 2013;Nash et al, 2015).…”