Relationship power and sexual risk in a sample of drug-involved women.

Women are at increasing risk for exposure to HIV infection, often through primary male sexual partners. Research indicates that women‘s ability to practice safer sexual behavior is influenced by contextual and relational factors, including power dynamics between her and her male partner. Little research, however, has empirically examined relationship power in the context of drug-involved women. Using baseline data collected from a national multi-site trial of an HIV intervention for women in community-based substance abuse treatment program through the National Institute on Drug Abuse Clinical Trials Network (protocol CTN-0019), we examine the association between sexual relationship power and unprotected sexual occasions. The Sexual Relationship Power Scale (SRPS) includes two subscales representing two domains of power, decision-making dominance and relationship control, and was used to assess the impact of power on unprotected sexual occasions for women with male partners.

Using Generalized Linear Modeling (SAS GLIMMIX) and controlling for demographic, relationship, and substance use variables, the decision making dominance subscale was associated with a 24% decrease in unprotected sexual occasions (F=160.9, p<.001), while the control subscale was associated with a 24% increase in unprotected sex (F=81.9, p<.001). The paradoxical finding that specific types of relationship power lead to different outcomes regarding sexual risk will be discussed. Findings support further research on identifying important differences across domains of power, including data on both partners’ perceptions of power within different contexts, and the role of substance use on interpersonal power for women facing multiple inequalities.

Related protocols: CTN-0019