Problematic relationships can be common among female offenders. For example, incarcerated women reported more family and social relationship problems than incarcerated males (Peters et al. 1997
; Sheridan 1996
). Studies have documented how relationships within social networks can influence risky sexual and drug use behaviors among female substance users (Miller & Neaigus 2001
). Using the Relational Model (Finkelstein 1996
; Finkelstein & Piedade 1993
) that a woman’s “sense of self” is closely tied to her relationships and affiliations (Surrey 1991
; Miller 1976
), disempowering intimate relationships may be particularly harmful for the well-being of women. Previous research has considered relationship power in the context of community samples (Pulerwitz et al. 2002
; Pulerwitz, Gortmaker & DeJong 2000
), but there has not been research on relationship power conducted with women offenders who are incarcerated. It was unknown whether the nature of sexual partner relationships, particularly in terms of the distribution of power between women and their partners in those relationships, were related to risky sexual behaviors among women offenders.
This research makes several contributions to the existing literature. First, we measured the prevalence of multiple types of risky sexual behaviors among substance-using women offenders in the month prior to their incarceration. One strength of this research was that both measures that were specific to substance-using women (e.g. unprotected sex while “high” and unprotected sex in exchange for drugs, money, or gifts) and more general measures (e.g. unprotected vaginal sex and unprotected anal sex) were included. The prevalence of any unprotected vaginal sex was quite high (about 77%), although not particularly different from the general population. Data from a large US sample indicated that 81.3% of adults reported not using a condom during their most recent sexual encounter (Anderson 2003
). Given that the sample focused on substance-using women, it was not surprising that the majority of participants reported at least one instance of unprotected sex while high in the month before they entered prison. It should be noted that reducing risky sexual behaviors that occur in the context of drug use points to the potential health benefits that may be gained by delivering drug treatment services to incarcerated women.
The major substantive contribution of this research was the extension of the theoretical perspective of relationship power to the experience of substance-using women offenders. We examined the associations between perceived power in sexual partner relationships and risky sexual behaviors in the month before women entered prison. Initially we considered the overall measure of Relationship Power, which was negatively associated with the odds of unprotected anal sex and unprotected sex with a user of cocaine, methamphetamine and/or intravenous drugs in the multivariate models. Considering the Relationship Control and Decision-Making Dominance subscales, which had been combined in the overall measure, revealed several important findings. First, Decision-Making Dominance was not associated with any of the five risky sexual behaviors. This lack of significant findings is important because it suggests that the significant findings for the overall measure of Relationship Power were likely driven by Relationship Control rather than Decision-Making Dominance. In addition, the importance of power for risky sexual behaviors may have been attenuated by the inclusion of the nonsignificant Decision-Making Dominance items. Some support for this line of reasoning may be found in the results indicating that the dimension of Relationship Control was associated with four of the five risk behaviors compared to overall Relationship Power being associated with only two behaviors in the bivariate analyses.
Relationship Control was a significant covariate in three of the multivariate models. Specifically, women reporting that they had more control in their sexual partner relationship were significantly less like to engage in any unprotected vaginal sex, unprotected anal sex, and unprotected sex with a user of stimulants (e.g. cocaine, methamphetamine) or intravenous drugs. Reductions in the odds of these behaviors are important for several reasons. First, the association of Relationship Control with unprotected vaginal sex is particularly important given the high base-rate of this risky behavior in this population. In addition to reducing risks of HIV and STI transmission, reducing the prevalence of unprotected vaginal sex may also reduce the risk of unintentional pregnancy. The association for unprotected anal sex is important from a public health perspective because this activity has higher odds of HIV and STI transmission than unprotected vaginal sex if the partner has one of these infections (Gross et al. 2000
; Nicolosi et al. 1994
). Finally, a partner who uses stimulants or intravenous drugs is at increased risk of having contracted HIV, so unprotected sexual contact with these individuals pose additional health risks for women.
When the association of Relationship Control and “unprotected sex while high” was explored, Relationship Control was no longer associated when crack use was added into the model, indicating that crack use may mediate the relationship between Relationship Power and unprotected sex while high. This finding is in accordance with previous studies in which crack use was significantly associated with participating in HIV risk behaviors (McCoy et al. 2004
; Edlin et al. 1994
Of the five risky sexual behaviors, the only behavior for which there was no evidence of association with Relationship Power was unprotected sex in exchange for money, drugs, or gifts. Neither the overall measure of Relationship Power nor the subscales were associated with this particular type of risky sexual behavior, which was reported by about one-quarter of the women in the study. This is potentially disconcerting in that women who are trading sex are likely at higher risk for HIV and other STIs (Tortu et al. 1998
). On some level, it may be the case that Relationship Power is less relevant for these transactional sexual encounters that occur during what might be viewed as a brief, temporary association between two people rather than an ongoing relationship.
An additional unexpected finding was that marital status was not associated with any of the five sexual risk behaviors among these women offenders. The lack of significant differences was surprising because previous research had found that long-term committed relationships may actually be a risk factor (Schilling et al. 1993
), since unprotected sex may be viewed as a symbol of trust in the relationship (Morrill et al. 1996
). In part, this may be explained by the use of marital status rather than combining that measure with other indicators of relationship commitment. For example, within the category of “never married” women, there may be some who are in monogamous yet noncohabitating relationships, while others have multiple sexual partners. One cannot assume that the category of “married/cohabitating” only includes women in monogamous relationships. Finally, it may be the case that there simply were not enough married or cohabiting women to detect significant differences, as this group only represented about 15% of the sample.
The following limitations should be noted. First, study participants were not a random sample of incarcerated women. Although not randomly selected, all women who were eligible for release could have self-selected for participation since they were asked if they were interested in participating in the study. Additionally, these data are cross-sectional in nature, so causal relationships cannot be firmly established.
An additional and significant limitation is that this study used self-reported data, which may be influenced by biases related to recall and truthfulness. To some extent, the recall issue may be minimized by our reliance on any instance of the behaviors rather than asking participants to identify the number of times they engaged in the risky behavior in the month prior to incarceration. However, there are also potential issues of recall associated with the fact that the measurement of Relationship Power and risky sexual behaviors occurred just prior to release from prison and not during the usual functioning of the relationship itself. Furthermore, as the questions about sexual risk behaviors focus on very specific and potentially sensitive types of sexual activities, the possibility exists that some participants, who may be less comfortable discussing these sorts of issues, may underreport instances of risky sex. It is also unclear if individuals who are less willing to accurately report risky sexual behavior are likely to report more or less power in their relationship. While self-report data has been shown to be valid when compared to urinalysis for drug use (Del Boca & Noll 2000
; Rutherford et al. 2000
), it is more difficult to establish the validity of self-reported sexual behaviors because there are no biological markers that can be analyzed as in the case of drug testing. However, the validity of self-reported drug use measures, which focus on both a sensitive and illegal behavior, gives some hope that participants will be reasonably truthful in reporting any instances of these risky sexual behaviors.
There are many possible directions for future research both theoretically and methodologically. One possibility for addressing potential recall and truthfulness biases may be to investigate relationship dyads. By employing a paradigm in which both partners provide data, not only regarding their own perceptions and behaviors, but also those of their partner, it would be possible to investigate both consistencies and discrepancies in individual accounts of the relationship. This approach could allow greater insight into both individuals’ levels of engagement in the relationship and a more accurate assessment of the interpersonal dynamics unique to that dyad. Also, much of the research has only focused on the perspective of women, so adding the perspective of men may also yield important theoretical contributions to the literature.
Future research might also consider using a panel longitudinal design. By incorporating multiple waves of data collection, it may be possible to investigate whether women’s attitudes toward intimate relationships and relationship power vary across the actual span of their engagement in the relationship. It may also be possible to better understand the types of variables that are associated with perceived power within intimate relationships. Furthermore, future research might simultaneously consider sexual partner relationships as well as other forms of social relationships. For example, participation in risky sexual behaviors may decrease as feelings of affiliation in other types of close relationships increase. Perhaps as needs for close affiliations are met by interactions outside of the intimate relationship (i.e., like those with family, children, or close friends), beliefs about the necessity or importance of the risky relationship change as do the individuals’ perceptions of relationship power. Only by simultaneously considering a range of different types of social relationships might these patterns be fully understood.
Another area for future research is to better understand the associations between women’s perceived power in relationships, self-esteem, and the need to belong. For example, diminishing levels of self-esteem may serve to motivate women to seek out affiliations regardless of the extent to which such affiliations may actually pose risks to women. For women experiencing negative affect and dysphoria brought on by negative life events such as addiction or incarceration (c.f. Baumeister & Leary 1995
; Baumeister, Heatherton & Tice 1993
; Baumeister & Tice 1990
), affiliations, even risky ones, may hold the perceived possibility of emotional benefits to self-esteem. In this context, risky behaviors may be perceived by women as having symbolic value as methods for building trust in the relationship while gaining desired male approval and providing evidence of social desirability. For women in the present study, their impending incarceration may have provoked unstable feelings of self-worth and threatened their sense of stability within their intimate partner relationships because of the impending separation. Future research might consider a broader spectrum of psychological needs that may be fulfilled within the context of intimate relationships, such as needs for affiliation and self-esteem, and how impending incarceration may uniquely shift how these relationships function.
Finally, future studies are needed to examine whether interventions can effectively help women develop stronger perceptions about their abilities to exert power within their sexual relationships, particularly in terms of negotiating with their partners about safer sex practices. The present study of baseline data was collected as part of a larger protocol that is considering whether an intervention delivered during incarceration can successfully address “thinking myths” about relationships that may be barriers to reducing risky sexual behaviors once women reenter their communities (Staton-Tindall et al. 2007
). This intervention protocol offers the opportunity to even more clearly understand the influence of intimate partner relationships for women offenders, and if efficacy is demonstrated, may offer a method for reducing risks for this population.
Despite the limitations and need for future research, findings from this study have implications for women’s relationships, high risk HIV-related behaviors, and ultimately HIV prevention. These findings support the idea that maintaining power in relationships, particularly control within sexual relationships, may be of high importance for women in avoiding high-risk sexual behaviors that could lead to a greater potential for HIV infection. Furthermore, these results support a growing body of literature which generally suggests that promoting beliefs that empower women to take greater ownership of their decisions in sexual relationships leads to better health choices and ultimately greater feelings of efficacy and self-worth.