Exploring Associations between Theory of Gender & Power Constructs and STI Risk among Detained African American Girls Open Access

Abstract

Introduction: Over 20 million new cases of sexually transmitted infections (STIs) occur each year in the United States.  Previous research has shown that detained African American girls are more likely to experience compounded STI risk due to social determinants of health affecting their intersectional identities. Having an STI increases risk of acquiring human immunodeficiency virus (HIV), which highlights a need for intervention and research aimed at addressing these underlying risk factors.  This study aimed to retroactively apply a theoretical framework, the Theory of Gender & Power (TGP), to determine how the TGP constructs of sexual division of labor (SDL), sexual division of power (SDP) and structure of cathexis (CATH) influence girls’ risk of acquiring STIs and HIV.

Methods: A secondary data analysis of baseline IMARA study data was conducted among 188 detained African American girls.  Three independent composite risk variables were created to represent acquired TGP-related risk, and six dependent STI risk variables of interest were selected based on the literature.  Bivariate associations and multivariate logistic regression models were used to assess which of the TGP constructs could serve as statistically significant predictors of STI risk.

Results: Bivariate association analyses indicated statistically significant relationships between relationship control and all three TGP constructs of SDL (p=0.032), SDP (p<0.001), and CATH (p=0.021).  Only the SDP composite variable was significantly associated with fear of condom negotiation (p<0.001), refusal self-efficacy (p<0.001), unprotected sexual encounters (p<0.001), and lifetime sexual partners (p<0.001).  Condom use skills were not significantly associated with any TGP constructs.  Multivariate logistic regression models showed that SDP composite risk is a significant predictor of low levels of relationship control (AOR=1.319; 95%CI=[1.054, 1.651]; p=0.016), high fear of condom negotiation (AOR=1.826; 95%CI=[1.409, 2.367]; p<0.001), low refusal self-efficacy (AOR=1.754; 95%CI=[1.359, 2.264]; p<0.001), more unprotected sexual encounters (AOR=1.445; 95%CI=[1.132, 1.845]; p=0.003), and more lifetime sexual partners (AOR=1.708; 95%CI=[1.335, 2.185]; p<0.001).

Discussion: HIV prevention intervention efforts should intervene upon the sub-constructs of sexual division of power risk, including physical exposures and behavioral risks.  Findings align with similar studies and strengthen the body of literature surrounding theory-driven secondary data analyses within compounded risk populations.

Table of Contents

1    Introduction......................................................................................... 1

2    Literature Review................................................................................ 6

2.1    Introduction........................................................................ 6

2.2    HIV and STIs..................................................................... 6

2.3    Burden of Disease in Vulnerable Populations................... 8

               2.3.1    African American Women............................................. 8

               2.3.2    Adolescents.................................................................... 9

               2.3.3    Detained Juveniles....................................................... 10

2.4    Compounded STI Risk for Detained Black Girls............. 12

2.5    Social Determinants of Health.......................................... 13

2.6    The Theory of Gender & Power........................................ 14

2.7    Summary & Objectives..................................................... 17

3    Methods............................................................................................. 19

3.1    Introduction...................................................................... 19

3.2    Participants....................................................................... 19

3.3    Procedures........................................................................ 20

               3.3.1    Recruitment.................................................................. 20

               3.3.2    Data Collection............................................................. 21

3.4    Measures.......................................................................... 22

               3.4.1    Demographics.............................................................. 22

               3.4.2    Independent Variables: TGP Constructs...................... 22

               3.4.3    Dependent Variables: STI Risk Factors....................... 30

3.5    Data Analysis................................................................... 33

4    Results.............................................................................................. 34

4.1    Descriptive Statistics of Sample...................................... 34

4.2    Descriptive Statistics of Study Variables......................... 34

     4.2.1    Independent Variables: TGP Constructs.................. 34 

               4.2.2    Dependent Variables: STI Risk Factors....................... 37

4.3    Bivariate Associations...................................................... 38

4.4    Multivariate Logistic Regression Analyses...................... 41

5    Discussion......................................................................................... 45

5.1    Summary of Findings....................................................... 45

5.2    Strengths and Limitations................................................ 47

5.3    Implications for Future Research..................................... 49

5.4    Conclusions...................................................................... 50

6    References......................................................................................... 52

7    Appendices........................................................................................ 60

7.1    Appendix A – IMARA Codebook.................................... 61

7.2    Appendix B – Figure 3..................................................... 71

7.3    Appendix C – Figure 4..................................................... 72

7.4    Appendix D – Figure 5..................................................... 73

7.5    Appendix E – Figure 6...................................................... 74

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	sexually transmitted infection adolescent sexual health reproductive health African American Theory of Gender and Power HIV secondary data analysis detained social determinants juvenile women STI Black STD Theory of Gender & Power
Committee Chair / Thesis Advisor	DiClemente, Ralph J., Emory University
Committee Members	Renfro, Tiffaney L., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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