Relationship power, decision making, and sexual relations: an exploratory study with couples of Mexican origin

Journal of Sex Research, Nov, 2002 by S. Marie Harvey, Linda J. Beckman, Carole H. Browner, Christy A. Sherman

An emerging public health priority is strengthening women's ability to protect themselves from HIV/STDs and to negotiate safer sex behaviors with their heterosexual partners. A focus on Latina women is important for several reasons. First, Latina women are disproportionately affected by HIV/AIDS and other STDs. The annual rate of AIDS cases reported in 1999 among Hispanic female adults and adolescents (34.6 per 100,000) was over three times the rate among non-Hispanic Whites (9.0 per 100,000) (CDC, 1999). Compared to non-Hispanic Whites, Hispanic women also have higher rates of chlamydia, gonorrhea, and syphilis (Division of STD Prevention, 1999). Furthermore, HIV infection and AIDS have increased dramatically among U.S. women over the past 10 years and, since 1994, heterosexual contact has been the largest exposure category (CDC, 1999). Among Hispanic adult and adolescent women, heterosexual contact was the exposure category for 47% of AIDS cases and 43% of HIV infection cases reported through December 1999 (CDC, 1999).

Male condoms are currently the only widely accepted method for preventing the transmission of HIV and other STDs for sexually active individuals. Some men are unwilling to use condoms and, due to gender-based power imbalances, some women may be unable to negotiate use (Amaro, 1995). Wingood and DiClemente (2000) define lack of "perceived control or power to avoid unhealthy behaviors" (p. 544) as a behavioral risk factor that influences women's risk of HIV. Several researchers have suggested that women are likely to have difficulty in negotiating safer sex strategies with their male partners because of perceived imbalances in relationship power (e.g., Amaro, 1995; Amaro & Gornemann, 1992; Fullilove, Fullilove, Haynes & Gross, 1990; Gomez & Marin, 1996; Pulerwitz, Gortmaker, & DeJong, 2000; Wingood & DiClemente, 1998, 2000; Wingood, Hunter-Gamble, & DiClemente, 1993; Worth, 1989). At the same time, previous studies indicate that women's inability to negotiate condom use is one of the strongest correlates of poor condom use (Catania et al., 1992; Fullilove et al., 1990; Peterson et al., 1992; Wingood & DiClemente, 1998).

These gender-based power imbalances are potentially more salient for Latina women due to the cultural values of a traditionally machista society in which men are defined by their ability to be in control and to assert dominance by being the active sexual partner, the penetrator (Melhuus, 1996). In such a society, type and frequency of sexual behaviors are said to be most often determined by men (Amaro, 1988; Amaro & Gornemann, 1992; Wood & Price, 1997). Findings from a study of over 500 Latina women indicate that feelings of powerlessness and inability to influence risk-reduction decisions and behaviors were perceived as barriers to HIV/STD prevention among the majority of women interviewed (Amaro & Gornemann, 1992).

Moreover, in a recent study of predominately Latina (89%) women, sexual relationship power was positively associated with consistent condom use (Pulerwitz, Gortmaker, & DeJong, 2000). Thus, women's perceived sense of powerlessness and their inability to affect safer sex decisions may be key factors in Latino women's risk for HIV/STDs.

Despite these findings, the predominant theoretical models prevalent in HIV/STD behavior change have been justly criticized as being individualistic in their conceptualization. They often ignore the social and cultural context of women's sexual behaviors and assume that the individual has total control over behavior. They fail to address the diverse contextual factors related to gender, such as power differentials that likely influence behaviors that put women at risk for HIV (Amaro, 1995). Moreover, power in heterosexual relationships has been conceptualized and measured in a multitude of ways, and researchers do not agree on a definition of interpersonal power or on what makes individuals feel powerful in the context of their relationship. In addition, most research on relationship power has failed to include diverse samples of couples, including those from different ethnic and social backgrounds. Yet it would not be surprising to find that the sources, processes, and outcomes of power will differ for diverse groups because of unique sets of values, experiences, and traditions.

Given these concerns, we designed a study to examine power dynamics among couples of Mexican origin. We drew on the theoretical literature in the social sciences that defines interpersonal power (i.e., relationship power) as the ability to influence another person in order to achieve desired ends (Balswick & Balswick, 1995; Huston, 1983). More simply, interpersonal power refers to one person's power over another (Yoder & Kahn, 1992). In contrast to power to (i.e., personal power or empowerment), interpersonal power is an individual characteristic that concerns the relationship between two people (Yoder & Kahn, 1992).

Most work in this area has focused on marital power. Balswick and Balswick (1995) describe what they refer to as the democratic exchange model of marital power derived from the social exchange model promoted by Brickman (1974) and Scanzoni (1979). Power in the social exchange model can best be understood by examining three components of power outlined by Cromwell and Olson (1975): the bases of power (i.e., sources of power), the processes of power, and the outcomes of power. Power bases consist of resources (money, employment, skills, status, knowledge, affection and nurturance, and physical attractiveness); power processes consist of interactions (persuasion, assertiveness, problem solving); and power outcomes have to do with who gets their way and who makes important decisions. In this model the outcomes of power are determined by each partner using his or her resources to negotiate what each needs or wants in the relationship. Two interdependent but different outcomes of power, control over one's partner and ability to make decisions, are supported by findings from validation of the Sexual Relationship Power Scale, one of the only scales measuring relationship power. A factor analysis using oblique rotation revealed two types of relationship power: Relationship Control and Decision Making Dominance (Pulerwitz, Gortmaker, & DeJong, 2000).