Differences In Sexual Assertiveness and Perceptions of HIV Risk In Ethnic Minority Women Aged 50 and Older

BACKGROUND AND PURPOSE: Sexual assertiveness has been linked to sexual risk behaviors in women, but little has been investigated on its influence on HIV risk perceptions and behaviors in women aged 50 and older. It has been suggested that older women in general suffer from lower levels of sexual assertiveness because of their structurally disadvantaged position in society. Relational context, interpersonal power, and silencing can affect women's perceptions of their sexual rights, influencing their ability to communicate sexual preferences and desires. The purpose of this study was to examine sexual communication, perception of HIV risk, and ethnicity in relation to risk and protection in a community sample of women aged 50 and older. This study was guided by the theory of gender and power emphasizing the factors affecting health behaviors and HIV risk within interpersonal, socio-political, and cultural contexts.

METHODS: Using a cross-sectional design, we recruited a community-based ethnically-diverse sample of 572 women aged 50 to 93 years (M=63.6 years, SD=10.5) in South Florida to complete an anonymous pen-and-paper questionnaire. Participants were recruited from community sites where older women frequently visit (e.g., social clubs, health clinics). To test the hypothesis that that there will be ethnic group differences with regard to sexual assertiveness, a one-way analysis of variance [ANOVA] was conducted to explore ethnic group differences in these attitudes/behaviors. The variable, ethnicity, included three groups: Black, Hispanic, and non-Hispanic white. A Pearson Chi-Square test was performed to determine differences in perceptions of risk for HIV between the three ethnic groups.

RESULTS: The results of the one-way ANOVA were significant, F(2,438)=4.85, p=.008, indicating ethnic group differences regarding sexual assertiveness. Results of a follow-up Tukey test indicated that there was a significant difference between Blacks and the other two ethnic groups, that is, Black women were less likely than Hispanic or non-Hispanic white women to be sexually assertive in soliciting information regarding their partners' HIV risk behaviors (e.g., sexual history or injection drug use). The Chi-Square indicated there is a significant difference between the groups regarding perception of risk, X²(2,N=505) = 20.11, p< .01. Black women were significantly more likely to believe they were at risk for HIV compared to Hispanics and non-Hispanic whites.

CONCLUSIONS AND IMPLICATIONS: This study provides new and important information about sexual risk and HIV-risk perception in women aged 50 and older, suggesting Black older women may have a unique set of factors that impact their sexual risk and protective behaviors. These findings highlight the importance of examining the intersection of ethnicity, gender, and age that can help guide the development of targeted interventions for this group. HIV education combined with sexual assertiveness skill building strategies might prove useful if incorporated into HIV risk-reduction interventions for Black older women. Social work practitioners are uniquely positioned to address how and why sexual communication affects risk and protection in Black older women, how structural barriers (e.g., gender inequities) shape these attitudes in earlier stages of life, and the modification of these attitudes to produce healthier outcomes.