Overcoming Sexual Health Challenges in the Context of Intimate Partner Sexual Violence: Implications for Women-Centered Interventions

Background and Purpose:Women who experience intimate partner violence (IPV) have unique risk contexts that increase their susceptibility to negative sexual health outcomes. Using a syndemic intersectionality framework, this study seeks to understand women’s sexual risk across multiple levels of their social ecological environments: the biological self; the gendered social self; gender norms and social expectations; proximal social networks; and the broader social environment.

Methods: In this qualitative descriptive study, a purposeful sample of women who experienced IPV (n=28) was recruited from a domestic violence program and the community at large. The sample represented diverse ages (from 22 years to 60 years) and ethnicities (57% White; 14% African American; 11% Hispanic; 7% Native American; 7% multiracial – unreported and Asian/White; 4% South Asian). Data were collected with semi-structured, in-person interviews, averaging 59 minutes. Interviews were audio-recorded and transcribed. Data were stored and analyzed in NVivo Qualitative Software (Version 11.1.1). Methods of analysis included process coding (first cycle coding) and focused coding (second cycle coding), with the use of the syndemic intersectionality framework as an analytic template. Detailed process notes, analytic memos, coding checks, and the use of visual analytic displays were used to increase the trustworthiness of findings.

Findings: As women discussed their risk in terms of the biological self, they focused on how female bodies were targets of sexual violence: simply being female (i.e. having a vagina) makes one rape-able. Furthermore, sexual victimization directly impacted women’s physical bodies – 86% of the sample reported negative sexual health outcomes. In regards to their gendered social selves, women said that their voices were silenced, their sexual needs were not met, and they prioritized others above themselves. In regards to gendered social expectations, women described historic imbalances of sexual power as a risk factor: “for all those past years – we were made to, um, you know, bow down to the man’s needs and [sex is] one of the man’s needs,” (Carrie). Given these norms, women struggled with facing men’s sexual pressures, having sex without communicating, externalizing locus of control for sexual decision-making, and “performing” sexually. In women’s proximal networks, risky sexual partners and abuse in their families of origin impacted their risk. In their broader social environments, homelessness, lacking resources – primarily health insurance – and lost economic opportunities (related to aging as women) influenced risk. However, across these levels, women also expressed resiliency, too. For example, participating in research was both therapeutic and a form of resistance: “I want to get my story out there. . . I want to help other people. . . just to say, you’ve got to stand up for yourself.”

Conclusions and Implications: Women often fought a tension between ascribing to and veering from sexually risky gender norms. Social workers can identify when and how women veer from sexually risky gendered expectations and build upon women’s resiliency factors in helping them develop plans for their sexual safety, particularly in the context of intimate partner violence and across the levels of their social ecology.