Dianne F. Harrison

Relationship dynamics ethnicity and condom use among low-income women.

CONTEXT Womens protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use. METHODS Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms. RESULTS Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently. CONCLUSIONS HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Advancement for Women in Hierarchical Organizations: A Multilevel Analysis of Problems and Prospects

Womens problems and prospects for advancement to upper level positions in hierarchical organizations are analyzed within a five-level framework of social organization. The five levels are (1) societal; (2) institutional; (3) organizational; (4) role; and (5) individual. Corresponding units of analysisfor each level are identified and discussed. To illustrate the framework, two problems confronting women are identified for each level, along with possible corrective actions. Conclusions are that (1) fundamental change in womens status in hierarchical work organizations will require simultaneous efforts on all five levels of social organization; (2) change in any realm requires political action against ideological justifications and claims for womens exclusion; and (3) the division of labor between the sexes in relation to work and child/family/home responsibilities must change before women can receive equitable treatment in the workplace. The authors call for more research on the interrelations between influences and factors across levels of social organization.

THE MULTIPLE JEOPARDY OF RACE, CLASS, AND GENDER FOR AIDS RISK AMONG WOMEN:

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk (frequency of condom use) and gender (decision making with regard to condom use and gender attitudes) are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome (AIDS), a quite contemporary awareness of womens gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus (HIV). The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection.

The association between substance use condom use and sexual risk among low-income women.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

Factors associated with use of the female condom.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

CONTEXT Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of womens background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS Both womens individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and womens control over economic decision-making ensure greater protection against HIV infection.

Ethnic Differences in Sexual Decisions and Sexual Behavior

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Women in Social Work Education: Progress or Promise?

Abstract The literature on the status of female social work educators has addressed the problems these educators face in the areas of salaries, academic rank and tenure, publication rates, and level of decision making. Given this attention to the status of these educators, one might expect positive resolutions to these problems. This article, which is based on a review of both the current literature and statistics on US social work faculty, evaluates the status of women faculty in social work academia to determine if progress has been made. Findings reveal that female educators are seeing slow improvment in some areas; however, inequalities continue. The authors suggest strategies for supporting the development and retention of women faculty.

Doctoral Research on Social Work Practice: A Proposed Agenda

Abstract This paper discusses various issues relevant to direct practice and/or clinical dissertations in social work. Specific requirements for such dissertations are proposed, including the suggestions that the research have direct applications for the improvement of practice methods and that dissertations in social work should be distinguished from those in related areas. Issues related to the role of supervisory faculty and curriculum needs are also explored. The authors express a decided preference for experimental outcome studies which evaluate the efficacy of social work interventions, and propose a national research agenda among social work doctoral programs to foster such research.

Faculty Hiring in Social Work: Dilemmas for Educators or Job Candidates?

Abstract The paper reports the results of a national survey completed in 1986 which identified factors affecting recruitment and hiring decisions in graduate and undergraduate schools of social work. A total of 387 responses were received. Implications for job candidates and faculty are discussed.