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Klein, Elifson, and Sterk (2007) interviewed 250, primarily African American, women "at risk" for HIV infection and living in metropolitan Atlanta, Georgia, "to explore the relationship between childhood neglect experiences, self-esteem, attitudes toward condom use, and involvement in HIV-related risky behaviors" (p. 39). "Among the most … important findings … are those pertaining to the specific role that childhood neglect experiences play in adversely affecting the outcomes studied. As hypothesized, being neglected led to diminished self-esteem, adhering to more negative attitudes toward condom use, and involvement in a greater number of HIV-related risk behaviors" (p. 48).
The investigators speculate that
[o]ne of the uniquely harmful aspects of being neglected is the implied message that one does not matter, that one's needs – like oneself – are insufficiently important to be attended to. In situations of neglect, the people who ordinarily would discipline or take care of the child simply do not care enough about that person to invest the physical or emotional energy required to interact with him/her. ... By being treated in a manner that conveys no sense of mattering to others and no sense of worth, many neglected persons fail to develop any true sense of self-esteem (i.e., neither poor nor good self-esteem is developed, since the person becomes disinclined to think in terms of him/herself) and, therefore, invest no value in themselves or their futures. Under such circumstances, it is entirely foreseeable that ... such persons would think of condoms in a negative way, that they would engage in high rates of risky behaviors, and so forth. To them, taking risks and the future are, ostensibly, irrelevant. For such persons, having sex with someone or engaging in other types of risky behavior may be a way of establishing a human connection – a way of trying to fill the emotional void created by having been neglected. (p. 49)
Klein and colleagues conclude that "[b]y ... help[ing] persons with low-self-esteem and/or neglect in their backgrounds to deal with their residual emotional and psychosocial issues, ... [clinicians] will, in all likelihood, be more effective at changing the belief and attitude structures that underlie involvement in risky behaviors and more effective at bringing about reductions in the risky behaviors themselves" (p. 49).
Cole, Logan, and Shannon (2007) examined sexual risk behavior among a sample of 673 women who had obtained protective orders against violent male partners.
There are three main findings from this study: (1) Severity of physical violence and length of relationship were associated with riskier sexual behavior, after controlling for other factors; (2) Most women with recent partner violence experiences who had obtained protective orders are exposed to risk for HIV through their inconsistent condom use with partners (particularly their abusive partners) who are engaging in high-risk behaviors; and (3) Substance abuse and dependence were positively associated with higher sexual risk behavior. (pp. 108-109)
Interestingly, 22% of the women in this sample engaged in extrarelational sexual activity and "the majority of women who had sex with individuals other than their abusive partner in the past year did not consistently use condoms with those sex partners" (p. 110). Cole and colleagues emphasize that clinicians working
with women who are contemplating leaving partners, or who are in the process of terminating a relationship, or who have recently terminated relationships with abusive partners [should] assess the women's perceptions about level of risk with new partners. Moreover, it is particularly important that women adopt safer sexual practices with partners in the beginning of their relationships because evidence indicates that it is easier to establish a pattern of safer sexual practices at the onset of a relationship than it is to adopt these practices in an established relationship after couples have engaged in riskier behavior ... . (p. 110)
On two occasions spaced 1 year apart, Fitzgerald, Lundgren, and Chassler (2007) assessed factors associated with HIV risk behaviors among 185 women who had a history of injecting drug use. Risk behaviors included injecting drugs during the preceding 6 months, sharing needles during the preceding 6 months, and engaging in unprotected sex during the preceding 30-day period. The investigators found that "living with a spouse at year one was significantly and positively associated with high-risk behaviours at both time points. Being prescribed medications for psychological or emotional problems … [and] testing positive for ... HIV ... were significantly and negatively associated with reporting high-risk behaviours at both time points" (p. 67). These findings
suggest that spousal relationships can expose women to HIV/AIDS risky behaviours[,] while HIV ... testing and prescription of psychiatric medication may help to protect women from these … risks. Given these findings, future design and implementation of prevention and treatment efforts targeting women at risk for HIV/AIDS should address women's empowerment, social status and interpersonal relationship issues, as well as include comprehensive health services. These comprehensive health services should include appropriate mental health diagnosis and treatment as well as HIV ... testing. (p. 72)
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Spring 2007 Newsletter / Volume 8, Issue 3
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