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Wenzel et al. (2004) conducted structured interviews with two stratified random samples of women – 460 women residing in shelters and 438 women residing in low-income housing – in Los Angeles County. Even when controlling for demographics, they found that sheltered women, in comparison with housed women, were more likely to report experiences of physical and sexual violence, HIV risk behavior, substance use and disorder, and the co-occurrence of these problems over the preceding year. On the basis of these findings, Wenzel and colleagues encourage clinicians to differentiate among subgroups of indigent women in the planning of interventions.
The significantly higher rates of health threats among women living in shelter situations suggest that these women urgently need services to simultaneously enhance their HIV protective behaviors, reduce their alcohol and drug use, reduce their risk of being victimized, and address any negative physical or psychological impacts of having been previously victimized. For women entering shelters, screening and assessment for violent experiences and substance use could be instituted, and screening must be followed by appropriate referrals to services and safeguards against excluding women from eligibility for shelter services in the case of positive screens. Ideally, appropriate services would be provided to women in-house, ... [since t]he group setting of the shelter may facilitate the more intensive services that women in these settings need ... and is an ideal one for instructional activities in HIV risk reduction as well as education on the co-occurrence of HIV risk, violence, and substance use. (p. 622)
Harvey and Bird (2004) focused on the connection between power in heterosexual relationships and sexual decision-making through exploratory interviews involving two samples: 22 young, African-American women at risk for HIV/sexually transmitted diseases (STDs) and their male partners; and an additional 40 young, African-American women at risk for HIV/STDs without their partners. As for what makes women feel powerful in their relationships with a husband or partner, four themes were identified: 1) the link between relationship power and having control/making unilateral decisions; 2) power derived from money, education, and/or physical attractiveness; 3) power derived from feeling nurtured/cared for by one's partner; and 4) sharing sexual decision-making – and thus sharing power – with one's partner. Harvey and Bird go on to observe that
[c]ultural beliefs about women's feelings of power in relationships could be addressed in the design of interventions … intended to reduce HIV/STD transmission among young African American women. For example, if women believe that having goals, making decisions for themselves, and being able to provide for their families are important sources of power, then providing access to job and skills training and professional development may enhance women's feelings of power and, in turn, support … prevention behaviors. Similarly, given that having strong, secure relationships with their partners is believed to be an important source of … power, and that many women appear to make sexual decisions jointly with their partners, then building and strengthening … relationships could prove to be an important strategy for disease prevention. (p. 17)
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Winter 2005 Newsletter / Volume 6, Issue 2
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