Relationship Dynamics as Inconsistent Mediators of Traumatic Stress and Condomless Sex Among Jail-detained Women

Abstract

Incarcerated women, especially women in jail, are at high risk for HIV and other sexually transmitted diseases. Research is needed to establish the key predictors of risk behavior, so that these can be targeted in interventions. Traumatic stress, substance use and intimate relationship dynamics likely influence infection and transmission risk among incarcerated women; however, these effects are not well understood. The author tested a model, based in Social Action Theory, of the effects of traumatic stress on condomless sex through the mediators of relational anxiety, relationship power, relationship closeness, and substance use. Jail-detained women who reported having a main sex partner in the three months prior to their arrest were interviewed (N = 205). The original model, accounting for 28% of the variance in condomless sex, had acceptable fit and found evidence for the effects of all factors except substance use. A better fitting model that re-specified effects of relationship power leading to substance use and substance use leading to relationship closeness was also supported, with all paths significant. Finally, a simplified model excluding substance use was tested and demonstrated almost identical fit and beta values. Results suggest that traumatic stress among jail-detained women impacts condom use within main partnerships through divergent effects on closeness and power in the relationship. This may obscure the importance of traumatic stress on condomless sex when these pathways are omitted in statistical analyses. The results have compelling implications, but they require replication, especially given the limitations of cross-sectional data and retrospective reporting. Ultimately, interventions aimed at alleviating traumatic stress among women involved in the criminal justice system should consider evaluating relationship dynamics and sexual health practices.