EXAMINING SYMPTOMS OF DEPRESSION, SILENCING THE SELF, SEXUAL RELATIONSHIP POWER AND HIV VULNERABILITY AMONG AFRICAN AMERICAN WOMEN IN THE SOUTHERN UNITED STATES

Abstract

Background. HIV remains a serious concern among women in the United States (U.S.). Nineteen percent (19%) of new diagnoses are among women and the vast majority (84%) are attributed to heterosexual contact. African American women (AAW) represent 67% of all new cases of HIV among women in the Southern United States (U.S.), a significant disparity given AAW make up only 22% of the population in the South. Power differentials within relationships, referred to as sexual relationship power (SRP), may impact AAW as they make decisions about their sexual health. While navigating relational and social dynamics, women may develop psychological distress and coping mechanisms such as depression and silencing the self (STS), respectively. Understanding how depression, STS, and SRP are related and impact HIV vulnerability in this population of women may be key in developing targeted HIV prevention strategies. Illuminating factors associated with HIV vulnerability among African American women that are potentially amenable to change is critical for informing targeted HIV prevention strategies and ending the HIV epidemic. Purpose. The purpose of this research was to examine the influence of depressive symptoms, silencing the self (STS), and sexual relationship power (SRP) on the HIV vulnerability of AAW in the South. The Theory of Gender and Power guided the study and informed the data collection and analysis. Methods. A cross-sectional descriptive study utilizing purposive and snowball sampling methods was used to examine the relationships between depressive symptoms, silencing the self, and sexual relationship power on HIV vulnerability among AAW in the South. Five survey tools were used to capture respondents' information regarding depressive symptoms (PHQ-9), silencing the self (Silencing the Self Scale; STSS), sexual relationship power (Sexual Relationship Power Scale; SRPS); HIV knowledge (HIV Knowledge Questionnaire; KQ-18); and HIV vulnerability (Safe Sex Behavior Questionnaire; SSBQ) among AAW residing in the Southern U.S. Results. The findings reveal that all of the participants acknowledged some level of depressive symptoms (100%) as measured by the PHQ-9 tool, with 80.4% of participants reporting that they experience minimal to mild depressive symptoms and 19.7% participants reporting moderate to severe symptoms. The findings indicated that depressive symptoms and STS are associated in this sample of AAW. It was noted that as depressive symptoms increased, STS also increased, while SRP decreased. Thus, indicating women who felt more empowered within the spaces of their relationships exhibited less STS behaviors. Discussion. Vulnerability to HIV disproportionately affects AAW in the Southern U.S. The Theory of Gender and Power provided a lens for examining the impact of depressive symptoms, STS, and SRP among this group of AAW residing in Southern U.S. Implications of this study include clear indications of a need to increase mental health awareness, address the behavior of silencing the self, and intervene to reduce depressive symptoms among this population of women. Nurses are uniquely positioned to interact with AAW in the healthcare arena as the first contact with the patient. Increased use of screening tools such as the PHQ-9 at provider visits to detect those AAW who are experiencing depressive symptoms may assist with initiating therapy and/or referrals for mental health care. Awareness of the impact gender and power has in women's relationships can optimize HIV prevention efforts among women. Ultimately, these findings are useful in informing future nursing research and practice with HIV prevention interventions aimed at optimizing the health of AAW who are vulnerable to HIV.