Objectives: This study explores the contribution of psychosocial factors on sex behaviors of midlife and older women. Methods: A community-based sample of ethnically diverse women (N = 572) between the ages of 50 and 93 completed standardized measures of self-silencing, self-esteem, sensation-seeking behavior, HIV-related stigma behavior, sexual assertiveness, and safer sex behaviors. Results : Results from the regression analysis indicated the model significantly predicted safer sex behaviors (p < .001), with self-silencing (β = —.115, p < .05) and age (β = .173, p < .001) as significant predictors. Bivariate correlation analysis indicated an inverse correlation between HIV stigma (p < .05) and safer sex behaviors. Discussion: Implications for further study and practice are discussed to include considerations for development of age- and gender-appropriate prevention interventions assisting women with interpersonal processes combined with skills for active involvement in addressing high-risk sex behaviors.
AIDS Community Research Initiative. (2008). HIV health literacy ACRIA update: Older women and HIV. Retrieved April 6, 2008, from http://www.acria.org/treatment/treatment_edu_winterupdate2008_older.html
2.
Akers, A.Y., Bernstein, L., Doyle, J., & Corbie-Smith, G. (2008). Older women and HIV testing: examining the relationship between HIV testing history, age, and lifetime HIV risk behaviors. Sexually Transmitted Diseases, 35, 420-423.
3.
Amaro, H., & Raj, A. (2000). On the margin: Power and women's HIV risk reduction strategiesSex Roles, 42, 723-749.
4.
Bancroft, J., Janssen, E., Carnes, L., Goodrich, D., Strong, D., & Long, J.S. (2004). Sexual activity and risk taking in young heterosexual men: The relevance of sexual arousability, mood, and sensation seeking. Journal of Sex Research, 41, 181-192.
5.
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
6.
Bauman, L.J., Stein, R.E., & Ireys, H.T. (1991). Reinventing fidelity: The transfer of social technology among settings. American Journal of Community Psychology, 19, 619-639.
7.
Belcher, L., & Kalichman, S. (1998). A randomized trial of a brief HIV risk reduction counseling intervention for women. Journal of Counseling and Clinical Psychology, 66, 856-861.
8.
Bowleg, L., Belgrave, F.Z., & Riesen, C.A. (2000). Gender roles, power strategies, and precautionary sexual self-efficacy: Implications for Black and Latina women's HIV/AIDS protective behaviors. Sex Roles, 42, 613-635.
9.
Bradley, G., & Wildman, K. (2002). Psychosocial predictors of emerging adults' risk and reckless behaviors. Journal of Youth and Adolescence, 31, 255-265.
10.
Bronfenbrenner, U. (1977). Toward an experimental ecology of human development . American Psychologist, 32, 513-531.
11.
Brown, L., Macintyre, K., & Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15(1), 49-69.
12.
Carr, D., House, J.S., Kessler, R., Neese, R., Sonnega, J., & Wortman, C. (2000). Marital quality and psychosocial adjustment to widowhood among older adults: A longitudinal analysis. Journal of Gerontology, Social Sciences, 55B, S197-S207.
13.
Casteñada, D. (2000). HIV/AIDS-related services for women and the rural community context. AIDS Care, 12, 549-565.
14.
Centers for Disease Control and Prevention. ( 2007). HIV/AIDS Surveillance Report 2005 (Rev. ed.), 17. Retrieved March 17, 2008, from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/
15.
Connell, R.W. (1987). Gender and power. Stanford, CA: Stanford University Press.
16.
Coon, D., Lipman, P.D., & Ory, M. (2003). Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older. Journal of Acquired Immune Deficiency Syndromes, 33, 194-205.
17.
Crawford, I., Hammack, P.L., McKirnan, D.J., Ostrow, D., Zamboni, B.D., & Robinson, B., et al. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships . AIDS Care, 15, 513-524.
18.
Dancy, B. (1996). What African-American women know, do, and feel about AIDS: A function of age and education. AIDS Education and Prevention, 8(1), 26-36.
19.
DeMarco, R.F., Miller, K.H., Patsdaughter, C.A., Grindel, C.G., & Chisholm, M. (1998). From silencing the self to action: Experiences of women living with HIV/AIDS. Health Care for Women International , 19, 539-552.
20.
DiClemente, R.J., & Wingood, G.M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 274, 1271-1276.
21.
DiIorio, C., Parsons, M., Lehr, S., Adame, D., & Carlone, J. (1992). Measurement of safe sex behavior in adolescents and young adults. Nursing Research, 41, 203-208.
22.
Donohew, L., Zimmerman, R., Cupp, P.S., Novak, S., Colon, S., &Abell, R. (2000). Sensation seeking, impulsive decision-making, and risky sex: implications for risk-taking and design of interventions. Personality and Individual Differences, 28, 1079-1091.
23.
Emlet, C.A. (2005). Measuring stigma in older and younger adults with HIV/AIDS: An analysis of an HIV stigma scale and initial exploration of subscales . Research on Social Work Practice, 15(4), 291-300.
24.
Emlet, C.A. (2007). Extending the use of the 40-item HIV-stigma scale to older adults: An examination of reliability and validity. Journal of HIV/AIDS & Social Services, 6(3), 43-54.
25.
Emlet, C.A., & Farkas, K.J. (2002). Correlates of service utilization among midlife and older adults with HIV/AIDS: The role of age in the equation. Journal of Aging Health, 14, 315-335.
26.
Emlet, C.A., & Farkas, K.J. (2001). A descriptive analysis of older adults with HIV/AIDS in California. Health and Social Work, 26, 226-234.
27.
Fauchald, S.K. (2004). The influence of self-esteem, self-silencing, and abuse on safer sex behaviors of rural women. Unpublished doctoral dissertation, Barry University, Miami.
28.
Fenaughty, A.M., & Fisher, D.G. (1998). High-risk sexual behavior among drug users: The utility of a typology of alcohol variables. Sexually Transmitted Diseases, 25(1), 38-43.
29.
Fowler, J.P. (2005). The well project: HIV and older women. Retrieved April 6, 2008, from http://www.thewellproject.org/en_US/Womens_Center/HIV_and_Older_Women.jsp
30.
Gaylord, S. (2001) Women and aging: A psychological perspective. In J. D. Garner & S.O. Mercer (Eds.), Women as they age (pp. 49-68). New York: Haworth.
31.
Gonzalez, R., Vassileva, J., Bechara, A., Grbesic S., Sworowski, L., Novak, R.M., et al. (2005). The influence of executive functions, sensation seeking, and HIV serostatus on the risky sexual practices of substance-dependent individuals. Journal of the International Neuropsychological Society, 11(2), 121-131.
32.
Gullette, D.L., & Lyons M. A. (2005). Sexual sensation seeking, compulsivity, and HIV risk behaviors in college students. Journal of Community Health Nursing, 22(1), 47-60.
33.
Hader, S.L., Smith, D.K., Moore, J.S., & Holmberg, S.D. (2001). HIV infection in women in the United States: Status at the millennium. Journal of the American Medical Association, 285, 1186-1192.
34.
Hartmann, U., Philippsohn, S., Heiser, K., & Ruffer-Hesse, C. (2004). Low sexual desire in midlife and older women: Personality factors, psychosocial development, present sexuality. Journal of Urology, 174, 263-264.
35.
Hoyle, R.H., Fejfar, M.C., & Miller, J.D. (2000). Personality and sexual risk taking: A quantitative review. Journal of Personality, 68, 1203-1231.
36.
Inungu, J.N., Mokotoff, E.D., & Kent, J.B. (2001). Characteristics of HIV infection in patients fifty years or older in Michigan. AIDS Patient Care & STDs, 15, 567-573.
37.
Jack, D.C. (1991). Silencing the self: Women and depression. New York: Harper Perennial.
38.
Jack, D.C., & Dill, D. (1992). The silencing the self scale: Schemas of intimacy associated with depression in women. Psychology of Women Quarterly , 16, 97-106.
39.
Jones, R. (2004). Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young urban women. Research in Nursing & Health, 27, 185-197.
40.
Kalichman, S.C., & Cain, D. (2004). A prospective study of sensation seeking and alcohol use as predictors of sexual risk behaviors among men and women receiving sexually transmitted infection clinic services. Psychology of Addiction Behavior, 18, 367-373.
41.
Kalichman, S.C., Cain, D., Zweben, A., & Swain, G. (2003). Sensation seeking, alcohol use and sexual risk behaviors among men receiving services at a clinic for sexually transmitted infections. Journal of Studies on Alcohol, 64, 564-569.
42.
Kalichman, S.C., Heckman, T., & Kelly, J.A. (1996). Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior. Archives of Sexual Behavior, 25, 141-154.
43.
Kalichman, S.C., Simbayi, L.C., Jooste, S., Toefy, Y., Cain, D., Cherry, C. et al. (2005). Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS and Behavior, 9(2), 135-143.
44.
Kelly, A.B., Masterman, P.W., & Marlatt, G.A. (2005). Alcohol-related associative strength and drinking behaviours: Concurrent and prospective relationships. Drug and Alcohol Review, 24, 489-498.
45.
Lindau, S.T., Leitsch, S.A., Lundberg, K.L., & Jerome, J. (2006). Older women's attitudes, behavior, and communication about sex and HIV: A community-based study. Journal of Women's Health, 15, 747-753.
46.
Lindau, S.T., Schumm, L.P., Laumann, E.O., Levinson, W., O'Muircheartaigh, C.A., & Waite, L.J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762-774.
47.
Mack, K.A., & Ory, M.G. (2003). AIDS and older Americans at the end of the twentieth century. Journal of Acquired Immune Deficiency Syndromes, 33(Suppl. 2), S68-S75.
48.
Marks, G., Crepaz, N., Senterfitt, J.W., & Janssen, R.S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39, 446-453.
49.
Meuris, S. (2007). Elderly people's sexuality. Revue Medicale de Bruxelles, 28, 356-358.
50.
Montgomery, J.P., Mokotoff, E.D., Gentry, A.C., & Blair, J.M. (2003). The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care, 15, 829-837.
51.
Montoya, I.D., & Whitsett, D.D. (2003). New frontiers and challenges in HIV research among older minority populations. Journal of Acquired Immune Deficiency Syndromes, 33, 218-221.
52.
Morokoff, P.J., Quina, K., Harlow, L.L., Whitmire, L., Grimley, D.M., & Gibson, P.R., et al. (1997). Sexual Assertiveness Scale (SAS) for women: Development and validation. Journal of Personality and Social Psychology, 73, 790-804.
53.
Neundorfer, M.M., Harris, P.B., Britton, P.J., & Lynch, D.A. (2005). HIV-risk factors for midlife and older women. The Gerontologist, 45, 617-625.
54.
National Council on the Aging. (2000). Sex after 60: A natural part of life survey. Retrieved May 22, 2005, from http://206.112.84.147/content.cfm?sectionID=109&detail=134
55.
Noar, S.M., Carlyle K., & Cole, C. (2006). Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use. Journal of Health Communication, 11, 365-390.
56.
Neely-Smith, S. (2003). The influence of self-esteem and self-silencing on self efficacy for negotiating safer sex behaviors in urban Bahamian women . Doctoral dissertation, Barry University, Miami, FL. (UMI Number 3093267).
57.
Neundorfer, M.M., Harris, P.B., Britton, P.J., & Lynch, D.A. (2005). HIV-risk factors for midlife and older women. The Gerontologist, 45, 617-25.
58.
Noar, S.M., Morokoff, J., & Redding, C.A. (2002). Sexual assertiveness in heterosexually active men: A test of three samples. AIDS Education and Prevention , 14, 330-342.
59.
Paranjape, A., Bernstein, L., St George, D.M., Doyle, J., Henderson, S., & Corbie-Smith, G.J. (2006). Effect of relationship factors on safer sex decisions in older inner-city women. Women's Health, 15(1), 90-97.
60.
Padian, N.S., Shiboski, S.C., Glass, S.O., & Vittinghoff, E. (1997). Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: Results from a ten-year study. American Journal of Epidemiology, 146, 350-357.
61.
Pinquart, M., & Sorensen, S. (2001). Gender differences in self-concept and psychological well-being in old age: A meta-analysis. Journal of Gerontology: Psychological Sciences, 56, 195-213.
62.
Pirkle, E.C., & Richter, L. (2006). Personality, attitudinal and behavioral risk profiles of young female binge drinkers and smokers. Journal of Adolescent Health, 38(1), 44-54.
63.
Poirot, C. (2002). Risk of AIDS rising for older adults. In CDC HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis Prevention News Update. Retrieved May 14, 2005, from http://www.thebody.com/cdc/news_updates_archive/nov11_02/older_adults_aids.html
64.
Quandt, S.A., McDonald, J., Arcury, T.A., Bell, R.A., & Vitolis, M.Z. (2000). Nutritional self-management of elderly widows in rural communities. The Gerontologist, 40, 86-96.
65.
Quina, K., Harlow, L.L., Morokoff, P.J., & Burkholder, G. (2000). Sexual communication in relationships: When words speak louder than actions. Sex Roles , 42, 523-549.
66.
Rickert, V.I., Sanghvi, R., & Wiemann, C.M. (2002). Is lack of sexual assertiveness among adolescent and young adult women a cause for concern? Perspectives in Sex and Reproductive Health, 34, 178-183.
67.
Robinson, J.G., & Molzahn, A.E. (2007). Sexuality and quality of life. Journal of Gerontological Nursing, 33(3), 19-27.
68.
Rolison, M.R., & Scherman, A. (2003). College student risk-taking from three perspectives . Adolescence, 38, 689-704.
69.
Rosenberg. M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
70.
Satcher, A.J., Durant, T., Hu, X., & Dean, H.D. (2007). AIDS cases among women who reported sex with a bisexual man, 2000-2004-United States. Women Health, 46(2-3), 23-40.
71.
Savasta, A. (2004). HIV: Associated transmission risks in older adults-An integrative review of the literature. Journal of the Associated of Nurses in AIDS Care, 15(1), 50-59.
72.
Schable, B., Chu, S.Y., & Diaz, T. (1996). Characteristics of women 50 years of age or older with heterosexually acquired AIDS. American Journal of Public Health, 86, 1616-1618.
73.
Schackman, B.R., Gebo, K.A., Walensky, R.P., Losina, E., Muccio, T., & Sax, P.E. et al. (2006). The lifetime cost of current human immunodeficiency virus care in the United States, Medical Care, 44, 990-997.
74.
Sherman, S.G., Gielen, A.C., & McDonnell, K.A. (2000). Power and attitudes in relationships (PAIR) among a sample of low-income, African-American women: Implications for HIV/AIDS prevention. Sex Roles, 42, 283-294.
75.
Simoni, J.M., Walters, K.L., & Nero, D.K. (2000). Safer sex among HIV+ women: The role of relationships . Sex Roles, 42, 691-708.
76.
Smith, G.E., Gerrard, M., & Gibbons, F.X. (1997). Self-esteem and the relation between risk behavior and perceptions of vulnerability to unplanned pregnancy in college women. Health Psychology, 16(2), 137-146.
77.
Somlai, A.M., Kelly, J.A., Heckman, T.G., Hackl, K., Runge, L., & Wright, C. (2000). Life optimism, substance use, and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged inner city women. Journal of Women's Health and Gender-Based Medicine , 9, 1101-1111.
78.
Somlai, A.M., Kelly, J.A., McAuliffe, T.L., Gudmundson J.L., Murphy, D.A., Sikkema, K.J., et al. (1998). Role play assessments of sexual assertiveness skills: Relationships with HIV/AIDS sexual risk behavior practices. AIDS and Behavior, 2, 319-328.
79.
Soler, H., Quadagno, D., Sly, D.F., Riehman, K.S., Eberstein, I.W., & Harrison, D.F. (2000). Relationship dynamics, ethnicity and condom use among low-income women. Family Planning Perspectives, 32(2), 82-88, 101.
80.
Sormanti, M., & Shibusawa, T.J. (2007). Predictors of condom use and HIV testing among midlife and older women seeking medical services. Journal of Aging Health, 19, 705-719.
81.
Stampley, C.D., Mallory, C., & Gabrielson, M. (2005). HIV/AIDS among midlife African American women: An integrated review of literature. Research in Nursing & Health, 28, 295-305.
82.
Thompson, J.C., Kao, T.C., & Thomas, R.J. (2005). The relationship between alcohol use and risk-taking sexual behaviors in a large behavioral study. Preventive Medicine , 41(1), 247-52.
83.
van Baarsen, B. (2002). Theories on coping with loss: The impact of social support and self-esteem on adjustment to emotional and social loneliness following a partner's death in later life. Journal of Gerontology: Psychological Sciences, 57(1), 33-42.
84.
Wechsler, H., Lee, J.E., Kuo, M., Seibring, M., Nelson, T.F., & Lee, H. (2002). Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health college alcohol study surveys: 1993-2001. Journal of American College Health, 50, 203-217.
85.
Weinhardt, L.S., Carey, M.P., Carey, K.B., & Verdecias, R.N. (1998). Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness. Journal of Consulting and Clinical Psychology , 66, 680-684.
86.
Widman, L., Welsh, D.P., McNulty, J.K., & Little, K.C. (2006). Sexual communication and contraceptive use in adolescent dating couples. Journal of Adolescent Health, 39, 893-899.
87.
Wingood, G.M., & DiClemente, R.J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27, 539-565.
88.
Wingood, G.M., & DiClemente, R.J. (1998). Pattern influences and gender-related factors associated with noncondom use among young adult AfricanAmerican women. American Journal of Community Psychology , 26(1), 29-52.
89.
Witte, T.H., & Sherman, M.F. (2002). Silencing the self and feminist identity development . Psychological Reports, 90, 1075-1083.
90.
Wolitski, R.J., Jones, K.T., Wasserman, J.L., & Smith, J.C. (2006). Self-identification as "down low" among men who have sex with men (MSM) from 12 US cities. AIDS Behavior, 10, 519-529.
91.
Zablotsky, D., & Kennedy, M. (2003). Risk factors and HIV transmission to midlife and older women: Knowledge, options, and initiation of safer sex practices. Journal of Acquired Immune Deficiency Syndromes, 33, 122-130.
92.
Zuckerman, M. (1979). Sensation seeking: Beyond the optimal level of arousal. Hillsdale, NJ: Lawrence Erlbaum.
93.
Zuckerman, M. (1994). Behavioral expression and biosocial bases of sensation seeking. New York: Cambridge University Press.
94.
Zuckerman, M., Eysenck, S.B.J., & Eysenck, H.J. (1978). Sensation seeking in England and America: Cross-cultural, age, and sex comparisons. Journal of Consulting and Clinical Psychology, 46, 139-149.
