Title: Safe Sex Communication between Women and their Stable Partners in the Dominican Republic
Description: Aside from sub-Saharan Africa, the Caribbean is the only region where the number of women and girls living with human immunodeficiency virus (HIV) is greater than that of men and boys. In the Dominican Republic (DR), the number of all diagnosed HIV cases that were women increased from 27% in 2003 to 51% in 2013, which indicates a shift in the burden of HIV from men to women. Women in stable relationships in the DR have risk for HIV and other sexually transmitted infections (STIs) related to high rates of multiple concurrent partners and low condom use among stable partners. Past HIV prevention efforts in the DR have largely focused on encouraging consistent condom use. However, this may not be a feasible solution for women in relationships. In this dissertation, I sought to examine safe sex communication (SSC) as a possible alternative to consistent condom use for HIV/STI prevention among women in stable heterosexual relationships in DR. I began by conducting an integrative literature review and identified multiple relationship, individual, and partner factors related to SSC among Latina women in stable relationships.

Then I conducted a mixed methods study guided by the Theory of Gender and Power with women in stable heterosexual relationships who seek care at Clínica de Familia La Romana in the DR. First, I conducted a qualitative descriptive study to describe SSC. Emergent content analysis of eleven interview transcripts following Colaizzi’s method revealed two main themes: (1) Context of sexual risk (i.e., the meaning of safe sex for stable partners, behaviours related to sexual risk, beliefs and attitudes related to sexual risk, confianza (trust) between stable partners, economic power within relationships, and learning to manage safe sex within a stable relationship) and (2) SSC (i.e., reasons to talk about safe sex, methods, content, and outcomes, influential factors, and ideas for improvement). Second, I conducted a cross sectional survey with 100 women to identify psychosocial correlates of SSC. The mean age of women was 35.72 years, average relationship length was 8.5 years, and 46.91% were living with HIV.

Logistic regression analysis revealed that lower SSC self-efficacy (OR = 0.20, 95% confidence interval = 0.08 – 0.50) and greater difference in age between partners (OR = 0.91, 95% confidence interval = 0.85 – 0.98) were both significantly related to less SSC. Information from this dissertation can be used to help identify women in the DR who are at risk for poor SSC with their stable partners and guide researchers, health care providers, and other individuals involved in efforts to reduce HIV/STI risk among this population to develop more effective interventions for this population. Future research should determine which safe sex behaviors SSC is related to among Latina women with stable partners, as well as which aspects of SSC can be generalized to women of all Latino subcultures and nationalities. Additionally, more information is needed about the male partner’s role in SSC within their stable relationship and what factors influence partner SSC among Latino men in stable relationships.