Empowerment and Condom Use Among Mexican and Mexican American Women in Illinois

Abstract

This study used a survey of 218 Mexican women living in Illinois to test if measures of women’s empowerment in the economic, sociocultural, interpersonal/relational, and political dimensions influenced condom use. Our findings revealed that sociocultural and political forms of empowerment were significantly correlated with condom use. More specifically, women who were allowed to leave the house to visit friends without their husband/partner’s permission, had a cell phone, worked for or contributed to a political campaign, participated in a public meeting, and voted were more likely to use condoms with their husband or partners than other women. In addition, women who were younger and completed the survey in English were also more likely to use condoms. However, neither women’s economic nor interpersonal empowerment in their romantic relationship influenced condom use. Thus, women’s general empowerment may be a crucial preamble to safe sex.

Keywords

HIV prevention Latinas Mexican women social empowerment political empowerment

In 2005, HIV/AIDS was the fourth leading cause of death among Hispanic/Latino men and women aged 35 to 44 in the United States (CDC Division of HIV/AIDS Prevention, 2008). Although during recent years Hispanics or Latinos accounted for 14% of the total population living in the United States, in 2006 they represented 19% of the total number of new AIDS cases (CDC Division of HIV/AIDS Prevention, 2008). In addition, women around the world, including Latinas, have been disproportionally affected by HIV (Galanti, 2003), and most of these women are at risk of HIV infection because of heterosexual contact (Castaneda, 2000). Based on a survey of 218 Mexican women conducted in the state of Illinois in 2011, this article hypothesized that the level of empowerment of women in the economic, sociocultural, familial/interpersonal, and political dimensions could impact condom use.

This article concentrates on Mexicans because this group encompasses 18.3 million of the foreign-born people living in the United States (U.S. Census Bureau, 2009) and faces a number of structural barriers that make people within this group especially vulnerable. In addition, 40% of Latinos living in the United States were born in a different country (U.S. Census Bureau, 2009) and many of them have poor English language skills. Therefore, persons of Mexican descent in the United States are in a vulnerable situation that affects their living conditions in general and their HIV vulnerability in particular (Albarracin & Plambeck, 2010). In addition, 1,864,582 Latinos were living in Illinois in 2000, representing almost 15% of the total population of the state (U.S. Census Bureau, 2009). Furthermore, since 2000, the Latino population in Illinois has been increasing at an unprecedented pace. For instance, there has been a noticeable growth of the Latino population in urbanized areas, with an 11% growth in Cook County and almost 41% growth in several counties surrounding Chicago, the places where some of our interviews took place.

The most comprehensive meta-analysis on the factors shaping condom use among Latinos and Latin Americans (Albarracin, Albarracin, & Durantini, 2008) showed that most theory-based behavioral interventions are ineffective in increasing condom use among Latinas. For instance, Latina and Latin American females responded favorably only to threat-inducing arguments but decreased condom use when other strategies were used (Albarracin et al., 2008). Furthermore, the emphasis on prevention to encourage condom use makes it ineffective not only because the decision to use condoms is largely controlled by males (Amaro & Raj, 2000; Raj, Silverman, & Amaro, 2004) but also because prevention strategies that include condom-use-skills training seem to decrease condom use among women (Albarracin et al., 2008) and can put women at an increased risk of violence (Jenkins, 2000).

Another branch of research emphasizes the role of culture and gender roles/beliefs in HIV/AIDS prevention (Amaro, 1988; Amaro & Raj, 2000; Gómez & Marín, 1996). For example, these works have emphasized the role of Machismo and Marianismo in discouraging women’s negotiation skills in the relationship, male sexual restraint, and open talks about sexual issues and condom use negotiation. However, whereas these works focus on individual and sexual behaviors purportedly specific to Latino culture (Abel & Chambers, 2004; Amaro, 1988; Amaro & Raj, 2000; Gómez & Marín, 1996), most of them fail to consider that sexual behaviors are a part of the general lack of power affecting women in the economic, sociocultural, interpersonal/relational, and political dimensions (one notable exception is Amaro, 1995).

Different works have applied the idea of empowerment both to general health and HIV prevention (Bustamante-Gavino, Rattini, & Khan, 2011; Gómez, Hernandez, & Faigeles, 1999; Greig & Koopman, 2003; Gutierrez, Joo Oh, & Gillmore, 2000; Nitza, Chilisa, & Makwinja-Morara, 2010; Norwood, 2011; Rosenthal & Levy, 2010) and other contexts (Al-Dajani & Marlow, 2010; Malhotra, Schuler, & Boender, 2002), including family dynamics, family planning, and micro-credit, among others. Empowerment can be defined as “the process by which people, organizations, and communities gain mastery over their lives” (Rappaport, 1984, in Beeker, Guenther-Grey, & Raj, 1998) and we prefer it to that of “inequality” because the latter misses the point that transmission is relational (Edstrom, 2010). Because gender equality implies a society in which women and men enjoy the same opportunities, rights, and obligations (Bustamante-Gavino et al., 2011) and to avoid creating another typology of empowerment, this research follows a previously developed broad conception of empowerment that includes the economic, sociocultural, familial/interpersonal, and political spheres (Malhotra et al., 2002).¹ The purpose of this research was to determine if these dimensions of female empowerment influenced condom use.

Method

Participants

In this study, we recruited 218 Mexican women 18 years of age and older in Carpentersville, Chicago Heights, and Monmouth, Illinois, during the month of July 2011. The recruitment took place at three locations where the Mexican General Consulate in Chicago held its Mobile Consulates program. Through this program, the Mexican Consulate brings the services offered at its main office (passport and ID renewals, birth and death certificates, and dual nationality process, among others) to the locations where Mexican citizens live.

Procedures

Every woman who was married or in a relationship in the waiting area of the Mobile Consulates was invited to participate and the participation rate was about 80%. If women agreed to participate, they were read the consent form and asked to orally express their willingness to participate. All participants in this study were volunteers and received no compensation for their participation. Respondents were given the option of taking the survey either in Spanish or English, thus mitigating the effect of a potential language barrier. Finally, all of our interviewers were female, bilingual, and bicultural.

For the analysis of the data, we used linear regression analysis and thus selected the variables reflecting empowerment that significantly correlated with condom use. We then built a multivariate regression model with hierarchical entry of variables including first our control variables (age, education, relationship status, English reading skills, and the preferred language for the interview) and then the variables showing significant results in the regression analyses.

Measures

This study used one measure of condom use for main partners based on self-reported data reflecting how often participants used condoms with their main partner. The measure was posed as follows: How often do you use condoms when you have sex with penetration with your main partner? The possible responses were never (1), almost never (2), sometimes (3), almost always (4), and always (5). The study also included questions concerning condom use with secondary partner(s) that were excluded from this article.

Our structured interviews also included questions on the preferred language for the interview (Spanish, no difference, English), demographic characteristics, relationship status, English reading skills (from cannot read a book well at all to can read a book very well), as well as questions related to economic, sociocultural, familial/interpersonal, and political empowerment.

Economic equality

The set of questions related to money and finances included the following items, the last four of which draw on the General Social Survey: Do you work for pay? Response choices were yes (2), no (1), DK, and NA. If yes, how many hours a week? Responses were coded as part-time (1) or full-time (2). Which of the following comes closest to describing the system that you and your husband/partner use to organize the income that one or both of you receive? Possible answers were husband/partner manages all the money (1), woman has a housekeeping allowance (2), all the money is pooled (3), keep finances completely separate (4, later left out), woman manages all the money (4), and DK; NA. This question is about some of the financial decisions that you and your husband/partner may make. For each decision, please tell me how it was made the last time you faced the decision. The decisions were whether or not to buy furniture and whether or not to buy a car and the possible answers were husband/partner alone (1), husband/partner after consulting with woman (2), husband/partner and woman together (3), woman after consulting with husband/partner (4), woman alone (5), and DK; NA. The “don’t know” and “not available” answers were excluded from our variables and a higher number always reflected a greater degree of women’s power.

Sociocultural equality

Six items were meant to assess the degree social freedom of the woman (adapted from Malhotra et al., 2002): Which of the following comes closest to describing the system that you and your husband/partner use to decide when the woman needs to leave the house to run errands/visit friends? The possible answers were husband/partner decides when wife needs to leave the house to run errands/see friends (1), both woman and husband/partner decide when woman needs to leave the house to run errands/see friends (2), woman decides when she needs to leave the house to run errands/see friends (3), and DK; NA. Please indicate which places you have visited in the last month: supermarket, kids’ school, hairdresser, clothing store, church, pharmacy, a friend’s house, a relative’s house (Hashemi, Schuler, & Riley, 1996). Each of these questions was turned into a separate variable, no (1) and yes (2). Have you visited those places without your husband/partner, some alone and some with your husband, or mostly alone? Possible answers were with husband (1), some alone and some with your husband (2), and alone (3). Finally, the last two questions within this category were as follows: Do you drive? and Do you have a cell phone? The possible answers were yes (2) or no (1). The “don’t know” and “not available” answers were excluded from our variables and a higher number reflected a greater degree of women’s power.

Familial/interpersonal relations

The first set of questions related to the division of labor within the household and was taken from the General Social Survey: Who in the household cares for the sick, does the cleaning, prepares meals, plans meals, does the laundry? The possible answers to these questions were always the woman (1), usually the woman (2), about equal or both together (3), usually the man (4), always the man (5), is done by a third person (6, later excluded), can’t choose, and NA. Another set of four questions assessed the power in initiating sexual relations: Who usually initiates sexual relations? Possible responses were always the man (1), usually the man (2), about equal or both together (3), usually the woman (4), always the woman (5), can’t choose, and NA. When your husband/partner wants to have sexual relations and you are tired or not in the mood, what do you do? Response choices were as follows: always have sexual relations anyway (1), almost always have sexual relations anyway (2), sometimes have sexual relations anyway (3), almost never sexual relations when you are not in the mood (4), and never have sexual relations when you are not in the mood (4). Other questions addressed childbearing decisions (adapted from Malhotra et al., 2002): Who in the household decides when (and if) you are going to have a child (think about the kids you have)? Answers were always the man (1), usually the man (2), about equal or both together (3), usually the woman (4), always the woman (5), no one really decides (6, later excluded), can’t choose, and NA. Two questions were included that relate to use of contraception: Does the couple use contraception? Responses were yes (2) or no (1). Who makes the decisions regarding contraception? Options were always the man (1), usually the man (2), about equal or both together (3), usually the woman (4), always the woman (5), can’t choose (later excluded), and NA. Finally, the last section of familial/interpersonal questions included the following item on spouse selection: Which of the following best describes the way you selected your spouse/partner? The possible answers were as follows: the man decided (1), both the woman and the man decided it together (2), the woman decided (3), it was done by a third person (4, later excluded), can’t choose, and NA. The “don’t know” and “not available” answers were excluded from our variables and a higher number reflected a greater degree of women’s power.

Political participation

Respondents were also asked a number of questions from the national survey of Latinos conducted by the Pew Foundation regarding participation in different political activities, commonly used in political science to assess different degrees of involvement (e.g., contacting a public official shows a greater degree of political involvement than just voting). Participants were asked if in the last year they had contacted a public official, contributed money to a political candidate or worked as a volunteer or for pay for a political candidate, attended a public meeting or demonstration. In addition, our participants were asked if they are registered to vote, have voted in an election in the United States. The possible answers to all these questions were yes (2), no (1), DK, and NA. The “don’t know” and “not available” answers were excluded from our variables and a higher number reflected a greater degree of women’s power.

Results

Description of the Sample

Condom use with main partner

The reported levels of condom use with main partners were considerably low and only 16% of our participants reported using condoms almost always (6%) or always (10%). At the same time, the proportion of out participants who reported never (64%) or almost never using condoms with the main partner (9%) was 73%. Finally, the remaining 11% reported sometimes using condoms with their main partners. For a summary of the demographic characteristics of our sample, please see Table 1.

Table 1.

Sample: Selected Demographic Variables.

Variable	Statistic
Age
M	36.50
SD	9.50
Education
Less than high school	62.4% (136)
High school or more	36.7% (80)
NA	0.9% (2)
Relationship status
Married	69.0% (151)
Living with partner/in a relationship	31.0% (65)
English reading skills
Very well/pretty well	25.0% (56)
Just a little/not at all	75.0% (173)
Language of the interview
English	7.0% (15)
Spanish	89.0% (195)
Doesn’t make a difference	4.0% (10)
English reading skills
Just a little/not at all	78.0% (171)
Very well/pretty well	22.0% (48)
Kids
Has kids	89.0% (195)
Doesn’t have kids	11.0% (23)

Note. Actual number within parentheses.

Predictors of condom use

The aim of this article was to test the relation of condom use with economic, sociocultural, familial/interpersonal, and political empowerment. Five control variables were included in the full model, namely, age, education, relationship status, English reading skills, and preferred language for the interview (see Table 2). The linear regression with hierarchical entry of variables for condom use inclusive of the empowerment measures showed encouraging results when compared with our model with only the control variables (see Table 2). For example, the R² for the condom use model increased from .11 to .23 once the empowerment measures were included in the model.

Table 2.

Linear Regressions Predicting Condom Use for Main Partners.

	B
Variable	Model control	Condom use frequency
Age	−.13 (.01)*	−.26 (.01)**
Education	.01 (.20)	—
Relationship status (single vs. married)	−.18 (.22)**	—
English reading skills	.11 (.10)	—
Language of the interview	.07 (.21)	−.04 (.22)
Permission to visit friends (yes/no)		.20 (.21)**
Cell phone ownership (no/yes)		.01 (.31)
Volunteered/contributed political campaign (no/yes)		.09 (.54)
Attended a public meeting		.09 (.36)
Voted in an election		.22 (.42)***
R² and p less than within parentheses	.11 (.00)	.23 (.00)

Note. Standard errors within parentheses.

p < .10. **p < .05. ***p < .01.

Women who were younger and decided to answer the survey in English were more likely to use condoms than women who were older and preferred to do the interview in Spanish. Education, English reading skills, and relationship status were excluded from the final linear regression model with hierarchical entry of variables (see Table 2).

No indicators of economic empowerment showed a significant correlation with condom use, and therefore were excluded from our model. Two measures of sociocultural equality showed significant results, the system used to decide when the woman needs to leave the house to visit friends (needs permission vs. doesn’t need permission), and whether or not the woman had a cell phone (see Table 2). Specifically, women who were more likely to decide for themselves when to leave the house to visit friends and had a cell phone were also more likely to use condoms than women who needed permission from their husband/partner to leave the house and did not have a cell phone. In contrast, other measures of sociocultural empowerment showed no significant correlation with condom use and were therefore excluded from our model.

None of the indicators of familial/interpersonal power² showed a significant association with condom use and these variables were all excluded from the full model. Three of our six indicators of political empowerment were included in our model. These three indicators were whether the woman worked for or contributed to a political campaign, attended a public meeting, or voted in a U.S. election (see Table 2). The responses showed that women who were more likely to participate in these activities were also more likely to use condoms. The other political variables showed no significant results in the original linear regressions and were therefore excluded from our model.

Discussion

This study tested the impact of measures of economic, sociocultural, familial/interpersonal, and political empowerment on condom use and found support for the contention that sociocultural (Balasubramanian, Thamisoli, Umar, & Kanwar, 2010; Gómez et al., 1999; Rosenthal & Levy, 2010) and political empowerment (Amaro, 1995; Bustamante-Gavino et al., 2011; Gómez et al., 1999) were significant in predicting condom use among Mexican women. Thus, the level of power of women outside the household may be a crucial preamble to safe sex (Gómez et al., 1999).

Women who were younger were more likely to use condoms and this may be related to a generational difference between younger and older women in the acceptance of condoms (Albarracin & Plambeck, 2010). The preferred language influenced condom use implying that women who are more acculturated may also be more likely to use condoms (Carrillo, 2012).

Two indicators of sociocultural equality were included in the models, making sociocultural equality important in predicting condom use (see Table 2). Increased sociocultural empowerment likely develops women’s networks of support and provides them with the skills necessary to negotiate condom use with their husbands or partners. Therefore, HIV-prevention campaigns for Mexican women should assist them in gaining sociocultural mobility and independence, and developing formal and informal social networks.

Three indicators of political empowerment were also significant in predicting condom use (Beeker et al., 1998; Gómez et al., 1999; see Table 2). It is possible that women who participate in political activities develop the necessary skills to negotiate condom use with their husbands or partners. For example, community involvement can increase self-efficacy, self-esteem, and social support for safer sex (Ramirez-Valles, Kuhns, & Li, 2012). At the same time, resources like education and information may enable political participation and also facilitate condom use negotiation.

No indicator of economic empowerment showed any significant correlation with condom use (Amaro, 1995; Gómez et al., 1999; Mitra & Sarkar, 2011; Nitza et al., 2010). Although this finding may require further research, it is possible that economic independence may be less important than social and political ones in allowing women to engage in protected sex.

Contradicting an important body of literature (Gutierrez et al., 2000; Nitza et al., 2010; Norwood, 2011), the familial/interpersonal level of empowerment did not show a significant association with condom use. Thus, these findings support the contention that HIV-prevention campaigns for Mexican women may need to emphasize empowerment outside of their romantic relationships.

In sum, this study shows that social and political empowerment may be necessary to increase condom use among Mexican women. In turn, achieving gender equality and empowerment may require rectifying disadvantages through policies and programs that build women’s capabilities, improving their general access to social and political opportunity, and guaranteeing their safety (Grown, Gupta, & Pande, 2005). Gender equality indicates a society in which women and men enjoy the same opportunities, outcomes, rights, and obligations in all spheres of life (Bustamante-Gavino et al., 2011). Until this equality is achieved, women may be vulnerable to dangers, including that coming from HIV.

Footnotes

Acknowledgements

We are also grateful to the Mexican General Consulate in Chicago for their invaluable support for this research.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was done with the Support of a University Research Council’s grant from Western Illinois University.

Notes

Author Biographies

Julia Albarracin is an associate professor of political science at Western Illinois University. She received her PhD in political science in 2004 and has published several articles and book chapters on HIV prevention, immigration, and social and political participation.

Jennifer Chancay was a Peace Corps fellow at Western Illinois University where she obtained her MS in health education in 2012. She is now the Tobacco and Chronic Disease Program’s coordinator, Pima County Health Department, Arizona.

Dustin Hinrichs was a Peace Corps fellow at Western Illinois University where he obtained his MA in political science in 2011. He is currently a field coordinator at Trees Forever in Marion, Iowa.

Laura Sanchez received her BA in psychology in 2012 and is pursuing her MS in bilingual education at Western Illinois University.

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