The Four Bases of Gendered Power
It is important to note from the outset that Pratto and Walker (2004) conceptualized the four bases of gendered power as fungible. Thus, although distinctions can be made between the four bases of gendered power, the bases are interconnected and can reinforce each other. As a whole, these four bases are useful for outlining the ways gendered power dynamics work and contribute to women's HIV risk.
Force Force is the first base of gendered power (Pratto & Walker, 2004) because of its significant contribution to the maintenance of a power hierarchy between men and women. Force includes abuse, rape, assault, and any other form of violence against women that undermines women's power, even if it is indirectly the threat of violence that achieves this end (McCormick, 1994, pp. 119–146). Women's experience of force can be considered a form of “unofficial terror,” identified by SDT, in that it is not officially sanctioned by society, but at times is implicitly approved (Sidanius & Pratto, 1999). Specifically, a great deal of evidence points toward a connection between women's risk of contracting HIV from male partners and childhood abuse, sexual assault, and relationship abuse.
The impact of force on sexual risk behavior can date back to childhood. In the United States, a woman's history of child abuse has been found to predict greater sexual risk-taking as an adult (Allers & Benjack, 1991; Scott, Gilliam, & Braxton, 2005). For example, in a study with low-income African American women, childhood emotional, physical, and sexual abuse were each found to be independently related to failure to achieve condom use with a main partner (Perrino, Fernández, Bowen, & Arheart, 2006). Among college women, childhood sexual abuse predicted reduced ability to demand condom use or refuse sex (Johnsen & Harlow, 1996). Further, research with women in the United States from diverse racial and ethnic backgrounds has even found that women who were HIV-positive were more likely to have experienced childhood sexual assault than women who were HIV-negative (Paxton, Myers, Hall, & Javanbakht, 2004).
Rape and sexual assault as an adult are also significant sources of HIV risk for women (Scott et al., 2005), both by creating instances of risk within themselves and by affecting women's future behavior. In a study of American Indian and Alaskan Native women living in New York, having experienced sexual assault predicted greater sexual risk behavior (Evans-Campbell, Lindhorst, Huang, & Walters, 2006). Female sex workers in Cape Town, South Africa, discussed the common experience of being forced to have unprotected sex (Pauw & Brener, 2003). Rates of rape (both by strangers and by intimate partners) in South Africa are relatively high and have been on the rise (Ackermann & de Klerk, 2002), and South African women's past experiences of forced sex are associated with less condom use (Pettifor, Measham, Rees, & Padian, 2004; Thomas, 2005). In rural areas of Haiti, women's experiences of forced sex within the past year were related to their rates of sexually transmitted infection (STI) diagnoses (Kershaw et al., 2006).
Emotional and physical abuses in primary relationships also pose a challenge to women's ability to use condoms. Women in the United States with physically abusive partners were more likely to report never using condoms, experiencing abusive consequences of condom use negotiation, and fearing consequences of attempting to negotiate condom use (e.g., Molina & Basinait-Smith, 1998). Because women's experience of partner violence is closely related to the amount of power they have in those relationships, a history of violence has a negative effect on women's condom use with those partners (Pulerwitz et al., 2000). Among a diverse group of women in different regions of the United States, abused women reported more sexual risk behavior, less control over having safer sex, more unwanted sex, and lower self-efficacy for getting partners to use condoms (Beadnell, Baker, Morrison, & Knox, 2000). Fearing abuse by a partner can deter women from even raising safe-sex issues (Amaro, 1995).
Clark, Bruce, and Dude (2006), examining data from Demographic and Health Surveys in 22 African and seven Latin American countries, noted the significance of violence in predicting risk for HIV infection in the relationships of married female adolescents, in which age differences and tolerance of spousal abuse affect power inequities. Ackermann and de Klerk (2002) highlighted the acceptance of violence as a part of heterosexual relationships in South Africa and its relation to women's risk for contracting HIV from their partners. Among secondary school students in rural South Africa, the threat or use of force by male partners in heterosexual relationships predicted inconsistent condom use in those relationships (Hoffman, O'Sullivan, Harrison, Dolezal, & Monroe-Wise, 2006). Further, in a study of 1,366 women in Soweto, South Africa—even after controlling for age, for current relationship status, and for women's own risk behavior—partner violence and women's own feelings of being controlled in their relationships significantly predicted their actual HIV status (Dunkle et al., 2004). Similarly, in Tanzania a woman's lifetime experience of partner violence was found to be a significant predictor of her being HIV-positive (Maman et al., 2002).
In summary, research conducted worldwide suggests that childhood abuse, sexual assault, and abuse in relationships all predict sexual risk behavior in women. It seems clear that women's experiences of violence are associated with an increased risk of contracting HIV, specifically from male sexual partners.
Resource control Resource control includes access to well-paying jobs, education, health care, and institutional influence, which generally favors more men than women worldwide (Connell, 2005). Although continuing to address power on multiple levels like the other bases of gendered power, resource control particularly highlights the role of institutional and structural inequality in women's subordination (Pratto & Walker, 2004). Focusing on resource control addresses the ways that gender-based inequities increase HIV risk for women in general and also begins to provide evidence for the ways that other group-based hierarchies, such as race and class, are important to take into account when explaining heterosexual risk behavior. Specifically, research points to the relationships women's HIV risk has with economic dependence on male partners, poverty, sex work, education, and institutional influence.
Because of inequality in access to resources, women are often left economically dependent on male partners, making it challenging and sometimes even dangerous for women to negotiate condom use or discuss monogamy (Gutiérrez, Oh, & Gillmore, 2000). African American women in North Carolina reported that a main reason for having unprotected sex was their financial dependence on male partners (CDC, 2005). Similarly, in a study in Massachusetts, urban women's income positively correlated with their sexual relationship power (i.e., relationship control and decision-making dominance), which in turn accounted for more than 50% of their lack of condom use (Pulerwitz, Amaro, DeJong, Gortmaker, & Rudd, 2002). Financial decision making within a relationship is closely related to sexual decision making, and women who make financial decisions independently are more likely to use condoms consistently than women who either share financial decision making or do not participate in those decisions at all (Soler et al., 2000).
For low-income women, inequality in access to resources turns into dependence on men for survival, making it especially difficult for them to negotiate condom use and leave abusive or unfaithful men (Sikkema, Wagner, & Bogart, 2000). Also, many low-income women have more immediate worries, such as paying rent or having enough food, which may reasonably take precedence over protecting oneself from HIV (CDC, 2005; Mays & Cochran, 1988; Sikkema et al., 2000).
For women outside the United States and Europe, for whom rates of poverty and struggles for basic survival are often higher, the power dynamics involved in women's economic dependence on male partners can be even more pronounced. Machel (2001) concluded from work with secondary school–age women in Mozambique that middle class students more readily challenged gender norms than working-class students and were less likely to depend financially on their partners, leading to a class difference in the power they had in their sexual relationships and their risk of contracting HIV. Women's need for economic support is sometimes their reason for engaging in sexual relationships with men, regardless of how risky they may be (Luke, 2003). In research conducted in Kenya (Voeten, Egesah, Varkevisser, & Habbema, 2007), Côte d'Ivoire (Longfield, 2004), and Ghana (Ankomah, 1999; Mill & Anarfi, 2002), women discussed their sexual relationships with men as being in the interest of their own material gain, often leading to obligations to have unprotected sex, even when male partners are known to have other partners. Indeed, some work has analyzed heterosexual relationships using social exchange theory (e.g., Baumeister & Vohs, 2004), and when women's resources are limited, sex becomes a resource that has exchange value, giving power to the men who have the resources that women need.
For sex workers, sexuality is most obviously an economic resource used for exchange, and sex workers' need for resources, such as money, shelter, gifts, or drugs, is related to their level of power in influencing condom use (Gentry, Elifson, & Sterk, 2005; Nemoto, Iwamoto, Wong, Le, & Operario, 2004). Studies in Uganda and the former Zaire (now Democratic Republic of the Congo) found that the poorest sex workers had unprotected sex the most often (Gysels, Pool, & Nnalusiba, 2002; Schoepf, 1997). Research with women in the sex industry in Johannesburg, South Africa, suggests that the need to keep clients and make as much material gain with each client as possible becomes a barrier to practicing safe sex (Wojcicki & Malala, 2001). Another issue for female sex workers is access to institutional power within their line of work. In Indonesia (Basuki et al., 2002), the Dominican Republic (Kerrigan et al., 2003), and China (Yang & Xia, 2006) women's condom use rates were higher when the “pimps,” or others running establishments in which women were working, supported them in their condom use negotiation with clients and with condom availability.
Education influences women's risk of HIV infection as well, affecting women's HIV/AIDS knowledge and their power to reduce risk behavior. In one study with South African women, higher education level was one of the only significant predictors of decreased sexual risk behaviors (Kalichman et al., 2005). Education can increase women's knowledge, access to other resources, and power within their relationships, as exemplified in a study of orphans and vulnerable children in Zimbabwe (Gregson et al., 2005). It may also lead to increased challenging of gender norms and scripts associated with women's subordination. Indeed, education has been identified in large-scale studies throughout Latin America and Africa as having an ameliorating impact on women's HIV risk (Clark et al., 2006; Jewkes, Levin, & Penn-Kekana, 2003). Thus, having access to education seems to be vital for reducing HIV rates in women.
As explained by SDT, women in general, and especially poor women, women of color, and women outside the Western world, are underrepresented in the “hierarchy-enhancing” positions at the top of most institutions and companies (which wield the power to influence many factors affecting women's risk for HIV infection). Instead they are in “hierarchy-attenuating” positions (Pratto et al., 1997). Thus, choices about which contraceptives are produced and recommended are made by the male-dominated and male-focused pharmaceutical companies, medical field, and governments (Connell, 2005; Watkins & Whaley, 2000). This inequality in influence may partially explain why the male condom is the most commonly used HIV-prevention method, although the female condom, which could give more power to women, is efficacious when women are trained to use it (Beadnell et al., 2000; Heise & Elias, 1995; Hollander, 2002). In South Africa, Namibia, and Botswana, women who were told about the female condom were interested, excited, and even demanded that they be provided with a supply (Susser & Stein, 2000). Some female sex workers in South Africa reported that their experiences with using female condoms gave them power over protecting themselves during intercourse with clients and that clients were receptive to trying a new strategy; however, some women reported difficulties in its usage, most likely because they had not been properly trained (Pauw & Brener, 2003).
Thus, research both in the United States and internationally provides evidence that women's economic dependence on male partners, their experiences with poverty, sex workers' dependence on revenue from male partners, women's education levels, and their general lack of institutional influence all contribute to their sexual risk behavior. Clearly, women's lack of control over various forms of resources is associated with a substantial increase in their HIV risk.
Social obligations Social obligations constitute the third base of gendered power (Pratto & Walker, 2004), focusing on relationships and provision of care as sources of inequality between women and men. Social obligations include responsibilities to others (such as a partner or children), and the norm in most societies is for women, as compared to men, to have more obligations in terms of being caregivers or satisfying others' needs and desires (Ford, 2006, pp. 258–260; Pratto & Walker, 2004). In the United States, although more women now work outside the home, men have not increased their share of the caretaking responsibilities that have traditionally been handled by women (Eagly, Wood, & Johannesen-Schmidt, 2004). Women sometimes give caregiving responsibilities priority over issues related to their own health (e.g., Watkins & Whaley, 2000, p. 49), including HIV risk.
Specifically, research points to the connection between women's HIV risk behavior and their level of commitment to a relationship, which seems to reflect the level of felt obligation that a woman has to her male partner. Women who are in committed relationships with men are consistently less likely to use condoms and report more challenges to negotiating condom use than single women (Amaro & Raj, 2000; Gómez & Marín, 1996; Mays & Cochran, 1988). It may seem that lack of condom use within a relationship would not increase one's risk for HIV infection; however, because men may not be monogamous and may not be honest about or discuss their HIV status, some women become infected by long-term partners (e.g., Sikkema et al., 2000). Even when women know or suspect a partner's infidelity, they may have unprotected sex because of their sense of obligation to the relationship (Gentry et al., 2005). For example, pregnant women in rural areas of Haiti reported that despite knowing or suspecting that their male partners were unfaithful, they were still unlikely to use condoms (Kershaw et al., 2006). Although the connection between increased level of commitment in a relationship and decreased condom use has been noted frequently, identifying social obligations as an important and unique base of gendered power (Pratto & Walker, 2004) provides a possible clear explanation for this connection.
Marriage has an important impact on women's risk of contracting HIV in various countries in the world, especially when the men are significantly older (Clark et al., 2006; Heise & Elias, 1995). In some countries, like Kenya, Tanzania, Cameroon, and Zambia, a higher percentage of married 15- to 19-year-olds have HIV than unmarried individuals of the same age (Clark et al., 2006). Pettifor et al. (2004) found that in a nationally representative sample of more than 4,000 young women in South Africa, inconsistent condom users were more likely to be married, and in turn inconsistent condom use made one more likely to be HIV-positive. It is hard to know exactly why marriage would be related to sexual risk behavior, and it is certainly possible that these findings are more closely related to issues of resource control and economic dependency or exchange than social obligations. However, it is also possible that marriage creates a greater sense of obligation for women toward their husband in the same way that level of commitment in a relationship is related to women's risk. Additionally, there is some evidence that this association cannot be completely attributed to economic dependence. For example, even among Ugandan women who could support themselves and could more easily choose or leave partners, the more formal their relationship with a male partner, the harder negotiating condom use and refusing unprotected sex was (Nyanzi, Nyanzi, Wolff, & Whitworth, 2005).
Similarly, a study in Vietnam found that many female partners of male injecting drug users (IDUs) were monogamous and did not demand condom use although they were in a high-risk situation (Go, Quan, Voytek, Celentano, & Nam, 2006). On the other hand, the IDU male partners, despite their behavior (often involving unclean needles and unprotected sex with other people), did not feel the need to use condoms to protect their partners, demonstrating how gender differences in relationship obligations can increase women's HIV risk. Research with female sex workers in many countries, including the Dominican Republic, Ghana, Kenya, South Africa, and Zimbabwe, has illustrated that a condom is less likely to be used the more regular a client is or the more intimate the relationship with the client is perceived to be, and it is rarely used with personal partners (Côté et al., 2004; Kerrigan et al., 2003; Pauw & Brener, 2003; Ray, van de Wijgert, Mason, Ndowa, & Maposhere, 2001; Voeten et al., 2007).
In summary, research findings from various countries suggest that some sense of obligation or commitment that women feel when in relationships with men, which men often do not reciprocate, is associated with increased risky sexual behavior. The imbalance in social obligations expected of women versus men is an important factor to consider in understanding women's risk of contracting HIV from male partners.
Consensual ideologies The final base of gendered power consists of consensual ideologies (Pratto & Walker, 2004), which justify and sustain women's disadvantage worldwide. Consensual ideologies include gender roles, norms, stereotypes, and any other beliefs or expectations about men and women that are generally agreed upon in a society or culture, putting women in weaker positions in comparison to men (Eagly et al., 2004). An important contribution of SDT is the recognition that subordinate groups often play an active role in their own subordination and that the consensual nature of dominance, and the ideologies that maintain that dominance, is essential to understanding why social hierarchies persist (Sidanius & Pratto, 1999). Specifically, research points to the relationship of women's HIV risk with gender and sexual norms and scripts, fidelity issues, conceptions of masculinity versus femininity, homophobia, and more benevolent forms of sexism.
Ideologies about sexual behavior vary greatly by culture, but across many groups, gender roles assert that women are and should be the passive acceptors of sex whereas men are and should be the controlling aggressors (Bowleg, Lucas, & Tschann, 2004; Scott et al., 2005). For example, some women in the United States implicitly associate sexuality with submissiveness (Sanchez, Kiefer, & Ybarra, 2006), suggesting that these beliefs are consensual. Women have less power to influence condom use in the face of sexual gender norms suggesting they should not be knowledgeable about sex, be sexually assertive, or have control over their own sexuality (Fullilove et al., 1990; Gómez & Marín, 1996; Pratto & Walker, 2004; Sikkema et al., 2000). In countries as different as South Africa and Vietnam, research has demonstrated that gender norms and sexual scripts decrease women's ability to insist on condom use (Dunkle et al., 2004; Go et al., 2006; O'Sullivan, Harrison, Morrell, Monroe-Wise, & Kubeka, 2006). In rural Haiti, the more that a woman was able to communicate with her partner about sex, and the more power she felt she had in her relationship, the more she used condoms (Kershaw et al., 2006). Similarly, in Hong Kong, women's egalitarian gender attitudes were positively associated with condom use within their marriages (Tang, Wong, & Lee, 2001).
Both women and men often accept the idea that a woman should be faithful regardless of whether her male partner is (Fullilove et al., 1990). This ideology challenges women's condom use negotiation if they fear that issues of trust and fidelity will be raised in response. Among African American women, a history of having male partners raise questions of fidelity in response to women's suggestion of condom use predicted less condom use (Perrino et al., 2006). Women in Ghana reported that worrying that their male partners would raise issues about women's sexual activity outside of the relationship prevented women from negotiating condom use as well (Ankomah, 1999; Mill & Anarfi, 2002). Beliefs about promiscuity, which prescribe that good women should not have sex with multiple men, and the assumption that women carrying condoms or raising the issue of condoms with their partners are promiscuous result in women not wanting to talk about condoms or use condoms (Brown, Sorrell, & Raffaelli, 2005; Whitehead, 1997). In addition, the idea that men are less likely to stay monogamous than women, which is often accepted in society and justified by evolutionary or biological arguments (Bowleg et al., 2004), may lead women to avoid questioning their partners about fidelity.
Societal beliefs about what constitutes masculinity versus femininity and male versus female sexuality also relate to heterosexual risk behavior. In the United States and around the world, societies prescribe that men should feel good about having control over their female partners (Harvey, Beckman, Browner, & Sherman, 2002). This prescription could actually make it rewarding for men to achieve unprotected sex with their female partners against the women's wishes. Sexuality and sexual behavior are traditionally based on men's desires and performance, and men typically are assumed to be more knowledgeable about these issues than women. Thus, when women want to inform their male partners about the risk of HIV or to assert that they want to use condoms (which are often thought to interfere with men's performance and enjoyment), men may feel that norms are being broken and that their female partners are threatening their masculinity (Campbell, 1995; Whitehead, 1997). Research in South Africa and Namibia revealed that both men and women believe that some of the defining elements of masculinity are having multiple sexual partners (Hunter, 2005), having the right to be violent toward women in some instances (Kalichman et al., 2007), having many children, wanting unprotected sex, and being unconcerned with health, although many women criticize these ideas and recognize their links to HIV risk (Brown et al., 2005). Further, heterosexism and the belief that HIV is a gay man's disease make men in the United States specifically, where this association is still prevalent, want to distance themselves from concerns of HIV as well as prevent men who may have had sex with men in the past from revealing their history to their female partners (Campbell, 1995; CDC, 2006; McNair & Prather, 2004).
Many theorists have argued that sexism is often not explicit or hostile, but instead takes the form of benevolence, paternalism, or parentalism (e.g., Glick & Fiske, 1996; Jackman, 1994; Pratto & Walker, 2001). Across many countries, it is often believed that women should be protected and taken care of by men (i.e., benevolent sexism; Glick et al., 2000), yet this helps to maintain gender inequality and reduces women's power. Pratto and Walker (2001) explain that “widespread acceptance of parentalism allows institutions to collude in ‘protecting’ women by limiting their access to education, political power, health care, legal standing, and economic resources” (p. 95). This form of sexism plays out in marriage and committed relationships, creating the expectation that men will financially support and protect women and that in return women will take care of the family and home. These consensual ideas can even decrease women's desire to leave partners who may be abusive or put them at risk because those partners still promise the support and protection that they are expected to provide (Pratto & Walker, 2001). The ideas of benevolent, paternalistic, or parentalistic sexism are important to consider in this context; provide a good example of a consensual ideology that decreases women's power in heterosexual relationships; and begin to highlight how the four bases of gendered power are connected and reinforce each other.
Thus, much research from various countries supports the influence of gender norms and scripts and ideas about fidelity, homophobia, and benevolent forms of sexism as contributing to women's HIV risk. Clearly gender ideologies, which are often accepted by women themselves, contribute to women's lack of power to protect themselves from contracting HIV from male partners.
Other Contributions of SDT
Intersections with race and class SDT compels us to examine the intersections among different group-based power hierarchies because of the unique experiences of oppression resulting from intersecting group memberships (Pratto & Espinoza, 2001; Pratto et al., 1997; Sidanius & Pratto, 1999). Specifically, understanding the intersections among gender, race, and class can help us to understand why women of color and low-income women are disproportionately affected by HIV. Gendered power imbalances are exacerbated in communities where competition for men is greater due to an uneven sex ratio, which has been documented specifically in African American communities (Fullilove et al., 1990; McNair & Prather, 2004). This uneven ratio can at least in part be attributed to racism in the legal system causing disproportionate numbers of African American men to be incarcerated (e.g., Davis, 2004; Sidanius & Pratto, 1999). This inequality in the criminal justice system also leads to the disproportionate imprisonment of Latino men (Sidanius & Pratto, 1999), although not to the extent that is seen for African American men, and thus may also contribute to HIV risk for Latinas.
Another example of how race-based inequality intersects with gender to create a unique situation of HIV risk for women of color is in their experience of violence. Collins (1990) has argued that violence against African American women is accepted more than violence against other women because of the unique history of violence against African American women in the United States. As already reviewed, violence has been linked to risk for HIV infection, and if violence against African American women is accepted more because of the intersections of gender- and race-based hierarchies, these intersections would seem to create a unique experience of risk for this group. Similarly, one's immigration status has been linked to risk of experiencing violence because undocumented women who are victims of rape and other forms of violence are less likely to report crimes to the police because of their fears of a justice system that labels them “illegal” (e.g., Nemoto et al., 2004).
Class-based inequality also intersects with gender to create unique HIV risk. For example, in a recent study in the United States, abuse was a stronger predictor of being unable to refuse unwanted sex for homeless women than for women in low-income housing (Tucker, Wenzel, Elliott, Marshall, & Williamson, 2004). This is one example of the way that class, or access to resources, can contribute to women's experience of violence and moderate its relationship to condom use. Clearly, to understand why certain groups of women are disproportionately affected by HIV, race and class have to be included in our analysis. The unique circumstances of women of color and low-income women must be recognized, as more and more researchers have begun to do (e.g., Gentry et al., 2005; Wyatt & Chin, 1999).
These findings exemplify the ways that different group-based hierarchies intersect, as put forth by SDT, to affect HIV transmission in women, and, importantly, they also suggest that the field may benefit from future research that explores possible interactions among variables. Specifically, it is important to continue to explore the ways that the four bases of gendered power may moderate and be moderated by each other, other variables identified by SDT, and other variables that have been tied to HIV risk by other theoretical models.
Men's risk The current theoretical framework has thus far helped us to specify how power contributes to heterosexual risk behavior and HIV infection in women around the world. However, SDT also compels us to focus on the intergroup nature of power and dominance (Pratto et al., 2006; Sidanius & Pratto, 1999). Although imbalances in power particularly disadvantage women in terms of HIV prevention, and rates of HIV infection are even higher for women in some countries than they are for men, these same gendered bases of power also put men at risk. For example, two studies in Cape Town, South Africa revealed the importance of sexual assault in understanding both men's and women's risk for HIV infection, finding that one in five men reported either threatening physical force or using physical force to have sex with women and that this history of committing sexual assault was a predictor of other sexual risk behavior in men (Kalichman et al., 2005, 2007). If gender inequality rooted in force, resource control, social obligations, and consensual ideologies leads to unprotected sex between women and men, then clearly these four bases of power are also contributing to men's risk for HIV infection. Specifically, if conceptions of masculinity and male sexuality are such that having power over women in different realms of life and achieving unprotected sex with many female partners (without much concern for health risks, even for oneself) are reinforced, then these social constructions of masculinity and male sexuality greatly increase men's chances of both contracting HIV and then passing it on to their subsequent partners (e.g., Hunter, 2005; Pleck, Sonenstein, & Ku, 1993). Gendered power hurts men in addition to women; thus, confronting gender inequality should help to reduce HIV rates in men as well as women.
SDO SDO, defined as support for group-based hierarchy and inequality or the belief that some groups are better than others, is an important element of SDT (Sidanius & Pratto, 1999), and it can help to explain individual differences in adherence to certain ideologies, relationship dynamics, and HIV risk behavior. SDO has been found to be positively related to sexist beliefs, such as negative attitudes toward women's rights (Heaven, 1999) and tolerance of sexual harassment (Russell & Trigg, 2004). These patterns suggest that SDO is likely to be related to attitudes about gendered sexual norms, such as expecting women to be more passive and men more dominant in sexual relationships. Thus, as SDO increases, power inequity in a heterosexual relationship is likely to increase as well. SDT also posits that SDO is generally supported more by members of social groups with higher status, such as men (see Pratto et al., 2006), which helps to explain why some men would persist in wanting to maintain an imbalance in the power dynamics in their relationships with women, even if this can increase their own risk of contracting HIV. SDO may help to account for individual differences in the risk associated with heterosexual relationships; thus, the relationship between SDO and risk behavior is an important issue for future research to explore.
Mediators: Complementing Other Theoretical Models
The current theoretical framework does not stand in opposition to previous findings and models in the realm of women's HIV risk, but instead can complement them. By exploring mediators of the relationship between power and heterosexual risk behavior, we can integrate the current theoretical framework with existing social-cognitive and motivational theoretical models and other important variables. There is already evidence that some established factors that predict HIV risk are at least partial mediators of the relationships between the four bases of power and heterosexual risk behavior. For example, research has found that drug and alcohol use, depression, and self-efficacy are all mediators of the relationship between childhood abuse and adult sexual risk behavior (e.g., Newcomb, Locke, & Goodyear, 2003). Women who have experienced sexual and physical abuse are more likely to use substances that can impair their ability to engage in safer sex (Quina et al., 1997). In addition, low-income women may be particularly likely to use drugs and alcohol as an escape from their struggles, contributing to increased risk behavior (e.g., Paxton et al., 2004; Perrino et al., 2006; Scott et al., 2005). These examples present the possibility that substance use is a mediator between women's lack of resources or experiences with violence and their HIV risk.
Women's acceptance of their own sexuality and perceived control over their sexual encounters were found to directly correlate with their feelings of self-efficacy for condom use (Bryan, Aiken, & West, 1996, 1997). This finding suggests that women's self-efficacy may be a mediator between the relationships consensual ideologies have with women's sexual behavior and HIV risk. Among women living in low-income areas of the United States, those who were physically abused had lower self-efficacy for using condoms with their male partners than those who were not physically abused (Beadnell et al., 2000), suggesting that self-efficacy may be an additional mediator of the relationship that physical abuse has with condom use. Future work should continue to test for mediating factors to highlight integrative models that could map out more clearly the relationship that SDT and the four bases of gendered power have with other theories, such as self-efficacy theory and the theories of reasoned action and planned behavior. Such modeling can increase our understanding of the underlying mechanisms and processes contributing to women's risk of contracting HIV from male partners.