African American Men's Perceptions of Power in Intimate Relationships

Abstract

Power in intimate relationships is an important predictor of sexual risk behavior. The purpose of this study was to better understand African American men's perceptions of interpersonal power. Twenty African American men participated in focus groups to elicit their perceptions of power in intimate relationships; their responses were analyzed using grounded theory. From this analysis, a conceptual framework was developed that, among African American men, power in relationships was largely determined by the contribution of financial resources, and/or withholding sex. These findings were then considered in light of existing social-psychological theories of power in relationships. Future research should consider how to incorporate this understanding of interpersonal power into current theories of sexual risk behavior in order to develop more effective HIV risk reduction programs.

African American Men's Perceptions of Power in Intimate Relationships

African American men and women are disproportionately burdened by STIs and HIV. Data from the Centers for Disease Control and Prevention (CDC) indicate that African Americans accounted for 51% of newly diagnosed cases of HIV/AIDS from 2001 to 2004 (Centers for Disease Control and Prevention, 2007); rates of HIV among African American women are 21 times higher than among Caucasian women (with the majority of cases acquired through heterosexual contact; Centers for Disease Control and Prevention, 2007). Thus, interventions to prevent STI transmission among African Americans are critical. To date, however, little sexual health research has focused on the unique needs and perspectives of African American men.

Theories of health behavior, such as the Information-Motivation-Behavioral Skills model (IMB), have been useful in predicting sexual behavior (Fisher & Fisher, 2000); however, much of the variance in sexual behavior remains unexplained after accounting for the constructs in these models. A limitation of these health behavior theories is that they focus on individual-level variables (e.g., self-efficacy) as predictors of sexual behaviors; because sexual behavior occurs in a dyadic context, a fuller understanding of sexual behavior requires consideration of interpersonal factors, including the balance of power between partners (Amaro, 1995; Amaro & Raj, 2000). An individual who lacks power in a relationship may be unable to convince a partner to engage in safer sexual behavior, despite having the information, motivation, and skills to do so. Thus, power may be an important variable to consider in sexual health research (Amaro, 1995; Amaro & Raj, 2000; Wyatt, 1994).

Empirical research has identified a relation between power in relationships and sexual risk behavior. Studies demonstrate that women who thought they had more power in their relationships use condoms more frequently (Kline & VanLandingham, 1994; Pulerwitz, Amaro, DeJong, Gortmaker, & Rudd, 2002; Pulerwitz, Gortmaker, & DeJong, 2000). In addition, condom use was more frequent among women who (a) made more of the decisions in a relationship in general (Pulerwitz et al., 2002; Pulerwitz et al., 2000), and (b) shared in or made specific decisions about how to spend money (Soler et al., 2000), whether or not to use a condom (Harvey, Bird, DeRosa, Montgomery, & Rohrbach, 2003; Harvey, Bird, Galavotti, Duncan, & Greenberg, 2002), and when to have sex (Harvey et al., 2003). Tschann et al. (2002) reported that adolescents who thought their partner wanted the relationship more than they themselves did (a proxy for relationship power) were more likely to “get their way” about condom use, regardless of gender.

In one qualitative study investigating power, African American women defined power as: (a) being in control and being able to tell the other person what to do; and (b) making decisions, including decisions about money. Several sources of power were identified by the participants, including having money, having good judgment, being educated, being attractive, feeling respected by their partner, and having or withholding sex (Harvey & Bird, 2004). In a study with couples of Mexican origin, similar definitions of power were reported, and women's sources of power included having economic independence, being attractive, having or withholding sex, and feeling loved by their partner; in contrast, men's sources of power included having money, the cultural norm of machismo, and using physical violence (Harvey, Beckman, Browner, & Sherman, 2002).

The short-term purpose of this study is to better understand African American men's perceptions of power in intimate relationships; the long-term purpose is to inform theories of sexual risk behavior and to facilitate the development of more culturally sensitive and effective sexual risk reduction interventions for African American men.

Methods

Participants

Twenty African American men between 20 and 41 years of age (M = 29.3, SD = 6.4) participated. All men were attending a public sexually transmitted infection (STI) clinic in an urban area of upstate New York; all had engaged in recent sexual risk behavior (i.e., inconsistent condom use and sex with more than one partner, sex with a partner who had other partners, sex with a partner who injected drugs, or sex with a partner who had an STI or HIV). Twelve men (60%) had a high school degree or less, 13 (65%) were unemployed, and 7 (41%) had an annual family income of less than $15,000. The majority of men (n = 17; 85%) were unmarried; two men (10%) were married, and one man (5%) was divorced. Men reported high levels of recent sexual risk behavior, with an average of 3.9 (SD = 6.3) sexual partners in the past 3 months, and an average of 7.7 (SD = 14.9) episodes of unprotected sex in the past 3 months. No one reported having sex with men.

Procedures

Participants were recruited from a public STI clinic and screened to determine eligibility (i.e., recent sexual risk behavior). Eligible patients were invited to attend a focus group discussion about health issues for African American men. Patients were told that the groups would last two hours, refreshments would be provided, and they would be reimbursed $20 for their time. Patients who consented to participate were assigned to one of four focus group times, and were given a printed invitation with the date and time of the focus group. Contact information was obtained, and patients were given reminder calls one to two days before their scheduled focus group.

Four focus groups were conducted, with group size ranging from three to seven (M = 5). When the men arrived for the focus group, facilitators explained the purpose of the study and the format of the group, and obtained written, informed consent from all participants. The participants completed a brief paper-and-pencil questionnaire to obtain demographic and sexual behavior information. Before beginning the focus group, facilitators discussed ground rules (e.g., respect for others, right to speak).

Facilitators followed a semi-structured guide with questions related to multiple partners, condom use, health concerns, relationships, masculinity, substance use, the community, and the role of the media in promoting sexual health. Questions related to relationship power included: (a) Who do you think has more power in a sexual relationship, the man or the woman? (b) Does this differ depending on the type of relationship (e.g., girlfriend, mother of your children)? (c) Are there ways in which men have more power, and ways in which women have more power? (d) What are some of the ways that women show their power? (e) What are some of the ways that men show their power? and (f) Does use of physical strength or force ever come into play? Facilitators probed responses and asked open-ended follow-up questions. The semi-structured questions were intended to be a stimulus for a discussion of power; however, most of the discussion occurred when the facilitators asked open-ended follow-up questions. Facilitators allowed participants to direct the focus group discussion. Information learned from earlier focus groups was investigated further in later groups.

Each focus group was conducted by two African American male facilitators. The lead facilitator, a doctoral student in counselor education, had considerable experience facilitating focus groups. Both facilitators had training and experience in STI/HIV prevention and in issues of importance to African American men. Before conducting the focus groups, the facilitators met with members of the research team to discuss the rationale for the focus groups and facilitator roles during the focus groups.

Data Analyses

All focus groups were recorded using a digital audio recorder. The recordings were transcribed, and transcripts were checked for accuracy. Grounded theory (Glaser & Strauss, 1967) was used to analyze the focus group transcripts. One member of the team was primarily responsible for coding the transcripts. During the coding process, transcripts were first divided into meaningful units; next, based on careful listening to recordings and reading through the transcripts, categories were created, and each unit from the transcript was assigned to one or more categories. Sub-categories were then created within each category, and units were assigned to the subcategories. A second coder, who was well-acquainted with the data, reviewed the categories and subcategories, and the assignment of units to the subcategories. Coders met regularly to discuss the emerging categories. Coding disagreements were discussed; in each case, the two coders reached a consensus on the coding through discussion. Throughout the coding process, analytic memos were written. The research team discussed the results, and generated themes and ideas, which led to the development of working hypotheses. Throughout the coding process, categories and subcategories were constantly compared and revised, and working hypotheses were revised, as new information was considered, or as the research team came to new understandings of the data.

To optimize the credibility and trustworthiness of the results, the coders held regular meetings, analytic memos were used to develop and revise working hypotheses, and meetings with members of the research team were convened; during research team meetings, results were discussed and members of the team were challenged to think of the data in new ways. In addition, information obtained in initial focus groups was investigated further in subsequent focus groups to assure that we understood the emergent themes accurately and completely. These strategies, combined with the number of participants in the study (N = 20), all helped to ensure credibility and trustworthiness of results.

Results

Two main themes related to power emerged from our analyses. The first, endorsed by a majority of men, was that power distribution in heterosexual relationships is determined by who contributes the most resources to the relationship. The second theme was that there were several sources of power in relationships, including money, sex, threats of physical violence, attractiveness, and the shortage of African American men. From these themes, a conceptual framework was developed that, among African American men, power in intimate relationships is largely determined by the contribution of resources, including money and sex.

Power in Relationships is Determined by Resources Contributed to the Relationship

The majority of participants expressed that power in a relationship is highly variable and depended on unique features within a given relationship. Specifically, participants expressed that the resources contributed to the relationship determined who had more power in the relationship. For example, either the man or the woman could have more power in a relationship, depending on who had greater economic resources and who “paid the bills.” As one participant said, “Who's carrying most of the weight and commands most of the respect probably is gonna be the one in power.”

However, a minority of men found it difficult to concede that a woman could have greater power, even if she brought more resources to the relationship. One participant, whose partner paid the bills, took credit for molding his partner into someone who could keep a job and make money, thus undermining her power: “...that's how I trained my girl. I wanted her to be able to hold down a foundation, because I knew I was a dude always in the streetsy.... So I found my girl early in high school, and she came out the way I wanted her to come out.” When the facilitator asked who had more power in a sexual relationship, one participant replied, “Me...man, dick run the ship.” These participants’ language reflected their belief in their positions of power over women, calling a woman's main partner her “boss.” One participant said that women should know their place, stating “She should know what time it is.”

To justify this power of men over women, some participants expressed the opinion that women wanted men to be in control. For example, one participant thought that women let men have power by not standing their ground, stating “A lot of times [women] let the man run over ‘em and don't even care ‘cause a lot of the time I wouldn't run over that woman if she stood her ground, but she let me run over her, so I do it.”

However, for some, men's ascribed power was more nominal than real. One participant thought that men would say they had power, even if they did not, because “...dudes are arrogant.... So, I think that, of course, a guy gonna say that ‘cause he's the king of the jungle, he's the lion, you know what I'm saying.” A few participants expressed an egalitarian view of power, stating that both men and women have power in relationships, and that “it's a give and take.”

Sources of Power in Relationships

Men identified several sources of power in relationships. The two most commonly identified sources of power were money and withholding sex. Physical attractiveness and the shortage of African American men also emerged, indirectly, as sources of power. Most men did not consider physical violence to be a source of power in intimate relationships.

Money

The most commonly mentioned source of power in relationships was money. As one participant stated, “[The] one paying the bills is the one that makes the rules.” Thus, having money was tied to making the decisions in a relationship. Having a source of income and having a stable residence seemed to be particularly related to having power in a relationship. The men frequently pointed out that if someone who owned a house and paid the bills became angry with his/her partner, he/she could force the partner to leave the house. One man said “If you have a woman that's got the job...and she's payin’ the bills and she got a man that's workin’ on the streets, hustlin’, sellin’ drugs, with no types of benefits or nothin’...and he's livin’ in her house...she's gonna have the upper hand as far as their relationship, you know, cause she can kick the man out any time she want to, and where he gonna go?”

Sex

Granting access to sex, or withholding sex, was also a source of power. One participant pointed out “[Sex is] the only thing that they can take away from you, you can't get for yourself.” Withholding sex was described as a particularly relevant source of power for women. “Number one way that [women] show they have power is by holding out on sex.” A few men mentioned that men could also show they had power in a relationship by withholding sex.

Although refusing to have sex was a way to show power, it had a drawback, namely, the person who withheld sex also had to go without sex. However, one man pointed out that if he withheld sex from his primary partner, he would still be able to have sex with his secondary partners; thus, he would get to have sex but his primary partner (whom he assumed did not have another partner) would have to wait. “I mean, wifey acting crazy, you know you got another one on the side, you know what I mean. You know you're still going to get sex, but it's not with her, though, she got to hold on....”

Threat of force

None of the men thought that physical force was a source of power in relationships. Most men thought that violence should not be used in relationships. For example, one participant, when asked about physical violence towards women, said “I ain't going to jail for nobody. Point blank, you know it ain't our game out here once the police get called.... I ain't going to jail for nobody.” Several men mentioned that if a situation or relationship escalated to the point that a man wanted to be violent, he should leave the relationship. A few participants expressed the opinion that some women seemed to like physical force to be used in sexual situations, and that the only time physical force was acceptable was during sex. One participant said “That's the only time when [physical force] is alright, is during sex, you know what I'm saying. If you, I know I done choked a couple...I mean, done grabbed some hair.”

Only one participant mentioned the threat of force (although not actual force or violence) as a source of power. This participant said, “I tell females...I don't put up with that shit. I talk like I ain't going to do it. I make ‘em think, I make ‘em scared and shit. Keep ‘em in check that way. That shit work though.”

Physical attractiveness

In one focus group, it was suggested that unattractive women do more household chores and take better care of their partners. One man said, “Some people say just get an ugly girl.... ‘Cause they make you, they do for you.” Another participant discussed being embarrassed about being seen with his partner because she was unattractive, but remaining in a relationship with her because she gave him money and material goods.

Shortage of African American men

Several men commented on the shortage of available African American men, and the corresponding surplus of women. One man noted “And for every man in here there's at least three to four women because our Black young man population, either they're dead or they're in jail or they're geeked [drugged] out.” Another participant stated “there's so many [women] out here, it's so plentiful it ain't even fun no more...”

The shortage of available men and surplus of available women made it easy for men to leave relationships, because they could easily find another partner. One man stated, “it is too many women out here to be stuck on one.” Another participant noted that if you do leave a partner, most of the time you have another relationship on the side anyway. One man commented that it was not necessary to use physical force in a relationship, because if a woman did not do what you told her to do, you could easily replace her. “Then you got your side chick, she going to do whatever you tell her to do, and you don't have to hit her or whatever. If you, she piss you off, you gonna get, you out, you know what I'm saying, you fired, get out of here. She know that she can be replaced too easily.”

However, the shortage of men did not seem to give men power over their primary partners because primary partners were often the mother of their children, and this role (and relationship) could not be replaced. One man said “Wifey the only one that's really gonna have the balls to step to you on a fight me back level, you know what I'm saying. Anybody else could be replaced, you can't replace the mother of your child.”

Discussion

The majority of African American men who participated in this study attributed relationship power to the contribution of resources; thus, from most men's perspective, either the man or the woman could be in power, depending on the resources each contributed. This result corroborates findings from other studies that report that women often have power in relationships, or that they and their partner share power (e.g., Cabral, Pulley, Artz, Brill, & Macaluso, 1998; Felmlee, 1994; Harvey et al., 2003; Harvey, Bird et al., 2002; Soler et al., 2000).

Understanding of these results was enhanced by considering the findings through the lens of psychosocial theories. Thus, according to social exchange theory, transactions between individuals are viewed as an exchange of material and non-material goods. According to this perspective, people seek to maximize the rewards received and minimize the costs incurred from social exchanges (Homans, 1958). The individual who is more dependent has less power in a relationship; the more an individual needs the resources offered by another, and the fewer options an individual has to obtain those resources elsewhere, the more dependent an individual will be (Emerson, 1962). Resource theory examines power in the family context, and posits that the more resources an individual brings to a relationship (relative to the partner's resources), the more power he or she has in that relationship (Blood & Wolfe, 1960). As one participant stated, “The primary power holder is probably the person with whatever it is that the person wants...you want what I got, so I mean you're gonna do basically whatever it is that I asked you to do to get what I got.”

Despite the notion that resources contributed determine power, a few men thought that, de facto, men had more power than women in relationships. Thus, even in situations where women brought more resources to the relationship, some men were able to reframe the situation so that they retained more power. “Normative resource theory,” an extension of resource theory, may be a useful framework for explaining this finding. According to this theory, cultural or normative expectations about who has power as a factor in the balance of power in family relationships (Rodman, 1967). Throughout history, men have had more economic, social, and political power than women (Connell, 1987); thus, men may have power ascribed to them because of traditional, socio-cultural norms. This perspective is neither new, nor limited to socioeconomically disadvantaged African American men. Future research should investigate what individual and relationship characteristics are associated with the perception that power is determined by resource contribution, and what characteristics are associated with the perception that, de facto, men have more power. It is interesting to note that, although some men thought that power was shared, and many men stated that women could have more power in a relationship, depending on the resources she contributed to the relationship, none of the men stated that women had more power in relationships by default. If women had more power it was because they earned it, by their contribution of resources.

Participants named several sources of power in relationships. The most commonly cited sources of power were money and sexual decision making (primarily through refusal of sex). Individuals who were able to contribute these resources (or, in the case of sex, to withhold these resources) had more power in the relationship. Many of the sources of power described by men in this study confirm other researchers’ conceptualizations of the sources of power. Money or income has often been considered a source of relationship power, and previous studies have found that income or employment is related to relationship power (e.g., Saul et al., 2000; Wingood & DiClemente, 1998). Historically, men have received higher wages than women, and this imbalance in economic power has been hypothesized to account for, in part, men's greater power (Connell, 1987). However, in the present study, many of the men talked about their female partners having a stable income, and owning or renting a house; when these conditions hold, women enjoyed at least equivalent if not greater power. Most of the situations in which the men discussed money as a source of power were primary partnerships, although some men mentioned money as a source of power in secondary relationships as well. It is important for sexual health researchers to recognize that men who are unemployed or earn less than their female partners may feel they have less power in relationships. Money may especially be a source of power in relationships in impoverished communities, where resources are scarce. Indeed, this balance of interpersonal power is similar to the balance of community-level power described in a recent ethnographic study in urban, low-income housing projects (cf. Venkatesh, 2008).

Withholding sex was also commonly mentioned as a source of power. Sex as a source of power is rarely mentioned in social exchange and resource theories of power. However, as one participant noted astutely, sex is the only resource a person cannot obtain for him or herself. Harvey and colleagues similarly found that withholding sex was mentioned as a source of power by African American women and women of Mexican origin (Harvey, Beckman et al., 2002; Harvey & Bird, 2004). Withholding sex may be more important in some socio-cultural contexts than in others; for example, Whitehead (1997) suggests that because African American men typically lack economic and political power, sexual power may be the only power these men believe that they possess. Sex may be an important resource or reward obtained from intimate relationships, particularly among individuals where other forms of power are not easily achievable, and perhaps should be considered in future conceptualizations of the sources of power in intimate relationships.

The strategy of withholding sex was most often mentioned as a source of power for women (i.e., women withhold sex from men), perhaps because of cultural or societal norms that men are always interested in sex (and thus are very invested in this reward), and women are sexual “gatekeepers” who are not particularly interested in sex (and thus do not incur costs as a result of withholding sex). However, a few men also reported withholding sex as a means of gaining or maintaining power. For these men, few costs were incurred because they had a sexual partner on the side, and were still able to enjoy sex while depriving a partner of this pleasure.

Only one participant described threatening women with physical force as a power source. In a previous study with men and women recruited from an STI clinic (Carey, Vanable, Senn, Coury-Doniger, & Urban, 2008), women in intervention groups frequently mentioned the use of physical force in intimate relationships. Indeed, intimate partner violence is a serious and prevalent phenomenon in the U. S. (Centers for Disease Control and Prevention, 2008). Thus, it was surprising that men did not mention physical force as a source of power. Perhaps the men were reluctant or embarrassed about discussing the use of physical force with women, although their frank discussion of other socially sensitive topics, including the use of physical force during sex, challenges this explanation. Men may also have been concerned that they would be reported to the police if they admitted to abusing their partners (indeed, the consent form identified threats to self or others as limits to confidentiality). Alternatively, men may not think physical force is an important source of power in relationships. As one participant stated, because there were so many alternative women, if a relationship got to the point where he wanted to be violent, he would just leave the relationship. For many men, the motivation to avoid violence seemed to be related to a desire to avoid jail rather than the recognition that violence was morally wrong.

Although men did not explicitly link attractiveness and power, a lack of physical attractiveness for women was tied to a lack of power. Some men preferred to be in a relationship with a less attractive woman because then they (i.e., the relatively more attractive partner) will have more power in the dyad. Men may perceive that unattractive women invest more in their relationships because they have fewer options. However, men's discussions of physical attractiveness also revealed there is a drawback to using this source of power, namely, being in a relationship with someone who is unattractive can undermine a man's reputation. Whitehead (1997) identified reputation as a critical aspect of masculinity among African American men. Thus, although being more physically attractive than a partner could give a man more power in that relationship, it may result in less power for the man in other contexts, where his reputation is important.

Power is not only related to the resources or rewards given by someone, but power is also inversely related to a person's ability to obtain the rewards somewhere else. According to social exchange theory, someone who can easily obtain the rewards or resources somewhere else will have more power in relationships. Much has been written about the shortage of African American men relative to African American women, and the possible impact of the male-to-female ratio on HIV and STIs (Adimora & Schoenbach, 2002, 2005). Specifically, the male-to-female ratio may contribute to men having multiple partners, because men's female partners know if they object to concurrent partners, they can be easily replaced. Although participants did not explicitly cite the male-to-female ratio as a source of power, they frequently discussed the shortage of African American men and the corresponding surplus of African American women, and acknowledged that it would be easy to leave a relationship because of the availability of other women with whom they could form new relationships. In addition, the shortage of African American men may undermine one of women's sources of power: withholding sex. Because of the unbalanced male-to-female ratio, men can obtain sex from someone other than their primary partner, making sex a less valuable resource. Thus, in addition to individual and dyadic-level determinants, social and structural variables also need to be investigated as influences on power in relationships.

Some men indicated that although it would be easy to replace a casual partner because of the surplus of women, it would be difficult to replace a primary partner. In social exchange theory terms, there may be great costs associated with ending a primary relationship, such as a loss of intimacy and less contact with one's children. Further research on interpersonal power should investigate the distinction between primary and secondary partners, and consider the costs incurred with ending each type of relationship.

These findings should be considered in light of the participants’ socio-cultural context. It is interesting that men's perceptions of power were consistent with social exchange and resource theories of power, which were developed largely from data on European Americans. However, several factors that are relatively unique to African American men deserve mention. Whitehead (1997) has suggested that concepts of masculinity are closely linked to having economic, political, and sexual power. Because African American men often lack the first two types of power, sexual power may be their only source of power; thus, in this context, sexual power may assume greater importance. The men in this study reported that money was a source of power in relationships, but acknowledged that their female partners often had more economic power, thus giving the female partners more power in the relationship. Withholding sex also was a source of power primarily for the female partner; if, as Whitehead (1997) posited, sexual power is particularly important for African American men who lack economic and political power, withholding sex could undermine one of these men's few sources of power. It is significant that both of the main sources of interpersonal power identified by the men in this study (i.e., money and withholding sex) were most often sources of power for women. The one source of power that was actually available to men was the low male-to-female ratio, which allowed men to have multiple sexual partners with little fear of reprisal from their partners (Carey, Senn, Seward, & Vanable, in press).

It is interesting that, other than withholding sex as a source of power, men did not mention power in relation to sexual behavior or safer sex. Men are often assumed to have more power in sexual decision-making areas, in part because of social and cultural norms, and in part because men have physical control over whether or not a condom is used (Amaro, 1995). Some research supports the idea that men are in charge of sexual decision-making (e.g., Kennedy et al., 2007), whereas other research suggests that sexual decision-making is often mutual (e.g., Bowleg, 2004; Harvey, Bird et al., 2002; Harvey et al., 2003). Future research should investigate whether men, women, or both have more perceived power in sexual decision-making, characteristics of relationships in which men and women share sexual decision-making power, and how sexual decision-making power affects engagement in safer sexual behaviors.

Although the findings from this study are important and novel, the limitations of this study should be acknowledged and the results interpreted mindful of these limitations. This study was conducted with a small sample of socioeconomically disadvantaged African American men seeking care at an STI clinic. In addition, to be eligible, men had to have engaged in recent sexual risk behavior; thus, these results may not generalize to men outside of this setting, or to men who were not engaging in sexual risk behavior. Women's perspectives on power in relationships was not investigated, but should be investigated in future studies. Finally, the study investigated general power in relationships, but did not ask participants about power in specific domains, such as sexual decision-making or condom use. Although having more general power has been related to engaging in safer sex for women (Pulerwitz et al., 2002; Pulerwitz et al., 2000), it may be important to investigate power in specific domains, specifically in sexual decision-making domains (Harvey et al., 2003).

The study findings have implications for both researchers and clinicians. First, clinicians and researchers need to recognize, as many do (e.g., Amaro, 1995; Wingood & DiClemente, 1998), that a lack of power may restrict an individual's ability to engage in safer sex. Second, the effect of power on safer sex should be researched further, and should be incorporated into models of health behavior. Extant models have been criticized because they do not include gender, dyadic, and power issues (Amaro, 1995; Amaro & Raj, 2000). However, research on the relation between power and sexual behavior can also be criticized for failing to include constructs suggested by models of health behavior. Just as an individual who has information, motivation, and safer sex skills but lacks power may not be able to enact safer sex behaviors, an individual who is powerful but lacks information, motivation, or safer sex skills also likely will not engage in safer sex behaviors. All possible determinants needs to be considered when predicting sexual behavior, and new models of health behavior incorporating power should be developed. Third, more research on men's power in relationships is needed, because few studies have considered the influence of men's perceptions of power on sexual risk behavior. Because condom use, the modal safer sex strategy, is under the direct control of men, it is not clear who would control condom use in a relationship where the female partner had more general power. Finally, sexual risk reduction interventions that include a component designed to enhance the dignity and self-worth of socioeconomically disadvantaged men, and to reduce gender-based power differentials in their relationships, should be developed and evaluated. The benefits of enhancing men's self-worth and partner egalitarianism need to be made more compelling at the individual level.

Moreover, it will be necessary to extend and supplement the individual- and group-level interventions typical in STI prevention research with structural interventions. For example, money and material goods were often cited as sources of power in relationships; structural interventions that focus on providing education to young women, creating jobs for the unemployed, increasing pay for individuals who are underemployed, or creating stable housing for individuals who could not otherwise afford housing may be effective at reducing power differences between men and women. As one example of such interventions, research on micro loans to women in the developing world suggests that when women control their own money they are better able to engage in HIV-related negotiation (Ashburn, Kerrigan, & Sweat, 2008). By understanding more about power in relationships, researchers may be able to design more effective sexual risk reduction interventions.