The Influence of Self-esteem and Self-silencing on Self-efficacy for Negotiating Safer Sex Behaviors in Urban Bahamian Women

Abstract

The rapidly increasing rate of HIV/AIDS among Bahamian women is daunting for the future of Bahamian society. Despite many concerted efforts, scientists are unable to find a cure for HIV disease and are faced with the multiple challenges that treatment and management strategies bring for persons living with AIDS. As a result, there is a major focus on HIV prevention. The purpose of this study was to understand the characteristics that put urban Bahamian women at risk for HIV/AIDS so that gender appropriate and culturally sensitive prevention interventions could be developed and implemented.

A cross-sectional, correlational survey design was used to study the relationships between select demographic variables (i.e., age, income, education), self-esteem, self-silencing, and self-efficacy for negotiating safer sex behaviors in urban Bahamian women. Data were collected from urban Bahamian women ( N = 661) ages 18 to 78 years from a variety of community sites in Nassau, Bahamas. Data were collected using an 80-item anonymous questionnaire which included: (a) The 16-item Taylor' Self-Esteem Inventory (TSEI) (Taylor & Tomasic, 1996); (b) The 31-item Silencing The Self Scale (STSS) (Jack & Dill, 1992); (c) The 12-item Self-Efficacy Scale (SES) to measure self-efficacy for negotiating safer sex behaviors (Dilorio et al., 1997); and (d) demographic and background questions.

Hypothesis testing was conducted using Pearson product-moment correlation coefficients (r) and logistic regression analyses, which revealed mixed results. Three of four hypotheses were supported, and the fourth hypothesis was partially supported. Self-esteem and self-silencing were negatively correlated ( r = −.56, p < .01), self-esteem and self-efficacy for negotiating safer sex behaviors in urban Bahamian women were positively correlated (r = .22, p < .01), and self-silencing and self-efficacy for negotiating safer sex behaviors in urban Bahamian women were negatively correlated (r = .15, p < .01). Additionally, age (OR = 1.02, 95% CI = 1.01–1.04), education (OR = 1.10, 95% CI = 1.00–1.20), and self-esteem (OR = 1.03, 95% CI = 1.02–1.04) were significant independent and combined predictors of self-efficacy for negotiating safer sex behaviors in urban Bahamian women.

The results of this study suggest that in addition to being gender appropriate and culturally sensitive, HIV prevention interventions developed and implemented for Bahamian women should also be tailored with respect to age and educational level and address self-esteem enhancement. Future research should include replication of this study with rural Bahamian women, urban and rural Bahamian men, and urban and rural Caribbean adults and adolescents as well as evaluation of theory-based self-esteem and skills building HIV prevention interventions.