African American Women's Experiences of Power Imbalance and Safe Sex Practices: A Scoping Review

African American women continue to face power imbalances when engaging in heterosexual sexual contact with African American men, due to historical contexts, sexual scripts, and gender-based stereotypes that stem from discrimination. However, the impact of power imbalances on safe sex practices is poorly understood due to deep-rooted traditional gender roles. The goal of this scoping review is to better understand the literature on power imbalance and safe sex practices and identify gaps in knowledge that will better inform future interventions for African American women.

Online databases identified 548 papers published in the United States between 2004 and 2021, from which 18 selected publications were identified that included power imbalance concepts, such as condom negotiation and sexual risk taking. The study selection process was highlighted using the PRISMA diagram. Data were extracted and evaluated based on the interventions using thematic analysis.

The review of outcomes and measures was guided by the utilization of theoretical frameworks and intersectional structural factors, such as gender imbalances and cultural norms. In many studies, women believed that men controlled sexual relationships and sexual and reproductive decision-making. African American women who reported less relationship power in their heterosexual relationships were less likely to suggest condoms in sexual encounters. Overall, relationship power was associated with condom negotiation behavior among African American women.

The findings from this scoping review suggest a large body of recent literature about power imbalance, as well as its impact on safe sex practices among African American women. Some findings suggest that African American women's fear of violence hinders them from making healthy sexual decisions regarding their own health. However, more research is needed, as this scoping review sets the groundwork for future systematic reviews.