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There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. The social cognitive theory was the framework that guided this study. ANOVAs were used to determine differences in means of the four sexual assertiveness subscales across the demographic categories (age, sexual orientation, income, education, and relationship status. HIV, AIDS, and sexual transmitted disease communication assertiveness mean scores were significantly higher among higher income Black women (padj=.016) and Black women with a college versus a high school degree (padj=.047). Moreover, Pearson bivariate correlation results showed self-esteem was significantly positively associated with all but one measure (sexual initiation) of sexual assertiveness. Health educators can use the findings of this study to create education initiatives that focus on building self-esteem and sexual assertiveness behaviors among Black women as an HIV/AIDS prevention method.

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[pt] O objetivo desta dissertação foi instrumentalizar pesquisas em assertividade sexual no Brasil. Para isso foram realizados dois estudos, o primeiro foi uma revisão sistemática buscando por ensaios clínicos randomizados que tivessem uma intervenção com desfecho em assertividade sexual, e quais suas principais características e fatores que mais impactariam neste resultado. Retornaram 10 estudos revisados, com nove intervenções diferentes e envolvendo 1285 participantes no total. Uma meta-análise apontou que comparado ao grupo controle, todas as intervenções experimentais foram efetivas, fossem estudos exclusivamente com adolescentes estadunidenses ou com adultos iranianos, esse último grupo apresentando alta heterogeneidade em seus resultados. O segundo estudo se propôs a investigar as propriedades psicométricas da Escala de Assertividade Sexual para mulheres brasileiras. Foi conduzida uma pesquisa transversal que contou com 1031 mulheres, com mulheres que tiveram relações sexuais recentes e outras que não. Verificamos que o instrumento é psicometricamente aceitável e possui bons índices de ajuste, e não apresentou diferença de resposta nesses dois grupos de mulheres. Evidencia-se assim que a assertividade sexual é uma habilidade social com diversos benefícios a autonomia sexual, portanto integrar e expandir seu desenvolvimento no Brasil pode impactar positivamente na saúde sexual da população, além de termos uma medida que pode ser replicada em estudos e na prática clínica, verificando essas mudanças na assertividade sexual. / [en] The objective of this dissertation was to provide tools for research on sexual assertiveness in Brazil. To this end, two studies were conducted. The first was a systematic review searching for randomized clinical trials with an intervention with an outcome in sexual assertiveness, and their main characteristics and factors that would most impact this result. Ten reviewed studies were returned, with nine different interventions and involving 1,285 participants in total. A meta-analysis showed that compared to the control group, all experimental interventions were effective, whether studies exclusively with American adolescents or with Iranian adults, the latter group presenting high heterogeneity in their results. The second study aimed to investigate the psychometric properties of the Sexual Assertiveness Scale for Brazilian women. A cross-sectional study was conducted with 1,031 women, including women who had recent sexual intercourse and others who had not. We found that the instrument is psychometrically acceptable has good adjustment indices, and did not present a difference in response in these two groups of women. It is thus evident that sexual assertiveness is a social skill with several benefits to sexual autonomy, therefore integrating and expanding its development in Brazil can have a positive impact on the sexual health of the population, in addition to having a measure that can be replicated in studies and clinical practice, verifying these changes in sexual assertiveness.

“Girl-on-girl” behaviour is portrayed as sexy, liberating, and edgy in contemporary popular culture, mass media, and public settings such as bars and parties. This study looked at the relation of women’s participation in public same-sex sexual behaviour (PSSSB), age, and sexual orientation (heterosexual versus some degree of same-sex orientation) with the following dependent variables: perceptions of PSSSB pressure, reasons for and feelings after engaging in PSSSB, sexual depression, sexual assertiveness, sexual self-efficacy, sexual locus of control, sexual monitoring, and use of PSSSB to explore sexual orientation. Of the 451 women (ages 19-40) who completed the online questionnaire, 54% reported having engaged in PSSSB. Most participants agreed that young women feel pressured to engage in PSSSB and listed media, popular culture, male friends, and peers as sources of this pressure. Exclusively heterosexual women who had engaged in PSSSB (n=100) reported significantly higher perceived social pressure, more subsequent negative feelings, higher sexual depression, greater external sexual locus of control, lower sexual assertiveness than all other participants, and lower scores on sexual self-efficacy than PSSSB women with same-sex orientations. Emerging adult, but not older heterosexual PSSSB women, had significantly higher sexual compliance scores. Heterosexual and same-sex orientation PSSSB women had the highest rates of sexual monitoring, and although their reasons for engaging in PSSSB were different, a majority of both listed alcohol and exploration as factors that contributed to their public girl-on-girl behaviour. Heterosexual women who had not engaged in PSSSB indicated the lowest rates of sexual exploration. Reasons for these differences are discussed. / Graduate