The authors of a recent study revealed that endorsement of certain marianismo beliefs, related to women acting virtuous and chaste, may promote abstinence, but also are associated with sexual risk behaviors.1
Contraceptive Technology Update (CTU) contacted researcher Melissa M. Ertl, PhD, an assistant professor of psychology at the University of Minnesota. Ertl discusses her research into Latina college students’ beliefs, which she conducted with Cara Fresquez, MAC-P, an advanced doctoral student in counseling psychology at the University at Albany-State University of New York. The following transcript has been lightly edited for length and clarity.
• CTU: Please describe the theory about traditional gender role beliefs among Latina college students and how this could affect sexual risk behaviors.
• Ertl: There has been a growing interest in understanding the influence of gender-specific roles, values, and beliefs on health outcomes. Marianismo beliefs are a term used to describe traditional Latinx gender roles and expectations, which are considered to be a central organizing structure in Latinx culture. Gender role schema theory describes how women are socialized to endorse certain traditional gender role beliefs and adopt stereotypically gendered behaviors in their everyday lives.
Notions of marianismo are derived from representations of the Virgin Mary and efforts for Latina women to behave in idealized ways — promoting family cohesion, upholding virtuosity, demonstrating subservience in relationships with men, maintaining agreeable relationships, and guiding the family spiritually.
Regarding how this can impact sexual behaviors, traditional gender role beliefs for Latina women include being viewed as pure or abstinent from sex, nonsexual, or naive about sex to maintain family honor. These gendered expectations can also take the form of avoidance of discussing what some consider to be controversial topics, like sex and birth control, to promote harmonious relationships. Other gendered expectations may include Latina women deferring sexual decision-making to partners, being strongly committed to relationships, avoiding infidelity, and having strong aspirations for marriage and childbearing.
In some ways, marianismo beliefs may be protective against risk behaviors. In other cases, marianismo beliefs may pose a risk factor for behaviors that can increase the likelihood of adverse sexual health outcomes.
We were very interested in studying whether and how marianismo beliefs might be associated with abstinence from sex and sexual health behaviors like STI [sexually transmitted infection] and HIV testing. This has major implications for prevention efforts with Latina women, who are affected by significant sexual health disparities in the United States — especially for college students, who are at a unique developmental period during young adulthood that may often include sexual risk-taking. We were interested to learn about the role of gender role beliefs in relation to sexual health behaviors.
• CTU: Please describe your findings and how they could affect STI/HIV risk among this population.
• Ertl: The major contribution of our study is that it clarified the answer to the question as to whether marianismo beliefs were linked with sexual health behaviors that can help prevent the spread of STIs and HIV, including testing and consistency of condom use, or whether marianismo solely promoted abstinence among Latina young adults. Findings provided insight into how certain marianismo beliefs — specifically, endorsement of the virtuous and chaste belief — may promote abstinence but not protective sexual health behaviors among those who are sexually active. This distinction is relevant for culturally responsive sexual health education and health promotion efforts with Latina young adults and may inform efforts to reduce disparities in adverse sexual health outcomes in this population.
In other words, in our study, Latina women who endorsed the virtuous and chaste belief to a greater extent — or the notion that Latina women should be “pure” and should abstain from premarital sex — were at lower odds of being sexually active.But once sexually active, those who endorsed the virtuous and chaste belief to a greater extent were less likely to be tested for STIs and HIV. That is, endorsement of the virtuous and chaste belief may serve as a risk factor for Latina young adults who are sexually active, since not being tested and having knowledge of one’s STI status or HIV serostatus might increase risk of transmission and has implications for serostatus disclosure and their health if left untreated.
Women who endorse the virtuous and chaste belief to a greater extent may place a strong value on virginity or endorse a stigmatized view of premarital sexual behavior and may not seek out sexual education. Then, once sexually active, they may continue to lack comfort with acknowledging their sexuality or engaging in sexual health behaviors like STI and HIV testing that, if known to others, could confer social risk, such as perceptions about promiscuous behavior.
Additionally, prior studies indicate that naïveté about sex can minimize knowledge about sexual health, hinder the adoption of an empowered preventive mindset, and promote a stigmatized view of STI and HIV testing — which, taken together, may prevent Latina college students from accessing critical sexual healthcare and preventive services recommended by national guidelines.
• CTU: How should reproductive health clinicians and providers adjust their sexual risk and contraceptive counseling to meet the needs of this population? For instance, what would be a good way to approach the subject with patients who hold to the virtuous and chaste belief?
• Ertl: Reproductive health clinicians and providers should conduct a full assessment of sexual health needs and desires with Latina patients to ensure that care is aligned with patient goals.
Providing education that aims to promote knowledge, increase the accuracy of risk perception, and improve patient attitudes related to prevention is critically important. Emphasizing self-determination, autonomy, and empowerment, as well as the many avenues for prevention, including highly effective biomedical strategies like HIV pre-exposure prophylaxis, can increase self-efficacy to engage in prevention behaviors and promote improved sexual health outcomes. Given that only about half the participants in our sample were tested for HIV in the last year, this underscores the need to incorporate STI and HIV testing into routine care.
For reproductive health clinicians and providers working with Latina young adult women and populations for whom the gendered role of being virtuous and chaste may be salient, it is important to recommend testing as a standard of care.
Clinicians and providers also may consider how to best implement culturally responsive prevention programs that account for marianismo beliefs and other culturally relevant values and beliefs, such as the centrality of family; for example, highlighting the importance of engaging in prevention behaviors to stay healthy for one’s family.
For example, psychoeducation on gendered power dynamics in relationships and how those may be linked with risk for STIs and HIV may be helpful — including content tailored to increasing awareness of how traditional gender role beliefs, such as the belief that Latinas should be abstinent until marriage, be chaste, and remain naïve about sex, could reduce sexual health knowledge and decrease the likelihood to be tested for STIs and HIV. Skills-based initiatives to increase comfort with sexual communication and decision-making processes also might be beneficial. Public health campaigns on college campuses should emphasize sexual health literacy and empowered sexual decision-making.
• CTU: What more should family planning and reproductive health providers know about working with Latina patients? Is there a takeaway message you would like to send?
• Ertl: For family planning and reproductive health providers, being apprised of local and national data on persisting sexual health disparities is critical. Providers should assess unmet community needs in their practice. When working directly with patients, they should emphasize an array of prevention options available to help patients make informed decisions about their care.
Given the strong evidence for culturally tailored interventions and practices, community-based prevention efforts that account for the role of cultural factors concerning health behaviors may be beneficial, including strategies like the use of [community health workers] and empowered peers who can serve as patient advocates, educators, and outreach workers.
A main takeaway message of our study is that STI and HIV testing may be underutilized among Latina young adults who endorse certain traditional gender role beliefs. Providers should be aware of the need to promote sexual health knowledge and interest in testing among sexually active patients.
REFERENCE
- Ertl MM, Fresquez CL. Do traditional gender role beliefs promote abstinence and sexual health behaviors among Latina college students? Arch Sex Behav 2023;Dec 29. doi: 10.1007/s10508-023-02760-x. [Online ahead of print].
The authors of a recent study revealed that endorsement of certain marianismo beliefs, related to women acting virtuous and chaste, may promote abstinence, but also are associated with sexual risk behaviors.
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