Role Play Assessments of Sexual Assertiveness Skills: Relationships with HIV/AIDS Sexual Risk Behavior Practices

Abstract

Conceptual formulations of HIV risk reduction and many HIV prevention interventions reported in the literature emphasize the role of sexual assertiveness, negotiation, and communication skills as key elements for enacting behavior change. However, there have been few attempts to determine if objective ratings of individuals' sexual communication skill effectiveness are actually associated with their levels of HIV sexual risk behavior. In the current study, 114 severely mentally ill men and women role-played scenes in which confederates simulated attempts to coerce unprotected sex. Participants' role-played responses were transcribed verbatim and later rated for quality in several areas of assertiveness skill effectiveness. In addition, participants provided detailed information concerning their sexual behavior practices in the past 30 days. Participants were categorized into highly, intermediately, or poorly skilled groups based on effectiveness in role play performance, and the groups were then compared on indices of HIV risk behavior. Individuals with high objectively rated sexual assertiveness skill had the lowest number of unprotected sex acts, the smallest number of different sexual partners, the smallest number of casual sex partners, and the highest levels of condom-protected sex in the past 30 days. Individuals with poor sexual assertiveness role-play skills had the highest levels of sexual risk behavior. These associations were especially pronounced among women. Findings of this research provide support for teaching individuals to develop and refine their sexual assertiveness and communication skills in HIV prevention programs. Future research issues in this area are highlighted.