BackgroundEducational campaigns to prevent HIV/AIDS have shown mixed success in Africa. We hypothesized that women's lack of agency in decision-making and taking discernible actions reduces the beneficial impact of HIV-related knowledge. MethodsWe used data from Population-based HIV Impact Assessment (PHIA) surveys in Malawi, Tanzania and Zambia. A subsample of surveys that were completed by married adult women were selected for the HIV knowledge module which included responses for household decision-making questions. We created a binary variable for agency (ability to participate in decision-making about household matters, health, and sex), and scalar variables for HIV-related knowledge and sexual behaviors. We used regression analysis using survey weights with the behaviors as dependent variables. ResultsWe pooled survey results from 16,822 women (63% from Tanzania, 19% from Malawi and 18% from Zambia). Altogether, 13.5% of women (17% of those 15-24 years old) exhibited poor agency. Those with a higher degree of agency had higher education, were working, and were wealthier. Women lacking agency were significantly less likely to use condoms (4.7% vs. 6.2%, P=0.022). Approximately 95% reported having a single partner over past 12 months, while Zambian women with no agency showed significantly lower rate of 92% (odds ratio, OR=0.66, 95% confidence interval, CI=0.45-0.95, P=0.027). The rate of HIV testing across the three countries was 83%-92%. In Tanzania, presence of good knowledge and agency together increased the odds of HIV testing by 60% (interaction term). However, among those with good knowledge yet reporting poor agency, the likelihood of HIV testing decreased by 65%, nullifying knowledge impact. We did not observe similar associations in Malawi. Among women with poor knowledge, lack of agency reduced the odds of condom use by 50% compared to those with agency. Alternatively, for women who exhibited good knowledge without agency, the odds of condom use was more than double compared to women with some agency (OR=2.14, 95% CI=1.07-4.27, P=0.032)). ConclusionsWe detected a moderating effect for agency on knowledge-driven behavior. Results on different behaviors and across individual countries are mixed and suggest caution to derive definitive conclusions. Despite limitations, these findings indicate that policies that increase women's agency may help anti-HIV programs' success.Women have fallen victim to the HIV/AIDS epidemic at disproportionally higher rates than men, especially in African countries. 1 This fact has created a sense of priority to promote improved safe sex practices that could protect women against the infection. In this effort, educationbased interventions have been successful in providing greater access to healthcare services and other resources in low-income countries, though the uptake of disease preventative behaviors has been generally low. 2,3 Women, in particular married women, have very low rates of condom use. For instance, in Kenya, 1.8% and in Zambia 4.7%, of married women use con...
Background HIV/AIDS continues to persist as a major global public health issue in Africa. Within the younger adult population, adolescent girls and younger women aged 15 to 29 years have been identified as having a heightened risk of contracting HIV. Risky sexual behaviors are important drivers behind the HIV prevalence gender gap among younger adults in sub-Saharan Africa. Methods We used nationally representative survey data from three sub-Saharan African countries, Malawi, Tanzania and Zambia, to explain the relationship between HIV prevalence and having an older partner and/or having multiple partners using a logit model. We then proceeded to conduct a Blinder-Oaxaca decomposition analysis to better understand the gap drivers. Results We found that while the gender gap is driven largely by women having higher levels of risk for sexual behaviors and other risk factors in two of the study countries, this was not found in the third. We also found that different sexual behaviors vary in their riskiness across countries. Having multiple partners and having an older partner carried a similar risk with regard to younger adults contracting HIV in Malawi; in Tanzania and Zambia the risk associated with having multiple partners was greater than the risk associated with having an older partner. In all three countries the risk of being a younger adult female was higher than men, other risk factors the same. Conclusions Risky sexual behavior contributed to increased prevalence of HIV in the study countries. Policies aiming to encourage younger women to form relationships with men among their cohort would be most impactful in Malawi, where currently many younger women have partners who are more than five years their senior compared to younger men. Other policies can attempt to reduce non-monogamous relationships among younger adults, wherein multiple partners are a key driver of the HIV gender gap.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.