Conundrum of Sexual Decision Making in Marital Relationships: Safer-Sex Knowledge, Behavior, and Attitudes of Married Women in Zambia

Abstract

Recent research suggests that Zambian women face an increasing risk of contracting human immunodeficiency virus (HIV) within marital relationships. Married women's perceived ability to negotiate safer sex or adopt self-efficacy practices is recognized as critical in preventing new infections within marriage. Yet women's self-efficacy practices, such as requesting condom use or refusing sex within marriage, are influenced by individual and context-specific factors. Using the 2007 Zambia Demographic and Health Survey data from 4,306 married women, this article examines the association between married women's perceived ability to negotiate safer sex and a range of attitudinal, knowledge, and sociodemographic variables. Results from complementary log-log regression models reveal that married women who have factual knowledge about HIV transmission and prevention, as well as those who have been tested for their HIV serostatus, were more likely to report they can request that their husbands use a condom. Rural married women were more likely to report they can refuse their husbands sex compared to woman in urban areas. Likewise, married women who agree that a wife is justified in refusing her husband sex if he sleeps with other women were more likely to report they can negotiate safer sex compared to women who disagree. These findings suggest that married women are able to negotiate safer sex if they have correct factual knowledge about HIV transmission and are aware of their rights within marital relations.

Persistent misconceptions about HIV transmission among males and females in Malawi

“…There were four questions related to HIV transmission beliefs: whether respondents believe that 1) HIV can be spread through witchcraft and other supernatural means; 2) HIV can be spread through sharing food with a person with HIV; 3) HIV can be spread through mosquito bites; 4) and, a healthy-looking person cannot be infected with HIV. Previous studies [ 3 – 6 ] have concluded that endorsing any form and/or number of misconception about HIV transmission is associated with risky sexual behaviours. Also, governments and NGOs in Malawi have put much effort into eliminating misconceptions about HIV transmission [ 2 ].…”

“…Despite major efforts at behaviour change, myths and misconceptions about HIV transmission remain an important influence on risky sexual behaviours [ 3 – 6 ]. Subsequently, the behavioural change model is limited in capturing the influence of myths and misconceptions to inform clinical or scientific understanding of the ways in which HIV is transmitted or prevented [ 7 , 8 ].…”

“…Earlier research indicates that endorsing misconceptions about HIV transmission is linked to risky sexual behaviours, including early sexual debut, non-use of contraceptive methods, and inability to negotiate for safer sexual intercourse [ 3 – 5 ]. Despite its association with risky sexual behaviours, which could lead to HIV transmission, there are only few studies that examine the prevalence and factors associated with misconceptions about HIV transmission [ 11 , 35 ].…”

Assessment of Key HIV Misconceptions among Inhabitants of a Rural Community in Enugu State, Nigeria

“…Misconceptions about HIV/AIDS could usually be associated with different risky behaviours that might lead to getting infected with HIV [10] [14]. Misconception has the potential of preventing people from taking necessary steps aimed at preventing HIV infection [26].…”

“…This is worrisome since misconceptions of these types are associated with behaviours that are predisposed to HIV infection [14]. Correct knowledge about HIV is very crucial in controlling the spread of the infection [15].…”