Empowerment and HIV Risk Behaviors in Couples: Modeling the Theory of Gender and Power in an African Context

Abstract

Background: Young women and girls in Eastern and Southern Africa are at elevated risk of acquiring human immunodeficiency virus (HIV) compared with men, largely due to power dynamics within heterosexual relationships that contribute to HIV risk behaviors. Few studies employ a comprehensive framework to examine divisions between men and women and HIV risk behaviors in an African context. Thus, we examined associations between levels of women's empowerment and HIV risk behaviors applying the Theory of Gender and Power. Methods: We used logistic regression (adjusted odds ratios or AORs) to assess associations between women's empowerment indicators and HIV risk behaviors (multiple sexual partners) and self-efficacy (ability to negotiate sex/sex refusal) with couples data (n = 12,670) from Malawi, Namibia, Zambia, and Zimbabwe. Results: Specifically, key drivers of high levels of empowerment among women were household decision-making involvement, female economic independence, and rejecting all reasons for wife-beating. Furthermore, higher levels of women's empowerment in coupled relationships was associated with safer sex negotiation in Malawi (AOR = 1.57, p < 0.05) and Zambia (AOR = 1.60, p < 0.0001) and sex refusal in Malawi (AOR = 1.62, p < 0.0001) and Zimbabwe (AOR = 1.29, p < 0.05). However, empowerment was not associated with the likelihood of the male partner having multiple sexual partners across all countries studied. Conclusions: These findings provide evidence that high levels of women's empowerment were associated with safer sex practices, although this varied by country. Policymakers should incorporate empowerment indicators to address women's empowerment and HIV prevention within African couples.

Women’s ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria

“…This provides support for the higher contraceptive use found among empowered women in many existing studies [ 28 – 30 , 33 , 34 ]. It may also account for a higher ability to negotiate safer sex as reported in some studies [ 32 , 35 ].…”

“…Studies have also linked a lack of autonomy in sexual relations to other adverse health outcomes such as mental health challenges [26], and newborn and infant morbidity [27]. Three, it also reflects the level of women's empowerment in society, which numerous studies [28][29][30][31][32][33][34] have found to strongly impact contraceptive use, and the ability to negotiate safer sex [35]. It is reasoned that through empowerment, women's autonomy and agency improve.…”

Women empowerment and utilization of HIV testing among couples in Zambia: Evidence from the Zambia Demographic and Health Survey 2018

“…Women who are empowered can make independent decisions regarding their health, including HIV testing without depending on their husbands or partners. Empowered women can negotiate for safer sex with their partners, reducing the chances of risky sexual behaviors [2]. However, harmful gender norms that enhance male dominance prevent women from exercising their right to negotiate for safe sex and utilize HIV prevention services such as HIV testing, putting them at a disproportionally higher risk of HIV transmission [3].…”

Men’s Involment in Contraceptives Use and Wellbeing of Women in Nigeria: Implications for FP2020

“…Sex is most frequent in violent relationships because husbands or partner assert the right to demand sex any time and weaken the power of negotiation of women for safe sex and unwanted pregnancies (Adhena et al, 2020; World Health Organization, 2013). Such power imbalance has been documented as an inhibiting factor against the use of condoms among women (Feyisetan & Oyediran, 2020; Woolfork et al, 2020). Likewise, where wives’ decision making power and knowledge about family planning are limited, the use of contraceptives will not be all-embracing between partners (Do & Kurimoto, 2012).…”