HIV Risk Assessment and Risk Reduction Strategies in the Context of Prevailing Gender Norms in Rural Areas of Cabo Delgado, Mozambique

Bandali, Sarah

doi:10.1177/1545109712453937

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…Participants who reported that they did not know whether their primary partner had ever been tested for HIV had a higher risk of HIV infection as well as late diagnosis of HIV in multivariable analyses. These findings contribute to the growing literature on how gender norms may influence sexual risk taking behaviors and risk reduction efforts in Mozambique [18]–[20] and suggests that HIV testing of couples might be an effective prevention strategy.…”

Section: Discussionsupporting

confidence: 54%

Determinants of Prevalent HIV Infection and Late HIV Diagnosis among Young Women with Two or More Sexual Partners in Beira, Mozambique

et al. 2013

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BackgroundThe prevalence and determinants of HIV and late diagnosis of HIV in young women in Beira, Mozambique, were estimated in preparation for HIV prevention trials.MethodsAn HIV prevalence survey was conducted between December 2009 and October 2012 among 1,018 women aged 18–35 with two or more sexual partners in the last month. Participants were recruited in places thought by recruitment officers to be frequented by women at higher-risk, such as kiosks, markets, night schools, and bars. Women attended the research center and underwent a face-to-face interview, HIV counseling and testing, pregnancy testing, and blood sample collection.ResultsHIV prevalence was 32.6% (95% confidence interval (CI) 29.7%–35.5%). Factors associated with being HIV infected in the multivariable analysis were older age (p<0.001), lower educational level (p<0.001), self-reported genital symptoms in the last 3 months (adjusted odds ratio (aOR) = 1.4; CI 1.1–2.0), more than one lifetime HIV test (aOR = 0.4; CI 0.3–0.6), and not knowing whether the primary partner has ever been tested for HIV (aOR = 1.7; CI 1.1–2.5). About a third (32.3%) of participants who tested HIV-positive had a CD4 lymphocyte count of <350 cells/µl at diagnosis. Factors associated with late diagnosis in multivariable analyses were: not knowing whether the primary partner has ever been tested for HIV (aOR = 2.2; CI 1.1–4.2) and having had a gynecological pathology in the last year (aOR = 3.7; CI 1.2–12.0).ConclusionsHIV prevalence and late diagnosis of HIV infection were high in our study population of young women with sexual risk behavior in Beira, Mozambique. HIV prevention programs should be strengthened, health care providers should be sensitized, and regular HIV testing should be encouraged to enroll people living with HIV into care and treatment programs sooner.

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Section: Discussionsupporting

confidence: 54%

Determinants of Prevalent HIV Infection and Late HIV Diagnosis among Young Women with Two or More Sexual Partners in Beira, Mozambique

et al. 2013

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“…Sexual relationships that occur between two people of different age brackets is a risk factor as seen from the results and it is common in many parts of the world [17,18]. Usually, these relationships are embraced for the benefit of material support and other gains to the women and for pleasure to the men [27].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, women living in rural areas are marginalized and disempowered and face geographical barriers in terms of accessing HIV knowledge and other HIV services [16]. Younger women married to older men do not have equal say in discussing safe sex practices [17,18]. In addition, the risk of HIV acquisition is also known to be high among cohabiting or married couples especially when one of the partners is HIV positive [19] or where intimate partner violence exists [20,21].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for HIV infection among married couples in Rakai, Uganda: a cross-sectional study

2020

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Background: Although married couples can be at an elevated risk of HIV infection, few studies have explored the risk factors for HIV infection at the couple-level. We explored the risk factors for HIV infection among married couples in settings with differing HIV prevalence levels in Rakai, Uganda. Methods: This was a cross-sectional study conducted among 664 heterosexual couples living in three HIV prevalence strata (low: 9-11.2%; medium: 11.4-20% or high HIV prevalence: 21-43%) in Rakai District, south-western Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioural characteristics from all consenting adults and aggregated to allow for couple-level analyses. We conducted bivariate and multivariable Logistic regression to assess the factors that were independently associated with HIV infection among married couples. Data were analysed using STATA statistical software (version 14.1). Results: Of the 664 couples, 6.4% (n = 42) were in HIV-discordant relationships; 5.8% (n = 39) were in concordant HIV-positive relationships while 87.8% (n = 583) were in concordant HIV-negative relationships. At the bivariate analysis, we found that residing in a high HIV prevalence stratum, reporting extra-marital relations, age difference between partners and number of previous marriages were significantly associated with being part of an HIV infected couple. After adjusting for potential cofounders, living in a high HIV prevalence stratum (Adjusted OR [AOR] =2.31, 95% CI: 1.52, 3.52), being in a third or higher order relationship (AOR = 3.80, 95% CI: 2.30, 6.28), and engagement in extra-marital relations (AOR = 1.75; 95% CI: 1.19, 2.59) were associated with couple HIV infection. Individuals that had stayed together for six or more years had 28% odds of being part of an HIV infected couple (AOR = 0.28; 95%CI: 0.18, 0.43). Conclusion: Living in a high HIV prevalence stratum, engagement in extra-marital relations and having a higher number of previous marriages were significant risk factors for HIV infection among married couples. Long marital duration was associated with reduced risk of HIV infection. Interventions that increase marital stability and those that promote pre-marital couples' HIV testing before marital formation can reduce HIV transmission risk among married couples in this setting.

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“…Women living in rural areas are marginalized and disempowered, and face geographical barriers in terms of accessing HIV knowledge and services [13]. In rural communities, the deeply entrenched beliefs about the role and position of women in society [3,4,11] place marriage as an important risk factor for HIV infection among women [4].…”

Section: Introductionmentioning

confidence: 99%

Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa

Madiba

Ngwenya

2017

Global Health Action

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Background: Women in sub-Saharan Africa bear the brunt of the human immunodeficiency virus (HIV) epidemic, and older married women and those in cohabiting relationships are regarded as the largest HIV risk group. Although preventing HIV infection in married or stable relationships is an international HIV prevention priority, little is known about the influence of sociocultural contexts on safe-sex practice by women, particularly older women in rural communities in South Africa. Objectives: This study aimed to examine how older women in a rural patriarchal society negotiate safer sex within marital and long-term cohabitation relationships, and their perceptions and experiences of barriers that influence condom use. Methods: Focus group discussions were conducted with married and cohabiting women aged 40–60 years recruited from primary health facilities in a rural district in Mpumalanga province, South Africa. A thematic analysis approach was used to analyse the data. Results: We found that although women reported negotiating safe sex in their relationships, they dreaded the possible consequences of suggesting condom use with their partners. Many factors made negotiating safe sex complex for these women: living in a patriarchal society where women play no part in sexual decision making, the fear of possible consequences of insisting on condom use, women’s inferior social position in marital relationships, cultural practices such as bride price, and gender inequality were the main barriers to practising safer sex. Conclusions: Older married and cohabiting women dreaded negotiating safer sex in this patriarchal society where women’s subordination is legitimized. The findings suggest that the women were at high risk of HIV infection because of their inability to negotiate condom use, or to reject forced sex and non-consensual sex. There is a need for interventions targeting older married and cohabiting couples and key stakeholders within communities to create awareness about cultural practices and beliefs that undermine women and HIV prevention efforts.

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HIV Risk Assessment and Risk Reduction Strategies in the Context of Prevailing Gender Norms in Rural Areas of Cabo Delgado, Mozambique

Cited by 10 publications

References 28 publications

Determinants of Prevalent HIV Infection and Late HIV Diagnosis among Young Women with Two or More Sexual Partners in Beira, Mozambique

Determinants of Prevalent HIV Infection and Late HIV Diagnosis among Young Women with Two or More Sexual Partners in Beira, Mozambique

Risk factors for HIV infection among married couples in Rakai, Uganda: a cross-sectional study

Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa

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