Individual and Interpersonal Characteristics that Influence Male-Dominated Sexual Decision-Making and Inconsistent Condom Use Among Married HIV Serodiscordant Couples in Gujarat, India: Results from the Positive Jeevan Saathi Study

Abstract

Approximately 40 % of new infections occur among married women. No studies have examined the factors that may contribute to HIV transmission among HIV-negative wives in HIV serodiscordant relationships in Gujarat, India. In 2010, a cross-sectional survey with 185 HIV serodiscordant, married couples (i.e. 185 HIV-positive husbands and their 185 HIV-negative wives) in Gujarat was conducted. Socio-demographic, individual, and interpersonal characteristics of HIV-positive husbands and their HIV negative wives were examined. The association of these characteristics with inconsistent condom use and male-dominated sexual decision-making, were examined using multivariate logistic regression analyses. Approximately 10 % of couples reported inconsistent condom use in the past 3 months and 20 % reported intimate partner violence (IPV). Reports of IPV were associated with a higher odds of inconsistent condom use among HIV-positive husbands (aOR = 6.281). Husbands who reported having received couples counseling had a lower odds of male-dominated decision making about condom use (aOR = 0.372). HIV-negative wives who reported sex communication had a lower odds of male-dominated decision making about condom use (aOR = 0.322) with their HIV-positive husbands. Although condom use is a traditional measure of risk behavior, other factors that facilitate risk, such as male-dominated sexual decision-making need to be considered in analyses of risk.

Risk Factors of Inconsistent Condom Use among Sexually Active Youths: Implications for Human Immunodeficiency Virus and Sexual Risk Behaviours in Malawi

“…Furthermore, a study of female sex workers in Ethiopia found that, work related violence was a contributing factor to unprotected sex among young people, thus facilitating the spread of sexually transmitted infections (Mooney et al, 2013). In another study, Patel et al (2014) reported that 10% of couples in India use condoms inconsistently in the past three months and the likelihood of inconsistent condom use was higher among partners who have suffered violence. Wealth was also given considerable attention in the study as a contributing factor toward inconsistent condom use.…”

A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya

“…While the causal mechanisms underlying these associations are not fully understood, it is clear that FI compromises women’s ability to negotiate safer sex practices when they are dependent on men for food and other resources. FI may also exacerbate gender-based imbalances in relationship power that can increase sexual risk by enhancing male control and decision-making dominance in sexual relationships, including the timing and frequency of sex (Patel et al, 2014; Shannon et al, 2012). Women’s low sexual relationship power has also been associated with less condom use (Campbell et al, 2009; Pettifor, Measham, Rees, & Padian, 2004; Pulerwitz, Amaro, De Jong, Gortmaker, & Rudd, 2002) and with physical violence and forced sex (Muldoon, Deering, Feng, Shoveller, & Shannon, 2015; Pulerwitz, Gortmaker, & De Jong, 2000).…”

A narrative systematic review of quantitative and qualitative evidence on the impacts of HIV on women living with HIV and their families in developing countries

“…Some of these impacts, including rejection by family, abuse by husband and in-laws, selective maltreatment in pregnancy by healthcare professionals especially when HIV status is known, HIV testing by coercion, sterilisation and abortion have not been reported as HIV impacts on men and other KAPs (26)(27)(28). Rejection and abuse against WLHIV by husbands and in-laws, for example, seem to be the consequences of the patriarchal system or sociocultural norms and values prevailing within societies and communities in many developing countries, that promote male or husbands' domination over women or wives' submission to husbands or male partners (45)(46)(47)(48)(49). Being infected with HIV also causes negative self-stigma among WLHIV, such as paranoia about people's negative reactions to their HIV status, fear of HIV status being recognised and spread out by other people and fear of rejection, and self-isolation.…”