Sexual Relationship Power and Malnutrition Among HIV-Positive Women in Rural Uganda

Siedner, Mark J.; Tsai, Alexander C.; Dworkin, Shari L.; Mukiibi, Nozmo F. B.; Emenyonu, Nneka; Hunt, Peter W.; Haberer, Jessica; Martin, Jeffrey N.; Bangsberg, David R.; Weiser, Sheri D.

doi:10.1007/s10461-012-0162-9

Cited by 14 publications

(12 citation statements)

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“…We also found that RC (i.e., relationship control) was more strongly correlated with sexual violence than DMD (i.e., decision-making dominance), which is consistent with a study of malnutrition among HIV-positive women from Uganda [41] and other research describing sexual violence as an attempt by men to maintain control over female partners (e.g., [22, 58, 59]). This finding may also be related to the psychometric properties of the RC subscale.…”

Section: Discussionsupporting

confidence: 91%

“…Little research has examined this association among entire samples of HIV-positive women, who have higher rates of violence and poverty than their HIV-negative counterparts [36–38] and are highly susceptible to stigma, discrimination, and poor physical and mental health as a consequence of their HIV status [39–41]. These co-occurring epidemics of psychosocial problems, often termed syndemics [42], may interact in ways that synergistically worsen health disparities between HIV-positive and negative individuals [43, 44], with the potential to further spread the HIV virus to children and men.…”

Section: Introductionmentioning

confidence: 99%

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Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

et al. 2016

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Gender-based power imbalances place women at significant risk for sexual violence, however, little research has examined this association among women living with HIV/AIDS. We performed a cross-sectional analysis of relationship power and sexual violence among HIV-positive women on anti-retroviral therapy in rural Uganda. Relationship power was measured using the Sexual Relationship Power Scale (SRPS), a validated measure consisting of two subscales: relationship control (RC) and decision-making dominance. We used multivariable logistic regression to test for associations between the SRPS and two dependent variables: recent forced sex and transactional sex. Higher relationship power (full SRPS) was associated with reduced odds of forced sex (AOR = 0.24; 95 % CI 0.07–0.80; p = 0.020). The association between higher relationship power and transactional sex was strong and in the expected direction, but not statistically significant (AOR = 0.47; 95 % CI 0.18–1.22; p = 0.119). Higher RC was associated with reduced odds of both forced sex (AOR = 0.18; 95 % CI 0.06–0.59; p < 0.01) and transactional sex (AOR = 0.38; 95 % CI 0.15–0.99; p = 0.048). Violence prevention interventions with HIV-positive women should consider approaches that increase women’s power in their relationships.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

et al. 2016

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“…Gender-based power imbalances within sexual relationships can negatively affect women’s sexual, reproductive, physical, and mental health (Blanc, 2001; Hatcher et al, 2012; McMahon et al, 2015; Siedner et al, 2012; Wingood & DiClemente, 2002). According to the theory of gender and power (TGP), there are three social structures that interact at the societal and institutional levels to influence health: economic inequalities (the division of labor), male partner control (the division of power), and social norms and affective attachments around gender (Connell, 1987).…”

Section: Introductionmentioning

confidence: 99%

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Conroy

McGrath

Rooyen

et al. 2016

Social Science & Medicine

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Introduction Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. Methods This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012–2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners’ perceptions of power influences their own (i.e., actor effect) and their partner’s reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). Results For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women’s reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men’s reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women’s reports of intimacy and negatively associated with women’s reports of conflict. Conclusions Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men’s perspectives into account to ensure positive relationship outcomes.

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“…Second, analyses of data collected from samples of non-HIV-infected persons have linked powerlessness to depression among women experiencing intimate partner violence [27], [31], and among young women [27], [29]. Studies have found other negative health impacts of low sexual power among HIV-infected women, including malnutrition and worse HIV treatment outcomes [32], [33].…”

Section: Introductionmentioning

confidence: 99%

Sexual Relationship Power and Depression among HIV-Infected Women in Rural Uganda

et al. 2012

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BackgroundDepression is associated with increased HIV transmission risk, increased morbidity, and higher risk of HIV-related death among HIV-infected women. Low sexual relationship power also contributes to HIV risk, but there is limited understanding of how it relates to mental health among HIV-infected women.MethodsParticipants were 270 HIV-infected women from the Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of individuals initiating antiretroviral therapy (ART) in Mbarara, Uganda. Our primary predictor was baseline sexual relationship power as measured by the Sexual Relationship Power Scale (SRPS). The primary outcome was depression severity, measured with the Hopkins Symptom Checklist (HSCL), and a secondary outcome was a functional scale for mental health status (MHS). Adjusted models controlled for socio-demographic factors, CD4 count, alcohol and tobacco use, baseline WHO stage 4 disease, social support, and duration of ART.ResultsThe mean HSCL score was 1.34 and 23.7% of participants had HSCL scores consistent with probable depression (HSCL>1.75). Compared to participants with low SRPS scores, individuals with both moderate (coefficient b = −0.21; 95%CI, −0.36 to −0.07) and high power (b = −0.21; 95%CI, −0.36 to −0.06) reported decreased depressive symptomology. High SRPS scores halved the likelihood of women meeting criteria for probable depression (adjusted odds ratio = 0.44; 95%CI, 0.20 to 0.93). In lagged models, low SRPS predicted subsequent depression severity, but depression did not predict subsequent changes in SPRS. Results were similar for MHS, with lagged models showing SRPS predicts subsequent mental health, but not visa versa. Both Decision-Making Dominance and Relationship Control subscales of SRPS were associated with depression symptom severity.ConclusionsHIV-infected women with high sexual relationship power had lower depression and higher mental health status than women with low power. Interventions to improve equity in decision-making and control within dyadic partnerships are critical to prevent HIV transmission and to optimize mental health of HIV-infected women.

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Sexual Relationship Power and Malnutrition Among HIV-Positive Women in Rural Uganda

Cited by 14 publications

References 44 publications

Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Sexual Relationship Power and Depression among HIV-Infected Women in Rural Uganda

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