The Influence of Power on HIV Risk Among Pregnant Women in Rural Haiti

Abstract

Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationship power, abuse history, and sexual communication) on sexual behavior (e.g., two or more partners in the year prior to pregnancy, condom use, condom-use intentions, and STI diagnosis) among 196 pregnant women recruited from five community dispensaries in rural Haiti. Results showed that gender and power factors significantly related to sexual behavior. Gender and power factors were most significant for condom use and intention to use condoms, accounting for 18 and 25% of the variance above and beyond HIV knowledge and demographic covariates, respectively. These results suggest the need to create prevention interventions that restore power imbalances, provide support for women suffering abuse, and strengthen communication skills.

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

“…Second, other variables not included in the current analysis may also explain sexual risk behavior. For example, Kershaw et al 27 examined sexual communication with partners, partner infidelity, and emotional, physical, and sexual abuse as separate independent variables predicting sexual behavior. In addition, research has shown a clear relationship between childhood abuse and sexual risk (e.g., Heiman and Heard-Davidson 62 ).…”

“…13,14 Using data collected from a sample of women with substance abuse disorders, mental health disorders, and a history of trauma (and a part of the larger Substance Abuse and Mental Health Services Administration Women, Co-Occurring Disorders and Violence Study), Amaro and colleagues 14 showed that women with higher relationship power were less likely to have unprotected sex. Several international studies (i.e., Haiti, South Africa) using an adapted 12-item SRPS measure 26 or a subset of SRPS questions 27,28 found mixed results. Dunkle and colleagues 26 reported that women with higher relationship control were more likely to have used a condom and less likely to have contracted HIV.…”

“…Pettifor and colleagues 28 also found relationship control positively associated with more consistent condom use, but not with less HIV infection. Kershaw et al 27 reported that decision-making dominance (using five items from the SRPS) was not significantly associated with condom use. Given the extent of the current literature, this study offered a unique opportunity to further examine sexual relationship power among a large, multisite sample of treatment-seeking women.…”

Association Between Childhood Sexual Abuse and HIV-Related Risk Factors for HIV-Positive Haitian Women

“…There is overwhelming research that shows an imbalance of power in relationships and intimate partner violence is highly correlated with HIV risk (Parcesepe et al, 2015;Borwein et al, 2014;Malow et al, 2013;Teitelman, Ratcliffe, Morales-Aleman, & Sullivan, 2008;Kershaw et al, 2006). Substantial research has also been conducted in relationship control and intimate partner violence between men and women and their relationship to HIV in Haiti (Conserve, Whembolua, & Surkan, 2014;Dévieux et al, 2013b;Malow et al, 2010;Gage & Hutchinson, 2006;Gage, 2005).…”

“…Research has shown that relationship control and women's susceptibility to violence in Haiti were attributed to lack of education, history of exposure to violence, traditional factors, partner's need for control, alcohol use, and female-dominated financial decision-making (Conserve, Whembolua, & Surkan, 2014;Dévieux et al, 2013b;Malow et al, 2010;Gage & Hutchinson, 2006;Gage, 2005). Moreover, gender inequality and high levels of sexual violence increase the HIV risk among Haitian women (Rahill, Joshi, & Hernandez, 2015;Logie, Daniel, Newman, & Loutfy, 2012;Purcell, 2012;Malow et al, 2010;Boesten & Poku, 2009;Kershaw et al, 2006).…”