Women’s Empowerment and HIV Testing Uptake: A Meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African Countries

Abstract

Background: There is a growing body of evidence suggesting that women’s empowerment can help achieve better health behaviours and outcomes. However, few have looked at the impact of women’s empowerment on HIV testing in Sub-Saharan Africa (SSA). This study investigated the association between women’s empowerment and HIV testing among women in 33 countries across SSA.
 Methods: Cross-sectional data from the most recent Demographic and Health Surveys (2005-2018) of 33 countries in SSA were used. Confounder adjusted logistic regression analysis was completed separately for each of the 33 DHS datasets to produce the adjusted Odds Ratio (OR) for the association between women empowerment and HIV testing. The regression analysis strictly accounted for the three design elements (weight, cluster and strata) to produce an estimate representative of the respective countries. Finally, an Individual Participant Data (IPD) meta-analysis approach was used to statistically pool the effect of women empowerment on HIV testing.
 Results: There was a wide variation in the percentage of women who were empowered among the countries studied, with only a few countries such as South Africa, Angola and Ghana having a high prevalence of negative attitudes toward wife beating. HIV testing was higher in Angola, Lesotho, Uganda and South Africa. While participation in one or two of the three decisions had been marginally associated with lower odds of HIV testing across the SSA regions (0.89; 95%CI: 0.83, 0.97); the corresponding prediction interval crossed the null. Being involved in the three decisions (0.92; 95%CI: 0.84, 1.00) and disagreement to wife-beating (0.99; 95%CI: 0.94, 1.05) had no statistical relationship with HIV testing uptake.
 Conclusion and Global Health Implications: The two indirect indicators of women empowerment could not predict HIV testing uptake. Further studies are recommended to establish the nature of the relationship between HIV testing and women’s empowerment that is measured through standard tools.
 Key words: • HIV/AIDS prevention • Women • Empowerment • Gender equality • Global health • Sub-Saharan Africa
 
 Copyright © 2020 Yaya et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria

“…Anaemia in pregnancy by the WHO classification is haemoglobin (Hb) concentration of <11 g/d. 6 Thrombocytopenia, is defined as low platelet count of <100×10 9 /l, with a count <50×10 9 /l considered severe, and <10×10 9 /l considered very severe, while leucopenia was defined as FBC of <3,000x10 9 /l in adult. 25 However, a lower Hb level of <10 g/dl is used by many African clinicians as indication of anaemia in pregnancy in most healthy African women thus falling below the WHO cutoff for anemia.…”

“…The PCV (%) values were converted to Hb (g/dl) by applying the constant factor of 0.3. 27 The Hb concentration, platelet, and CBC levels was divided into two groups:<10 g/dl, and >10 g/dl for Hb, <100 x10 9 /l, and >100 x10 9 /l for the platelet, and <3,000 x10 9 /l, and >3,000 x10 9 /l for the purposes of the study.…”

“…7,8 SSA also has the highest proportion of people living with of HIV across the globe, Nigeria being second to South Africa in this global burden and having over 1.8million of her people living with HIV (PLWH). 9 Women of reproductive age make up almost 57% of adults living with HIV, and responsible for 80% of HIVinfected women in the world, with HIV-prevalence rates exceeding 40% among the pregnant women in some areas. 10 Pregnant women with HIV are at higher risk of anaemia compared with their counterpart that are not infected.…”

Lack of agency and sexual behaviors among married women: a study of population-based HIV impact assessment (PHIA) surveys in Malawi, Tanzania and Zambia

“…On the other hand, in a meta-analysis of 33 sub-Saharan countries, Yaya 2020 18 found no significant relationship between empowerment and HIV testing uptake in more than half of the countries included in their study. This study used a combination of women's role in household decisionmaking and her attitude towards wife-beating as measures of empowerment.…”

“…14 While more evidence is accumulating within different cultural contexts, there is a lack of consensus on the most accurate measure for empowerment. Various studies have used factors such as literacy/education and wealth, 15,16 or a mixture of attitudes towards women's autonomy (women can refuse sex or ask for condoms), justification of wifebeating 17,18 and women's participating in household major decision-making as indicators of empowerment. 18,19 A study of 29 Sub-Saharan countries 13 found that women who believed they had the right to ask their husbands to use a condom if he had a sexually transmitted infection were more likely to have been tested for HIV.…”