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Journal ArticleDOI

Sexual Power and HIV Risk, South Africa

01 Nov 2004-Emerging Infectious Diseases (Centers for Disease Control and Prevention)-Vol. 10, Iss: 11, pp 1996-2004
TL;DR: Among a sample of young women, limited sexual power was associated with inconsistent condom use but not directly with HIV.
Abstract: Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women's power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman's experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17-3.78), and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently (95% CI 1.86-17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10-2.27).

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Citations
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Journal ArticleDOI
TL;DR: Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women and policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources.

1,110 citations

Journal ArticleDOI
TL;DR: It is argued that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours.
Abstract: Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted.

624 citations


Cites background from "Sexual Power and HIV Risk, South Af..."

  • ...It is hardly surprising that women with violent and controlling partners have been shown both to have more frequent sex and to use condoms less often [8,43-45]....

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Journal ArticleDOI
TL;DR: Research among various populations support the existence of a temporally and biologically complex relationship between HIV risk, lifetime exposure to violence and substance use, which is further complicated by gender and sexual decision-making norms.
Abstract: The objective of this study was to review original research on the intersection of violence against women by intimate partners and risk for HIV infection and highlight opportunities for new research and programme development. Seventy-one articles presenting original, peer-reviewed research conducted with females aged 12 years and older in heterosexual relationships during the past decade (1998–2007) were reviewed. Studies were eligible for inclusion if they addressed intimate partner violence (IPV) against women and HIV/AIDS as mutual risk factors. The prevalence of IPV and HIV infection among women varies globally, but females remain at elevated risk for both IPV and sexually transmitted/HIV infection, independently and concurrently. Comparisons between sero-negative and -positive women varied by geographic region; African HIV-positive women reported higher rates of victimisation while findings were inconsistent for HIV-positive women in the USA. Studies among various populations support the existence of...

403 citations

Journal ArticleDOI
TL;DR: At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers.
Abstract: Introduction : At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control. Discussion : Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations. Conclusions : There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative. Keywords: HIV prevention; adolescent girls; young women; prevention interventions. (Published: 26 February 2015) Citation: Dellar RC et al. Journal of the International AIDS Society 2015, 18(Suppl 1) :19408 http://www.jiasociety.org/index.php/jias/article/view/19408 | http://dx.doi.org/10.7448/IAS.18.2.19408

392 citations


Cites background from "Sexual Power and HIV Risk, South Af..."

  • ...Further, a young woman engaging in a relationship with an older man may be less likely to negotiate condom use given the gender-power dynamics in the southern African setting, further augmenting her risk [13,15]....

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Journal ArticleDOI
TL;DR: Food insufficiency is an important risk factor for increased sexual risk-taking among women in Botswana and Swaziland and targeted food assistance and income generation programs in conjunction with efforts to enhance women's legal and social rights may play an important role in decreasing HIV transmission risk.
Abstract: Background Both food insufficiency and HIV infection are major public health problems in sub-Saharan Africa, yet the impact of food insufficiency on HIV risk behavior has not been systematically investigated. We tested the hypothesis that food insufficiency is associated with HIV transmission behavior. Methods and Findings We studied the association between food insufficiency (not having enough food to eat over the previous 12 months) and inconsistent condom use, sex exchange, and other measures of risky sex in a cross-sectional population-based study of 1,255 adults in Botswana and 796 adults in Swaziland using a stratified two-stage probability design. Associations were examined using multivariable logistic regression analyses, clustered by country and stratified by gender. Food insufficiency was reported by 32% of women and 22% of men over the previous 12 months. Among 1,050 women in both countries, after controlling for respondent characteristics including income and education, HIV knowledge, and alcohol use, food insufficiency was associated with inconsistent condom use with a nonprimary partner (adjusted odds ratio [AOR] 1.73, 95% confidence interval [CI] 1.27–2.36), sex exchange (AOR 1.84, 95% CI 1.74–1.93), intergenerational sexual relationships (AOR 1.46, 95% CI 1.03–2.08), and lack of control in sexual relationships (AOR 1.68, 95% CI 1.24–2.28). Associations between food insufficiency and risky sex were much attenuated among men. Conclusions Food insufficiency is an important risk factor for increased sexual risk-taking among women in Botswana and Swaziland. Targeted food assistance and income generation programs in conjunction with efforts to enhance women's legal and social rights may play an important role in decreasing HIV transmission risk for women.

390 citations


Cites background from "Sexual Power and HIV Risk, South Af..."

  • ...As others have argued, there is a strong need to target gender-discrimination and gender-based violence in HIV prevention programs [18,26,36,37,43], an effort that will require social, legal, structural, and cultural changes at many levels in society....

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References
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Journal ArticleDOI
TL;DR: Women with violent or controlling male partners are at increased risk of HIV infection and it is postulate that abusive men are more likely to have HIV and impose risky sexual practices on partners.

1,358 citations

Journal ArticleDOI
TL;DR: The findings suggest that domestic violence is most strongly related to the status of women in a society and to the normative use of violence in conflict situations or as part of the exercise of power.

835 citations


"Sexual Power and HIV Risk, South Af..." refers background in this paper

  • ...In addition, our measure of physically forced sex captures only a narrow element of coercive or nonconsensual sex, which actually occurs on a continuum ranging from persuasion and trickery to force and rape (6,31)....

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Journal ArticleDOI
TL;DR: The rape statistic for the country is currently elusive but levels of non-consensual and coerced sex are clearly very high, and international comparison needs to be approached with caution.

768 citations


"Sexual Power and HIV Risk, South Af..." refers background or methods in this paper

  • ...In the context of masculine norms defined by male control over sexual decision-making and prevalent forced and coercive sex, many women do not have the right of refusal (6,8,10,32)....

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  • ...The Stepping Stones package, which is used by Planned Parenthood South Africa, also aims to challenge gender norms (32) and was recently found to increase women’s sexual power in a pilot evaluation (36)....

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Journal ArticleDOI
TL;DR: In this paper, the authors introduced a theoretically based and validated measure of relationship power dynamics, the Sexual Relationship Power Scale (SRPS), which was administered to a census of women (N = 388) at a community health clinic.
Abstract: This article introduces a theoretically based and validated measure of relationship power dynamics: the Sexual Relationship Power Scale (SRPS). Focus groups were conducted to generate items for Spanish- and English-language scales. The SRPS was administered to a census of women (N = 388) at a community health clinic. All respondents had a primary male partner; they were mostly Latina (89%), with mean age 27 years. The 23-item SRPS possesses good internal reliability (coefficient alpha = .84 for English version, .88 for Spanish version) and predictive and construct validity. Factor analyses support two subscales: Relationship Control and Decision-Making Dominance. As hypothesized, the SRPS was inversely associated with physical violence and directly associated with education and consistent condom use (p < .05).

658 citations


"Sexual Power and HIV Risk, South Af..." refers methods in this paper

  • ...Four questions were used to construct the relationship control scale, and these were drawn in part from the Sexual Relationship Power Scale (SRPS) (27), which contains 23 items in two subscales (decision-making dominance and relationship control)....

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  • ...Recent research conducted among antenatal clinic attendees who accepted routine HIV testing in Soweto adapted and validated the SRPS, including 12 items, for use in that context....

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