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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda

Authors: Olivia Nankinga, Cyprian Misinde, Betty Kwagala

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women’s background characteristics.

Methods

The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15–49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman’s reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful.

Results

Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women’s sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman’s participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner’s controlling behaviour, and having more than one life partner.

Conclusions

Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners.
Appendix
Available only for authorised users
Footnotes
1
The two missing cases for this question were dropped.
 
Literature
1.
World Health Organisation. Sexually Transmitted Infections (STIs): The importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. Geneva: World Health Organisation; 2013.
2.
UBOS, Macro International Inc. Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA & UBOS, Kampala Uganda: Uganda Bureau of Statistics & Macro International Inc; 2007.
3.
UBOS, ICF International Inc. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc; 2012.
4.
Ministry of Health [Uganda], ICF International Inc. Uganda AIDS Indicator Survey 2011. Kampala, Uganda: Ministry of Health (MOH) and Calverton, Maryland: ICF International; 2012.
5.
Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet. 2006;368(9543):1260–9.CrossRefPubMed
6.
Salam MA, Alim MA, Noguchi T. Spousal abuse against women and its consequences on reproductive health: a study in the urban slums in Bangladesh. Matern Child Health J. 2006;10(1):83–94.CrossRefPubMed
7.
Pederson A, Greaves L, Poole N. Gender-transformative health promotion for women: a framework for action. Health Promot Int. 2015;30910:140-50.
8.
9.
Sanchez DT, Phelan JE, Moss-Racusin CA, Good JJ. The gender role motivation model of women’s sexually submissive behavior and satisfaction in heterosexual couples. Personal Soc Psychol Bull. 2012;38(4):528–39.CrossRef
10.
Johnson S. The politics of population: Cairo 1994, vol. 3. UK: Earthscan Publications Limited; 2013.
11.
Wallerstein N. Powerlessness, empowerment, and health: implications for health promotion programs. Am J Health Promot. 1992;6(3):197–205.CrossRefPubMed
12.
Kabeer N. Gender equality and women’s empowerment: A critical analysis of the third millennium development goal 1. Gend Dev. 2005;13(1):13–24.CrossRef
13.
Kasturirangan A. Empowerment and programs designed to address domestic violence. Violence Against Women. 2008;14(12):1465–75.CrossRefPubMed
14.
Castro R, Casique I, Brindis CD. Empowerment and physical violence throughout women’s reproductive life in Mexico. Violence Against Women. 2008;14(6):655–77.CrossRefPubMed
15.
16.
Williams J. Measuring gender and women’s empowerment using confirmatory factor analysis, Population Program, Institute of Behavioural Science, University of Colorado, Boulder. 2005.
17.
Oxaal Z, Baden S. Gender and empowerment: definitions, approaches and implications for policy, Bridge, Institute of Development Studies. 1997.
18.
Crissman HP, Adanu RM, Harlow SD. Women’s sexual empowerment and contraceptive use in Ghana. Stud Fam Plan. 2012;43(3):201–12.CrossRef
19.
Wandera SO, Ntozi JP, Kwagala B. Spousal sexual violence, sexual behavior and sexually transmitted infections among ever-married women in Uganda. Afr Popul Stud. 2010;24:70-87.
20.
Antai D. Controlling behavior, power relations within intimate relationships and intimate partner physical and sexual violence against women in Nigeria. BMC Public Health. 2011;11(1):511.CrossRefPubMedPubMedCentral
21.
Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, Musonda R, Kasolo F, Gao F, Haworth A. Sexual behavior of HIV discordant couples after HIV counseling and testing. Aids. 2003;17(5):733–40.CrossRefPubMed
22.
23.
Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, Jansen HA, Heise L. What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011;11(1):109.CrossRefPubMedPubMedCentral
24.
Tumwesigye NM, Kyomuhendo GB, Greenfield TK, Wanyenze RK. Problem drinking and physical intimate partner violence against women: evidence from a national survey in Uganda. BMC Public Health. 2012;12(1):399.CrossRefPubMedPubMedCentral
25.
Kwagala B, Wandera SO, Ndugga P, Kabagenyi A. Empowerment, partner’s behaviours and intimate partner physical violence among married women in Uganda. BMC Public Health. 2013;13(1):1112.CrossRefPubMedPubMedCentral
26.
Part K, Rahu K, Rahu M, Karro H. Gender differences in factors associated with sexual intercourse among Estonian adolescents. Scand J Public Health. 2011;39:389-95.
27.
Marston C, King E. Factors that shape young people’s sexual behaviour: a systematic review. Lancet. 2006;368(9547):1581–6.CrossRefPubMed
28.
Chimbiri AM. The condom is an ‘intruder’in marriage: evidence from rural Malawi. Soc Sci Med. 2007;64(5):1102–15.CrossRefPubMed
29.
Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, Makumbi F, Wabwire-Mangen F, Kiwanuka N, Kigozi G. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. Aids. 2001;15(16):2171–9.CrossRefPubMed
30.
Chersich MF, Rees HV. Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. Aids. 2008;22:S27–40.CrossRefPubMed
31.
Carpenter LM, Kamali A, Ruberantwari A, Malamba SS, Whitworth JA. Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partners. Aids. 1999;13(9):1083–9.CrossRefPubMed
32.
Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376(9734):41–8.CrossRefPubMed
33.
Wandera SO, Kwagala B, Ndugga P, Kabagenyi A. Partners’ controlling behaviors and intimate partner sexual violence among married women in Uganda. BMC Public Health. 2015;15(1):214.CrossRefPubMedPubMedCentral
34.
Blanc AK. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Stud Fam Plan. 2001;32(3):189–213.CrossRef
35.
Stephenson R, Koenig MA, Acharya R, Roy TK. Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Stud Fam Plan. 2008;39(3):177–86.CrossRef
36.
Stephenson R, Koenig MA, Ahmed S. Domestic violence and symptoms of gynecologic morbidity among women in North India. Int Fam Plan Perspect. 2006;32:201–8.CrossRefPubMed
37.
Dude A. Intimate partner violence and increased lifetime risk of sexually transmitted infection among women in Ukraine. Stud Fam Plan. 2007;38(2):89–100.CrossRef
38.
Koenig MA, Zablotska I, Lutalo T, Nalugoda F, Wagman J, Gray R. Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda. Int Fam Plan Perspect. 2004;30:156–63.CrossRefPubMed
39.
Johnson PJ, Hellerstedt WL. Current or past physical or sexual abuse as a risk marker for sexually transmitted disease in pregnant women. Perspect Sex Reprod Health. 2002;62–67.
40.
Raiford JL, Seth P, DiClemente RJ. What girls won’t do for love: Human immunodeficiency virus/sexually transmitted infections risk among young African-American women driven by a relationship imperative. J Adolesc Health. 2013;52(5):566–71.CrossRefPubMedPubMedCentral
41.
42.
Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A. Intimate partner violence and HIV infection among married Indian women. JAMA. 2008;300(6):703–10.CrossRefPubMed
43.
Cates Jr W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis. 1999;26(4):S2–7.CrossRefPubMed
44.
Teitelman AM, Ratcliffe SJ, Morales-Aleman MM, Sullivan CM. Sexual relationship power, intimate partner violence, and condom use among minority urban girls. J Interpers Violence. 2008;23(12):1694–712.CrossRefPubMedPubMedCentral
45.
Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56(1):125–34.CrossRefPubMed
46.
Krantz G, Vung ND. The role of controlling behaviour in intimate partner violence and its health effects: a population based study from rural Vietnam. BMC Public Health. 2009;9(1):143.CrossRefPubMedPubMedCentral
47.
Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035.CrossRefPubMedPubMedCentral
48.
Seth P, Wingood GM, DiClemente RJ, Robinson LS. Alcohol use as a marker for risky sexual behaviors and biologically confirmed sexually transmitted infections among young adult African-American women. Womens Health Issues. 2011;21(2):130–5.CrossRefPubMedPubMedCentral
49.
Asiki G, Mpendo J, Abaasa A, Agaba C, Nanvubya A, Nielsen L, Seeley J, Kaleebu P, Grosskurth H, Kamali A. HIV and syphilis prevalence and associated risk factors among fishing communities of Lake Victoria, Uganda. Sex Transm Infect. 2011;87(6):511–5.CrossRefPubMed
50.
La Ruche G, Pedrono G, Semaille C, Warszawski J, Beltzer N. Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France. Rev Epidemiol Sante Publique. 2014;62(5):283–90.CrossRefPubMed
51.
Harling G, Subramanian S, Bärnighausen T, Kawachi I. Income inequality and sexually transmitted in the United States: Who bears the burden? Soc Sci Med. 2014;102:174–82.CrossRefPubMed
52.
Darj E, Mirembe FM, Råssjö E-B. STI-prevalence and differences in social background and sexual behavior among urban and rural young women in Uganda. Sex Reprod Healthc. 2010;1(3):111–5.CrossRefPubMed
53.
Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.CrossRefPubMed
54.
55.
56.
Ezumah NN. Gender issues in the prevention and control of STIs and HIV/AIDS: lessons from Awka and Agulu, Anambra State, Nigeria. Afr J Reprod Health. 2003;7:89–99.CrossRefPubMed
57.
Clark S. Early marriage and HIV risks in sub‐Saharan Africa. Stud Fam Plan. 2004;35(3):149–60.CrossRef
58.
Maharaj P, Cleland J. Condom Use Within Marital and Cohabiting Partnerships in KwaZulu‐Natal, South Africa. Stud Fam Plan. 2004;35(2):116–24.CrossRef
59.
Awusabo-Asare K, Anarfi JK, Agyeman D. Women’s control over their sexuality and the spread of STDs and HIV/AIDS in Ghana. Health Trans Rev. 1993;3:69–84.
60.
Rahman MM, Mostofa MG, Hoque MA. Women’s household decision-making autonomy and contraceptive behavior among Bangladeshi women. Sex Reprod Healthc. 2014;5(1):9–15.CrossRefPubMed
61.
Story WT, Burgard SA. Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh. Soc Sci Med. 2012;75(12):2403–11.CrossRefPubMedPubMedCentral
62.
de Lima YAR, Turchi MD, Fonseca ZC, Garcia FLB, e Cardoso FAdB, da Guarda Reis MN, de Britto Guimarães EM, Alves RRF, Carvalho NR, Alves MdFC. Sexually transmitted bacterial infections among young women in Central Western Brazil. Int J Infect Dis. 2014;25:16–21.
Metadata
Title
Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda
Authors
Olivia Nankinga
Cyprian Misinde
Betty Kwagala
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3103-0

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