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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Human Immunodeficiency Virus | Research article

Relationship power and HIV sero-status: an analysis of their relationship among low-income urban Zimbabwean postpartum women

Authors: Teurai Rwafa, Simukai Shamu, Nicola Christofides

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

HIV disproportionately infects women in many regions. Zimbabwe is one of the countries, most heavily affected. Unequal gender power relations between men and women can increase women’s vulnerability to HIV. The aim of this paper was to determine the relationship between gender power and HIV sero-status among postpartum women in Zimbabwe.

Methodology

A cross-sectional survey was conducted among 2042 women aged 15–49 years, attending postnatal-care at six public primary health care clinics in low-income urban communities of Harare in 2011. Women were asked about relationship power factors using an interviewer-administered questionnaire. The questionnaire included adapted WHO multi-country study items, which measure partner violence perpetrated against women. HIV status data were based on rapid HIV diagnostic tests done during earlier antenatal visits. The analysis was restricted to women with known HIV test results (n = 1951). Multivariable logistic regression analyses were performed to assess the predictors of HIV and relationship power factors.

Results

HIV prevalence was 15.3% (n = 299/1951). Three quarters of the women (76.9%, n = 1438/1871) reported some level of relationship control in their current/most recent intimate relationship. HIV positive women reported higher levels of control by the male partner in their intimate relationships. In adjusted models, the study found a significant association between relationship-control by the male partner and women’s HIV status (AOR 1.11, 95% CI 1.01–1.22), and the decision-making dimensions of relationship power. Although there were indications of high male partner control in participants’ intimate relationships, some women still had agency, as they were able to make independent decisions to fall pregnant. These women were less likely to be HIV positive (AOR 0.54, 95% CI 0.29–1.00). Having a partner who ever refused use of a family planning method was associated with increased odds of having a positive HIV status among the postpartum women (AOR 1.88, 95% CI 1.20–2.90).

Conclusion

Unequal gender power relations continue to be a risk factor for heterosexual transmission of HIV. This suggests that prevention efforts have not successfully resulted in gender equality. HIV prevention interventions should address gender power dynamics to help curb the disproportionate HIV burden among women.
Literature
1.
UNAIDS. Women and girls and HIV. Geneva: Switzerland; 2018.
2.
UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic: 2012. Geneva, Switzerland: UNAIDS; 2012. Report No.: 9291735922.
3.
Sia D, Onadja Y, Nandi A, Foro A, Brewer T. What lies behind gender inequalities in HIV/AIDS in sub-Saharan African countries: evidence from Kenya, Lesotho and Tanzania. Health policy and planning; 2013. p. czt075.
4.
Zimbabwe National AIDS Council. Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) 2006–2010: National AIDS Council, Harare, Zimbabwe; 2006.
5.
UNAIDS. UNAIDS Data 2018. Geneva: Switzerland; 2018.
6.
UNAIDS. The gap report. Geneva: Switzerland; 2014.
7.
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.CrossRef
8.
UNAIDS W. Report on the global HIV/AIDS epidemic. Geneva: Switzerland; 2000.
9.
Rao Gupta G, Whelan D, Allendorf K. Integrating gender into HIV/AIDS programmes: a review paper; 2003.
10.
Kambarami M. Femininity, sexuality and culture: patriarchy and female subordination in Zimbabwe. South Africa: ARSRC; 2006.
11.
Gupta GR. How men's power over women fuels the HIV epidemic: it limits women's ability to control sexual interactions. BMJ: British Medical Journal. 2002;324(7331):183.CrossRef
12.
Pettifor AE, Measham DM, Rees HV, Padian NS, Periago M, Fescina R, et al. Sexual power and HIV risk South Africa. Emerg Infect Dis. 2004;10(11):1996–2004.CrossRef
13.
Mane P, Aggleton P. Gender and HIV/AIDS: what do men have to do with it? Curr Sociol. 2001;49(6):23–37.CrossRef
14.
Njovana E, Watts C. Gender violence in Zimbabwe: a need for collaborative action. Reproductive health matters. 1996;4(7):46–55.CrossRef
15.
Conroy AA. Adapting the Sexual Relationship Power Scale for HIV/AIDS Research in Malawi. Population Association of America 2010 Annual meeting Dallas, Texas, April 15-17,, Denver DoHaBSUoC; 2010.
16.
Cohen D. Human capital and the HIV epidemic in sub-Saharan Africa: International Labour Organisation; 2002.
17.
Wingood G, DiClemente R, DiClemente R, Crosby R, Kegler M. The theory of gender and power. Emerging theories in health promotion practice and research: strategies for improving public health. San Francisco: Jossey-Bass; 2002. p. 313–45.
18.
Guedes A. Addressing gender-based violence from the reproductive health/HIV sector: a literature review and analysis. Popline. 2004.
19.
UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva: Switzerland; 2013.
20.
Zimbabwe National Statistics Agency, ICF International. Zimbabwe Demographic and Health Survey. Final report. Rockville, Maryland. USA: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International; 2015. p. 2016.
21.
UNAIDS. UNAIDS Data 2017. Geneva: Switzerland; 2017.
22.
23.
Zimbabwe National AIDS Council. Zimbabwe AIDS Response Progress Report 2014. 2014.
24.
Sen G, Östlin P. Gender inequity in health: why it exists and how we can change it. Taylor & Francis. 2008:1–12.
25.
Connell RW. Gender and power. Stanford, CA: Stanford University press; 1987.
26.
Dani AA, De Haan A. Inclusive states: social policy and structural inequalities: World Bank Publications; 2008.
27.
Whelan D. Gender and HIV/AIDS: taking stock of research and programmes. Popline. 1999.
28.
Durevall D, Lindskog A. Intimate partner violence and HIV in ten sub-Saharan African countries: what do the demographic and health surveys tell us? Lancet Glob Health. 2015;3(1):e34–43.CrossRef
29.
Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N, et al. Perpetration of partner violence and HIV risk behaviour among young men in the rural eastern cape. South Africa Aids. 2006;20(16):2107–14.PubMed
30.
Chin Y-M. Does HIV increase the risk of spousal violence in sub-Saharan Africa? J Health Econ. 2013;32(5):997–1006.CrossRef
31.
Colombini M, James C, Ndwiga C, Team I, Mayhew SH. The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya. J Int AIDS Soc. 2016;19(1):20766.CrossRef
32.
Mulrenan C, Colombini M, Howard N, Kikuvi J, Mayhew SH. Exploring risk of experiencing intimate partner violence after HIV infection: a qualitative study among women with HIV attending postnatal services in Swaziland. BMJ Open. 2015;5(5):e006907.CrossRef
33.
Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O'Campo P. HIV/AIDS and intimate partner violence: intersecting women's health issues in the United States. Trauma, Violence, & Abuse. 2007;8(2):178–98.CrossRef
34.
Shamu S, Abrahams N, Temmerman M, Zarowsky C. Opportunities and obstacles to screening pregnant women for intimate partner violence during antenatal care in Zimbabwe. Culture, health & sexuality. 2013;15(5):511–24.CrossRef
35.
Hatcher A, Stöckl H, Christofides N, Woollett N, Pallitto C, Garcia-Moreno C, et al. Mechanisms linking intimate partner violence and prevention of mother-to-child transmission of HIV: a qualitative study in South Africa. Soc Sci Med. 2016;168:130–9.CrossRef
36.
Hatcher AM, Smout EM, Turan JM, Christofides N, Stöckl H. Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis. Aids. 2015;29(16):2183–94.CrossRef
37.
Hampanda KM. Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia. Soc Sci Med. 2016;153:123–30.CrossRef
38.
Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82:299–307.PubMedPubMedCentral
39.
Shamu S, Abrahams N, Zarowsky C, Shefer T, Temmerman M. Intimate partner violence during pregnancy in Zimbabwe: a cross-sectional study of prevalence, predictors and associations with HIV. Tropical Med Int Health. 2013;18(6):696–711.CrossRef
40.
World Health Organization. WHO multi-country study on women's health and domestic violence against women: summary report of initial results on prevalence, health outcomes and women's responses. 2005.
41.
42.
Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7–8):637–60.CrossRef
43.
StataCorp. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
44.
Ranganathan P, Pramesh C, Aggarwal R. Common pitfalls in statistical analysis: logistic regression. Perspectives in clinical research. 2017;8(3):148.PubMedPubMedCentral
45.
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source code for biology and medicine, vol. 3; 2008. p. 17.
46.
Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360(9339):1083–8.CrossRef
47.
Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.CrossRef
48.
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.CrossRef
49.
Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.CrossRef
50.
Moore AM, Frohwirth L, Miller E. Male reproductive control of women who have experienced intimate partner violence in the United States. Soc Sci Med. 2010;70(11):1737–44.CrossRef
51.
Zimbabwe National AIDS Council. Zimbabwe: Analysis of HIV Epidemic, Response and Modes of Transmission: Zimbabwe National Aids Council; 2011.
52.
Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):11–6.CrossRef
53.
Matavire M. Interrogating the Zimbabwean traditional jurisprudence and the position of women in conflict resolution. A case of the Shona tribes in Muzarabani District. Int J Humanit Soc Sci. 2012;2:218–23.
54.
Piwoz EG, Viteri FE. Studying health and nutrition behaviour by examining household decision-making, intra-household resource distribution, and the role of women in these processes. Food processing. 1985;132(10):13.2.
55.
Watts C, Keogh E, Ndlovu M, Kwaramba R. Withholding of sex and forced sex: dimensions of violence against Zimbabwean women. Reproductive health matters. 1998;6:57–65.CrossRef
56.
Hindin MJ. Understanding women's attitudes towards wife beating in Zimbabwe. Bull World Health Organ. 2003;81(7):501–8.PubMedPubMedCentral
57.
Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, et al. Factors associated with HIV sero-status in young rural south African women: connections between intimate partner violence and HIV. Int J Epidemiol. 2006;35(6):1461–8.CrossRef
58.
Pulerwitz J, Amaro H, Jong WD, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14(6):789–800.CrossRef
59.
Kathewera-Banda M, Gomile-Chidyaonga F, Hendriks S, Kachika T, Mitole Z, White S. Sexual violence and women's vulnerability to HIV transmission in Malawi: a rights issue. Int Soc Sci J. 2005;57(186):649–60.CrossRef
60.
Gupta GR. Gender, sexuality, and HIV/AIDS: the what, the why, and the how. Can HIV AIDS Policy Law Rev. 2000;5(4):86–93.PubMed
61.
Harvey SM, Beckman LJ, Browner CH, Sherman CA. Relationship power, decision making, and sexual relations: an exploratory study with couples of Mexican origin. Journal of Sex Research. 2002;39(4):284–91.CrossRef
62.
Cavalin C, Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts C. WHO multi-country study on Women's health and domestic violence against women. Initial results on prevalence, health outcomes and Women's responses: JSTOR; 2010.
Metadata
Title
Relationship power and HIV sero-status: an analysis of their relationship among low-income urban Zimbabwean postpartum women
Authors
Teurai Rwafa
Simukai Shamu
Nicola Christofides
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7137-y

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