Gender Inequity Norms Are Associated with Increased Male-perpetrated Rape and Sexual Risks for HIV Infection in Botswana and Swaziland

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2012 Jan 17

PMID 22247761

Citations 80

Authors

Kate Shannon

Karen Leiter

Nthabiseng Phaladze

Zakhe Hlanze

Alexander C Tsai

Michele Heisler

Vincent Iacopino

Sheri D Weiser

Affiliations

Soon will be listed here.

Abstract

Background: There is limited empirical research on the underlying gender inequity norms shaping gender-based violence, power, and HIV risks in sub-Saharan Africa, or how risk pathways may differ for men and women. This study is among the first to directly evaluate the adherence to gender inequity norms and epidemiological relationships with violence and sexual risks for HIV infection.

Methods: Data were derived from population-based cross-sectional samples recruited through two-stage probability sampling from the 5 highest HIV prevalence districts in Botswana and all districts in Swaziland (2004-5). Based on evidence of established risk factors for HIV infection, we aimed 1) to estimate the mean adherence to gender inequity norms for both men and women; and 2) to model the independent effects of higher adherence to gender inequity norms on a) male sexual dominance (male-controlled sexual decision making and rape (forced sex)); b) sexual risk practices (multiple/concurrent sex partners, transactional sex, unprotected sex with non-primary partner, intergenerational sex).

Findings: A total of 2049 individuals were included, n = 1255 from Botswana and n = 796 from Swaziland. In separate multivariate logistic regression analyses, higher gender inequity norms scores remained independently associated with increased male-controlled sexual decision making power (AORmen = 1.90, 95%CI:1.09-2.35; AORwomen = 2.05, 95%CI:1.32-2.49), perpetration of rape (AORmen = 2.19 95%CI:1.22-3.51), unprotected sex with a non-primary partner (AORmen = 1.90, 95%CI:1.14-2.31), intergenerational sex (AORwomen = 1.36, 95%CI:1.08-1.79), and multiple/concurrent sex partners (AORmen = 1.42, 95%CI:1.10-1.93).

Interpretation: These findings support the critical evidence-based need for gender-transformative HIV prevention efforts including legislation of women's rights in two of the most HIV affected countries in the world.

Citing Articles

Intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean: Insights and pathways forward - A scoping review.

Malika N, Bogart L, Matovu J, Phaladze N, Mubiru K, Leon Rhandomy M PLOS Glob Public Health. 2025; 5(2):e0004240.

PMID: 39928642 PMC: 11809812. DOI: 10.1371/journal.pgph.0004240.

Misperception of Norms About Intimate Partner Violence as a Driver of Personal IPV Attitudes and Perpetration: A Population-Based Study of Men in Rural Uganda.

Perkins J, Nyakato V, Kakuhikire B, Sriken J, Schember C, Baguma C J Interpers Violence. 2024; 40(3-4):803-827.

PMID: 38842209 PMC: 11657416. DOI: 10.1177/08862605241254143.

Egalitarian Values and Sexual Behavior-The Role of Country Level Values in Shaping Individual Level Behaviors in Africa, South America and Asia.

Valverius A, Arnell L, Strandh M Int J Sex Health. 2024; 33(3):396-409.

PMID: 38595749 PMC: 10929577. DOI: 10.1080/19317611.2021.1919952.

How men influence young women taking PrEP: perspectives from young women, male partners, and male peers in Siaya county, Western Kenya.

Agot K, Onyango J, Perry B, Molokwu N, Taylor J, Ngoje D BMC Womens Health. 2024; 24(1):218.

PMID: 38570779 PMC: 10993511. DOI: 10.1186/s12905-024-03044-9.

Qualitative Evaluation of Treatment Partners for People With HIV in Botswana: Current Healthcare Provider Practices and Recommendations for Improvement.

Bogart L, Phaladze N, Kgotlaetsile K, Goggin K, Mosepele M Community Health Equity Res Policy. 2024; :2752535X231225809.

PMID: 38171536 PMC: 11219526. DOI: 10.1177/2752535X231225809.

References

Martin S, Kilgallen B, Tsui A, Maitra K, Singh K, Kupper L . Sexual behaviors and reproductive health outcomes: associations with wife abuse in India. JAMA. 1999; 282(20):1967-72. DOI: 10.1001/jama.282.20.1967. View

Dunkle K, Jewkes R, Nduna M, Levin J, Jama N, Khuzwayo N . Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa. AIDS. 2006; 20(16):2107-14. DOI: 10.1097/01.aids.0000247582.00826.52. View

Garcia-Moreno C, Watts C . Violence against women: its importance for HIV/AIDS. AIDS. 2000; 14 Suppl 3:S253-65. View

Shannon K, Kerr T, Strathdee S, Shoveller J, Montaner J, Tyndall M . Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009; 339:b2939. PMC: 2725271. DOI: 10.1136/bmj.b2939. View

Wingood G, Scd , DiClemente R . 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. DOI: 10.1177/109019810002700502. View

Gable L, Gostin L, Hodge Jr J . HIV/AIDS, reproductive and sexual health, and the law. Am J Public Health. 2008; 98(10):1779-86. PMC: 2636460. DOI: 10.2105/AJPH.2008.138669. View

van der Straten A, KING R, Grinstead O, Serufilira A, Allen S . Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS. 1995; 9(8):935-44. DOI: 10.1097/00002030-199508000-00016. View

Dunkle K, Jewkes R . Effective HIV prevention requires gender-transformative work with men. Sex Transm Infect. 2007; 83(3):173-4. PMC: 2659081. DOI: 10.1136/sti.2007.024950. View

Jewkes R, 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. DOI: 10.1016/S0140-6736(10)60548-X. View

10.

Gupta G . How men's power over women fuels the HIV epidemic. BMJ. 2002; 324(7331):183-4. PMC: 1122116. DOI: 10.1136/bmj.324.7331.183. View

11.

Zierler S, Krieger N . Reframing women's risk: social inequalities and HIV infection. Annu Rev Public Health. 1997; 18:401-36. DOI: 10.1146/annurev.publhealth.18.1.401. View

12.

Weiser S, Leiter K, Bangsberg D, Butler L, Korte F, Hlanze Z . Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med. 2007; 4(10):1589-97. PMC: 2039764. DOI: 10.1371/journal.pmed.0040260. View

13.

Jewkes R, Dunkle K, Koss M, Levin J, Nduna M, Jama N . Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors. Soc Sci Med. 2006; 63(11):2949-61. DOI: 10.1016/j.socscimed.2006.07.027. View

14.

Dunkle K, Jewkes R, Brown H, Gray G, McIntryre J, Harlow S . Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004; 363(9419):1415-21. DOI: 10.1016/S0140-6736(04)16098-4. View

15.

Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A . Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008; 337:a506. PMC: 2505093. DOI: 10.1136/bmj.a506. View

16.

Dunkle K, Jewkes R, Nduna M, Jama N, Levin J, Sikweyiya Y . Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. Soc Sci Med. 2007; 65(6):1235-48. PMC: 2709788. DOI: 10.1016/j.socscimed.2007.04.029. View

17.

El-Bassel N, Gilbert L, Wu E, Go H, Hill J . HIV and intimate partner violence among methadone-maintained women in New York City. Soc Sci Med. 2005; 61(1):171-83. DOI: 10.1016/j.socscimed.2004.11.035. View

18.

Amaro H . Love, sex, and power. Considering women's realities in HIV prevention. Am Psychol. 1995; 50(6):437-47. DOI: 10.1037//0003-066x.50.6.437. View

19.

Peacock D, Stemple L, Sawires S, Coates T . Men, HIV/AIDS, and human rights. J Acquir Immune Defic Syndr. 2009; 51 Suppl 3:S119-25. PMC: 2853958. DOI: 10.1097/QAI.0b013e3181aafd8a. View

20.

Pettifor A, Kleinschmidt I, Levin J, Rees H, MacPhail C, Madikizela-Hlongwa L . A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15-24 in South Africa: results of the baseline survey. Trop Med Int Health. 2005; 10(10):971-80. DOI: 10.1111/j.1365-3156.2005.01483.x. View