The aim of the paper is to investigate associations between a range of markers of gender inequity, including financial, psychological and physical violence, and two proximal practices in HIV prevention, namely discussion of HIV between partners and the woman suggesting condom use. The paper presents an analysis of data from a cross-sectional study of a representative sample of women from three South African Provinces which was primarily undertaken as an epidemiological study of gender-based violence. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households. Households were randomly selected from within clusters. One randomly selected woman aged 18–49 years was interviewed in each selected home. One thousand three hundred and six women were interviewed (90.3% of eligible women). One thousand one hundred sixty four women had a partner in the previous year and were asked questions related to HIV prevention and gender inequalities in the relationship. The results indicate that discussion of HIV was significantly positively associated with education, living in Mpumalanga Province, the man being a migrant, the woman having multiple partners in the past year and having no confidante. It was significantly negatively associated with living in the Northern Province, the relationship being poor and there being a substantial age difference between partners. The woman suggesting condom use was significantly positively associated with her education, her having multiple partners, domestic violence prior to the past year and financial abuse. It was negatively associated with the relationship being poor. We conclude that this suggests that some indicators of gender inequalities are significantly associated with discussion of HIV and condom use but the direction of association found was both positive and negative. This highlights the need for a more nuanced understanding of gender inequalities and their relationship to HIV risk. Suggestions for key research questions are made.
Gender issues are increasingly being recognised as having critical influences on the HIV epidemic in Southern Africa (UNAIDS, 2000). In her key note address at the XIIIth International Conference on AIDS in Durban, Rao Gupta described ways in which gender shapes HIV risk (Rao Gupta, 2000), arguing that the gender power imbalance, which is found to a varying extent in all societies, translates into a power imbalance in sexual interactions which increases vulnerability to HIV. For women social norms defining their acceptable behaviour, characteristics and responsibilities, economic dependency, and violence make them vulnerable, whereas ideals of masculinity associated with risk taking and sexual conquest also create vulnerability in men.
Maman, Campbell, Sweat, and Gielen (2000) presented a very comprehensive summary of the literature describing intersections between HIV and violence against women, but this also served to highlight the relatively small size of the body of literature. At the time of their review they only identified four quantitative studies reporting on violence limiting women's HIV protective behaviours. Qualitative research on gender and HIV prevention (e.g. Campbell, 2000; Wilton & Aggleton, 1991; Wood, Maforah, & Jewkes, 1998) has shown how gender inequalities influence HIV risk, and has enabled women's voices to be given prominence, yet the methods also have limitations. In particular, they do not enable measurement of the prevalence of forms of gender inequity, the strength of association with HIV and HIV risk practices, and the relative importance of different forms of gender inequality. A study of the epidemiology and consequences of violence against women in three South African Provinces included some questions on proximal HIV preventive practices as well as many markers of gender inequity, including intimate partner violence. This data set provides an opportunity to investigate some of these questions. The objectives of this paper are first to describe associations between a range of markers of gender inequality, including intimate partner violence, and two proximal practices in HIV prevention, namely discussion of HIV and the woman suggesting condom use. Secondly, to discuss the implications of the study's findings for research agendas on gender and HIV risk in Africa.
Research in South Africa has indicated that gender inequalities are strongly associated with at least the proximal HIV preventive practices of discussing HIV and the woman suggesting condom use, but many forms of gender inequity are either unrelated or do not demonstrate the anticipated direction of association. Whilst the study's findings are far from conclusive, they point towards a need to explore more critically the relationship between gender inequalities and HIV prevention, particularly as they are supported by findings from other studies in South Africa and the United States. The findings do support the general assertion that gender is an important influence on HIV preventive practices and needs to be more strongly emphasised in prevention programmes. The complexity of the relationship between gender and HIV indicated here highlights the need for gender issues as a whole to be integrated into HIV prevention programmes and not approached piecemeal.
