Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland

In a cross-sectional study, Sheri Weiser and colleagues found that food insufficiency was an important risk factor for increased sexual risk-taking in women in Botswana and Swaziland

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

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.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).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).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

Adjusted odds ratios of the independent relationship between gender inequity norms scores and violence, power, and sexual risk practices in Botswana and Swaziland, in sex-stratified models.

<p>All models adjusted for age, married/cohabitating, country of residence, alcohol consumption, and variables significant at p<0.10 in univariate analyses;</p><p>**Variables retained at significance p<0.05.</p><p>*Variables marginally significant at p<0.10.</p

Crude odds ratios of associations between gender inequity norms score and perpetration of rape, power, and sexual risk for HIV infection among men in Botswana and Swaziland (n = 999).

<p>*Based on National Institutes of Alcohol Use definition of “risky drinking”, problem drinking was defined as 8–14 drinks/week for women and 15–21 drinks/week for men, while heavy drinking was defined as >14 drinks/week for women and >21 drinks/week for men.</p

Crude odds ratios of associations between gender inequity norms scores and rape, power, and sexual risk for HIV infection among women in Botswana and Swaziland (n = 1050).

<p>*Based on National Institutes of Alcohol Use definition of “risky drinking”, problem drinking was defined as 8–14 drinks/week for women and 15–21 drinks/week for men, while heavy drinking was defined as >14 drinks/week for women and >21 drinks/week for men.</p

Socio-demographic characteristics, sexual risk practices and male sexual dominance among men (n = 999) and women (n = 1050) in a population-based probability sample in Botswana and Swaziland.

<p>Socio-demographic characteristics, sexual risk practices and male sexual dominance among men (n = 999) and women (n = 1050) in a population-based probability sample in Botswana and Swaziland.</p