| This study sought to use social-structural variables in exploring women's HIV-related risk behaviors in a sub-Saharan Africa setting, Uganda, in East Africa. Although much is known about structural and environmental approaches to HIV prevention among HIV negative women, little is known about the potential application of this approach to studying sexual risk behaviors and adherence to ART among HIV infected women. The overall aim of the study was to examine associations between social-structural variables (e.g., poverty, gender power dynamics) and two outcome variables: history of unprotected sex and self-reported adherence to ART among HIV infected women enrolled in drug therapy programs.; Data were collected using structured interviews with 377 HIV infected women in four different HIV/AIDS treatment programs in Kampala and Masaka, Uganda. A major finding of the study was that few women in the sample were sexually active (34%), partly due to the high proportion of non-sexually active widows (49%). The majority of sexually active women reported condom use at last sex act (75%) and disclosure of their HIV status to a main partner (78%).; In multivariate analysis condom use at last sex act was strongly predicted by the need to borrow food to survive (OR=5.440, 95% CI 1.237, 23.923, p<.05), possibly indicating that women engaging in sexual exchange for food are more likely to use condoms. Forced, coercive or survival sex was significantly associated with the number of meals missed per week due to lack of food (OR=1.130, 95% CI 1.125, 1.526, p<.005). In addition, married women compared to unmarried women were three times more likely to have experienced forced, coercive or survival sex (OR=2.911, 95% CI 1.234, 6.87, p<.05).; Because married women are considered to be relatively more economically stable, the findings that missing meals due to lack of food and married marital status are both associated with forced, coercive or survival sex, when adjusted for other factors, support the conclusion that both impoverished women and women with access to more resources can be at risk. Alternately, married women may not have as ready access to resources as is usually assumed and could also be engaging in sexual exchange behavior and borrowing food to get by.; In either case, married women are probably more likely than their unmarried counterparts to experience large gender power differentials, despite their economic resources, that limit their ability to use condoms. Indeed, for all women in the study, the structural equation modeling (SEM) model fitting analyses indicated that gender-based power may be a more important predictor than economic security of women's sexual risk behaviors. Neither factor was, however, predictive of ART adherence in this study sample.; In summary, findings suggested that sexual exchange for food and other assistance is probably common and likely driven by economic deprivation. On the contrary, results indicated that sexual exchange is not necessarily linked with risky behaviors such as lack of condom use. There is evidence of increased risk for married women in the study, especially the risk of forced, coercive or survival sex. The complex interactions between poverty, hunger, marital status, gender-based power and different HIV/AIDS risk behaviors should be further examined in order to inform the implementation of HIV/AIDS programs designed for women. (Abstract shortened by UMI.)... |
