AIDS and Behavior

, Volume 20, Issue 9, pp 2045–2053 | Cite as

Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda

  • Amy A. ConroyEmail author
  • Alexander C. Tsai
  • Gina M. Clark
  • Yap Boum
  • Abigail M. Hatcher
  • Annet Kawuma
  • Peter W. Hunt
  • Jeffrey N. Martin
  • David R. Bangsberg
  • Sheri D. Weiser
Original Paper


Gender-based power imbalances place women at significant risk for sexual violence, however, little research has examined this association among women living with HIV/AIDS. We performed a cross-sectional analysis of relationship power and sexual violence among HIV-positive women on anti-retroviral therapy in rural Uganda. Relationship power was measured using the Sexual Relationship Power Scale (SRPS), a validated measure consisting of two subscales: relationship control (RC) and decision-making dominance. We used multivariable logistic regression to test for associations between the SRPS and two dependent variables: recent forced sex and transactional sex. Higher relationship power (full SRPS) was associated with reduced odds of forced sex (AOR = 0.24; 95 % CI 0.07–0.80; p = 0.020). The association between higher relationship power and transactional sex was strong and in the expected direction, but not statistically significant (AOR = 0.47; 95 % CI 0.18–1.22; p = 0.119). Higher RC was associated with reduced odds of both forced sex (AOR = 0.18; 95 % CI 0.06–0.59; p < 0.01) and transactional sex (AOR = 0.38; 95 % CI 0.15–0.99; p = 0.048). Violence prevention interventions with HIV-positive women should consider approaches that increase women’s power in their relationships.


Relationship power Sexual violence Transactional sex HIV/AIDS Africa 



We thank the Uganda AIDS Rural Treatment Outcomes (UARTO) participants who made this study possible by sharing their experiences; Annet Kembabazi for providing study coordination and support; Doreen Akello, Marcy Mutumba, Christine Ngabirano, Ruth Ssentongo, and Florence Turyashemererwa for research assistance; and Dr. Jessica Haberer, Dr. Nozmu Mukiibi, Dr. Conrad Muzoora, Dr. Jude Senkungu for invaluable advice and oversight of study design and implementation. While these individuals are acknowledged for their assistance, no endorsement of manuscript contents or conclusions should be inferred. The study was funded by NIH K23 MH-079713, MH-079713-03S1, NIH R01 MH-054907, NIH P30 AI27763, and the Tim and Jane Meyer Family Foundation. Additional sources of salary support came from the Burke Family Foundation, NIH K24 MH-87227, K23 MH-096620, and T32 MH-019105.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Amy A. Conroy
    • 1
    Email author
  • Alexander C. Tsai
    • 2
  • Gina M. Clark
    • 3
  • Yap Boum
    • 4
  • Abigail M. Hatcher
    • 5
    • 6
  • Annet Kawuma
    • 4
  • Peter W. Hunt
    • 6
  • Jeffrey N. Martin
    • 7
  • David R. Bangsberg
    • 2
    • 8
  • Sheri D. Weiser
    • 6
  1. 1.Center for AIDS Prevention Studies, Department of MedicineUniversity of California - San FranciscoSan FranciscoUSA
  2. 2.Center for Global HealthMassachusetts General HospitalBostonUSA
  3. 3.Department of PsychiatryKaiser PermanenteSan FransciscoUSA
  4. 4.Faculty of MedicineMbarara University of Science & TechnologyMbararaUganda
  5. 5.Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  6. 6.Division of HIV/AIDS, Department of MedicineUniversity of California - San FranciscoSan FranciscoUSA
  7. 7.Department of EpidemiologyUniversity of California - San FranciscoSan FranciscoUSA
  8. 8.Department of MedicineHarvard UniversityBostonUSA

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