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

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Abstract

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.

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Acknowledgments

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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Authors and Affiliations

  1. Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA

    Amy A. Conroy

  2. Center for Global Health, Massachusetts General Hospital, Boston, USA

    Alexander C. Tsai & David R. Bangsberg

  3. Department of Psychiatry, Kaiser Permanente, San Franscisco, USA

    Gina M. Clark

  4. Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda

    Yap Boum & Annet Kawuma

  5. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Abigail M. Hatcher

  6. Division of HIV/AIDS, Department of Medicine, University of California - San Francisco, San Francisco, USA

    Abigail M. Hatcher, Peter W. Hunt & Sheri D. Weiser

  7. Department of Epidemiology, University of California - San Francisco, San Francisco, USA

    Jeffrey N. Martin

  8. Department of Medicine, Harvard University, Boston, USA

    David R. Bangsberg

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  1. Amy A. Conroy
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Conroy, A.A., Tsai, A.C., Clark, G.M. et al. Relationship Power and Sexual Violence Among HIV-Positive Women in Rural Uganda. AIDS Behav 20, 2045–2053 (2016). https://doi.org/10.1007/s10461-016-1385-y

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