Sexuality & Culture

, Volume 20, Issue 3, pp 535–554 | Cite as

Risky Sexual Behavior of Multiple Partner Relations and Women’s Autonomy in Four Countries

  • Cecilia MengoEmail author
  • Eusebius Small
  • Bonita B. Sharma
  • Ude Paula
Original Paper


Existent research reveals that inequitable gender-based power in relationships and intimate partner violence contribute to HIV rates among women in the developing world. This study uses a multi-country analysis to examine women’s autonomy in negotiating safe sex practices such as having sex with a partner with no other concurrent partner to reduce the risk of HIV/AIDS in Nigeria, Kenya, Malawi, and Nepal. The Demographic Health Survey data for Nigeria (2013), Kenya (2008–2009), Malawi (2010), and Nepal (2011) provide geographical variability as well as HIV risk variables. The sample included 16,540 women aged 15–49 years who self-identified as ever married. Factor analysis for women’s autonomy was conducted based on socio-cultural theory. Logistic regression was conducted and results identified decision-making, labor force participation, and individual autonomy as women autonomy factors significantly reduced the risk for HIV infection by having one sex partner who has only one sex partner. Other women autonomy factors related to lower risk for HIV include education, place of residence, and religion. Our study indicates that effective management of HIV transmission requires addressing women autonomy factors within the context of culture.


Culture Developing countries Sexual relationships Women autonomy 


  1. Adamczyk, A., & Greif, M. (2011). Education and risky sex in Africa: Unraveling the link between women education and reproductive health behaviors in Kenya. Social Science Research, 40, 654–666.CrossRefGoogle Scholar
  2. Allendorf, K. (2007). Do women’s land rights promote empowerment and child health in Nepal? World Development, 35(1975–88), 1980.Google Scholar
  3. Anderson, S., & Eswaran, M. (2009). What determines female autonomy? Evidence from Bangladesh. Journal of Development Economics, 90, 79–191.Google Scholar
  4. Atteraya, M. S., Kimm, H., & Song, I. H. (2014). Women’s autonomy in negotiating safer sex to prevent HIV: Findings from the 2011 Nepal demographic and health survey. AIDS Education and Prevention, 26(1), 1.CrossRefGoogle Scholar
  5. Bloom, S. S., & Griffiths, P. L. (2007). Female autonomy as a contributing factor to women’s HIV-related knowledge and behavior in three culturally contrasting states in India. Journal of Biosocial Science, 39(4), 557–573.CrossRefGoogle Scholar
  6. Brummelhuis, H., & Herdt, G. H. (Eds.). (2003). Culture and sexual risk: Anthropological perspectives on AIDs. New York: Gordon and Breach.Google Scholar
  7. Caldwell, J. C. (2000). Rethinking the African AIDS epidemic. Population and Development Review, 26(1), 117–135. doi: 10.1111/j.1728-4457.2000.00117.x.CrossRefGoogle Scholar
  8. Connell, R. W. (1987). Gender and power: Society, the person, and sexual politics. Stanford, CA: Stanford University Press.Google Scholar
  9. de Araujo, P., & Miller, M. (2014). Women’s health knowledge, sexual empowerment, and HIV/AIDS in Sub-Saharan Africa. Economics Bulletin, 34(3), 1875–1890.Google Scholar
  10. Durevall, D., & Lindskog, A. (2012). Economic inequality and HIV in Malawi. World Development, 40, 1435–1451.CrossRefGoogle Scholar
  11. Fontdevila, J. (2009). Framing dilemmas during sex: A micro-sociological approach to HIV risk. Social Theory and Health, 7, 241–263.CrossRefGoogle Scholar
  12. Hageman, K. M., Dube, H. M. B., Mugurungi, O., Gavin, L. E., Hader, S. L., & St. Louis, M. E. (2010). Beyond monogamy: Opportunities to further reduce risk for HIV infection among married Zimbabwean women with only one lifetime partner. AIDS and Behavior, 14(1), 113–124. doi: 10.1007/s10461-009-9603-5.CrossRefGoogle Scholar
  13. Haidt, J., & Hersh, M. (2001). Sexual morality: The cultures and emotions of conservatives and liberals. Journal of Applied Social Psychology, 31, 191–221.CrossRefGoogle Scholar
  14. Jejeebhoy, S. (2000). Women’s autonomy in rural India: Its dimensions, determinants and the influence of the context. In G. Sen & H. B. Presser (Eds.), Women’s empowerment and demographic processes. Oxford: Oxford University Press.Google Scholar
  15. Kalichman, S. C., Ntseane, D., Nthomang, K., Segwabe, M., Phorano, O., & Simbayi, L. C. (2007). Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sexually Transmitted Infections, 83(5), 371–375. doi: 10.1136/sti.2006.023630.CrossRefGoogle Scholar
  16. Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., Cherry, C., Jooste, S., & Mathiti, V. (2005). Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in cape town, south africa. Journal of Sex Research, 42(4), 299–305. doi: 10.1080/00224490509552285.CrossRefGoogle Scholar
  17. Kenya National Bureau of Statistics and ICF Macro. (2010). Kenya Demographic and Health Surveys 2008-09 [Homepage of USAID].
  18. Kenyon, C., & Zondo, S. (2011). Why do some South African ethnic groups have very high HIV rates and others not? African AIDS Research, 10, 51–62.CrossRefGoogle Scholar
  19. Lindgren, T., Rankin, S. H., & Rankin, W. W. (2005). Malawi women and HIV: Socio-cultural factors and barriers to prevention. Women and Health, 41, 69–86.CrossRefGoogle Scholar
  20. Mah, T. L., & Halperin, D. T. (2010). Concurrent sexual partnerships and the HIV epidemics in Africa: Evidence to move forward. AIDS and Behavior, 14(1), 11–16. doi: 10.1007/s10461-008-9433-x.CrossRefGoogle Scholar
  21. Mashinini, D. P., & Pelton-Cooper, M. (2012). HIV risk in a group of educated urban black African women in South Africa: Private accounts of gendered power dynamics. Feminism and Psychology, 22, 204–219.CrossRefGoogle Scholar
  22. Ministry of Health and Population (MOHP) [Nepal], New ERA, and ICF International Inc. (2012). Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland.Google Scholar
  23. Mykhalovskiy, E., & Rosengarten, M. (2009). HIV/AIDS in its third decade: Renewed critique in social and cultural analysis—An introduction. Social Theory and Health, 7, 187–195.CrossRefGoogle Scholar
  24. Namasivayam, A., Osuorah, D. C., Syed, R., & Antai, D. (2012). The role of gender inequities in women’s access to reproductive health care: A population-level study of Namibia, Kenya, Nepal, and India. International Journal of Women’s Health, 4, 351–364. doi: 10.2147/IJWH.S32569.Google Scholar
  25. National Population Commission [Nigeria] and ICF International. (2014). Nigeria Demographic and Health Survey 2013. Rockville, Maryland, USA: National Population Commission and ICF International.
  26. National Statistical Office (NSO) and ICF Macro. (2011). Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland, USA: NSO and ICF Macro.
  27. NEPHAK, & GNAP. (2009). The people living with HIV stigma Index. Country assessment. Nairobi: NEPHAK.
  28. Rohleder, P., Swartz, L., Kalichman, S., & Simbayi, L. (Eds.). (2009). HIV/AIDS in South Africa 25 years on: Psychosocial perspectives. New York: Springer.Google Scholar
  29. Rutstein, S. O., & Rojas, G. (2006). Guide to DHS statistics. Demographic and Health Surveys, Calverton, MD: ORC Macro.Google Scholar
  30. Snelling, D., Rasugu-Omariba, D. W., Hong, S., Georgiades, K., Racine, Y., & Boyle, M. H. (2007). HIV/AIDS knowledge, women’s education, epidemic severity and protective sexual behaviour in low- and middle-income countries. Journal of Biosocial Science, 39(3), 421. doi: 10.1017/S0021932006001465.CrossRefGoogle Scholar
  31. Stern, E., Rau, A., & Cooper, D. (2014). Sexual and reproductive health perceptions and practices as revealed in the sexual history narratives of South African men living in a time of HIV/AIDS. Journal of Social Aspects of HIV/AIDS, 11, 233–244.CrossRefGoogle Scholar
  32. Uchudi, J., Magadi, M., & Mostazir, M. (2012). A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa. Journal of Biosocial Science, 44(3), 289. doi: 10.1017/S0021932011000654.CrossRefGoogle Scholar
  33. Underwood, C., Skinner, J., Osman, N., & Schwandt, H. (2011). Structural determinants of adolescent girls’ vulnerability to HIV: Views from community members in Botswana, Malawi, and Mozambique. Social Science Medicine, 73, 342–350.CrossRefGoogle Scholar
  34. United States Central Intelligence Agency. (2013). The world fact book. Access 26 Jan.
  35. Weiser, S. D., Leiter, K., Bangsberg, D. R., Butler, L. M., Percy-de Korte, F., Hlanze, Z., et al. (2007). Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLOS Medicine, 4, 1589–1598.CrossRefGoogle Scholar
  36. World Bank. (2002). Education and HIV/AIDS: A window of hope. Washington, DC: The World Bank. Accessed 20 Feb 2012.
  37. Wechsberg, W. M., Myers, B., Reed, E., Carney, T., Emanuel, A. N., & Browne, F. A. (2013). Substance use, gender inequity, violence and sexual risk among couples in Cape Town. Cultural Health Sex, 15, 1221–1236.CrossRefGoogle Scholar
  38. World Health Organization. (2015). Maternal mortality. Retrieved from

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Cecilia Mengo
    • 1
    Email author
  • Eusebius Small
    • 2
  • Bonita B. Sharma
    • 2
  • Ude Paula
    • 2
  1. 1.The Ohio State University College of Social WorkColumbusUSA
  2. 2.The University of Texas at Arlington School of Social WorkArlingtonUSA

Personalised recommendations