Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationship power, abuse history, and sexual communication) on sexual behavior (e.g., two or more partners in the year prior to pregnancy, condom use, condom-use intentions, and STI diagnosis) among 196 pregnant women recruited from five community dispensaries in rural Haiti. Results showed that gender and power factors significantly related to sexual behavior. Gender and power factors were most significant for condom use and intention to use condoms, accounting for 18 and 25% of the variance above and beyond HIV knowledge and demographic covariates, respectively. These results suggest the need to create prevention interventions that restore power imbalances, provide support for women suffering abuse, and strengthen communication skills.
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REFERENCES
Adrien, A., Cayemittes, M., and Bergevin, Y. (1993). AIDS-related knowledge, attitudes, beliefs, and practices in Haiti. Bulletin of the Pan American Health Organization, 27, 234–243.
Behets, F. M., Genece, E., Narcisse, M., Liautaud, B., Cohen, M., and Dallabetta, G. A. (1998). Approaches to control sexually transmitted diseases in Haiti, 1992–95. Bulletin of the Pan American Health Organization, 76, 189–194.
Brewer, T. H., Hasbun, J., Ryan, C. A., Hawes, S. E., Martinez, S., Sanchez, J., et al. (1998). Migration, ethnicity and environment: HIV risk factors for women on the sugar cane plantations of the Dominican Republic. AIDS, 12, 1879–1887.
CDC (2005). Global AIDS Program: About our work behavior change communications. CDC.
Connell, R. W. (1987). Gender and power. Stanford, CA: Stanford University Press.
de Bruyn, M. (1992). Women and AIDS in developing countries. Social Science and Medicine, 34, 249–262.
DiClemente, R. J., Wingood, G. M., Crosby, R., Sionean, C., Brown, L., Rothbaum, B., et al. (2001). A prospective study of psychosocial distress and sexual risk behavior among black adolescent females. Pediatrics, 108(5), E85.
Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, J. A., Harlow, S. D. (2004). Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet, 363, 1415–1421.
Family Health International (1997). Family health international AIDS control and prevention project: Final report. FHI.
Farmer, P. E. (1995). Culture, poverty, and the dynamics of HIV transmission in rural Haiti. In H. T. Brummelhuis and G. Herdt (Eds.), Culture and sexual risk: Anthropological perspectives on AIDS (pp. 3–28). Newark, NJ: Gordon and Breach.
Fitzgerald, D. W., Behets, F., Caliendo, A., Roberfroid, D., Lucet, C., Fitzgerald, J. W., et al. (2000). Economic hardship and sexually transmitted diseases in Haiti's rural Artibonite Valley. American Journal of Tropical Medical Hygiene, 62, 496–501.
Garcia-Moreno, C., and Watts, C. (2000). Violence against women: Its importance for HIV/AIDS. AIDS, 14, S253–S265
Gay, J., and Underwood, U. (1991). Women in danger: A call for action. Paper presented at the World's Women 1970–1990. Trends and Statistics.
Harvey, S. M., Bird, S. T., Galavotti, C., Duncan, E. A., and Greenberg, D. (2002). Relationship power, sexual decision making and condom use among women at risk for HIV/STDs. Women and Health, 36, 69–84.
HIV/AIDS Surveillance Data Base (2000). International Programs Center, US Census Bureau.
Ickovics, J., Morrill, A., Beren, S., Walsh, U., and Rodin, J. (1994). Limited effects of HIV testing for women: A prospective study of behavioral and psychological consequences. JAMA, 272, 443–448.
Ickovics, J. R., Niccolai, L. M., Lewis, J. B., Kershaw, T. S., and Ethier, K. A. (2003). High post-partum rates of STDs among teens: Pregnancy as a window of opportunity for prevention. Sexually Transmitted Infections, 79, 469–473.
Ickovics, J. R., and Rodin, J. (1992). Women and AIDS in the United States: Epidemiology, natural history, and mediating mechanisms. Health Psychology, 11, 1–16.
Jack, N. (2001). HIV/AIDS in Caribbean children and adolescents. In B. Dicks (Ed.), HIV/AIDS and children in the English speaking Caribbean. New York: Haworth.
James, S., Reddy, S. P., Taylor, M., and Jinabhai, C. C. (2004). Young people, HIV/AIDS/STIs and sexuality in South Africa: The gap between awareness and behavior. Acta Paediatrica, 93, 264–269.
Kalichman, S. C., and Simbayi, L. C. (2004). Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa. AIDS Care, 16, 681–689.
Kalichman, S. C., Williams, E. A., Cherry, C., Belcher, L., and Nachimson, D. (1998). Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. Journal of Women's Health, 7, 371–378.
Kershaw, T. S., Ickovics, J. R., Lewis, J. B., Niccolai, L. M., Milan, S., and Ethier, K. A. (2004). Sexual risk following a sexually transmitted disease diagnosis: The more things change the more they stay the same. Journal of Behavioral Medicine, 24, 445–461.
Kershaw, T. S., Niccolai, L. M., Ickovics, J. R., Lewis, J. B., Meade, C., and Ethier, K. A. (2003). Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: Implications for prevention of repeat pregnancy. Journal of Adolescent Health, 33, 359–365.
Malow, R. M., Cassagnol, T., McMahon, R., Jennings, T. E., and Roatta, V. G. (2000). Relationship of psychosocial factors to HIV risk among Haitian women. AIDS Education and Prevention, 12, 79–92.
Mbizvo, E. M., Msuya, S. E., Hussain, A., Chirenje, M. Z., and Stray-Pederson, B. (2003). HIV prevalance in Zimbabwean women: 54–67% knowledge and perceived risk. International Journal of STD and AIDS, 14, 202–207.
Morrill, A., Ickovics, J., Golubchikov, V., Beren, S., and Rodin, J. (1996). Safer sex: Social and psychological predictors of behavioral maintenance and change among heterosexual women. Journal of Clinical and Consulting Psychology, 64, 819–828.
Nagelkerke, N. (1991). A note on the general definition of the coefficient of determination. Biometrika, 78, 691–692.
Niccolai, L. M., Ethier, K. A., Kershaw, T. S., Lewis, J. B., and Ickovics, J. R. (2003). Pregnant adolescents at risk: Sexual behaviors and sexually transmitted disease prevalence. American Journal of Obstetrics and Gynecology, 188, 63–70.
Njeru, E., Eldridge, G., Ngugi, E., Plummer, F., and Moses, S. (1995). STD partner notification and referral in primary level health centers in Nairobi, Kenya. Sexually Transmitted Diseases, 22, 231–235.
Park, I. U., Sneed, C. D., Morisky, D. E., Alvear, S., and Hearst, N. (2002). Correlates of HIV risk among Ecuadorian adolescents. AIDS Education and Prevention, 14, 73–83.
Peltzer, K. (2003). HIV/AIDS knowledge, attitudes, beliefs, and behaviors in a rural South African adult population. South African Journal of Psychology, 33, 250.
Pierre, J. A., and Fournier, A. M. (1999). Human immunodeficiency virus infection in Haiti. JAMA, 91, 165–170.
Pulerwitz, J., Gortmaker, S. L., and DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42, 637–660.
Raj, A., Silverman, J. G., and Amaro, H. (2004). Abused women report greater male partner risk and gender-based risk for HIV: Findings from a community-based study with Hispanic women. AIDS Care, 16, 519–529.
Robinson, T., Thompson, T., and Bain, B. (2001). Sexual risk-taking behavior and HIV knowledge of Kingston's street boys. Journal of HIV/AIDS Prevention and Education for Adolescents and Children, 4, 127–147.
Shrier, L. A., Goodman, E., and Emans, S. (1999). Partner condom use among adolescent girls with sexually transmitted diseases. Journal of Adolescent Health, 24, 357–361.
Smith Fawzi, M. C., Lambert, W., Singler, J. M., Koenig, S. P., Leandre, F., Nevil, P., et al. (2003). Prevalence and risk factors of STDs in rural Haiti: Implications for policy and programming in resource-poor settings. International Journal of STD and AIDS, 14, 848–853.
Smith Fawzi, M. C., Lambert, W., Singler, J. M., Tanagho, Y., Leandre, F., Nevil, P., et al. (2005). Factors associated with forced sex among women accessing health services in rural Haiti: Implications for the prevention of HIV infection and other sexually transmitted diseases. Social Science and Medicine, 60, 679–689.
Susser, I., and Stein, Z. (2000). Culture, sexuality, and women's agency in the prevention of HIV/AIDS in Southern Africa. Amercian Journal of Public Health, 90, 1042– 1048.
UNAIDS (2000). Fighting AIDS: A new global resolve. UNAIDS.
UNAIDS (2004). Report on the global AIDS epidemic. UNAIDS.
Wingood, G., and DiClemente, R. J. (2002). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27, 539–565.
Worth, D. (1990). Minority women and AIDS: Culture, race, and gender. In D. Feldman (Ed.), Culture and AIDS. New York: Praeger.
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Kershaw, T.S., Small, M., Joseph, G. et al. The Influence of Power on HIV Risk Among Pregnant Women in Rural Haiti. AIDS Behav 10, 309–318 (2006). https://doi.org/10.1007/s10461-006-9072-z
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DOI: https://doi.org/10.1007/s10461-006-9072-z