Community-Level Gender Equity and Extramarital Sexual Risk-Taking among Married Men in Eight African Countries

Article excerpt

CONTEXT: In many parts of Africa, women are most likely to become infected with HIV by having unprotected sex with their husbands, who may have acquired the virus through extramarital sex. However, the ways in which aspects of community environments--particularly those related to gender equity--shape men's extramarital sexual risk-taking are not well understood.

METHODS: Demographic and Health Survey data from eight African countries (Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia and Zimbabwe) were used to examine associations between married men's engaging in risky extramarital sex (i.e., having had both unprotected sex and extramarital sex) and indicators of gender equity and other community characteristics. Separate multilevel logistic regression models that incorporated individual, household and community measures were created for each country.

RESULTS: In five countries, men who lived in communities with more equal ratios of women to men with at least a primary education were less likely to report risky extramarital sexual activity (odds ratios, 0.4-0.6). A similar relationship was found in four countries for the ratio of women to men who were employed (0.4-0.5). In three countries, men who lived in communities with more conservative attitudes toward wife-beating or male decision making had elevated odds of extramarital sexual risk-taking (1.1-1.5).

CONCLUSIONS: While HIV prevention programs should focus on reducing gender inequities, they also need to recognize the conservative cultural factors that influence the formation of men's masculine identities and, in turn, affect their sexual behavior.

International Perspectives on Sexual and Reproductive Health, 2010,36(4): 178-188

A substantial body of evidence suggests that for many women in Africa, the greatest risk of HIV infection lies in marriage, and the greatest source of HIV infection is unprotected sex with their husbands. (1-4) Recent estimates suggest that nearly 80% of new HIV infections among heterosexual urban residents in Africa occur within marital or cohabiting unions. (2) In such cases, one partner either is HIV-positive prior to union formation or has acquired the virus through extramarital sexual activity. A pronounced double standard regarding extramarital sexual behavior exists in much of Africa; married men are much more likely than married women to engage in extramarital sex, and among males such activity is often socially and culturally condoned.(5-7) Therefore, African men commonly have concurrent marital (regular) and extramarital (casual) sex partners. In fact, although they have roughly the same number of partners as their American and European counterparts, they are more likely than Americans and Europeans to have concurrent rather than serial relationships. (8-10) Some investigators have argued that this pattern of concurrency has played an important part in driving the HIV epidemic in Africa.(11)

Despite the high prevalence of extramarital sexuality in the region, levels of condom use are low, particularly with regular partners. Men often report that condoms are unnecessary within unions and should be used only with casual partners.(12-14) In addition, some evidence indicates that men use condoms inconsistently with casual partners.(14-16) Thus, women are susceptible to HIV infection within marriage through unprotected sex with their husband if he has had extramarital exposure to the virus. While some previous studies have examined the factors associated with high-risk sexual behavior among African men, few have considered how such behavior is shaped by a man's social, cultural and economic environment. This analysis is designed to examine associations between African men's reports of risky extramarital sex and the economic, demographic and behavioral characteristics of residents of the communities in which they live--and more specifically, to identify how community-level gender equity, as measured by access to social capital, shapes married men's engagement in risky extramarital sex,

BACKGROUND

Barker and Ricardo have noted that in many cases, discourse around gender in resource-poor contexts refers almost exclusively to the disadvantages that women and girls face in obtaining good health outcomes and access to social capital (e. …