title: Gender inequity norms are associated with increased male-perpetrated rape and sexual risks for HIV infection in Botswana and Swaziland.
abstract: BACKGROUND
  There is limited empirical research on the underlying gender inequity norms shaping gender-based violence, power, and HIV risks in sub-Saharan Africa, or how risk pathways may differ for men and women. This study is among the first to directly evaluate the adherence to gender inequity norms and epidemiological relationships with violence and sexual risks for HIV infection.
  
  
  METHODS
  Data were derived from population-based cross-sectional samples recruited through two-stage probability sampling from the 5 highest HIV prevalence districts in Botswana and all districts in Swaziland (2004-5). Based on evidence of established risk factors for HIV infection, we aimed 1) to estimate the mean adherence to gender inequity norms for both men and women; and 2) to model the independent effects of higher adherence to gender inequity norms on a) male sexual dominance (male-controlled sexual decision making and rape (forced sex)); b) sexual risk practices (multiple/concurrent sex partners, transactional sex, unprotected sex with non-primary partner, intergenerational sex).
  
  
  RESULTS
  A total of 2049 individuals were included, n = 1255 from Botswana and n = 796 from Swaziland. In separate multivariate logistic regression analyses, higher gender inequity norms scores remained independently associated with increased male-controlled sexual decision making power (AORmen = 1.90, 95%CI:1.09-2.35; AORwomen = 2.05, 95%CI:1.32-2.49), perpetration of rape (AORmen = 2.19 95%CI:1.22-3.51), unprotected sex with a non-primary partner (AORmen = 1.90, 95%CI:1.14-2.31), intergenerational sex (AORwomen = 1.36, 95%CI:1.08-1.79), and multiple/concurrent sex partners (AORmen = 1.42, 95%CI:1.10-1.93).
  
  
  CONCLUSIONS
  These findings support the critical evidence-based need for gender-transformative HIV prevention efforts including legislation of women's rights in two of the most HIV affected countries in the world.
authors.affiliation: Division of AIDS, Department of Medicine, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada. gshi@cfenet.ubc.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Karen
authors.initials: K
authors.lastname: Leiter
authors.forename: Nthabiseng
authors.initials: N
authors.lastname: Phaladze
authors.forename: Zakhe
authors.initials: Z
authors.lastname: Hlanze
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Vincent
authors.initials: V
authors.lastname: Iacopino
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
mesh_terms: D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D019548:Crime Victims; D003430:Cross-Sectional Studies; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006806:Human Rights; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011902:Rape / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012742:Sex Offenses; D012725:Sexual Behavior; D014754:Violence; D055815:Young Adult