title: Individual and interpersonal characteristics that influence male-dominated sexual decision-making and inconsistent condom use among married HIV serodiscordant couples in Gujarat, India: results from the positive Jeevan Saathi study.
abstract: Approximately 40 % of new infections occur among married women. No studies have examined the factors that may contribute to HIV transmission among HIV-negative wives in HIV serodiscordant relationships in Gujarat, India. In 2010, a cross-sectional survey with 185 HIV serodiscordant, married couples (i.e. 185 HIV-positive husbands and their 185 HIV-negative wives) in Gujarat was conducted. Socio-demographic, individual, and interpersonal characteristics of HIV-positive husbands and their HIV negative wives were examined. The association of these characteristics with inconsistent condom use and male-dominated sexual decision-making, were examined using multivariate logistic regression analyses. Approximately 10 % of couples reported inconsistent condom use in the past 3 months and 20 % reported intimate partner violence (IPV). Reports of IPV were associated with a higher odds of inconsistent condom use among HIV-positive husbands (aOR = 6.281). Husbands who reported having received couples counseling had a lower odds of male-dominated decision making about condom use (aOR = 0.372). HIV-negative wives who reported sex communication had a lower odds of male-dominated decision making about condom use (aOR = 0.322) with their HIV-positive husbands. Although condom use is a traditional measure of risk behavior, other factors that facilitate risk, such as male-dominated sexual decision-making need to be considered in analyses of risk.
authors.affiliation: Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA, 30329, USA, snpate5@emory.edu.
authors.forename: Shilpa N
authors.initials: SN
authors.lastname: Patel
authors.forename: Gina M
authors.initials: GM
authors.lastname: Wingood
authors.forename: J K
authors.initials: JK
authors.lastname: Kosambiya
authors.forename: Frances
authors.initials: F
authors.lastname: McCarty
authors.forename: Michael
authors.initials: M
authors.lastname: Windle
authors.forename: Kathryn
authors.initials: K
authors.lastname: Yount
authors.forename: Monique
authors.initials: M
authors.lastname: Hennink
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003469:Culture; D003657:Decision Making; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D007398:Interpersonal Relations; D008297:Male; D036301:Qualitative Research; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology*; D012930:Social Dominance; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*