title: Gender-based power and couples' HIV risk in Uttar Pradesh and Uttarakhand, north India.
abstract: BACKGROUND
  Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic.
  
  
  METHODS
  Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures.
  
  
  RESULTS
  Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year.
  
  
  CONCLUSIONS
  If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India.
authors.affiliation: Medical student, School of Medicine, University of Texas Health Science Center at Houston, USA, alpna.a.agrawal@uth.tmc.edu.
authors.forename: Alpna
authors.initials: A
authors.lastname: Agrawal
authors.forename: Shelah S
authors.initials: SS
authors.lastname: Bloom
authors.forename: Chirayath
authors.initials: C
authors.lastname: Suchindran
authors.forename: Siân
authors.initials: S
authors.lastname: Curtis
authors.forename: Gustavo
authors.initials: G
authors.lastname: Angeles
mesh_terms: D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D015658:HIV Infections; D006801:Humans; D007194:India / Q000453:epidemiology; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008393:Marriage; D008875:Middle Aged; D011209:Power, Psychological; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D063507:Sexism / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D018454:Spouses / Q000523:psychology*; D055815:Young Adult