title: Heterosexual transmission of HIV in the Dominican Republic: gendered indicators are associated with disparities in condom use.
abstract: BACKGROUND
  Gendered dynamics in heterosexual relationships compromise women's self-efficacy and increase their vulnerability to acquiring HIV. This study examines the impact of socioeconomic determinants, media exposure, and sexual expectations on sexual behaviors of men and women in the Dominican Republic (DR).
  
  
  METHODS
  We analyzed cross-sectional data from 51,018 adults in the Dominican Republic age 15 to 45 years collected by the Demographics and Health Survey (DHS) in 2007. Measures included demographic and socioeconomic indicators, social exposures, sexual expectations and sexual behaviors. Logistic regression models explored gender differences in condom use.
  
  
  RESULTS
  Study findings indicated that women were less likely to use a condom at last intercourse than men (odds ratio [OR] = 0.29; 95 % CI = 0.27, 0.31). Among men, secondary (OR = 1.43; 95 % CI = 1.16, 1.76) and higher education (OR = 1.58; 95 % CI = 1.25, 2.00), being in the richest quintile (OR = 1.25; 95 % CI = 1.07, 1.47), and living in a female-headed household (OR = 1.13; 95 % CI 1.03, 1.23) increased the likelihood of condom use. Compared to never married men, currently and formerly married men were less likely to use condoms (OR = 0.03; 95 % CI = 0.03, 0.04 and OR = 0.67; 95 % CI = 0.60, 0.75, respectively). The odds of condom use increased for young women 15-19 years old in comparison with women age 30-34 years, but decreased as they grew older. For women, being in the richer quintile (OR = 1.28; 95 % CI = 1.06, 1.54), living in a female-headed household (OR = 1.26; 1.12, 1.41), and having good access to media (OR = 1.24; 95 % CI = 1.12, 1.42) increased the likelihood of condom use. Being currently married or formerly married and living in rural areas decreased such likelihood among women.
  
  
  CONCLUSIONS
  Study findings provide evidence that, in the DHS, socioeconomic and cultural differences between men and women affects condom use. Efforts to reduce HIV transmission within heterosexual relationships in the DR call for tailored, gender-specific interventions that take into account gender differences of power and sexual behaviors.
authors.affiliation: Department of Medicine, Pontificia Universidad Catolica Madre y Maestra, Santiago, Dominican Republic. mm.jimenez@ce.pucmm.edu.do.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Jimenez
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Illinois, USA. fandrade@illinois.edu.
authors.forename: Flavia C D
authors.initials: FC
authors.lastname: Andrade
authors.affiliation: Department of Human and Community Development, University of Illinois at Urbana-Champaign, Illinois, USA. mraffael@illinois.edu.
authors.forename: Marcela
authors.initials: M
authors.lastname: Raffaelli
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Illinois, USA. jiwez@illinois.edu.
authors.forename: Juliet
authors.initials: J
authors.lastname: Iwelunmor
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult