title: Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions.
abstract: BACKGROUND
  Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS.
  
  
  METHODS
  This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict).
  
  
  RESULTS
  For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict.
  
  
  CONCLUSIONS
  Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men's perspectives into account to ensure positive relationship outcomes.
authors: Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Amy.Conroy@ucsf.edu.
authors: Amy A
authors: AA
authors: Conroy
authors: Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 805, South Academic Block, Level C Room AC23, Tremona Road, Southampton SO16 6YD, UK; Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa. Electronic address: n.mcgrath@soton.ac.uk.
authors: Nuala
authors: N
authors: McGrath
authors: Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: hvanrooyen@hsrc.ac.za.
authors: Heidi
authors: H
authors: van Rooyen
authors: Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa; Division of Social Statistics and Demography, University of Southampton, Southampton SO17 1BJ, UK. Electronic address: v.hosegood@soton.ac.uk.
authors: Victoria
authors: V
authors: Hosegood
authors: Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Mallory.Johnson@ucsf.edu.
authors: Mallory O
authors: MO
authors: Johnson
authors: Global Health, International Center for Research on Women, 1120 20th Street NW, Suite 500 North, Washington, D.C., USA. Electronic address: kfritz@icrw.org.
authors: Katherine
authors: K
authors: Fritz
authors: Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Alexander.Marr@ucsf.edu.
authors: Alexander
authors: A
authors: Marr
authors: Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: tngubane@hsrc.ac.za.
authors: Thulani
authors: T
authors: Ngubane
authors: Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Lynae.Darbes@ucsf.edu.
authors: Lynae A
authors: LA
authors: Darbes
mesh_terms: D000328:Adult; D003142:Communication; D003220:Conflict, Psychological; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011209:Power, Psychological; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology; D012747:Sexual Partners / Q000523:psychology*; D013019:South Africa; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology; D055815:Young Adult
keywords: Couples; Gender; HIV/AIDS; Power; Relationship quality; South Africa