Abstract

BackgroundWomen in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection.PurposeTo examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women.MethodWomen (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV.ResultsCompared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex.ConclusionsFor women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues.

Highlights

  • South Africa has the largest number of people living with HIV/ AIDS with an estimated 5.6 million people [1]

  • Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex

  • For women in South Africa, fear of condom negotiation is related to higher risk of HIV

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Summary

Introduction

South Africa has the largest number of people living with HIV/ AIDS with an estimated 5.6 million people [1]. Women in South Africa are in a position of low status and power relative to men in economic, political, and social arenas This genderbased power imbalance has been shown to place women at an increased vulnerability to HIV infection, driven by the experience of gender-based violence [3,4]. Research has demonstrated how gender-based violence perpetrated by men against women can increase the latter’s vulnerability to HIV infection. This increase occurs as a result of factors like alcohol use and unprotected sex [5]. Women in South Africa are at high-risk for HIV infection and are dependent on their male partners’ use of condoms for sexual risk reduction. Purpose: To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women

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