Abstract
BackgroundGendered 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).MethodsWe 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.ResultsStudy 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.ConclusionsStudy 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2432-8) contains supplementary material, which is available to authorized users.
Highlights
Gendered dynamics in heterosexual relationships compromise women’s self-efficacy and increase their vulnerability to acquiring HIV
The Dominican Republic (DR) has the second highest number of adults living with HIV in the Caribbean [1,2,3]
Data and selection of participants We used cross-sectional population data from the Demographics and Health Survey (DHS) that was collected in the DR in 2007 through face-to-face interviews implemented by the Center of Demographic Studies (CESDEM) [28]
Summary
Gendered dynamics in heterosexual relationships compromise women’s self-efficacy and increase their vulnerability to acquiring HIV. DR is rated among the countries with the largest gender disparity in higher risk sex [6] These differences in sexual behaviors are embedded in a cultural context in which many women in unions in DR are unaware of their male partners’ encounters. As a result, they do not take the necessary steps, such as negotiating condom use, to protect themselves from STDs and HIV [7]. They do not take the necessary steps, such as negotiating condom use, to protect themselves from STDs and HIV [7] These gender differences in sexual behaviors are problematic in a context in which HIV transmission is primarily heterosexual and mainly attributable to unprotected sex [1, 7, 8]
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