HIV testing and tolerance to gender based violence: a cross-sectional study in Zambia.

Sara Gari,Jacob R S Malungo,Christian Schindler,Adriane Martin-Hilber,Maurice Musheke,Sonja Merten,Sten H Vermund

doi:10.1371/journal.pone.0071922

Sara Gari, Jacob R S Malungo + Show 5 more

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https://doi.org/10.1371/journal.pone.0071922

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Abstract

This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR = 2.48 95% CI = 1.00–6.19); tolerance to gender-based violence (OR = 2.10 95% CI = 1.05–4.32) and fear of social rejection (OR = 1.48 95% CI = 1.23–1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families.

Highlights

Gender inequity is intimately linked to HIV/AIDS
There is evidence showing that gender-power inequity in relationships and gender-based violence (GBV) increases vulnerability to HIV infection [1,2,3,4]
A team of 30 experienced Zambian surveyors, who were trained in survey techniques and sexual and reproductive health (SRH) issues, conducted the interviews in the respondents’ mother tongue

Summary

Introduction

Gender inequity is intimately linked to HIV/AIDS. Without addressing gender inequity AIDS will remain a substantial problem. There is evidence showing that gender-power inequity in relationships and gender-based violence (GBV) increases vulnerability to HIV infection [1,2,3,4]. In Zambia, the HIV prevalence among young women aged 15–24 is more than twice that of men in the same age category [5,6]. A number of factors resulting from gender inequity contribute to this higher prevalence. In Zambia, women have practically no ability to refuse sex or to demand the use of condom, a demonstration of their limited agency in sexual relationships. Age-mixing sexual patterns between young girls and older men play an important role on their greater susceptibility to HIV. Age-mixing sexual patterns between young girls and older men play an important role on their greater susceptibility to HIV. [7,8]

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