Abstract
BackgroundMany women living with HIV experience gendered power inequalities, particularly in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to make SRH decisions through a systematic review.Methods and findingsWe included peer-reviewed articles indexed in PubMed, PsycINFO, CINAHL, Embase, and Scopus published through January 3, 2017, presenting multi-arm or pre-post intervention evaluations measuring one of the following outcomes: (1) self-efficacy, empowerment, or measures of SRH decision-making ability, (2) SRH behaviors (e.g., condom use, contraceptive use), or (3) SRH outcomes (e.g., sexually transmitted infections [STIs]). Twenty-one studies evaluating 11 intervention approaches met the inclusion criteria. All were conducted in the United States or sub-Saharan Africa. Two high-quality randomized controlled trials (RCTs) showed significant decreases in incident gonorrhea and chlamydia. Sixteen studies measuring condom use generally found moderate increases associated with the intervention, including in higher-quality RCTs. Findings on contraceptive use, condom self-efficacy, and other empowerment measures (e.g., sexual communication, equitable relationship power) were mixed. Studies were limited by small sample sizes, high loss to follow-up, and high reported baseline condom use.ConclusionsWhile more research is needed, the limited existing evidence suggests that these interventions may help support the SRH and rights of women living with HIV. This review particularly highlights the importance of these interventions for preventing STIs, which present a significant health burden for women living with HIV that is rarely addressed holistically. Empowerment-based interventions should be considered as part of a comprehensive package of STI and other SRH services for women living with HIV.
Highlights
An increasing body of evidence demonstrates the ways unequal levels of power between men and women in intimate relationships prevent women, including women living with HIV, from making decisions regarding their sexual and reproductive health (SRH) [1,2,3,4,5]
While more research is needed, the limited existing evidence suggests that these interventions may help support the SRH and rights of women living with HIV
This review highlights the importance of these interventions for preventing STIs, which present a significant health burden for women living with HIV that is rarely addressed holistically
Summary
An increasing body of evidence demonstrates the ways unequal levels of power between men and women in intimate relationships prevent women, including women living with HIV, from making decisions regarding their sexual and reproductive health (SRH) [1,2,3,4,5]. Unequal control over and access to economic resources, unequal relationship power, and limited ability to make sexual decisions (including whether, when, how often, and with whom to have sex; and negotiating condom use, contraceptive or other protective practices) make women vulnerable to SRH risks [7,8]. Many women living with HIV experience gendered power inequalities, in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to make SRH decisions through a systematic review
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