Women’s Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa

Janke Tolmay,Louise Knight,Tara Polzer-Ngwato,Meghna Ranganathan,Lufuno Muvhango,Heidi Stöckl

doi:10.1007/s10461-021-03566-5

Abstract

In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women’s economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women’s household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and relationship status have a nuanced relationship with sexual risk behaviours. Thus, economic strengthening interventions should target relevant vulnerable women while also addressing the broader social and economic drivers of risky sexual behaviour.

Highlights

Sub-Saharan Africa bears a disproportionate burden of HIV/ AIDS; this region is home to 71% of all people living with HIV worldwide [1]
AIDS and Behavior sub-Saharan African countries have found that a significant number of new HIV infections [12] and most unprotected sexual acts between sero-discordant couples [13] occurred within marriage
To examine the lives of women enrolled in this scaled-up programme, we conducted a cohort study to interview participants right after completion of the ten-session curriculum, and 12 months later, whilst still enrolled in the microfinance programme. In this cross-sectional paper, we examine the association between income contribution to the household, relationship status, and engagement in risky sexual behaviours among adult women in rural South Africa a year after completing a gender training curriculum and receiving microfinance loans

Summary

Introduction

Sub-Saharan Africa bears a disproportionate burden of HIV/ AIDS; this region is home to 71% of all people living with HIV worldwide [1]. In sub-Saharan Africa, socio-demographic factors such as younger age, not being in stable or marital partnerships, female-headed households, and early age of first sex have shown to be drivers for risky sexual behaviours in women [11]. Divorced or formerly married women are frequently neglected in sexual risk behaviour research but remain at substantial risk, especially regarding multiple sexual partnerships [16]. These risks are often exacerbated by low relationship power and financial dependence, whether within a marital relationship or via casual sexual encounters in return for money or goods [5, 15, 17]. The exact pathways linking these factors remain unconfirmed, but studies have linked the experience of IPV and controlling partner behaviour with HIV infection through a complex interaction of bidirectional pathways, including through increased risky sex [10, 18,19,20]

Methods

Results

Conclusion