Abstract
ABSTRACTBackground:There is a growing body of evidence suggesting that women’s empowerment can help achieve better health behaviours and outcomes. However, few have looked at the impact of women’s empowerment on HIV testing in Sub-Saharan Africa (SSA). This study investigated the association between women’s empowerment and HIV testing among women in 33 countries across SSA.Methods:Cross-sectional data from the most recent Demographic and Health Surveys (2005-2018) of 33 countries in SSA were used. Confounder adjusted logistic regression analysis was completed separately for each of the 33 DHS datasets to produce the adjusted Odds Ratio (OR) for the association between women empowerment and HIV testing. The regression analysis strictly accounted for the three design elements (weight, cluster and strata) to produce an estimate representative of the respective countries. Finally, an Individual Participant Data (IPD) meta-analysis approach was used to statistically pool the effect of women empowerment on HIV testing.Results:There was a wide variation in the percentage of women who were empowered among the countries studied, with only a few countries such as South Africa, Angola and Ghana having a high prevalence of negative attitudes toward wife beating. HIV testing was higher in Angola, Lesotho, Uganda and South Africa. While participation in one or two of the three decisions had been marginally associated with lower odds of HIV testing across the SSA regions (0.89; 95%CI: 0.83, 0.97); the corresponding prediction interval crossed the null. Being involved in the three decisions (0.92; 95%CI: 0.84, 1.00) and disagreement to wife-beating (0.99; 95%CI: 0.94, 1.05) had no statistical relationship with HIV testing uptake.Conclusion and Global Health Implications:The two indirect indicators of women empowerment could not predict HIV testing uptake. Further studies are recommended to establish the nature of the relationship between HIV testing and women’s empowerment that is measured through standard tools.
Highlights
South Africa, Madagascar, Liberia, Lesotho, Angola, Namibia, Rwanda, Zimbabwe and Ethiopia had relatively higher percentage of women empowered in terms of participating in the three decision topics.The percentage of women who disagreed to all of the five wife-beating questions varied considerably from 0% in Chad to more than 94% in SouthAfrica.We showed huge between country disparity in terms of HIV testing, where the highest prevalence was in South Africa with nearly 76% and the lowest was in Senegal with nearly 32%
The study showed that women empowerment, as proxied by the two indicators,could not be a predictor of HIV testing uptake in the Sub-Saharan African region
Before concluding on the lack of predictive power of women empowerment on the uptake of testing for HIV in the region, further studies are required to produce concrete evidence on the issue
Summary
Sub-Saharan Africa (SSA) accounts for 12% of the global population, yet 71% of the global burden of HIV infection is found within the region.[6] 76% of the total people infected with HIV, 76% of the total new HIV infections, and 75% of the total HIV/AIDS related deaths recorded in 2015 occurred in SSA.[1,2] Young women bear a disproportionate burden of HIV infection. Few have looked at the impact of women’s empowerment on HIV testing in Sub-Saharan Africa (SSA).This study investigated the association between women’s empowerment and HIV testing among women in 33 countries across SSA
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