Inequitable Gender Attitudes Research Articles

Associations between exposures to occupation-related events, depression and intimate partner violence among women in the occupied Palestinian Territories

ABSTRACT War and conflict impact on women’s mental health and experiences of intimate partner violence (IPV), including in the occupied Palestinian Territories (oPT). Drawing on a cross-sectional population representative sample (n=534) collected in February 2017 in the oPT, we sought to (i) characterise the patterning of occupation-related events among women (18+) living in the oPT, (ii) to descriptively assess factors associated with this patterning, (iii) to assess the health impacts of occupation-related events by this patterning, specifically experience of IPV and poor mental health, and (iv) to assess the pathways through which occupation-related events are associated with IPV experience. Using Latent Class Analysis we identified three ‘classes’ of exposure to occupation-related events: 1 in 20 experienced multiple forms directed at themselves, their families and homes, 42.3% reported experiences against family members and their homes, and half reported relatively few direct experiences of occupation-related violence. Group membership was associated with increased past year IPV experience, and depressive symptoms. Using structural equation modelling we demonstrate that experiences of occupation-related events increased IPV experience via two mediated pathways; increased gender inequitable attitudes, and increased depressive symptoms and quarrelling with their husband. Preventing IPV requires addressing occupation-related events as well as transforming gender norms.

Examining determinants of gender attitudes: evidence among Tanzanian adolescents

BackgroundThe shaping of gender beliefs and attitudes in early adolescence affects the way young people internalize and self-enforce prevalent notions of masculinity and femininity, with lifelong consequences for sexual and reproductive health. This cross-sectional study examines determinants of gender attitudes among some of the poorest and most vulnerable adolescents in Tanzania using an ecological model.MethodsData come from baseline interviews with 2458 males and females aged 14–19 years conducted as part of a larger impact evaluation. Structural equation models are used to examine how factors at the community-, household-, and individual-levels influence gender attitudes in the four domains measured by the Gender Equitable Men (GEM) Scale (i.e. violence, sexual relationships, reproductive health and disease prevention, and domestic chores and daily life).ResultsA structural equation model of the four latent domains of the GEM scale regressed on individual, social-interactional and structural level characteristics indicated that secondary school attendance was associated with more equitable gender attitudes, while females held less equitable attitudes than males in the sample. Having had sexual intercourse was associated with more gender equitable attitudes among females, but the reverse was true among males.ConclusionsAddressing gender inequity requires understanding gender socialisation at the socio-interactional level. As females had more inequitable gender attitudes than males in the study, a special emphasis on highlighting the rights of women to girls should be considered. This study will inform future analysis of programme impacts on gender attitudes and sexual and reproductive health.

Harmful masculinities among younger men in three countries: Psychometric study of the Man Box Scale

In response to growing evidence of associations between harmful masculinities and adverse health outcomes, researchers developed the Man Box Scale to provide a standardized measure to assess these inequitable gender attitudes. In 2019, we evaluated the psychometric properties of the 17-item Man Box Scale and derived a 5-item short form. Using previously collected data (in 2016) from men aged 18–30 years across the United States (n = 1328), the United Kingdom (n = 1225), and Mexico (n = 1120), we conducted exploratory (EFA) and confirmatory factor analyses (CFA), assessed convergent validity by examining associations of the standardized mean Man Box Scale score with violence perpetration, depression, and suicidal ideation, and assessed internal consistency reliability of the full scale. We used item response theory (IRT) to derive a 5-item short form, and conducted CFA and additional assessments for reliability and convergent validity. We identified a single underlying factor with 15 items across all three countries. CFA resulted in good model fit. We demonstrated significant associations of standardized mean Man Box Scale score with violence perpetration (OR range = 1.57–5.49), depression (OR range = 1.19–1.73), and suicidal ideation (OR range = 1.56–2.59). IRT resulted in a 5-item short form with good fit through CFA and convergent validity, and good internal consistency. The Man Box Scale assesses harmful masculinities and demonstrates strong validity and reliability across three diverse countries. This scale, either short or long forms, can be used in future prevention research, clinical assessment and decision-making, and intervention evaluations.

"I got courage from knowing that even a daughter-in-law can earn her living": Mixed methods evaluation of a family-centred intervention to prevent violence against women and girls in Nepal.

We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs). We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends. The intervention positively impacted young married women's economic conditions, exposure to violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, β = 0.11, p-value<0.001) and savings (29.0% - 80.2%, β = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, β = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, β = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, β = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, β = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, β = -007, p-value<0.001). These changes were supported by qualitative findings. Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to violence in this community. It warrants further research to optimise its impact.

Patriarchy and gender-inequitable attitudes as drivers of intimate partner violence against women in the central region of Ghana

BackgroundIn order to reduce women’s exposure to violence and develop culturally appropriate interventions, it is important to gain an understanding of how men who use violence rationalize it. The present study sought to explore the perspectives of men who had used violence on their female partners, specifically their views on intimate partner violence (IPV), gender norms, manhood, their gender attitudes and to understand how these may drive male perpetrated IPV against women in the Central Region of Ghana.MethodsThis was a qualitative study involving purposively sampled adult men who had participated in a household-based survey in selected districts in the Central Region of Ghana and who had self-reported perpetration of IPV in the past 12 months. In-depth interviews were conducted with 17 men.ResultsData revealed how a range of social, cultural, and religious factors ̶ stemming from patriarchy ̶ combined to inform the construction of a traditional masculinity. These factors included the notion that decision-making in the home is a man’s prerogative, there should be rigid and distinct gender roles, men’s perceptions of owning female partners and having the right to have sex with them whenever they desire, and the notion that wife beating is legitimate discipline. Findings suggest that it was through performing, or aspiring to achieve, this form of masculinity that men used varying forms of violence against their female partners. Moreover, data show that the men’s use of violence was a tactic for controlling women and emphasizing their authority and power over them.ConclusionsDevelopers of interventions to prevent IPV need to recognize that there is a coherent configuration of aspirations, social norms and behaviours that is drawn on by some men to justify their use of IPV. Understanding the perspectives of men who have perpetrated IPV against women and their motivations for perpetration is essential for interventions to prevent IPV. This is discussed as drawing authority from ‘tradition’ and so engaging traditional and religious leaders, as well as men and women throughout the community, in activities to challenge this is likely to be particularly fruitful.

Engaging men to transform inequitable gender attitudes and prevent intimate partner violence: a cluster randomised controlled trial in North and South Kivu, Democratic Republic of Congo

IntroductionThe study objective was to understand the effectiveness of Engaging Men through Accountable Practice (EMAP), a group-based discussion series which sought to transform gender relations in communities, on intimate partner...

The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan

IntroductionWe assessed whether the Women for Women International (WfWI) economic and social empowerment programme could reduce women’s experiences of intimate partner violence (IPV) and depression in Afghanistan.MethodsWe conducted a two-arm...

Factors associated with IPV victimisation of women and perpetration by men in migrant communities of Nepal.

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women’s IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women’s lifetime IPV risk while mother-in-law cruelty and male control increased older married women’s lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women’s increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women’s increased IPV risk and hunger, mother-in-law cruelty and depression with older women’s IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women’s position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities.

The contribution of mental health and gender attitudes to intimate partner violence in the context of war and displacement: Evidence from a multi-informant couple survey in Iraq

RationaleIntimate partner violence is a prevalent issue in refugee and internally displaced populations in post-war and migration settings including camps in the Middle East. In this context, partner violence has been associated with war-related trauma, camp factors, individual characteristics, and gender attitudes. ObjectiveWith a dual-informant survey among a sample of Iraqi couples residing in a camp for displaced people in the Kurdistan Region of Iraq (N = 92) this study investigated the relationship between war-related psychopathology, attitudes towards women, and male-perpetrated partner violence. MethodModerated regression analysis was applied using information from both partners to predict partner violence reported by wives. ResultsOver 58% of the women in this sample reported past-year exposure to partner violence. Further analyses revealed significant main effects of men's self-reported psychopathology (posttraumatic stress disorder and depression) and their own gender attitudes on partner violence. In a multivariate regression, moderating effects were found, as higher psychopathology levels and inequitable gender attitudes in men interacted in the prediction of male-perpetrated partner violence. ConclusionsThis study highlights the high prevalence of partner violence among Iraqi displaced women. In addition, the results show an interplay of several violence-impelling factors in war-affected men. This emphasizes the importance of addressing both mental health issues and gender attitudes in the efforts to reduce or end violence against women in post-war settings.

Associations Between Lifetime Traumatic Experiences and HIV-Risk Behaviors Among Young Men Living in Informal Settlements in South Africa: A Cross-Sectional Analysis and Structural Equation Model.

Qualitative research emphasizes men's experiences of trauma increase HIV risk. We seek to understand associations between experience of traumatic events and HIV-risk behaviors among heterosexual men in 2 trials in urban informal settlements in South Africa. Cross-sectional surveys among men in Johannesburg and Durban, South Africa, enrolled in intervention trials. Adjusted logistic regression and structural equation modeling assessed associations between men's experiences of poverty and traumatic events, and HIV-risk behaviors (inconsistent condom use, transactional sex, and number of sex partners). We explored mediated pathways from trauma to HIV risk through mental health and alcohol, and gender attitudes. Among 2394 men, in adjusted logistic regression, transactional sex and 4 or more sex partners were associated with witnessing the murder of a family member, witnessing a murder of a stranger, experiencing excessive pain, been kidnapped, and witnessing a rape. More consistent condom use was associated with witnessing the murder of a family member, being kidnapped, and witnessing a rape. In 3 separate structural equation modeling pathways were consistent, trauma directly increased transactional sex, and past year sexual partners, and increased consistent condom use. Risk was increased through mental health pathways, and gender inequitable attitudes and practices. Men's HIV-risk behaviors in this population emerge at the confluence of poverty, traumatic experiences, and gender inequalities. Effective HIV-prevention interventions needs to reduce men's experiences of poverty and trauma, transform gender norms, and reduce the mental health impact of trauma.

Updates on adolescent dating and sexual violence prevention and intervention.

Dating and sexual violence victimization are not uncommon in early adolescence and increase in prevalence throughout adolescence into young adulthood with profound health and social consequences. Greater attention to what works in prevention is needed to inform current policies and practices. Adolescent dating violence (ADV) and sexual violence victimization, including cyber dating abuse, are highly prevalent among adolescents. Studies have found sex category differences, with adolescent girls reporting more victimization than boys, particularly sexual violence. Sexual and gender minority youth also experience a higher prevalence of violence victimization than their heterosexual counterparts. Studies on risk factors include examinations of childhood adversities, exposure to sexually explicit material and substance use as well as the role of gender inequitable attitudes on violence perpetration. Recent prevention research includes examining the impact of bystander interventions and transforming gender norms. Recent ADV/ sexual violence research highlights both prevalence and modifiable risk and protective factors that may help reduce such violence. Practitioners caring for youth should consider ADV/ sexual violence when seeing patients (including those struggling with substance use and other behaviours that contribute to poor health) and not simply rely on screening tools to identify those suffering from ADV/ sexual violence.

Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial

BackgroundEvidence-based interventions are essential in the prevention of violence against women (VAW). An understanding of risk factors for male perpetration of VAW using population-based research is crucial for developing such interventions. This study is a baseline assessment of a two-arm unmatched cluster randomised controlled trial (C-RCT), set up to assess the impact of a Rural Response System (RRS) intervention for preventing violence against women and girls in Ghana. This study aims at assessing past year prevalence and risk factors for sexual or physical intimate partner violence (IPV) perpetration among men.MethodsThe population-based survey involved 2126 men aged 18 and above living in selected communities in 4 districts in the central region of Ghana. Logistic regression techniques were used to determine risk factors for sexual or physical IPV perpetration. All models adjusted for age of respondent and took into account the study design.ResultsHalf of the men had perpetrated at least one form of violence against their intimate partners in their lifetime while 41% had perpetrated sexual or physical IPV. Majority (93%) of the men had been in relationships in the 12 months preceding the survey, and of these, 23% had perpetrated sexual or physical IPV. Childhood factors associated with sexual or physical IPV included witnessing abuse of mother (aOR:1.40(1.06–1.86)), and neglect (aOR:1.81(1.30–2.50)). Other major risk factors for IPV perpetration were: having multiple partners (aOR:1.76(1.36–2.26)), (involvement in transactional sex (aOR:1.76(1.36–2.26)), substance use (aOR:1.74(1.25–2.43)) and gender inequitable attitudes (aOR:0.94(0.91–0.97)).ConclusionChildhood violence experience and witnessing, risky behaviour (multiple partners, transactional sex, substance use) and gender inequitable attitudes are major risk factors for sexual or physical IPV perpetration. Perpetration of sexual or physical IPV tend to co-occur with non-partner violence and emotional IPV perpetration. Interventions targeting these factors are critical in reducing IPV.

Learning from our mothers: examining the role of intergenerational knowledge transfer in advancing gender equity among Sri Lankan youth

Abstract Background In a 2013 survey, over half of Sri Lankan men and women expressed gender-inequitable attitudes that equated masculinity with violence, and femininity with obedience to men. High rates of gender-inequitable attitudes are a community-level risk factor for gender-based violence including rape and intimate partner violence. In Sri Lanka, public health practitioners focused on reducing the health disparities resulting from gender inequity need to better understand the processes by which gender-inequitable attitudes develop and how to prevent them. The goal of this research was to identify potential points of intervention at which appropriate programmes and policies could most effectively cultivate gender-equitable attitudes among young people in Sri Lanka. Methods Over 9 months in 2016 and 2017, we interviewed more than 30 young adults in Sri Lanka to understand how their experiences helped them to develop their own gender identity, as well as to understand and respond to gender norms. Their responses were analysed using a grounded theory approach to explore which factors have most influenced the processes of gender norm learning, acceptance, or rejection throughout Sri Lankan young adults' lives. Findings Many interviews focused on the impact of elder family members on the interviewee's perception and acceptance of gender norms. Many young adults who did not agree with gender-inequitable norms reported receiving advice from their parents or other elder relatives to disregard norms and pursue their own non-conforming interests. In one example, many non-working mothers insisted on their daughters working and becoming financially independent. Interpretation Young people in Sri Lanka are repeatedly confronted by gender-inequitable attitudes in school, the media, politics, and society at large. However, family members can support youth to develop gender equitable attitudes and behaviours within this gender-inequitable society. Harnessing elders' positive wishes for their offspring's future may prove essential to advancing gender equity in the next generation of Sri Lankan adults. Even from gender-inequitable roles, parents may still support gender equity, and could be encouraged through public health interventions to support their children in realising their full potential. Elder family members are an untapped public health resource for advancing gender equity and reducing its related health disparities among Sri Lankan youth. Funding 2016 Fulbright US Student Grant.

Childhood Trauma, Gender Inequitable Attitudes, Alcohol Use and Multiple Sexual Partners: Correlates of Intimate Partner Violence in Northern Tanzania.

Intimate partner violence (IPV), including physical, sexual, emotional, and economic violence, has profound immediate and long-term effects on individuals and communities worldwide. To date, few studies have focused on couples' reporting of IPV. The aim of this article is to present the results of a survey of couples' reporting of IPV and the individual, interpersonal, and social correlates of IPV in northern Tanzania. Four hundred fifty couples from Karatu District, Tanzania, completed a questionnaire measuring attitudes on gender norms and relations, men's experience of childhood trauma, and men's perpetration and women's experience of IPV. We found high levels of acceptance and experience of IPV: 72% of men justified a husband's perpetration of IPV, and 54% of men and 76% of women said that a woman should tolerate violence to keep her family together. The majority of women had ever experienced IPV (77.8%), and 73.6% and 69% had experienced IPV in the past 12 and 3 months, respectively. Men were significantly less likely to report that they had committed IPV: 63.6% ever, 48.9% in the past 12 months, and 46.2% in the past 3 months. Multivariate logistic regression found that younger men, men who reported gender inequitable attitudes, childhood trauma, multiple sexual partners, and alcohol use were significantly more likely to report IPV perpetration in the past 3 months. Younger women, and women with low levels of education and reported food shortages were significantly more likely to report IPV in the past 3 months. These results indicate that social and individual acceptance and justification of IPV are common. Experience of violence persists over time in many relationships. This study demonstrates the need for interventions that address individual-, interpersonal-, and community-level determinants of IPV, including attitudes regarding gender equity, exposure to violence as children and intergenerational violence, lack of education, and poverty.

Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review.

BackgroundEarly adolescence (ages 10–14) is a period of increased expectations for boys and girls to adhere to socially constructed and often stereotypical norms that perpetuate gender inequalities. The endorsement of such gender norms is closely linked to poor adolescent sexual and reproductive and other health-related outcomes yet little is known about the factors that influence young adolescents’ personal gender attitudes.ObjectivesTo explore factors that shape gender attitudes in early adolescence across different cultural settings globally.MethodsA mixed-methods systematic review was conducted of the peer-reviewed literature in 12 databases from 1984–2014. Four reviewers screened the titles and abstracts of articles and reviewed full text articles in duplicate. Data extraction and quality assessments were conducted using standardized templates by study design. Thematic analysis was used to synthesize quantitative and qualitative data organized by the social-ecological framework (individual, interpersonal and community/societal-level factors influencing gender attitudes).ResultsEighty-two studies (46 quantitative, 31 qualitative, 5 mixed-methods) spanning 29 countries were included. Ninety percent of studies were from North America or Western Europe. The review findings indicate that young adolescents, across cultural settings, commonly express stereotypical or inequitable gender attitudes, and such attitudes appear to vary by individual sociodemographic characteristics (sex, race/ethnicity and immigration, social class, and age). Findings highlight that interpersonal influences (family and peers) are central influences on young adolescents’ construction of gender attitudes, and these gender socialization processes differ for boys and girls. The role of community factors (e.g. media) is less clear though there is some evidence that schools may reinforce stereotypical gender attitudes among young adolescents.ConclusionsThe findings from this review suggest that young adolescents in different cultural settings commonly endorse norms that perpetuate gender inequalities, and that parents and peers are especially central in shaping such attitudes. Programs to promote equitable gender attitudes thus need to move beyond a focus on individuals to target their interpersonal relationships and wider social environments. Such programs need to start early and be tailored to the unique needs of sub-populations of boys and girls. Longitudinal studies, particularly from low-and middle-income countries, are needed to better understand how gender attitudes unfold in adolescence and to identify the key points for intervention.

Correlates of postpartum common mental disorders: results from a population-based study in Amhara region, Ethiopia.

Postpartum common mental disorders are prevalent among women in Ethiopia. Data on associated factors are limited. This population-based study assessed mental health among 1294 nonpregnant, postpartum women in Amhara region. Poor health of the last delivered child and inequitable gender attitudes were associated with poor mental health among other factors. Social support from female friends was strongly protective. Community mental health services could strengthen social support between female friends with education and support group facilitation by health extension workers.

Prevalence and risk factors for intimate partner violence among Grade 8 learners in urban South Africa: baseline analysis from the Skhokho Supporting Success cluster randomised controlled trial.

Intimate partner violence (IPV) is a serious public health problem among adolescents. This study investigated the prevalence of and factors associated with Grade 8 girls' experience and boys' perpetration of IPV in South Africa. Participants were interviewed using interviewer-administered questionnaires about IPV, childhood violence, bullying, gender attitudes, alcohol use and risky sexual behaviours. Multiple logistic regression analysis was conducted to assess factors associated with girls' experience and boys' perpetration of IPV. Structural equation modelling (SEM) was conducted to assess the pathways to IPV experience and perpetration. Results show dating relationships are common among girls (52.5%) and boys (70.7%) and high prevalence of sexual or physical IPV experience by girls (30.9%; 95% CI: 28.2-33.7) and perpetration by boys (39.5%; 95% CI: 36.6-42.3). The logistic regression model showed factors associated with girls' experience of IPV include childhood experience of violence, individual gender inequitable attitudes, corporal punishment at home and in school, alcohol use, wider communication with one's partner and being more negative about school. We found three pathways from childhood trauma to IPV experience and perpetration in both models and these are through inequitable gender attitudes and risky sex, bullying and alcohol use. Prevention of IPV in children needs to encompass prevention of exposure to trauma in childhood and addressing gender attitudes and social norms to encourage positive disciplining approaches. : The trial is registered on ClinicalTrials.gov as NCT02349321.

Risk factors for men's lifetime perpetration of physical violence against intimate partners: results from the international men and gender equality survey (IMAGES) in eight countries.

This paper examines men’s lifetime physical intimate partner violence (IPV) perpetration across eight low- and middle-income countries to better understand key risk factors that interventions can target in order to promote gender equality and reduce IPV. We use data from men (n = 7806) that were collected as part of the International Men and Gender Equality Survey (IMAGES) in Bosnia and Herzegovina, Brazil, Chile, Croatia, Democratic Republic of Congo (DRC), India, Mexico, and Rwanda. Results show that there is wide variation across countries for lifetime self-reported physical violence perpetration (range: 17% in Mexico to 45% in DRC), men’s support for equal roles for men and women, and acceptability of violence against women. Across the sample, 31% of men report having perpetrated physical violence against a partner in their lifetime. In multivariate analyses examining risk factors for men ever perpetrating physical violence against a partner, witnessing parental violence was the strongest risk factor, reinforcing previous research suggesting the inter-generational transmission of violence. Additionally, having been involved in fights not specifically with an intimate partner, permissive attitudes towards violence against women, having inequitable gender attitudes, and older age were associated with a higher likelihood of ever perpetrating physical IPV. In separate analyses for each country, we found different patterns of risk factors in countries with high perpetration compared to countries with low perpetration. Findings are interpreted to identify key knowledge gaps and directions for future research, public policies, evaluation, and programming.

Gender-based power and couples' HIV risk in Uttar Pradesh and Uttarakhand, north India.

Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic. Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures. Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year. If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India.

Differences in Adolescent Relationship Abuse Perpetration and Gender-Inequitable Attitudes by Sport Among Male High School Athletes

School-based athletic programs remain an important context for violence prevention efforts although a better understanding of how gender attitudes and abuse perpetration differ among athletes is needed. We analyzed baseline survey data from the "Coaching Boys into Men" study-a school-based cluster-randomized trial in 16 high schools in Northern California. We describe relationships among gender-inequitable attitudes, sport type, and recent adolescent relationship abuse perpetration among a sample of male athletes (n = 1,648). Gender-inequitable attitudes (adjusted odds ratio (AOR), 3.26; 95% confidence interval (CI), 2.56, 4.15), participation in both high school football and basketball (AOR, 2.08; 95% CI, 1.37, 3.18), and participation in football only (AOR, 1.50; 95% CI, 1.02, 2.22) emerged as independently associated with recent ARA perpetration. Findings warrant targeted violence prevention efforts among male high school athletes that incorporate discussions of gender attitudes and healthy relationships, especially among sports teams at greater risk of adolescent relationship abuse perpetration.