HIV infection risk among women in South Africa: exploring the interplay between financial autonomy, sexual autonomy and intimate partner violence

Abstract

Abstract Aim: To assess the inter-relationships between women’s sexual autonomy (SA), financial autonomy (FA) and experience of intimate partner violence (IPV), and how these factors influence HIV infection risk. Subject and Methods: This is a secondary analysis of the 2016 South-Africa Demographic and Health Survey. The study included all ever-partnered women aged 18-49 who were randomly selected for the domestic violence and HIV test modules. SA was measured from questions about women’s ability to refuse sex or request condom use. FA was measured from questions about women’s employment status, personal earnings, etc. IPV was measured from questions about women’s experience of emotional, physical and/or sexual violence. Bivariate analyses were used to assess the inter-relationships between SA, FA and IPV, and their individual relationships with HIV. Lastly, a multiple logistic regression model assessed their mutually adjusted associations with HIV infection risk. Results: There was no apparent relationship between sexual and financial autonomy, but they were weakly inversely associated with IPV. In the bivariate analyses, all three variables were associated with HIV risk. However, in the mutually adjusted model, only SA and IPV remained associated with HIV risk. Low SA (AOR = 2.01, 95% CI: 1.30 to 3.10, p=0.006) and exposure to sexual violence (AOR = 2.91, 95% CI: 1.14 to 7.43, p = 0.03) were associated with higher odds of HIV seropositivity. Conclusion: This study highlighted the important roles of SA and IPV on women’s HIV risk, as well as the need for further research to clarify the role of FA.