The effect of gender inequality on HIV risks among couples in North India

Background: India ranks third in the world in the number of HIV/AIDS cases. Gender-based power factors are believed to contribute significantly to disease spread in the country, where few studies have examined this. Purpose: This dissertation's overarching aim was to examine the impact of unequal gender relations on proximal, distant, and programmatic HIV risks among couples in North India. Methods: Population-based data from 2003 were collected among 3,385 married couples living in Uttar Pradesh and Uttaranchal, North India. Outcomes examined were sexual HIV risks, HIV/STI awareness, condom access, HIV stigma, and HIV facility testing awareness. Two major predictors were tested: men's expression of inequitable gender norms and women's autonomy. Estimated models used structural equation modeling controlling for socio-demographic effects. Results: Men expressing inequitable gender norms were more likely to report risky sexual behavior, STI symptoms, HIV stigma, and lack of HIV facility testing awareness (p<.05). Women with high levels of autonomy were less likely to have husbands who engaged in risky sex and reported STI symptoms (p<.05). Autonomous women were also more likely to be aware of HIV and other STIs and have access to condoms (p