Gender disparities in HIV risk in the Dominican Republic: How do gendered power indicators explain sexual behaviors and HIV-related attitudes?

Growing evidence in several professional fields supports that women’s vulnerability to HIV is not only the result of socioeconomic factors, but also the outcome of a cumulative history of cultural influences that have shaped mutually exclusive, specific roles for both men and women. In heterosexual relationships, social normalization of gender roles explains the limited power that women perceive on communicating about sexuality with their partners, demanding fidelity, seeking self-protection in sexual intimate encounters, or negotiating condom use; and this is regardless of their level of education. In the Dominican Republic (DR), the HIV infection has been feminized due to the ‘macho’ culture, which encourages men to be promiscuous and unfaithful, but discourages condom use. On the contrary, the culture encourages women to be faithful to their husbands, but discourage sexual communication. Consequently, Dominican women have limited access to means of protection and condom negotiation with their sexual partners. The mainly heterosexual nature of the HIV epidemic in the DR requires a deep understanding of the role of and the associations between social and cultural factors to define power imbalance and gender dynamics that result in women’s and perhaps men’s vulnerability to HIV. The purpose of the current study is to understand gender inequalities in HIV risk among adults 15 to 49 years old in the DR, and to understand women’s vulnerability to the infection. Two main aims have been proposed. First, the study aims to examine and contrast the impact of several gendered power indicators on sexual behaviors among men and women. Second, the study intents to examine and contrast the impact of gendered power indicators on sexual behaviors and HIV-related attitudes among currently married and formerly married women. Cross-sectional population data from the Demographic and Health Survey [DHS] collected in the DR in 2007 was analyzed. Participants for this study included 51,018 men and women aged 15 to 49 years old who completed their gender-specific interviews. Measurements included demographics, gendered power indicators, and HIV indicators. Gendered power indicators included three main categories: gendered rights (socioeconomic factors), gendered responsibilities (power dynamic factors), and gendered expectations (social norms and gender roles). Sexual behaviors included condom use and premarital sex. HIV-related attitudes included condom acquisition. Descriptive survey analysis and nested logistic regression models were completed. Our results for goal 1 indicated that women were less likely to use a condom than men (OR=0.30, p0.005). Among currently married women, however, the odds of condom acquisition increased with higher education, wealth, occupation, access to media, and acceptance of abstinence for both men and women (p