Improved HIV Awareness and Perceived Empowerment to Negotiate Safe Sex among Married Women in Ethiopia between 2005 and 2011
Editor: Georgios Pollakis, University of Liverpool,
United Kingdom
Received: August
Improved HIV Awareness and Perceived Empowerment to Negotiate Safe Sex among Married Women in Ethiopia between 2005 and 2011
Zaake De Coninck * 0
Ibrahim A. Feyissa 1
Anna Mia Ekstr om 0 2
Gaetano Marrone 0 2
0 Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet , Stockholm , Sweden,
1 CDC/WHO Stop Transmission of Polio/STOP Consultant, Expanded Program of Immunization Unit, World Health Organization , Kenya,
2 Department of Infectious Diseases, Karolinska University Hospital , Stockholm , Sweden
Introduction: The HIV prevalence rate in Ethiopia for married (or cohabiting) women is 3 times that found amongst women who have never been married. While marriage used to be seen as a protective factor against HIV, evidence suggests that this is no longer necessarily the case. This study analyses the trend and sociodemographic determinants of HIV awareness and safe sex negotiation among married women in Ethiopia between 2005 and 2011. Methods: Data from Ethiopian Demographic and Health Surveys conducted in 2005 and in 2011 were analysed. Socio-demographic variables as well as 'survey year' were selected to assess their interaction with selected HIV awareness and safe sex negotiation indicators. Multivariable regression analyses were performed. Odds ratios and confidence intervals were computed. Results: A significant increase in knowledge of HIV and ability to negotiate safer sex occurred between 2005 and 2011 reflecting a positive trend in gender empowerment amongst married Ethiopian women. Some of these advancements were striking, for instance respondents were 3.6 times more likely to have ''Heard of AIDS'' in 2011 than in 2005. HIV awareness and safer sex negotiation were significantly associated with higher education, higher socioeconomic status, those who had heard of HIV, those of the Orthodox Christian faith, and (to some extent) those living in rural areas. Conclusion: HIV awareness has increased significantly in Ethiopia over the last decade but married women are still disproportionately susceptible to HIV.
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Community programmes, already effective in Ethiopia, also need to target this
vulnerable sub-group of women.
At least 1.3 million people are estimated to be living with HIV in Ethiopia, one of
Africas largest countries and home to almost 92 million inhabitants [1]. When
the rate of heterosexual transmission was last surveyed in 2005, it accounted for
87% of the cases [2], and as of 2011 the HIV prevalence rate among women was
almost twice (1.9%) that among men (0.9%) [3]. In addition, only 35% of
Ethiopian women compared to 56% of men understood two of the main ways to
prevent HIV transmission (by limiting sexual intercourse to one uninfected
partner and by using a condom consistently) [3]. Public health programmes have
thus targeted women in order to reduce the countrys HIV incidence and
prevalence rates.
A vast majority of these programmes focus on premarital relationships
specifically young and never-married individuals [3]. In 1998, the Ethiopian
National HIV/AIDS Policy was implemented for over a decade and it highlighted
youth as a high-risk group - along with commercial sex workers and their clients,
mobile groups (long distance truck drivers, military personnel), street children,
refugees, and prisoners [4]. Unlike young or pre-married demographics, older or
married women were not recognised as a vulnerable target group. Indeed, the
policy highlights the important role to be played by the Ministry of Education: to
ensure that appropriate curriculum and teaching materials shall be developed and
implemented for HIV/AIDS/STD in school health education at all levels and for
interventions to be developed and implemented for youth out-of-school in rural
and urban areas [4]. Ethiopias Strategic Plan for Intensifying Multisectoral HIV
and AIDS Response in Ethiopia II (2009-2014) also highlights never-married
sexually active females and youth as some of the most at-risk groups in Ethiopia
with regards to HIV. Married and older women are still not a targeted group [5].
These, both previous and current programmes ignore the fact that a significant
amount of HIV infection occurs within the context of marital relationships. While
marriage used to be seen as a protective factor against HIV, recent findings suggest
that this is no longer necessarily the case. Research conducted in Zambia and
Rwanda [6], and in Ghana and Kenya [7] concludes that married women are
more vulnerable to HIV than non-married women. In South Africa, a
populationbased study demonstrates that condom use increased amongst casual relationships
but not amongst regular partners or married couples [8]. In Indonesia, one study
highlights the fact that married women have, in general, less knowledge about
HIV transmission than married men and that this was significantly associated
with a lack in negotiating sex [9]. Separa (...truncated)