The Association of Women’s Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan Africa

• Published in: Journal of Epidemiology and Global Health 2023-12, Vol.13 (4), p.816-824
• Main Authors: Schierl Theresa, Tanaka, Luana Fiengo, Klug, Stefanie J, Winkler, Andrea Sylvia, Stelzle Dominik
• Format: Article
• Language: English
• Subjects: Condoms; Demographic and Health Surveys; Demography; Empowerment; Health surveys; HIV; HIV testing; Human immunodeficiency virus; Medical tests; Sex; Sexual behavior; Sexually transmitted diseases; STD; Sub-Saharan Africa, sexual health, reproductive health; Surveys; Women’s empowerment
• ISSN: 2210-6006; 2210-6014
• DOI: 10.1007/s44197-023-00153-w

BackgroundWomen’s empowerment is an important factor for HIV prevention, but the association with HIV-related indicators has never been quantified. In this study, we examined the association between women’s empowerment and selected HIV-related indicators.MethodsWe used the latest Demographic and Health Surveys that included HIV testing among other biomarkers of 31 countries in sub-Saharan Africa. Empowerment was measured by the Survey-based Women’s EmPowERment (SWPER) index and was compared to the HIV-related indicators: HIV status, HIV testing (ever and in the past 12 months), condom use at last high-risk sex, the ability to ask the partner to use a condom, and the ability to refuse sex.Results208,947 women were included in the analysis, of whom 100,924 (48%) were considered highly empowered and 21,933 (10%) as lowly empowered. There was no association between empowerment and HIV status (OR = 1.12, 95% confidence interval [CI] 0.98–1.28). Highly empowered women were more likely to have ever been tested for HIV (OR = 1.67, 95% CI 1.60–1.74) but less likely to have been tested for HIV in the past 12 months (OR = 0.92, 95%CI 0.88–0.96). Highly empowered women were more commonly able to ask the partner to use a condom (OR = 1.69, 95% CI 1.63–1.75) and to refuse sex (OR = 1.78, 95%CI 1.72–1.85).ConclusionsWomen’s empowerment does not seem to be linked to HIV status, but it is strongly associated with a woman’s ability to make decisions about their sexual behavior. Empowering women and young girls has the potential to contribute toward achieving the United Nations’ goal of ending AIDS by 2030.