Contexts of gender: A multilevel study of women and HIV/STI risk behavior in the Dominican Republic and Haiti

Hispaniola is the area of the Americas hardest-hit by HIV/AIDS. In the island's two countries, Haiti and the Dominican Republic (DR), half of new infections are among women. Previous studies suggest that gender equity within women's intimate relationships and in society at large affect women's HIV risk. However, no study to date has examined these multiple levels of context and HIV risk in Haiti and the DR. Using recent data from the Demographic and Health Surveys (Haiti 2005 and DR 2002), this study examines how individual and community characteristics are associated with two outcomes: 1) women's HIV prevention knowledge, and 2) condom use at last sex. Descriptive results indicate similar levels of HIV knowledge (Haitian women: 83%; Dominican women: 86%), but differences in rates of condom use at last sex (11% versus 6%, respectively). Multivariate regression was used to assess the relationship between measures of gender equity at the individual level and knowledge and behavioral outcomes. Measures of equity, such as partner age differences and women's control of economic resources, were associated with HIV knowledge and condom use at last sex. Multilevel regression was used to additionally account for community-level characteristics such as percentage of female-headed households and mean educational achievement. Preliminary results indicate that mean education of women in the community is positively associated with HIV knowledge and condom use at last sex, over and above the effect of individual characteristics. These findings suggest that programs and policies to reduce HIV gender disparities must address multiple levels of women's risk.