Influence of gender norms, sexual norms, and women's autonomy on couples' HIV risk 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. Methods: The study uses population-based data from 2003 collected among 3,385 married couples living in North India. Outcomes examined were whether or not husbands reported extramarital or paid sex and reported STI symptoms. Three major predictors were tested: husbands' gender role norms; husband's sexual norms; and wives' autonomy, a scale widely used in the Demographic Health Surveys. Estimated models used structural equation modeling controlling for socio-demographic effects. Results: Husbands reporting sexual norms that are taboo in Indian society were more likely to engage in risky sex and report STI symptoms (p<.001). Husbands with dominant attitudes regarding women's roles were more likely to report risky sex (p<.01). Wives' autonomy was only associated with husbands' reported STI symptoms (p<.05). Conclusions: Men's attitudes, not only women's are important in evaluating the effect of gender inequity on HIV spread. The study findings demonstrate that men's gender role norms and sexual norms are important determinants of HIV risk in North India. Programs that screen and target men who ascribe to dominant gender role norms and taboo sexual norms may be successful in reducing HIV risk in the general population.