Examining the role of shared decision-making and economic participation in condom use among young women in the Dominican Republic

Background: The rate of HIV/AIDS is increasing among young women in the Dominican Republic. Because young women report using condoms far less often than men, efforts to increase condom use are essential. Gender inequalities may shape the sexual behaviors of women as condom use is not directly under her control. We aimed to determine if shared decision-making and economic participation were associated with condom use among young women in the Dominican Republic. Methods: We utilized data from the 2007 Dominican Republic Demographic Health Survey. Our sample included 2,382 sexually active, non-pregnant, women ages 15-24 who were married or living with a partner. We generated weighted frequencies to describe sample characteristics and used logistic regression to determine if shared decision-making and economic participation were related to condom use at last sexual intercourse. Results: Fourteen percent of women reported using a condom at last intercourse. After controlling for socio-demographic characteristics, women who helped make all decisions were 1.64 times more likely to have used a condom than those who did not help make all decisions (p=0.028). Surprisingly, economic participation was negatively associated with condom use (OR=0.49, p=0.008) but this effect disappeared after simultaneously considering shared decision-making and economic participation. Conclusions: Although strategies to reduce sexual risk for women have recently focused on improving economic participation, this research suggests that these approaches may not directly reduce sexual risk. Relationship dynamics may be more important to address among young adults in the Dominican Republic and in other low-income countries. Potential mechanisms are discussed.