Exploring gender disparities in HIV risk in the Dominican Republic: Do gendered power indicators explain sexual behaviors?

Background: The main mode of HIV transmission in the Dominican Republic [DR] is heterosexual, and is mainly attributable to unprotected sex. This study explored gender differences in the association between gendered power indicators and condom use in the DR.

Methods: We analysed 2007 DHS cross-sectional data from 51638 adults aged 15 to 45 years. Gendered power indicators included: rights (education, wealth, residence), responsibilities (household head, access to media), and expectations (sexual initiation, promiscuity, unfaithfulness, sexual submissiveness). Condom use was the main outcome. Nested logistic regressions were completed.

Results: Women were less likely to use condoms than men (OR=0.22; p<0.001). When adding demographics into the model, condom used remained lower among women and being in an older than 30 years or currently married decreased the likelihood of condom use, regardless sex (p<0.001. When gendered rights were added to the model, education increased the odds of condom use for women with higher education (OR=1.38), but not for men. When gendered responsibilities were added, living in a female-headed household increased the likelihood of condom use for both men (OR=1.13) and women (OR=1.25) (p<0.001), but good access to media increased such likelihood for women, but not men. Within the complete model, which added gendered expectations, women who agreed with sexual submissiveness were less likely to use a condom (OR=0.66; p<0.001).

Conclusions: Our study found differences in the association between gendered power and condom used between men and women in the DR. Gendered-specific interventions are needed to promote HIV reduction within heterosexual relationships.