Marital status and HIV risk among women in the Dominican Republic: The role of gendered power indicators on condom use

Background: The role of marital status as a predictor of HIV risk is not conclusive. This study aims to examine the impact of gendered power indicators on condom use by marital status among women aged 15 to 49 years in the Dominican Republic [DR].

Methods: We analysed 2007 DHS cross-sectional data from 19818 women. Gendered power indicators included: rights (education, wealth, residence, occupation), responsibilities (household head, access to media, violence exposure), and expectations (sexual initiation, promiscuity, unfaithfulness, sexual submissiveness). Condom use was the main outcome. Nested logistic regressions were completed.

Results: Among never married women, being age 30 and older (p<0.001) and living in the countryside (OR=0.65; p<0.005) decreased the likelihood of condom use. Being in the richer quintile (OR=1.72) and having fair access to media (OR=1.62) increased such likelihood (p<0.001). Among currently married women, similar associations were found; however, women working on sales or living in a female-headed household were 53% and 71%, respectively, more likely to use a condom. Currently married women previously exposed to sexual violence were three times more likely to use a condom that non-exposed women (OR=3.46, p<0.001). Among former married women, the odds of condom use increased for few occupations (sales, domestic, clerical, or services), but decreased with age 40 or older (OR=0.54; p<0.001).

Conclusions: The impact of gendered indicators on condom use among women in the DR varies according to marital status. Strategies to reduce HIV risk should tailor marital status and age to better address specific women’s power issues to use condoms.