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NEGOTIATION FOR SAFER SEX AMONG MARRIED WOMEN IN CAMBODIA: THE ROLE OF WOMEN'S AUTONOMY

Published online by Cambridge University Press:  21 March 2013

MENGIENG UNG*
Affiliation:
Department of Geography, University of Western Ontario, London, Ontario, Canada
GODFRED O. BOATENG
Affiliation:
Department of Sociology, University of Western Ontario, London, Ontario, Canada
FREDERICK A. ARMAH
Affiliation:
Department of Geography, University of Western Ontario, London, Ontario, Canada
JONATHAN A. AMOYAW
Affiliation:
Department of Sociology, University of Western Ontario, London, Ontario, Canada
ISAAC LUGINAAH
Affiliation:
Department of Geography, University of Western Ontario, London, Ontario, Canada
VINCENT KUUIRE
Affiliation:
Department of Geography, University of Western Ontario, London, Ontario, Canada
*
1Corresponding author. Email: [email protected]

Summary

Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated.

Type
Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

Abadian, S. (1996) Women's autonomy and its implication on fertility. World Development 24(12), 17731809.CrossRefGoogle Scholar
Abebe, Y., Schaap, A., Mamo, G., Negussie, A., Darimo, B., Wolday, D. & Sanders, E. J. (2003) HIV prevalence in 72,000 urban and rural male army recruits, Ethiopia. AIDS 17, 18351840.CrossRefGoogle Scholar
Adimora, A. A. & Auerbach, J. D. (2010) Structural interventions for HIV prevention in the United States. Journal of Aquired Immuno Deficieny Syndromes 55 (Supplement 2), 132135.CrossRefGoogle ScholarPubMed
Al Riyami, A. A., Afifi, M. & Mabry, R. (2004) Women's autonomy, education and employment in Oman and their influence on contraceptive use. Reproductive Health Matters 12(23), 144154.CrossRefGoogle ScholarPubMed
Amaro, H. (1995) Love, sex, and power: considering women's realities in HIV prevention. American Psychologist 50, 437447.CrossRefGoogle ScholarPubMed
Amaro, H. & Raj, A. (2000) On the margin: power and women's HIV risk reduction strategies. Sex Roles 42(7/8), 723749.CrossRefGoogle Scholar
Auerbach, J. D. (2009) Transforming social structures and environments to help in HIV prevention. Journal of Health Affairs 28(6), 16551665.CrossRefGoogle ScholarPubMed
Auerbach, J. D., Cáceres, C. F. & Parkhurst, J. O. (2011) Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological consideration. Global Public Health 6 (Supplement 3), 293309.CrossRefGoogle Scholar
Bracher, M., Santow, G. & Watkins, S. C. (2003) ‘Moving’ and marrying: modelling HIV infection among newly-weds in Malawi. Demographic Research 1, 208244.Google Scholar
Clark, S. (2004) Early marriage and HIV risks in sub-Saharan Africa. Studies in Family Planning 35(3), 149160.CrossRefGoogle ScholarPubMed
Clark, S., Bruce, J. & Dude, A. (2006) Protecting young women from HIV/AIDS: the case against child and adolescent marriage. International Family Planning Perspectives 32, 7988.CrossRefGoogle ScholarPubMed
Cogneau, D. & Grimm, M. (2006) Socioeconomic status, sexual behaviour, and differential AIDS mortality: evidence from Cote d'Ivoire. Population Research and Policy Review 25, 393407.CrossRefGoogle Scholar
Cohen, S. A. (2004) Delayed marriage and abstinence until marriage on a collision course? The Guttmacher Report on Public Policy 7(2).Google Scholar
DHAPP (2010) Winning Battles in the War Against HIV/ADIS. US Department of Defense HIV/AIDS Prevention Program.Google Scholar
Dixon-Mueller, R. (1993) The sexuality connection in reproductive health. Studies in Family Planning 24(5), 269282.CrossRefGoogle ScholarPubMed
Dunkle, K. L., Stephenson, R., Karita, E., Chomba, E., Kayitenkore, K., Vwalika, C.et al. (2008) New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet 371, 21832191.CrossRefGoogle ScholarPubMed
Exner, T., Hoffman, S., Dworkin, S. & Ehrhardt, A. A. (2003) Beyond the male condom: the evolution of gender-specific HIV interventions for women. Annual Review of Sex Research 14, 114136.Google ScholarPubMed
Gray, R. T., Heymer, K. J., Hoare, A., Kwon, J. A., Thein, H. H., Lote, N.et al. (2009) What impact might the economic crisis have on HIV epidemics in Southeast Asia? Current HIV Research 7, 656665.CrossRefGoogle ScholarPubMed
Gupta, G. R. (2001) Gender, sexuality, and HIV/AIDS: the what, the why, and the how. SIECUS Report 29, 612.Google Scholar
Gyimah, S. O., Tenkorang, E. Y., Takyi, B. K., Adjei, J. & Fosu, G. (2010) Religion, HIV/AIDS and sexual risk-taking among men in Ghana. Journal of Biosocial Science 42, 531547.CrossRefGoogle ScholarPubMed
Hargreaves, J. R. & Glynn, J. R. (2002) Educational attainment and HIV-1 infection in developing countries: a systematic review. Tropical Medicine & International Health 7(6), 489498.CrossRefGoogle ScholarPubMed
Ickovics, J. R., Thayaparan, B. & Ethier, K. A. (2000) Women and AIDS: a contextual approach. In Baum, A., Revenson, T. & Singer, J. (eds) Handbook of Health Psychology. Lawrence Erlbaum, Hillside, NJ, pp. 821839.Google Scholar
Kabeer, N. (2005) Gender equality and women's empowerment: a critical analysis of the third millennium development goal. Gender & Development 13(1), 1324.CrossRefGoogle Scholar
Kippax, S., Crawford, J., Waldby, C. & Benton, P. (1990) Women negotiating heterosex: implications for AIDS prevention. Women's Studies International Forum 13(6), 533542.CrossRefGoogle Scholar
Kippax, S., Noble, J., Prestage, G., Crawford, J. M., Campbell, D., Baxter, D. & Cooper, D. (1997) Sexual negotiation in the ‘AIDS era’: negotiated safety revisited. AIDS 11(2), 191197.CrossRefGoogle ScholarPubMed
Kishor, S. (2000) Empowerment of women in Egypt and links to the survival of their infants. In Presser, H. & Sen, G. (eds) Women's Empowerment and Demographic Processes: Moving Beyond Cairo. Oxford University Press, New York.Google Scholar
Kritz, M. M., Makinwa-Adebusoye, P. & Gurak, D. T. (2000) The role of gender context in shaping reproductive behaviour in Nigeria. In Presser, H. & Sen, G. (eds) Women's Empowerment and Demographic Processes: Moving Beyond Cairo. Oxford University Press, New York.Google Scholar
Logan, T. K., Cole, J. & Leukefeld, C. (2002) Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin 128, 851885.CrossRefGoogle ScholarPubMed
McNair, L. D. & Prather, C. M. (2004) African American women and AIDS: factors influencing risk and reaction to HIV disease. Journal of Black Psychology 30, 106123.CrossRefGoogle Scholar
Marshall, G. N., Schell, T. L., Elliott, M. N., Berthold, S. M. & Chun, C. A. (2005) Mental health of Cambodian refugees 2 decades after resettlement in the United States. Journal of the American Medical Association 294, 571579.CrossRefGoogle ScholarPubMed
Michelo, C., Sandoy, I. & Fylkesnes, K. (2008) Antenatal clinic HIV data found to underestimate actual prevalence declines: evidence from Zambia. Tropical Medicine and International Health 13, 171179.CrossRefGoogle ScholarPubMed
Mollica, R. F., Donelan, K., Tor, S., Lavelle, J., Elias, C.Frankel, M. & Blendon, R. J. (1993) The effect of trauma and confinement on functional health and mental health status of Cambodia living in Thailand–Cambodia border camps. Journal of the American Medical Association 270, 581586.CrossRefGoogle ScholarPubMed
Myers, H. F. & Durvasula, R. S. (1999) Psychiatric disorders in African American men and women living with HIV/AIDS. Cultural Diversity and Ethnic Minority Psychology 5, 249262.CrossRefGoogle Scholar
National AIDS Authority (2010) A Situation and Response Analysis of HIV and AIDS in Cambodia. NNA, Phnom Penh, Cambodia.Google Scholar
National Institute of Statistics (2011) Cambodia Demographic and Health Survey 2010. National Institute of Statistics, Directorate General for Health, and ICF Macro, Phnom Penh, Cambodia and Calverton, MD, USA.Google Scholar
National Institute of Statistics (2004) Cambodia Inter-Censal Population Survey 2004. General Report. Phnom Penh, Cambodia.Google Scholar
Pulerwitz, J., Gortmaker, S. L. & DeJong, W. (2000) Measuring sexual relationship power in HIV/STD research. Sex Roles 42, 637660.CrossRefGoogle Scholar
Pulerwitz, J. & Dworkin, S. L. (2006) Give-and-take in safer sex negotiations: the fluidity of gender-based power relations. Sexuality Research and Social Policy Journal 3, 4051.CrossRefGoogle Scholar
Rojanapithayakorn, W. (2006) The 100% Condom Use Programme in Asia. Reproductive Health Matters 14(28), 4152.CrossRefGoogle ScholarPubMed
Sanders-Phillips, K. (2002) Factors influencing HIV/AIDS in women of colour. Public Health Reports 117, S151156.Google Scholar
Shannon, K., Kerr, T., Allinott, S., Chettiar, J., Shoveller, J. & Tyndall, M. W. (2008) Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Social Science & Medicine 66(4), 911921.CrossRefGoogle ScholarPubMed
Sopheab, H., Neal, J. J., Morineau, G., Saphonn, V. & Vun, M. C. (2006) Report on HIV Sentinel Surveillance in Cambodia, 2003. National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia. URL: www.nchads.orgGoogle Scholar
Sopheab, H., Saphonn, V., Chhea, C. & Fylkesnes, K. (2009) Distribution of HIV in Cambodia: findings from the first national population survey. AIDS 23, 13891395.CrossRefGoogle ScholarPubMed
Tenkorang, E. Y. (2012) Negotiating safer sex among married women in Ghana. Archives of Sexual Behaviour doi: 10.1007/s10508-012-9960-4CrossRefGoogle ScholarPubMed
Williams, S. P., Gardos, P. S., Ortiz-Torres, B., Tross, S. & Ehrhardt, A. A. (2001) Urban women's negotiation strategies for safer sex with their male partners. Women & Health 33, 133148.CrossRefGoogle ScholarPubMed
Wingood, G. M. & DiClemente, R. J. (2000) Application of the theory of gender and power to examine HIV related exposures, risk factors, and effective interventions for women. Health Education and Behaviour 27, 539565.CrossRefGoogle ScholarPubMed
Wyatt, G. E., Williams, J. K., Loeb, T., Carmona, J., Chin, D. & Presley, N. (2002) Does history of trauma contribute to HIV risk for women of colour? Implications for prevention and policy. American Journal of Public Health 92, 660665.CrossRefGoogle ScholarPubMed