The effect of gender role norms, sexual norms and autonomy on couples’ HIV risk in North India

Alpna Agrawal, University of North Carolina at Chapel Hill
Shelah S. Bloom, University of North Carolina at Chapel Hill
Chirayath Suchindran, University of North Carolina at Chapel Hill

Background: India ranks third in the world in the number of HIV/AIDS cases; and gender-based power factors are believed to contribute significantly to disease spread. Few studies in India have examined this. Methods: The study uses population-based data from 2003 collected among 3,385 married couples living in North India. The outcomes examined were husbands' reported extramarital or paid sex and STI symptoms. Major predictors measured husbands’ gender role norms, sexual norms, and wives’ autonomy. Estimated models used structural equation modeling, controlling for socio-demographic effects. Results: Husbands reporting taboo sexual norms were more likely to report risky sex and STI symptoms (p<.001). Husbands with dominant gender-role attitudes were more likely to report risky sex (p<.001). Wives' autonomy was negatively associated with husbands' STI symptoms (p<.05). Conclusion: These findings demonstrate that gender-based power with respect to men’s norms and women's autonomy are potentially critical determinants of HIV risk in North India.