Sexual Relationship Power Equity Is Associated With Consistent Condom Use and Fewer Experiences of Recent Violence Among Women Living With HIV in Canada. (15th August 2022)

• Record Type: Journal Article
• Authors: Closson, Kalysha; Lee, Melanie; Gibbs, Andrew; Nicholson, Valerie; Gormley, Rebecca; Parry, Rebeccah; Ding, Erin; Li, Jenny; Carter, Allison; Pick, Neora; Loutfy, Mona; de Pokomandy, Alexandra; Greene, Saara; Logie, Carmen H.; Kaida, Angela
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 90:Number 5(2022)
• Page Start: 482
• Page End: 493
• Publication Date: 2022-08-15
• Subjects: women -- Canada -- violence -- condom use -- sexual relationship power -- CHIWOS; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000003008
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured the prevalence and key outcomes of relationship control among WLWH in Canada. Methods: Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included the relationship control SRP subscale by Pulerwitz (2000). Scale scores were dichotomized into medium/low (score = 1–2.82) vs. high relationship control (score = 2.82–4), and high scores indicate greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use [consistent (ref), inconsistent, or never]; any sexual, physical, and/or emotional violence; and physical and/or sexual violence [never (ref), recent (≤3 months ago), and previous (>3 months ago)]. Results: Overall, 473 sexually active WLWH (33% of cohort), median age = 39 (IQR = 33–46) years, 81% on antiretroviral therapy, and 78% with viral loads <50 copies/mL were included. The subscale demonstrated good reliability (Cronbach's alpha = 0.92). WLWH with high relationship control (80%) were more likely ( P < 0.05) to be in a relationship, have no children, have greater resilience, and report less sociostructural inequities. In adjusted models, high relationship control was associated with lower odds of inconsistent vs. consistent condom use [adjusted odds ratio (aOR): 0.39 (95% confidence interval: 0.18 to 0.85)], any recent violence [aOR: 0.14 (0.04–0.47)] as well as recent physical and/or sexual [aOR : 0.05 (0.02–0.17)] but not previous violence (vs. never). Discussion: Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes.