HIV knowledge and behaviors among women in the Dominican Republic and Haiti: A multilevel study of the importance of individual, relationship, and community characteristics.

摘要

The Dominican Republic and Haiti are home to three-quarters of the estimated 230,000 people living with HIV in the Caribbean. High HIV prevalence and an increasing burden of HIV infection among women in these countries highlight the need to understand factors affecting women's HIV knowledge and related behaviors. Research in other developing countries indicates that in addition to physiological factors related to biological sex, gender , the socially-constructed roles and expectations ascribed to men and women, affects women's risk for HIV. Gender works at multiple levels, from the individual woman to the broader social context, to structure women's opportunities, experiences, and choices. No known quantitative study to date has examined these multiple levels of context for women and HIV in the Dominican Republic and Haiti.;This dissertation utilized nationally representative data from the 2002 and 2005 Demographic and Health Surveys to examine how individual, relationship, and community characteristics are associated with HIV prevention knowledge, health services use, and condom use. The dissertation used data from a sample of sexually active women of reproductive age in each country, as well as information on the communities in which these women live (DR: N=16,986 women in 1,278 communities; Haiti: N=7,255 women in 339 communities). Multiple logistic regression models, estimated separately for each outcome, assessed the individual and relationship characteristics associated with women's knowledge and behaviors. In addition, multilevel modeling techniques were employed, capitalizing on the nested data structure to evaluate the association of key community characteristics with women's HIV-related outcomes.;Individual-level results indicate women's HIV knowledge, health services use, and condom use vary by relationship type, age, and socioeconomic status in both countries. Characteristics of women's partners, such as educational attainment and educational and age homogamy, are significantly associated with the outcomes in both countries. Multilevel results indicate community social, economic, and attitudinal characteristics are associated with women's HIV-related outcomes; however, which community characteristics matter varies by outcome and by country. Results highlight the role of social context for women and HIV, uncovering new areas for future research into HIV knowledge and behaviors among women.