Relationship Power and HIV Testing Behavior in Malawi

描述（由申请人提供）：在整个撒哈拉以南非洲，包括马拉维，基于性别的权力不平衡继续使个人面临更大的艾滋病毒/艾滋病风险。研究表明，性关系中的权力与健康有几种联系，其中之一是通过其对使用保健服务的影响。自愿艾滋病毒咨询和检测（VCT），在马拉维越来越重要的预防服务，一直没有充分的研究关系权力方面。尽管广泛获得VCT，但检测的吸收率很低，对于那些接受VCT的人来说，性行为的改变充其量仍然是适度的。我假设关系权力是可以解释夫妻之间艾滋病毒检测行为的缺失信息之一。性别与权力理论认为，经济上的不平等、一方对另一方的控制以及与性别和性行为有关的社会规范可以解释男性和女性的行为。我将使用TGP生成关于功效和HIV检测之间相互作用的假设。该项目有三个具体目标，重点是第三个目标。第一个目标是利用已婚和正在约会的男女的重点群体进行一项形成性研究，以了解马拉维夫妇中具有文化根源的权力层面。第二个目的是探讨适当的定量措施的四个理论化的结构性关系的权力马拉维的情况下：依赖，爱和信任的感觉，有效的合作伙伴的沟通，和经验的关系优势。第三个目标是进行定量研究，使用的权力措施，从目标2了解关系权力的影响，对三个方面的艾滋病毒检测：使用检测服务，披露的检测结果，以及如何学习一个人的艾滋病毒状况影响关系权力后测试。我将利用目前正在进行的Tsogolo La Thanzi（TLT）研究收集的高质量纵向夫妇数据，探索基于TGP的功率和测试研究假设的措施。我预计，关系权力的水平将决定个人是否接受过以前的艾滋病毒检测，这种关联将因性别而异。测试结果的披露将取决于获得财富和财产，权力和测试结果。我还预计，艾滋病毒检测将改变夫妻之间的关系权力动态，然而，变化的方向将取决于性别，感知的检测结果和实际的检测结果。 公共卫生相关性：关于决定健康决策的关键关系变量的新信息将产生关于夫妇行为的深远结论，这些结论可用于制定新的人际行为理论。这项研究不仅将扩大对夫妇动态与艾滋病毒检测之间关系的理解，还将有助于为整个撒哈拉以南非洲的个人和夫妇预防服务提供证据基础。最后，新的措施的关系权力的马拉维的情况下，将提供机会，以评估公共卫生干预措施的有效性，旨在改善夫妇之间的性别关系。

DESCRIPTION (provided by applicant): Gender-based power imbalances continue to place individuals at increased risk for HIV/AIDS throughout sub-Saharan Africa, including Malawi. Research has shown that power in sexual relationships is linked to health in several ways, one of which is through its influence on the use of health services. Voluntary HIV counseling and testing (VCT), an increasingly important prevention service in Malawi, has been inadequately studied with regard to relationship power. Despite widespread access to VCT, uptake of testing is low and for those who do receive VCT, sexual behavior change remains modest at best. I postulate that relationship power is one of the missing pieces of information that could explain HIV testing behavior within couples. The Theory of Gender and Power (TGP) proposes that the economic inequality, control of one partner over the other, and social norms related to gender and sexual behavior can elucidate the behavior of men and women. I will use the TGP to generate hypotheses regarding the interaction between power and HIV testing. This project has three specific aims, with a focus on the third aim. The first aim is to conduct a formative study using focus groups of married and dating men and women to understand the culturally rooted dimensions of power within Malawian couples. The second aim is to explore appropriate quantitative measures of four theorized constructs of sexual relationship power for the Malawi context: dependence, feelings of love and trust, effective partner communication, and experiences of relationship dominance. The third aim is to conduct a quantitative study using measures of power from aim 2 to understand the effects of relationship power on three aspects of HIV testing: use of testing services, disclosure of test results, and how learning one's HIV status influences relationship power after testing. I will utilize high-quality, longitudinal couple data collected through the currently ongoing Tsogolo La Thanzi (TLT) study to explore measures of power and test study hypotheses based on the TGP. I expect that the level of relationship power will determine whether individuals have received a previous HIV test and this association will vary by gender. Disclosure of test results will depend upon the access to wealth and property, power, and the test result. I also anticipate that HIV testing will change relationship power dynamics within couples, however, the directionality of changes will depend upon gender, perceived test result, and actual test result. PUBLIC HEALTH RELEVANCE: New information on key relationship variables that determine health decision-making will generate far- reaching conclusions about couple behavior that can be used to formulate new interpersonal theories on behavior. Not only will this study broaden understandings of the relationship between couple dynamics and HIV testing, it will contribute to the evidentiary basis for individual and couple-based prevention services throughout sub-Saharan Africa. Finally, new measures of relationship power for the Malawi context will provide opportunities to evaluate the effectiveness of public health interventions aimed at improving gender relations within couples.