Understanding the Role of Relationship Power in HIV Testing Behavior: A Study of

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高的艾滋病毒/艾滋病风险。研究表明，性关系中的权力在若干方面与健康有关，其中之一是通过其对卫生服务使用的影响。自愿艾滋病毒咨询和检测（VCT）是马拉维一项日益重要的预防服务，但在关系权力方面没有得到充分研究。尽管广泛获得了VCT，但接受检测的人很少，而对于那些接受了VCT的人来说，性行为的改变最多也只是适度的。我认为，关系权力是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（TGP）认为，经济不平等、一方对另一方的控制以及与性别和性行为相关的社会规范可以解释男性和女性的行为。我将使用TGP来产生关于权力和HIV检测之间相互作用的假设。本项目有三个具体目标，重点是第三个目标。第一个目标是开展一项形成性研究，利用已婚和约会男女的焦点小组来了解马拉维夫妇内部根植于文化的权力层面。第二个目的是在马拉维的背景下探索四种理论化的性关系权力结构的适当定量测量：依赖、爱和信任的感觉、有效的伴侣沟通和关系支配的经验。第三个目标是使用目标2中的权力度量进行定量研究，以了解关系权力对艾滋病毒检测的三个方面的影响：检测服务的使用、检测结果的披露以及检测后了解自己的艾滋病毒状况如何影响关系权力。我将利用通过目前正在进行的Tsogolo La Thanzi （TLT）研究收集的高质量的纵向夫妇数据来探索基于TGP的权力测量和检验研究假设。我预计，关系权力的水平将决定个人是否接受过先前的艾滋病毒检测，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、感知检测结果和实际检测结果。

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.