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Sexual Relationship Power and Periconception HIV-Risk Behavior Among HIV-Infected Men in Serodifferent Relationships


Gender norms affect HIV risk within serodifferent partnerships. We assessed how the sexual relationship power described by men living with HIV (MLWH) associates with periconception HIV-transmission risk behavior. Quantitative surveys were conducted with 82 MLWH reporting a recent pregnancy with an HIV-negative or unknown-serostatus partner in KwaZulu-Natal, South Africa. Surveys assessed decision-making dominance (DMD) using the Pulerwitz et al. sexual relationship power scale; partnership characteristics; and HIV-risk behaviors. Multivariable logistic regression models evaluated associations between DMD score and HIV-risk behaviors. Higher male decision-making dominance was associated with non-disclosure of HIV-serostatus to pregnancy partner (aRR 2.00, 95% CI 1.52, 2.64), not knowing partner’s HIV-serostatus (aRR 1.64, 95% CI 1.27, 2.13), condomless sex since pregnancy (aRR 1.92, 95% CI 1.08, 3.43), and concurrent relationships (aRR 1.50, 95% CI 1.20, 1.88). Efforts to minimize periconception HIV-risk behavior must address gender norms and power inequities.


Las normas de género afectan el riesgo de VIH dentro de asociaciones serodiferentes. Se evaluó cómo el poder de relación sexual descrito por los hombres que viven con el VIH (MLWH) se asocia con la conducta de riesgo de transmisión del VIH periconcepción. Se realizaron encuestas cuantitativas con 82 MLWH que informaron sobre un embarazo reciente con una pareja VIH-negativa o desconocida en el estado serostatos en KwaZulu-Natal, Sudáfrica. Las encuestas evaluaron el predominio en la toma de decisiones (DMD) utilizando Pulerwitz et al. escala de poder de relaciones sexuales; características de la asociación; y conductas de riesgo de VIH. Los modelos multivariables de regresión logística evaluaron las asociaciones entre la puntuación de DMD y las conductas de riesgo de VIH. El mayor predominio masculino en la toma de decisiones se asoció con la no divulgación del estado serológico del VIH a la pareja del embarazo (aRR 2.00, IC 95% 1.52,2.64), sin saber el estado serológico del VIH de la pareja (aRR 1.64, IC 95% 1.27,2.13), sin condón sexo desde el embarazo (aRR 1.92, IC 95% 1.08,3.43) y relaciones concurrentes (aRR 1.50, IC 95% 1.20,1.88). Los esfuerzos para minimizar la periconcepción del comportamiento del riesgo de VIH deben abordar las normas de género y las inequidades de poder.

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The authors report no conflicts of interest. This work was supported by the Harvard CFAR (P30 AI060354) and K23 MH095655. Dr. Khidir received financial support for this work from the HIV Medicine Association (HIVMA) Medical Student Award and the Harvard Medical School Scholars in Medicine Office. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Lynn T. Matthews.

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Khidir, H., Mosery, N., Greener, R. et al. Sexual Relationship Power and Periconception HIV-Risk Behavior Among HIV-Infected Men in Serodifferent Relationships. AIDS Behav 24, 881–890 (2020). https://doi.org/10.1007/s10461-019-02536-2

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  • HIV prevention
  • Behavior change
  • Safer conception
  • MLWH
  • HIV-serodiscordant
  • South Africa