Gender inequality and HIV-1 infection among women in Moshi Tanzania.

This study examined the hypothesis that multiple dimensions of gender inequality increase womens risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi Tanzania. In addition we explored the extent to which gender inequality elevates womens risk for HIV directly or indirectly through risk behaviour factors. Gender inequality was measured by coerced first sex intimate partner violence age difference between partners partners contributions to childrens expenses and ever had problems conceiving. Risk behavior factors included number of sexual partners for women in last three years partner had other wives or girlfriends non-use of condom and alcohol use at least once a week in last 12 months. Multivariate analysis showed that HIV infection was associated with all the indicators of gender inequality with the exception of intimate partner violence after controlling for background characteristics. After adjustment for risk behaviour factors and background characteristics experience of coerced first sex before age 18 years having a partner more than 10 years older and partners low financial contributions to children retained their relationship with HIV infection while ever had problems conceiving became non-significant. Thus risk behaviour factors had a modest mediating effect on the relationship between gender inequality and HIV. The findings suggested that multiple dimensions of gender inequality in heterosexual relationships fuel womens higher risk for HIV infection directly and indirectly through risk behaviour providing further evidence for extending current HIV interventions to incorporate womens empowerment and promotion of behavioural change among men. (authors)