Abstract

Introduction: Despite the fact that men are driving the HIV/AIDS epidemic in southern Africa (SA), it has been “feminized” to stigmatize women as the vectors of transmission. Women in the region disproportionately bear the burden of disease, and although levels of female literacy and education have increased, the empowerment of women over their own lives has progressed sporadically, stagnated, or regressed. Methods: Using Demographic and Health Surveys (DHS) data from six SA countries, a retrospective observational study was conducted to 1) examine the association between HIV seropositivity and empowerment in women, 2) analyze empowerment in relation to risk of HIV infection, and 3) evaluate the impact of education on HIV seropositivity in women. Results: Women who reported not having decision-making authority for large household purchases had the highest odds of HIV (adjusted OR 1.6, 95% CI 1.1-2.4, p=0.018). Further, women who lack healthcare decision-making authority (adjusted OR 1.5, 95% CI 1.0-2.2, p=0.054) and justify wife-beating (adjusted OR 1.4, 95% CI 1.0-1.9, p=0.027) have increased risk. Education beyond primary school was not associated with increased risk. Discussion: The health and safety of women are integral to children, families, communities, and countries. This study suggests that the wives or female partners of men who delegate or share decision-making authority for large household purchases are at lower risk of contracting HIV from their husbands. The authors therefore urge SA government entities to adopt strong, vocal, and radical approaches to advocate for women’s empowerment in preventing HIV infection and in all other spheres of society.