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Web End = Arch Sex Behav (2016) 45:383393 DOI 10.1007/s10508-015-0572-7
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Web End = Community Inuences on Married Womens Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis
Syeda S. Jesmin1 Cynthia M. Cready2
Received: 22 August 2014 / Revised: 17 January 2015 / Accepted: 29 March 2015 / Published online: 11 July 2015 Springer Science+Business Media New York 2015
Abstract The inuence of disadvantaged or deprived communityonindividualshealthrisk-behaviorsisincreasinglybeing documented in a growing body of literature. However, little is known about the effects of community characteristics on womens sexual attitudes and behaviors. To examine community effects on married womens safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married womenin600communities.Weestimatedtwomultilevellogistic regressionmodels.Model1,whichincludedonlyindividual-level variables, showed that womens autonomy/empowerment, age, and HIV knowledge had signicant associations with their safer sex negotiation attitudes. We did not nd any socioeconomic statusgradientinsafersexnegotiationattitudesattheindividuallevel. Adding community-level variables in Model 2 signicantly improved the t of the model. Strikingly, we found that higher community-levelpovertywasassociatedwithgreaterpositivesafersex negotiation attitudes. Prevailing gender norms and overall womens empowerment in the community also had signicant effects. While research on community inuences calls for focusing on disadvantagedcommunities,ourresearchhighlightstheimportanceof not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex.Tohave sufcientandequitableimpactonmarriedwomens sexual and reproductive health, sexual and reproductive health
promotionpoliciesandprogramsneedtobedirectedtowomen in wealthier communities as well.
Keywords Bangladesh Community Women
Safer sex negotiation Sexually transmitted infections
Introduction
Globallyeverydaynearly1millionpeopleacquireanewsexually transmitted infection (STI), 8090% of which occur in the developing world (World Health Organization [WHO], 2013). Women, particularly, are at greater risk of STI contraction as socialandpoliticalfactorsinteractwiththeirbiologicalvulnerability (Ostrach & Singer, 2012). Being married has been reported to exacerbatewomensriskofSTIcontraction(Hirsch,2007;Tenko-rang, 2012). To reduce married womens risk for STIs, it is important to understand the factors that are associated with their safer sex practices.
The impact of personal characteristics, including socioeconomic status (SES), gender norms, and relationship power, on married womens sex negotiation is well documented (Golobof, Weine, Bahromov, & Luo, 2011; Jesmin & Cready, 2014; Kordoutis, Loumakou, & Saradou, 2000; Lot, Tehrani, Khoei, Yaghmaei,&Dworkin,2013;Popoola,2009;Pulerwitz,Amaro, DeJong,Gortmaker,&Rudd,2002;Smit,2008).However,little is...