The influence of
disadvantaged or deprived community on individuals' health risk-behaviors is
increasingly being documented in a growing body of literature. However, little
is known about the effects of community characteristics on women's sexual
attitudes and behaviors.
To examine community effects on married women's safer
sex negotiation attitudes, we analyzed cross-sectional data from the 2011
Bangladesh Demographic and Health Surveys on a sample of 15,134 married women
in 600 communities.
We estimated two multilevel logistic regression models.
Model 1, which included only individual-level variables, showed that women's
autonomy/empowerment, age, and HIV knowledge
had significant associations with their safer sex negotiation attitudes. We did
not find any socioeconomic status gradient in safer sex negotiation attitudes
at the individual level. Adding community-level variables in Model 2
significantly improved the fit of the model.
Strikingly, we found that higher
community-level poverty was associated with greater positive safer sex
negotiation attitudes. Prevailing gender norms and overall women's empowerment
in the community also had significant effects. While research on community
influences calls for focusing on disadvantaged communities, our research
highlights the importance of not underestimating the challenges that married
women in economically privileged communities may face in negotiating safer sex.
To have sufficient and equitable impact on married women's sexual and
reproductive health, sexual and reproductive health promotion policies and
programs need to be directed to women in wealthier communities as well.
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- 1Department of Sociology and Psychology, University of North Texas at Dallas, 7400 University Hills Blvd., Dallas, TX, 75241, USA. syeda.jesmin@untdallas.edu.
- 2Department of Sociology, University of North Texas, Denton, TX, 76203-5017, USA.
- Arch Sex Behav. 2016 Feb;45(2):383-93. doi: 10.1007/s10508-015-0572-7. Epub 2015 Jul 11.
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