Power & the Association with Relationship Quality in South African Couples: Implications for HIV/AIDS Interventions

INTRODUCTION:

Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS.

METHODS:

This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict).

RESULTS:

For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict.

CONCLUSIONS:

Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men's perspectives into account to ensure positive relationship outcomes.

Below:  Hypothesized pathways between female power, male gender norms, shared power, and relationship quality using an actor-partner independence model

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By:  Conroy AA1, McGrath N2, van Rooyen H3, Hosegood V4, Johnson MO5, Fritz K6, Marr A7, Ngubane T8, Darbes LA9.

• 1Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Amy.Conroy@ucsf.edu.
• 2Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 805, South Academic Block, Level C Room AC23, Tremona Road, Southampton SO16 6YD, UK; Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa. Electronic address: n.mcgrath@soton.ac.uk.
• 3Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: hvanrooyen@hsrc.ac.za.
• 4Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa; Division of Social Statistics and Demography, University of Southampton, Southampton SO17 1BJ, UK. Electronic address: v.hosegood@soton.ac.uk.
• 5Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Mallory.Johnson@ucsf.edu.
• 6Global Health, International Center for Research on Women, 1120 20th Street NW, Suite 500 North, Washington, D.C., USA. Electronic address: kfritz@icrw.org.
• 7Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Alexander.Marr@ucsf.edu.
• 8Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa. Electronic address: tngubane@hsrc.ac.za.
• 9Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. Electronic address: Lynae.Darbes@ucsf.edu. 
• Soc Sci Med. 2016 Jan 28;153:1-11. doi: 10.1016/j.socscimed.2016.01.035.

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