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The Association of Women’s Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan Africa
Authors: Theresa Schierl, Luana Fiengo Tanaka, Stefanie J. Klug, Andrea Sylvia Winkler, and Dominik Stelzle
Source: Journal of Epidemiology and Global Health, DOI:
Topic(s): HIV/AIDS
Reproductive health
Sexual health
Women’s empowerment
Country: Africa
  Multiple African Countries
Published: SEP 2023
Abstract: Background Women’s empowerment is an important factor for HIV prevention, but the association with HIV-related indicators has never been quantified. In this study, we examined the association between women’s empowerment and selected HIV-related indicators. Methods We used the latest Demographic and Health Surveys that included HIV testing among other biomarkers of 31 countries in sub-Saharan Africa. Empowerment was measured by the Survey-based Women’s EmPowERment (SWPER) index and was compared to the HIV-related indicators: HIV status, HIV testing (ever and in the past 12 months), condom use at last high-risk sex, the ability to ask the partner to use a condom, and the ability to refuse sex. Results 208,947 women were included in the analysis, of whom 100,924 (48%) were considered highly empowered and 21,933 (10%) as lowly empowered. There was no association between empowerment and HIV status (OR?=?1.12, 95% confidence interval [CI] 0.98–1.28). Highly empowered women were more likely to have ever been tested for HIV (OR?=?1.67, 95% CI 1.60–1.74) but less likely to have been tested for HIV in the past 12 months (OR?=?0.92, 95%CI 0.88–0.96). Highly empowered women were more commonly able to ask the partner to use a condom (OR?=?1.69, 95% CI 1.63–1.75) and to refuse sex (OR?=?1.78, 95%CI 1.72–1.85). Conclusions Women’s empowerment does not seem to be linked to HIV status, but it is strongly associated with a woman’s ability to make decisions about their sexual behavior. Empowering women and young girls has the potential to contribute toward achieving the United Nations’ goal of ending AIDS by 2030.