AIDSQuest: The HIV/AIDS Survey Library
Topic D: Gender and Sexual Relationships

Overview
HIV/AIDS programs and studies are increasingly taking into account the social context of the individual when attempting to understand HIV prevention and care. There is ample evidence that sexual risk behaviors are influenced by social and interpersonal factors. Issues related to gender and the interpersonal nature of sexual relationships are among such factors.

Gender refers to the expectations or norms within a society about the roles and responsibilities that are appropriate for women and men. Research has shown that the gender-based imbalance in power found in the economic and social spheres of life is reflected in sexual relationships. Women often have less control over the nature and timing of sex and the practice of protective behaviors. A woman's ability to practice safer sex  may be influenced by her ability to communicate openly about sex with her partner, the power dynamic in their relationship, or how much the partner believes in traditional gender roles. Beliefs or norms about masculinity and femininity often encourage men to have multiple partners and women to be passive and ignorant about matters of sexuality and reproduction. Gender, therefore, affects both women's and men's risk of HIV and other STIs.

In addition, societal expectations of men and women have an impact on their care and support needs. For example, the burden of AIDS-related care (financial, medical, and psychological) often falls disproportionately on women. Including issues related to gender in AIDS surveys can provide very useful information regarding the context of HIV/AIDS risk, care, and support.

Gender issues have been separated into two topic areas: communication, negotiation, and power in relationships; and gender roles and norms.

Measurement issues
It is difficult to measure abstract social concepts such as power in sexual relationships or gender norms, and measures for these concepts are still under development. Yet, many surveys have explored these issues, and some have already been rigorously tested for their reliability and validity (i.e.,  confidence that the questions related to gender norms are actually measuring these norms). A number of these tested surveys have been included in this section.

It is important to keep in mind that conflicting norms can be held by different sub-groups. For example, norms against condom use (such as it is not "masculine" to use one) can be held by a young man's group of friends or peers, while norms in support of condom use (such as it signifies a "caring partner") can be held by other groups in that young man's life, such as teachers and parents. Therefore, surveys sometimes include questions about general norms as well as norms of specific sub-groups.

Gender norms questions are normally phrased as general statements about acceptable beliefs or behaviors—"Women shouldn't talk openly about sexual matters"—or as beliefs held by specific important others—"My partner thinks that we should get an HIV test."

There is much interest in the communication and negotiation of safer sex. It is important to keep in mind that there is a continuum of communication and negotiation between partners. Raising an issue is part of the continuum, and being able to insist on condom use, or refuse to have sex, is a different part of the continuum. Questions can range from "Did you ever discuss getting an HIV/AIDS test with your partner?" to "Have you ever insisted on condom use?" Questions should be designed to reflect exactly what the researcher wants to know.

Asking questions to both members of a couple, or asking individuals about both themselves and their partners, permits an analysis of relationship issues. It is possible to analyze couple data as a unit or both members of a couple separately.

As with other types of questions, it is important to keep comparability in mind when designing a survey. This is especially true if you are going to ask similar questions within the same survey, collect more than one round of data (e.g., pre-and post-tests), or if you will want to compare your results to other studies. For example, measurement of power in sexual relationship can be presented in different ways:

"Who has more power in your relationship?" and "My partner has the final say about important decisions such as how we raise our children."

While both statements attempt to measure power in sexual relationships, the meaning of each statement is different, and responses to each could not be directly compared. The second statement is more specific and less likely to be interpreted in multiple ways, and therefore probably more valid.

Examples of questions relating to gender and sexual relationships have been selected from the following questionnaires:

1. Communication, negotiation, and power in relationships

• Horizons—HIV-associated Violence: Implications for HIV Counseling and Testing Programs

• MEASURE DHS+—AIDS Module

• Horizons—Female Condom User Study

• Pulerwitz et al.—Sexual Relationship Power Scale

• UCSF CAPS—Home Health Study/National AIDS behavioral study

• UCSF CAPS—Condom Use Among Hispanics

• Morokoff et al.—Sexual Assertiveness Scale for Women

• FHI—Behavioral Surveillance Survey

• WHO—WHO Multi-country Study on Women’s Health and Life Experiences

2. Gender roles and norms

• Horizons—Programming for HIV Prevention in Thai Schools

• Horizons—HIV-associated Violence: Implications for HIV Counseling and Testing Programs

• Horizons—Determining Needs and Opportunities to Address Trafficking of Girls and Women

• MEASURE DHS+—AIDS Module

• UCSF CAPS—Home Health Study/National AIDS Behavioral Study 

• UCSF CAPS—Condom Use Among Hispanics

• MEASURE Evaluation—Perform System of Indicators Survey in Uttar Pradesh, India: Men's Questionnaire

• Pleck et al.—Male Role Attitudes Scale

• WHO—WHO Multi-country Study on Women’s Health and Life Experiences

Print this page

@ E-mail this page

This page updated 21 August 2006

---