In sub-Saharan Africa women have disproportionately higher HIV prevalence than men. This is in spite of the wide availability of HIV information, condoms and HIV testing services. UNAIDS has proposed that due to women's fear of stigma and rejection by their partners, women are not able to seek HIV testing and other HIV services. In order to inform targeted programming for women it is important to examine to what extent women in Africa have attained HIV information and positive attitudes and whether these have been transformed into preventive behavior and ultimately reduction in HIV risk. In addition, it is vital to delineate the influence of socio demographic characteristics on the behavior change pathway of women.
We analyzed cross-sectional data from demographic health surveys (DHS) conducted between 2010 and 2014 in Kenya, Tanzania, Uganda, Rwanda, Zambia and Malawi. The data showed that only 48% had comprehensive knowledge and that younger, rural, unmarried and poorer women were more likely to have low levels of HIV knowledge compared to older, urban, married and richer women respectively. The data also showed that while 75% of the respondents supported refusal of sex and 85% supported demand of condom use with a husband in case of suspected extra-marital sex women with certain characteristics—younger, less educated, poorer women—were less supportive of, and likely less motivated to undertake, sexual negotiation. The analysis also shows that 71% of the respondents had ever been tested for HIV but again women with certain characteristics—younger, rural, less educated, unmarried and poorer—had significantly lower odds of having ever been tested for HIV.
We therefore, recommend that national HIV/AIDS programs undertake to examine barriers hindering younger, rural, less educated, unmarried and poorer women from accessing comprehensive HIV information, gender empowerment interventions, female and male condom supplies as well as HIV testing services. Specific strategies tailored to women of these characteristics should be developed and rolled out targeting these women.