HIV-positive women under the age of 26 with more gender-equal views were more likely to have used a condom in their most recent sexual encounter, the study found.
Published in the journal PLOS ONE, the study found that HIV-positive South African women under the age of 26 were more likely to have used a condom during their last episode of sexual intercourse if they had more gender-equal views, compared with women whose views were more male dominated.
Study co-author Dr. Nuala McGrath, of the University of Southampton in the UK, and colleagues reached their findings by enrolling 530 sexually active HIV-positive adults - 372 women and 158 men - from KwaZulu-Natal in rural South Africa.
The participants were questioned about their views and experiences of gender norms during a visit to an HIV care clinic. According to Dr. McGrath, gender norms are defined as "social and cultural constructions of the ways that women and men are expected to behave."
The participants were also asked about their past relationships, sexual activity and practices and the disclosure of their HIV status to their partner. Information on participants' sociodemographic and socioeconomic status was also obtained.
Less gender-equal views may reduce women's ability to negotiate safer sex
The team found that both men and women were likely to have more equal perceptions of gender norms if they had a higher level of education, and among women under the age of 26, more gender-equal views were linked to greater condom use in their most recent sexual encounter.
What is more, women who had more gender-equal views were also more likely to have ever used a condom and were more likely to have used a condom during their first sexual experience.
Among women aged 26 and older and men of all ages, however, condom use did not appear to be affected by views on gender equality.
Explaining why women with less gender-equal views may be less likely to practice safer sex, Dr. McGrath says the belief that men are the more dominant gender can reinforce a woman's feeling of inequality in a relationship and in society as a whole.
"This could reduce their ability to refuse sexual advances and to negotiate safer sexual practices, including condom use," she adds.
Communication between partners 'plays a critical role in safer sex'
The study results also revealed that - compared with men - women were more likely to have had a partner who insisted on sexual intercourse, and unwanted sex was linked to lower condom use among women during their last sexual encounter.
Both men and women who told their partner about their HIV status and who knew their partner's HIV status were much more likely to have used a condom during their last sexual encounter, according to the findings.
"Although partners' HIV status didn't seem to have an impact on condom use, knowledge of a partner's status was an important factor, suggesting that communication between partners plays a critical role in safer sex," says Dr. McGrath.
However, the team also found that high levels of perceived stigma linked to HIV prevented condom use among women.
Worldwide, more than 35 million people are living with HIV or AIDS, with almost 70% of these individuals living in sub-Saharan Africa. South Africa has the highest HIV prevalence rates among women.
While condom use has generally increased over sub-Saharan Africa in recent years, it remains a barrier to HIV prevention. Some countries such as Ivory Coast and Uganda have seen a decline in condom use.
Based on their findings, the team concludes that gender equality may be an important factor for condom use among young HIV-positive women, adding:
"Strategies to address gender equity should be integrated into positive prevention interventions targeting both women and men, and supported by efforts at a societal level to decrease gender inequality."
They note that the study also emphasizes the need to encourage couples to talk about HIV and to combat stigma related to the disease.
The study is subject to some limitations. The team points out that the study participants were not randomly selected - they knew their HIV status and had chosen to seek care and take part in the study. As such, they are cautious about generalizing their findings to all individuals with HIV.
In addition, they say that women who attended the HIV care clinic may have been more empowered to do so, meaning they may have more gender-equal views than women who did not attend the clinic.
Medical News Today recently reported on a study of HIV-infected men in Uganda that found men undergoing circumcision may be at higher risk of infecting female partners with the disease as their wounds are healing.