Does land ownership by women reduce HIV risk?

Women's land ownership and risk of HIV infection in Kenya

Muchomba FM, Wang JS, Agosta LM. Soc Sci Med. 2014 Aug;114:97-102. doi: 10.1016/j.socscimed.2014.05.055. Epub 2014 Jun 2.

Theory predicts that land ownership empowers women to avoid HIV acquisition by reducing their reliance on risky survival sex and enhancing their ability to negotiate safer sex. However, this prediction has not been tested empirically. Using a sample of 5 511 women working in the agricultural sector from the 1998, 2003 and 2008-09 Kenya Demographic and Health Surveys, we examined the relationship between women's land ownership and participation in transactional sex, multiple sexual partnerships and unprotected sex, and HIV infection status. We controlled for demographic characteristics and household wealth, using negative binomial and logistic regression models. Women's land ownership was associated with fewer sexual partners in the past year (incidence rate ratio, 0.98; 95% confidence interval [CI], 0.95-1.00) and lower likelihood of engaging in transactional sex (odds ratio [OR], 0.67; 95% CI: 0.46-0.99), indicators of reduced survival sex, but was not associated with unprotected sex with casual partners (OR, 0.64; 95% CI, 0.35-1.18) or with unprotected sex with any partner among women with high self-perceived HIV risk (OR, 1.02; 95% CI, 0.57-1.84), indicating no difference in safer sex negotiation. Land ownership was also associated with reduced HIV infection among women most likely to engage in survival sex, i.e., women not under the household headship of a husband (OR, 0.40; 95% CI, 0.18-0.89), but not among women living in husband-headed households, for whom increased negotiation for safer sex would be more relevant (OR, 1.74; 95% CI, 0.92-3.29). These findings suggest that reinforcing women's land rights may reduce reliance on survival sex and serve as a viable structural approach to HIV prevention, particularly for women not in a husband's household, including unmarried women and female household heads.

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Editor’s notes: A range of social and economic factors influence the degree to which individuals and communities are vulnerable to HIV infection. In some settings, a lack of land ownership has been shown to increase women’s risk of partner violence. This paper assessed whether women who own land have lower HIV risk. For single women or women in female-headed households, land ownership was associated with a reduced risk of HIV infection. Interestingly, lower HIV risk didn’t appear to be associated with an increased ability to negotiate safer sex practices, but rather arise from women's reduced economic reliance on high-risk sexual partnerships. The findings also suggest that women's own access to land had a greater influence on their HIV risk than household-level wealth, suggesting that household level wealth is not the same as wealth owned by women. Although the analysis is of cross-sectional data, and so causality cannot be established, the findings suggest that increasing women’s ownership of land may provide a structural mechanism to reduce women’s HIV vulnerability. This contributes to the increasing body of evidence that points to the potentially important role that economic empowerment programmes may play in helping to reduce women’s vulnerability to HIV.

Africa
Kenya
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