Our purpose in conducting this study was to examine the interplay between relationship power variables, intimate partner victimization, and HIV risks among young adults in partnerships in Cebu City, the Philippines. Women in this sample were well educated, with the majority completing high school. Only 40% of the sample was employed outside the home at the time of the study, however, which may indicate the more traditional roles of men as the breadwinners. The fact that not quite one-third of the partnered sample was legally married indicates that, while traditional marriage may be idealized in the Philippines, cohabitation is becoming a more accepted norm.
The relationship between decision making and IPV was not significant, but the limited sample size may have had more of an effect on this rather than the relationship being one of chance alone. The relationship was positive in direction, indicating that higher decision-making power on the part of the woman placed her at risk for experiencing more abuse by her partner. Although it may seem contrary to what might be expected, it is consistent with common decision-making practices about household matters among adults in the Philippines, which was what the study instrument measured. For example, Filipina women often are responsible for financial management, making household decisions, and making decisions regarding family planning. In previous research working with the mothers within the CLHNS, investigators found that this “dominance” in decision making is not necessarily protective against IPV experience (Hindin & Adair, 2002
). Instead, they found that women who dominate the decisions of household matters were nearly four times more likely to experience abuse than those women in households where decisions were made jointly.
Given that we constructed this latent variable as a combination of economic power, household decision making, and sexual/self decision making, it is important to note that being a decisionmaker does not necessarily mean that one is in “control” of the factors involved in the decision. Lack of money can be a source of tension within the couple. For instance, a woman may be responsible for financial management, yet the man is often the primary breadwinner. In these times of economic crisis, unemployment is on the rise and this has a direct impact on household budgets and couple dynamics. The woman’s role as financial manager and household decisionmaker becomes strained, and she may be blamed for the financial problems. Conflicts may arise. As demonstrated in , financial concerns were a primary reason for men to hurt their partners.
At the same time, higher internal LOC is positively related to more abuse. The relationship here may indicate that independent thinking on the part of the woman does not prevent the experience of violence. This also has been demonstrated in qualitative violence literature, in which women voice feelings of strength even in the face of violent partners (Davis, 2002
). In this context, the relationship between LOC and abuse may be attributed to several things. It could come from the challenging of more traditional household-level gender norms. Researchers have shown this to be associated with increased violence in other Asian countries, such as Bangladesh (Kabeer, 2001
; Schuler, Hashemi, Riley, & Akhter, 1996
). On a societal level, Filipino gender roles are less rigidly demarcated than in other countries, and women enjoy a fair amount of autonomy. Yet, on the household level, traditional views of male and female roles are still present.
Another reason for this positive relationship may stem from an element that pertains to this age specifically. Developmentally, young adults are becoming more independent and can sometimes experience feelings of rebellion against their families and society. This can influence their choices in partners at this early stage, perhaps selecting a partner who embodies rebellion rather than one who embodies responsibility. In addition, high levels of self-agency and LOC have not been predictive of lower risk-taking behaviors among young adults (Breakwell & Millward, 1997
; Burns & Dillon, 2005
). Our results support these previous findings, suggesting that higher internal LOC is not necessarily protective and may, in fact, confer risk among females in this age group.
The strong relationship between IPV and HIV risk behaviors supports what has been previously found by researchers in many other settings (see Campbell et al., 2008
; Gielen et al., 2007
for detailed reviews on the topic). It is important to note, however, that the self-reported HIV risk behavior of “multiple partners” is the female having multiple partners. In some other resource-limited settings, researchers also have assessed the HIV risk factor of multiple partners on the part of abusive male partners because young women who are experiencing violence at the hands of their partners are more likely to engage in risk behaviors or be put at risk for STIs through their partners’ actions. We note that the high prevalence of STI symptoms in this group and the low prevalence of multiple sex partners may indicate some nonmonogamy on the part of the partners, but we had no way of assessing the presence of cooccurring relationships. In addition, the higher levels of decision-making power and a more internal LOC indirectly affect HIV risk through experiences of violence. This may, in part, be attributed to the age of the sample, given the developmental stage of young adults. A wider age range would allow for examination of this in greater detail.
Important to note is the high prevalence of cooccurring violence in this sample. Thirty-seven percent of the women reported being victims of violence. Thirty-one percent reported that the violence in their relationship was cooc-curring. The extent to which the effect of IPV on HIV risk differs between those in violent relationships in which the violence is cooccurring and those who are only victimized was difficult to assess accurately in this sample. Additionally, the level to which the women’s perpetration of violence is initiative versus reactionary to partner aggression is not entirely clear. We would need to further assess this with a larger sample, which would allow for subgroup analysis to determine whether the relationships between study variables are different in mutually violent relationships (Graves, Sechrist, White, & Paradise, 2005
We chose to focus on young adults and their behaviors, especially since this group is at particular risk globally for HIV, although these young women may not have had as much exposure to violence, decision making, or both, as older women in their communities. The average age of the subsample we analyzed here was quite young (20 years), in part because more than half of the subsample belonged to a birth cohort (index children of the CLHNS). By including the female partners of the male index children, we incorporated a wider age range. In addition, we were unable to assess the length of these relationships. By limiting the subsample to those women who were either married or cohabitating with their partners, however, we ensured that they were in situations where they faced decision making in their partnerships.
Because this was a secondary analysis of data, our construction of the variables was constrained by the questions contained in the survey. The measures for LOC were based on general life decision questions, rather than on questions specific to IPV or HIV protection intentions. In future work, it would be more helpful to measure LOC and self-efficacy questions that pertain specifically to IPV and HIV. In future studies, questions assessing HIV risk should be more specific. For instance, questions referring to condom use should measure not only use/nonuse but consistency of use and with which partners.
One other limitation is the use of self-report outcome variables instead of biological markers. This is particularly germane to the endogenous variable of HIV risk. This study was conducted in a low HIV-prevalence setting with limited HIV testing occurring. Therefore, very few people in the general population know their HIV status as confirmed through testing. This did not allow us to examine objective outcomes, such as clinical, biological, or both HIV markers. Instead, we relied on self-report of risk behaviors that have been strongly associated with HIV seroconversion in other studies.