Sexual behaviour practices of spouses and condom usage in Russian context

1. Abstract no. A-155-0144-01884 & CDC083 Sexual behaviour practices of spouses and condom usage in Russian context Violetta Khabibulina, cand.bio.sci, MSW, MPH Kazan, Tatarstan, Russia; Social Science Research Council, New York, USA Mentor - Dr Cynthia Buckley, PhD Texas University (Austin, TX, USA)

2. The increasing incidence of HIV attributable to heterosexual transmission within marriages raises demanding attention to couple as unit of analysis and to spouses' risky sexual behaviour practices. Over the last decade the main focus and emphasis on reproductive health (RH) components was given rather to the sexually active couples than on women only (Bawah AA, 2002; Becker S., 1996). Among different preventive approaches the constant and correct usage of condom is considered by health professionals as the most crucial one. This criterion of non-risky sexual behaviour is seemed quite questionable for the married people themselves who tend to trust their partners. The medical point about the effective method of contraception can be in strong contrast with social values/attitudes, and decision to use condom can be positioned as an act of distrust, non-fidelity. Exposure-outcome research indicate that men and women with concurrent partnerships are significantly more likely to be HIV-positive than those who have not had multiple sexual partners during their lifetime (Mishra V., Bignami-Van Assche S. 2008). Background

3. Sexual dataset Individual dataset Household dataset Inclusion criteria: - Married/uncertain + - Filled individual Questionnaire + - Established status of “SPOUSE” with another family member within given household SIH dataset – 12Round = 3418 individuals Both spouses filled two Questionnaires SIH-selected-12R =1446 couples Methods Pathway to construct the couples’ RLMS dataset (Russian Longitudinal Monitoring Survey with Sexual History Supplement in 2003, 12 Round, 2003)

4. Methods • The secondary data analysis of the only nationally representative Russian Longitudinal Monitoring Survey (RLMS with Sexual History Supplement in 2003) explores which social and sexual factors define condom usage during marital sex. • The OUTCOME – “condom use at last marital sex event” - is defined as self-reported by both spouses, and combinations of answers are categorized into three options of couple-level variable: “Yes” / “No” / “Uncertain”. • Univariate analyses: - Chi-Square test - ANOVA (analysis of variances) • Variables testing: Pearson / Spearman correlation Multinominal Logistic Regression is applied with dependent variableCONDOM USAGE by a couple: “No” vs “Yes” ; “Uncertain” vs “Yes” Independent variables: (nominal with dummy reference category, and ordinal, and continuous (numerical): • I Block: Social – demographical characteristics of a couple from HH-information and individual datasets (place of living; spouses’ employment status; wife’s and husband’ age, and difference between them; duration of union, reported by each spouse); • II Block: Practices related to sexual behaviour and health (“type of extramarital sexual partner, if any” ; “number of sexual partners over 12 mo” ; “noticed any signs of STD” ; “alcohol usage during sex event” . • III Block: Attitudes/knowledge on HIV - “Possible to prevent HIV?”; “ Does condom prevent from HIV?”; “Fidelity helps to prevent HIV?”.

5. Results The social predictors are place of living and age (I block): • couple residing in rural places (compare to capitals, p=0.000, OR=0,32) is less likely to use condom. • also couple with older versus younger wife (p=0.073) is less likely to use condom. Each year of wife’s age gives 1, 05 times higher chances to not use condom. • The more difference in age between spouses, then they less likely to use condom (p=0.007). Each year of age difference gives 1, 1 times higher chances to not use condom. Among three measures on Knowledge & Attitudes regarding HIV prevention (III block): only wife's pessimistic opinion regarding someone's ability to avoid HIV-infection significantly decreases the couple's chances to NOT use condom (p=0.021, OR=0,44). • Among sexual behaviour factors, the extramarital affair of wife marginally reduces the likelihood of condom use within marriage (p=0.083). • STD experience (p=0.046) and suspicious of other spouse in adulteryof only husband (p=0.017) increase the chances of condom use by his couple.

6. Conclusion • Extramarital partner. For a man having recent intercourses with a female friend or on occasion doesn’t change his couple’s (and underlying his own) attitudes regarding condom usage. It is what to think for health promotion programs about.Interestingly, with marginal significance value (p=0.083, “Not used” vs “Yes” OR=7,18) wife’s sexual behaviour has relations to her couple’s decision on condom’ usage. Perhaps, couple has seven times higher chances to NOT use condom if wife was recently involved into sex event with her “friend” (considered as constant concurrent sexual partner)! • STD experience of only husband has reflections on couple (and his own?) taking condom usage into serious consideration. That is, appeared signs of having STD compare to NO any signs, results in 2,7 times higher chances to use condom with a wife. (p=0.046, for “Yes used” vs “Not used ” OR=2,68) • The same tendency of husband-centered role is observed when we analyze answers regarding suspicious of other spouse in non-fidelity. If Husband- not Wife! – suspects the spouse, his couple (because of his decision?) has 4,7-fold increased chances to use condom (p=0,017, for “Yes used” vs “Not used ” OR=4,74.

7. Conclusion • In Russian context, older couples, where wife has concurrent partner but husband absolutely not aware of that, under heightened risk of unsafe sex. • AIDS awareness doesn't increase condom use, the decision process of which reveals the husband-dominated role. • Comparison with world's marital sex practices would benefit these empirical findings on understanding of condom usage patterns.

8. Acknowledgments: This research was assisted by a grant from the Eurasia Program of the Social Science Research Council with funds provided by the Ford Foundation Moscow. The work would not be done in a whole volume without supervision of Dr Cynthia Buckley, PhD (Texas University). I am thankful for helpful comments to: • Irina Denisova, PhD, CEFIR and Russian Economic School, Moscow, Russia, and • Alexandra Vacroux, PhD, Woodrow Wilson International Center for Scholars, Washington, DC, USA.