Dawit Alemu

Date of Award

Fall 2019

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Donaldson Conserve


Introduction: Sub-Sahran Africa constitute two-thirds of all people living with HIV in the world. HIV infection rate is high in the continent with women comprising 56% of new HIV infections among adults 15 and older. Women 15 to 24 are the most affected constituting 66 % of new infections occurring among this age group. The purpose of this study was to examine how gender power relations between men and women affect health seeking behavior, particularly HIV testing, among Ethiopian women age15 to 49.

Methods: The Ethiopian Demographic and Health Survey (EDHS) from 2016 served as the data source for this study. The EDHS sample was determined using a two-stage stratified cluster sampling design. Participants included 12, 688 Ethiopian men between the ages of 15 and 59 and 15,683 Ethiopian women between the ages of 15 and 49. The sub-sample for this dissertation study consisted of all currently married women within the EDHS sample. Kabeer’s theoretical framework and Anderson’s Behavioral Model guided variable selection. The outcome variable, “ever being tested for HIV,” was assessed using a bivariate analysis and multivariate logistic regression. Participants with missing data on questions related to decision making, emotional violence and other covariates adjusted in the multiple logistic regression were excluded from the analysis. Sampling weights that accounted for complex survey design were incorporated in all analyses.

Results: Several indicators of women’s empowerment were associated with HIV testing among women. After adjusting for covariates, socio-economic status, health care decision vi making, household decision making, and media exposure independently predicted HIV testing uptake. Women currently employed, those with better education, who participated in household decision making and decision making related to their own health care, and who reported higher exposure to the media were more likely to have been tested for HIV. Having experienced emotional violence by an intimate partner did not independently predict HIV testing uptake.

Conclusion: This research is the first of its kind to explore the association of aspects of women’s empowerment with HIV testing in Ethiopia, using a national sample. The results indicated the importance of socio-economic status, media exposure, participation in household decision making, and health care decision making in Ethiopian women’s uptake of HIV testing. These findings are relevant for those who design programs and policies related to promoting uptake of HIV testing among women, particularly in Sub-Saharan Africa.


© 2019, Dawit Alemu