HIV Testing, Household and Reproductive Health Decision-Making: The Role of Women Autonomy in a Nationally Representative Study in Cambodia.

Abstract

Background and objective: Women's autonomy plays a critical role in decision-making of health service use. This study aims to evaluate the relationship between Human Immunodeficiency Virus (HIV) testing and decision-making autonomy among Cambodian women aged 15-49.

Methods: We used data from the 2021-2022 Cambodia Demographic and Health Survey (DHS) and our sample consisted of currently married/cohabiting women aged 15-49 (N = 13,755). The outcome variable was "ever been tested for HIV." Covariates were household decision-making and reproductive health decision-making scores, socio-demographic characteristics (age, place of residency, education, wealth quintiles, and employment status), and HIV knowledge (HIV self-test kits, drugs to prevent HIV in babies during pregnancy, antiretroviral [ARV] drugs, and pre-exposure prophylaxis).

Results: Sixty-one percent of studied women reported ever being tested for HIV. The logistic regression results revealed that women with a higher household decision-making score (aOR = 2.09, p < 0.001), reproductive health decision-making score (aOR = 1.72, p < 0.001), from 25 to 29 age groups (aOR = 2.21, p < 0.001), with a higher education (aOR = 1.96, p = 0.001), from the richest groups (aOR = 1.73, p < 0.001), had knowledge of HIV test kits but never get tested (aOR = 1.38, p = 0.035), heard of drugs to avoid HIV transmission to babies during pregnancy (aOR = 1.21, p < 0.001), and heard of ARV drugs (aOR = 1.28, p < 0.001) were more likely to get tested for HIV than their counterparts. Women living in rural areas (aOR = 0.56, p < 0.001) and those who had discriminatory attitudes (aOR = 0.76, p = < 0.001) were less likely to get HIV tests than those in urban areas and those without discrimination.

Conclusion and global health implications: Findings revealed that greater autonomy is important for health care use, particularly HIV testing for women in Cambodia.