Expectations for male provision and women's sexual health risks in sub-Saharan Africa
Faculty associate Kirsten Stoebenau’s recently published article in Archives of Sexual Behavior highlights her work developing the Gender Role and Male Provision Expectation (GRMPE) scale and testing it in a sample of individuals with a disproportionately higher risk of HIV.
Women living in sub-Saharan Africa are at a greater risk of HIV infection, and for women engaging in transactional sex relationships, the risk is doubled. In this area, there is a fundamental gender expectation that men should be the providers of the family, while women should be caretakers. However, there is a dearth of research investigating the implications of upholding this belief on sexual health risks. Additionally, though other questionnaires measuring men's and women’s endorsement of male provisional roles have been developed, there have been very few efforts to test the salience of these scales in sub-Saharan African contexts.
Thus, Stoebenau and colleagues employed a mixed-methods approach to create and test the GRMPE scale. Participants were located in Uganda, and the majority were unmarried, sexually active women between 15-24 years of age. The researchers recruited participants from lower and middle-income communities and included participants with high and low literacy.
In Phase 1, the researchers tested an initial set of 50 scale items with semi-structured interviews (n=44 individuals) and focus groups (n=19 groups). Each item assessed the extent to which male provision influences gender role expectations. Qualitative data collection revealed the salient endorsement of ties between provider masculinity and men’s sexual decision-making control. Deductive qualitative coding was used to capture the endorsement of five domains identified from the extant literature. After the removal of items with low variability and/or relatability, 31 out of 50 items remained for further testing. Phase 2 consisted of 32 cognitive interviews aimed at refining the wording of scale items. This led to further modification and removal of scale questions, leaving the researchers with 26 items.
Lastly, in Phase 3, pilot testing of the GRMPE scale was conducted to test its fit and validity (n=108). The researchers oversampled participants from venues associated with transactional sex (e.g., nightclubs and universities). Confirmatory factor analysis of a 4-individual factor with a second-order factor model revealed satisfactory overall model fit indices. The four subscale factors identified were Authority, Sexual Decision-Making, Women’s Sexual Agency, and Provision and Love. Additionally, the researchers tested associations between sub-scale scores and behavioral outcomes (e.g., engagement in transactional sex, multiple partners, and age at first sex). Sub-scale scores explained 64.0% of the variance in transactional sex engagement, 50.7% of the variance in multiple partners, and 40.8% of the variance in age at first sex.
The GRMPE scale has important implications for the development of sexual health interventions in sub-Saharan Africa. Stoebenau suggests that focusing on addressing male provision expectations can be an important avenue for reducing women’s HIV risk. She emphasizes that these interventions should be aimed at women and men, as both groups upheld these beliefs.
Stoebenau, K., Bingenheimer, J. B., Kyegombe, N., Datar, R., & Ddumba-Nyanzi, I. (2022). Development of the Gender Roles and Male Provision Expectations Scale. Archives of Sexual Behavior, 1-17. https://doi.org/10.1007/s10508-022-02479-1
