Factors associated with Myanmar women's attitudes toward negotiating safer sexual relations

Globally, HIV and STIs remain major public health challenges, with women disproportionately affected. Myanmar is among the 35 countries contributing to 90% of new HIV infections worldwide. Addressing these challenges requires strengthening women's ability and fostering positive attitudes toward negotiating safer sexual relations (SSR), as these factors directly influence their behaviors and capacity to protect their sexual health. This study aimed to identify factors associated with Myanmar women's attitudes toward negotiating SSR, and examine changes in associations when additional variables were introduced.

This study analyzed a weighted sample of 6,127 married women aged 15 to 49 from the most recent nationally representative 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS). Descriptive analysis and both simple and multiple logistic regression analyses were applied in this study.

Overall, 86.5% of the sample reported positive attitudes toward negotiating SSR. Higher odds of positive attitudes were consistently observed among women who were undecided about fertility preference (aOR 1.893, 95% CI: 1.028-3.488), in the poorer (aOR 1.381, 95% CI: 1.092-1.747) and richest (aOR 1.537, 95% CI: 1.117-2.114) wealth quintiles, residing in regions (aOR 1.442, 95% CI: 1.208-1.720), living in monogamous households (aOR 1.524, 95% CI: 1.132-2.051), knowledgeable about HIV transmission (aOR 1.495, 95% CI: 1.141-1.959), and self-efficacy in refusing sex and requesting condom usage (aOR 1.388, 95% CI: 1.128-1.708, aOR 2.713, 95% CI: 2.228-3.303, respectively), even after adjusting for all variables. Interestingly, employed women were consistently less likely to report positive attitudes, even in Model 2 (aOR 0.849, 95% CI: 0.722-0.999).

This study found that most married women in Myanmar had positive attitudes toward negotiating SSR. Additionally, the findings revealed the complexity of factors associated with their attitudes, underscoring the importance of addressing both structural and interpersonal barriers. Gender-sensitive and tailored public health interventions, including sexual and reproductive health education, are needed to help reduce HIV/STI transmission and improve reproductive health outcomes.