Using the Inequitable Gender Norms Scale and Associated HIV Risk Behaviors among Men at High Risk for HIV in Ghana and Tanzania

Abstract

Context:

Gender norms influence unintended pregnancy, maternal health, HIV/AIDS infection, and act as barriers to reproductive health services. The Gender Equitable Men (GEM) scale has been used widely in programs and research in African settings, but it has yet to be statistically validated.

Method:

We examined the internal and external validity of the Inequitable Gender Norms (IGN) subscale of the GEM scale in Tanzania and Ghana using a two-step, mixed-method process. Confirmatory factor analysis tested the internal validity of the subscale and regression tests identified associations between the IGN scale and several HIV risk-related variables.

Results:

The IGN scale was shown to be a useful measure of gender norms in both countries. Excluding two questions that measured attitudes toward homosexuality, the scale met the hypothesized single factor structure. Furthermore, the IGN scores were significantly associated with several HIV risk variables in both samples.

Conclusions:

The IGN scale is a robust measure of gender norms in these African countries. However, the role of attitudes toward homosexuality as a contributor to gender norms measurement needs further exploration. Our analyses provide a basis for using the IGN scale to provide a contextualized understanding of men’s perceptions of gender norms and to evaluate programs focused more equitable gender norms. We are aware of only one other measure of gender norms that has been statistically validated in the African Context.