{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:58:54Z","timestamp":1763621934442,"version":"3.45.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2019s 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\u2019s attitudes toward negotiating SSR, and examine changes in associations when additional variables were introduced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study analyzed a weighted sample of 6,127 married women aged 15 to 49 from the most recent nationally representative 2015\u201316 Myanmar Demographic and Health Survey (2015\u201316 MDHS). Descriptive analysis and both simple and multiple logistic regression analyses were applied in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>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\u20133.488), in the poorer (aOR 1.381, 95% CI: 1.092\u20131.747) and richest (aOR 1.537, 95% CI: 1.117\u20132.114) wealth quintiles, residing in regions (aOR 1.442, 95% CI: 1.208\u20131.720), living in monogamous households (aOR 1.524, 95% CI: 1.132\u20132.051), knowledgeable about HIV transmission (aOR 1.495, 95% CI: 1.141\u20131.959), and self-efficacy in refusing sex and requesting condom usage (aOR 1.388, 95% CI: 1.128\u20131.708, aOR 2.713, 95% CI: 2.228\u20133.303, 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\u20130.999).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1586603","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:17:52Z","timestamp":1763619472000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with Myanmar women\u2019s attitudes toward negotiating safer sexual relations"],"prefix":"10.3389","volume":"13","author":[{"given":"Myo","family":"Tint","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Napaphat","family":"Poprom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aksara","family":"Thongprachum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1186\/s12905-022-01989-3","article-title":"Exploring the perception and socio-cultural barriers to safer sex negotiation among married women in Northwest Nigeria","volume":"22","author":"Awoleye","year":"2022","journal-title":"BMC Womens Health"},{"key":"ref3","first-page":"10","article-title":"Negociando el sexo mas seguro [Negotiating safer sex]","volume":"4","author":"Gordon","year":"1991","journal-title":"National Library Med"},{"key":"ref4","year":"2024"},{"key":"ref5","first-page":"5","volume-title":"Annual Progress report 2019","year":"2020"},{"key":"ref6","year":"2024"},{"key":"ref7","year":"2025"},{"key":"ref8","year":"2024"},{"key":"ref9","first-page":"1","volume-title":"Sexually transmitted infection management guideline","year":"2017"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1017\/S0021932022000220","article-title":"Attitude towards negotiating safer sexual relations: exploring power dynamics among married couples in India","volume":"55","author":"Vishwakarma","year":"2023","journal-title":"J Biosoc Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0253438","DOI":"10.1371\/journal.pone.0253438","article-title":"Negotiation of the use of medical contraception: levers and obstacles within married couples in Benin","volume":"16","author":"Aguessivognon","year":"2021","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1207\/s15327027hc1202_5","article-title":"Factors predicting safe-sex talk and condom use in early sexual relationships","volume":"12","author":"Troth","year":"2000","journal-title":"Health Commun"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12905-022-01602-7","article-title":"Women\u2019s attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role?","volume":"22","author":"Imo","year":"2022","journal-title":"BMC Womens Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1080\/09540120802009070","article-title":"Negotiating safe sex among women of afro-Surinamese and Dutch Antillean descent in the Netherlands","volume":"20","author":"Bertens","year":"2008","journal-title":"AIDS Care"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1080\/13691058.2014.901561","article-title":"Can a woman refuse sex if her husband has a sexually transmitted infection? 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