AIDS Education and Prevention, 26(1), 1–12, 2014 © 2014 The Guilford Press 1 Heejin Kimm is affiliated with the Institute for Health Promotion & Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. Mad- hu Sudhan Atteraya and In Han Song are affiliated with Yonsei University Graduate School of Social Welfare, Seoul, Republic of Korea. This research was supported by Basic Science Research Program Through the National Research Founda- tion of Korea (NRF) funded by the Ministry of Education, Science and Technology (14245). Address correspondence to Heejin Kimm, M.D., M.P.H., Ph.D., Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. E-mail: solarcell@naver.com WOMEN’S AUTONOMY IN NEGOTIATING SAFER SEX ATTERAYA ET AL. WOMEN’S AUTONOMY IN NEGOTIATING SAFER SEX TO PREVENT HIV: FINDINGS FROM THE 2011 NEPAL DEMOGRAPHIC AND HEALTH SURVEY Madhu Sudhan Atteraya, Heejin Kimm, and In Han Song Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between wom- en’s autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face- to-face interviews. Autonomy was measured in Decision-Making Participa- tion and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15–49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the high- est decision-making participation. These women showed higher OR for ‘ask for condom use’ in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women’s autonomy on sexual health. It emphasizes women’s empowerment-based approach to curbing HIV/AIDS in developing coun- tries. Women’s ability to negotiate for their rights on safer sex is desirable for sexual health and HIV prevention when intimate partners are engaging in risky behavior (Man- tell, Stein, & Susser, 2008). Women’s inability to negotiate safer sex is more likely to result in the risk of HIV infection (Wingood & DiClemente, 2000). Conversely, empowering women to negotiate safer sex is an effective HIV prevention strategy (Amaro, 1995; Exner, Seal, & Ehrhardt, 1997; Wingood & DiClemente, 1996).