Statement of the Problem: Of the 19.4 million people living with HIV in eastern and southern Africa in 2016, 59% of them were women and girls. The elevated risk of acquiring HIV is due to many factors that drive disempowerment in heterosexual relationships and HIV risk behaviors. Few studies employ a comprehensive framework to examine divisions between men and women and HIV risk behaviors in an African context.Purpose: To assess the association between empowerment indicators and attitudes based on the Theory of Gender and Power and HIV risk behaviors in couples by country.Methods: In the first study, we defined the womens empowerment predictor as household decision-making, female economic independence, wife-beating attitudes, and age and educational differences between partners. The outcomes of interest were infidelity by the man and self-efficacy for a woman to initiate safe sex and refuse sex. In the second study, we analyzed associations between attitudes towards womens empowerment (household decision-making and wife-beating attitudes) and the same HIV risk behaviors. Overall, we conducted cross-sectional analyses, using logistic regression, of couples aged 15-64 in countries with Demographic and Health Survey data and high HIV prevalence: Malawi, Namibia, Zambia, and Zimbabwe.Results: Female economic independence, household decision-making involvement, and rejecting all reasons for wife-beating were strong indicators of high levels of empowerment. High versus low womens empowerment was associated with an increased likelihood of safer sex negotiation among women in Malawi (AOR=1.57, 95% CI: 1.08-2.00) and Zambia (AOR=1.60, 95% CI:1.34-1.91), and sex refusal among women in Malawi (AOR=1.62, 95% CI: 1.29-2.04) and Zimbabwe (AOR=1.29, 95% CI:1.04-1.59). Empowerment attitude discordance was associated with infidelity among men in Zambia and Zimbabwe (AOR=1.94, 95% CI: 1.39-2.40; AOR=1.88, 95% CI: 1.27-2.77), and a decreased likelihood of safer sex negotiation in Zambia (AOR=0.58, 95% CI: 0.42-0.81) and of sex refusal in Malawi (AOR=0.66, 95% CI: 0.45-0.97), Zambia, (AOR=0.74, 95% CI: 0.58-0.95), and Zimbabwe (AOR=0.72, 95% CI: 0.57-0.91).Conclusions: Empowerment indicators and attitudes drive relationship dynamics, sexual power, and sexual behavior in African couples. Policymakers should incorporate these factors to enhance programs that facilitate empowerment for HIV prevention.