For a growing number of women in rural Mexico, and around the world, marital sex represents their single greatest risk for HIV infection.
According to a new Mailman School of Public Health Study, because marital infidelity by men is so deeply ingrained across many cultures, existing HIV prevention programs are putting a growing number of women at risk of developing the HIV virus. The findings, indicating that globally, prevention programs that take a "just say no" approach and encourage men to be monogamous are unlikely to be effective, underline the need for programs that make extramarital sex safer, rather than - unrealistically - to eradicate it. These findings are published in the June 2007 issue of the American Journal of Public Health.
The article's lead author, Jennifer S. Hirsch, PhD, associate professor of Sociomedical Sciences at Columbia University Mailman School of Public Health, is principal investigator on a large comparative study showing that the inevitability of men's infidelity in marriage is true across cultures. This was borne out in the research conducted in rural Mexico as well as in similar studies she is overseeing in rural New Guinea and southeastern Nigeria, which are published in the same issue of the American Journal of Public Health. Two additional studies underway, in Uganda and Vietnam, are expected to show similar results.
The Mexico study was based on six months of anthropological research, including participant observation, 20 marital case studies, 37 key informant interviews, and document analysis to explore the factors that shape HIV risk among married women in Degollado, one of the Mexico's rural communities.
In rural Mexico, reputation is a critical aspect of sexual identity, and attention to reputation provides insight into why people act in ways that are socially safer, but physically risky. "What we found in our research was that culturally constructed notions of reputation in this community led to sexual behavior designed to minimize men's social, rather than viral, risks," said Dr. Hirsch. "We also saw that men's desire for companionate intimacy actually increases women's risk for HIV infection."
A major factor in the study was that married men in the community left their homes to travel to the United States or large Mexican cities to find work. While away for long periods, they engaged in extra-marital and unsafe sex, which can lead to HIV infection. When men return home, they are said to be on honeymoon again, which includes resuming marital sexual relations.