He forced me to love him: putting violence on adolescent sexual health agendas.

Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and men's sexual power and privilege. Conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Although the women's vulnerability paradigm was a radical revision of earlier views of women in the epidemic, mounting challenges undermine its current usefulness. We review the etiology and successes of the paradigm as well as its accruing limitations. We also call for an expanded model that acknowledges biology, gender inequality, and gendered power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men.

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2009.159723

Rethinking Gender, Heterosexual Men, and Women's Vulnerability to HIV/AIDS

This paper explores meanings and understandings of sexual exchange for material gain in an urban township of Durban, South Africa. The analysis argues against the tendency to assume too readily that all forms of sexual exchange are oriented towards subsistence, and not consumption. This paper also argues that sexual exchange is the means used by women in this study to pursue images and ideals largely created by the media and globalisation. It is revealed that transactional sex is perceived as ‘normal’ leading many women to accept men's multiple partners and to put themselves as risk of contracting HIV/AIDS (despite having knowledge of the pandemic). Finally, the paper highlights women's power and agency whereby women are asserting themselves in order to exploit sexual relationships in the interests of new ‘needs’ – the commodities of modernity

Transactional Sex and the Pursuit of Modernity

Relationship dynamics and teenage pregnancy in South Africa.

▪ Abstract This article examines the development of anthropological research in response to AIDS. During the first decade of the epidemic, most social science research focused on the behavioral correlates of HIV infection among individuals and failed to examine broader social and cultural factors. By the late 1980s, however, pioneering work by anthropologists began to raise the importance of cultural systems in shaping sexual practices relevant to HIV transmission and prevention. Since the start of the 1990s, this emphasis on cultural analysis has taken shape alongside a growing anthropological research focus on structural factors shaping vulnerability to HIV infection. Work on social inequality and the political economy of HIV and AIDS has been especially important. Much current research seeks to integrate both cultural and structural concerns in providing an alternative to more individualistic behavioral research paradigms.

Sexuality, Culture, and Power in HIV/Aids Research

Anthropology and AIDS: the cultural context of sexual risk behavior among urban Baganda women in Kampala, Uganda.

Social scientists interviewed 65 HIV-infected Baganda women (cases) and 65 HIV-free women (controls) attending the pediatric clinic at Mulago Hospital in Kampala Uganda to examine cultural determinants of sexual risk behaviors for AIDS. These 17-30 year old women did not know their serostatus. Baganda society expects women have sex only with their husbands while it allows husbands to have >1 partner. All women averaged 1 sexual partner in the last year for fear of infant death if they had sex with anyone other than the childs father during pregnancy or lactation. Yet over the last 5 years cases had more partners than controls (2.5 vs. 2; p=.001). Cases were more likely to report that it was traditionally expected for women to have sex with other men during certain times such as funerals and weddings (37% vs. 20%; p<.05). HIV-positive women were more apt to note economic reasons as justification for having sex with someone other than their husband (47% vs. 35%; p=.05). All the women knew about AIDS. Even though more cases knew that having 1 partner helps prevent AIDS (75% vs. 65%) the difference was insignificant. No significant difference in knowledge of other prevention means existed between the 2 groups. Both HIV-positive women (86%) and HIV-negative women (77%) were afraid of acquiring AIDS through sexual intercourse since they knew their husbands participated in risky behavior. Cases were more likely to have reduced risk behavior particularly by having only 1 partner to avoid AIDS than controls (63% vs. 35%; p<.01). Women who did not change behavior did not change because they already had 1 partner. Only 5% of cases and 3% of controls had ever used condoms. Thus health education programs must address financial needs to motivate women to practice risk reduction behavior. Research is needed to understand sexual behavior to determine whether male sexual behavior poses a great risk of HIV infection in women.

Cultural Determinants of Sexual Risk Behavior for AIDS among Baganda Women

More than 17000 cases of AIDS had been reported in Uganda through 1990 the second highest number of cases in the world over the period. The male/female sex ratio of AIDS cases in Uganda is approximately 1:1 with HIV transmitted mainly through heterosexual intercourse and women having slightly higher HIV infection rates than men. 65 HIV-infected and 65 HIV-uninfected women matched for age and at least 3 months postpartum at Mulago Hospital in Kampala Uganda were interviewed in Luganda the language of the Baganda to determine their sexual behavior and attitudes toward condom use. Study participants were aged 15-30 years (mean age 21 years) and better educated than the Kampala population overall with 92% of cases and 95% of controls literate. Their sociodemographic characteristics AIDS knowledge and prevention and attitudes toward condoms are presented. The women know about AIDS and the threat it poses to their lives. They therefore have limited their number of sex partners in response to the AIDS epidemic. Many however still believe they are at risk of HIV infection because they are unsure whether their husbands are having extramarital sexual relations. Only 5% of the cases and 3% of controls reported ever having used a condom for either protection against sexually transmitted diseases or contraception. No study subject reported current use of condoms. Fears about condom safety and efficacy and the belief that the man will reject condom use are the main reasons why the women in the study reject condom use.

Rebecca Mukasa

Papers

Anthropology and AIDS: the cultural context of sexual risk behavior among urban Baganda women in Kampala, Uganda.

Cultural Determinants of Sexual Risk Behavior for AIDS among Baganda Women

Culture sexual behavior and attitudes toward condom use among Baganda women.

for AIDS among Baganda Women