According to this study, marital sex is the single greatest HIV risk for women around the world.
Marital infidelity by men is so deeply ingrained across many cultures, say Mailman School of Public Health researchers, 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—trying to eradicate it.
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.
"The result is that women are infected by their husbands, the very people with whom they are supposed to be having sex and, according to social conventions of Mexico, the only people with whom they are ever supposed to have sex,” said Dr. Hirsch. "This challenges existing approaches to HIV prevention. It renders abstinence impossible and unilateral monogamy ineffective. Marital condom use is also not a serious option, because of women’s deep, culturally supported commitment to the fiction of fidelity.”
In New Guinea, researchers also saw labor migration as a major contributor to infidelity. Moreover, many men did not view sexual fidelity as necessary for achieving a happy marriage, but they viewed drinking and "looking for women” as important for male friendships.
In the Nigerian study, the social organization of infidelity was shaped by economic inequality, aspirations for modern lifestyles, gender disparities, and contradictory moralities. There, it is men’s anxieties and ambivalence about masculinity, sexual morality, and social reputation in the context of seeking modern lifestyles – rather than immoral sexual behavior and traditional culture – that exacerbate the risks of HIV/AIDS.
According to Dr. Hirsch, the policy implications of these findings are clear. "This study has direct implications for the types of prevention programs we should be supporting,” she observes. "We might find men’s persistent and widespread participation extramarital sex to be troubling – but it’s a deeply rooted aspect of social organization, and one that is unlikely to be easily changed. Public health programs alone can’t stop extramarital sex, so we need to think about how to reduce the risk. Saying that ‘be faithful’ will protect married women is not true – unilateral monogamy is not an effective prevention strategy.”