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Understanding HIV Risk in Married Women

Marital sex is known to be a leading risk factor for HIV infection among women worldwide. Now, an NIH-funded collaborative study including the Mailman School of Public Health reveals that cultural expectations and changing attitudes about love and marriage encourage male infidelity.
   Jennifer Hirsch, Ph.D., associate professor of sociomedical sciences and lead author, conducted the six-month study in a rural Mexican village. She found that the forces that promote extramarital sex – access to alcohol and women; patterns of economically driven mobility; and the segregation of men’s and women’s “spheres” in society and in family life – are pervasive and extremely powerful. While the overall HIV infection rate in Mexico is low at 0.3 percent, certain groups have higher levels. In returning migrants, for example, infection rates are as high as about 1 percent because many men travel to areas such as New York City, where HIV-prevalence is much higher and where they engage in unsafe extramarital sex during their long absences. When migrant workers return to their Mexican wives, they are said to be on their honeymoon and resume marital sexual relations.
   “Women are infected by their returning 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,” says Dr. Hirsch.
   Dr. Hirsch collaborated with anthropologists from Brown, University of Toronto, University of Washington, and Washington University who worked at sites from New Guinea to Vietnam and reported similar findings. These findings have far-reaching implications for public health policy, especially with respect to U.S. funding for AIDS prevention, which requires that a third be spent teaching abstinence and monogamy. “If you tell people to be abstinent until marriage, but their greatest risk of HIV infection actually comes after marriage, it’s not useful advice,” says Dr. Hirsch.
   Dr. Hirsch recommends making condoms available in places where men are likely to meet partners for extramarital sex and exploring ways that migration policies contribute to marital risk. “We found that it’s not as if there are men who engage in extramarital sex and men who don’t. There are contexts in which all men are much more likely to,” she says. “We have to do a better job of thinking about what those contexts are, and working within that framework.”