For many women around the world, marital sex represents their single greatest risk for HIV infection. That's according to a new Mailman School of Public Health Study, which notes that marital infidelity by men is deeply ingrained across many cultures and that current HIV prevention efforts encouraging men to be monogamous are unlikely to be effective.
Appearing in the American Journal of Public Health, the study examined male infidelity and HIV risk in Mexico, New Guinea and Nigeria. Cultural influences were identified as being key across all countries.
In rural Mexico, reputation is a critical aspect of sexual identity, and provides insight into why people act in ways that are socially safer, but physically risky. "What we found in our research was that notions of reputation in this community led to sexual behavior designed to minimize men's social, rather than viral, risks," said lead researcher, Jennifer S. Hirsch. "We also saw that men's desire for companionate intimacy actually increases women's risk for HIV infection."
The researchers noted that a major factor was that married men 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. When men return home, they are said to be "on honeymoon" again, which includes resuming marital sexual relations. "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," said Hirsch.
In New Guinea as well, the researchers found commuting for work to be 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, it was men's anxieties about masculinity, sexual morality, and social reputation that exacerbated the risks of HIV/AIDS.
Hirsch said that two additional studies were now underway in Uganda and Vietnam, and were expected to show similar results. She believes that rather than preaching fidelity, male infidelity needs to be accepted and addressed through HIV prevention campaigns. "We might find men's persistent and widespread participation in 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."
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Source: Columbia University's Mailman School of Public Health