What Works for Women and Girls

“Reflections on men and HIV/AIDS are usually limited totheir culpability as drivers ofthe epidemic. Addressing theseissues effectively means movingbeyond laying blame, and startingto develop interventions toencourage uptake of prevention,testing and treatment for men—for everyone’s sake”(Mills et al., 2009: 276).to partner’s behavior, rather than the woman’s behavior.Women who had ever had a violent partner were more thantwo times as likely to report being at risk for HIV; womenwho were coerced to have sex and/or felt that their currentpartners would react negatively if she refused sex without acondom were more than three times as likely report beingat risk for HIV (Kelvin et al., 2008). A survey of 126 peoplein South Africa found that women felt at risk of contractingHIV because of the multiple partnerships of their currentmale partner, but felt disempowered to do anything tochange their risk of acquiring HIV (Ngema et al., 2008). Astudy of 50 low-income Chilean women found that “womenwho are vulnerable to HIV do not perceive themselves atrisk. They believe that HIV is something that happens tohomosexually active men or to [sex workers], not something that happens to women in a stablerelationship” (Cianelli et al., 2008: 298).Traditional Gender Norms Also Hurt MenMen are also affected by gender norms that define masculinity as including early, risky sexwith multiple partners (WHO, 2007a; Barker et al., 2007b). A survey of 1,268 respondentsin Botswana who held three or more gender discriminatory beliefs had nearly three times theodds of having unprotected sex in the past year with a non-primary partner as those who heldfewer gender discriminatory beliefs (PHR, 2007a). Homophobia makes men who have sexwith men more likely to marry a woman to diminish stigma and legal or other consequences,where homosexuality is illegal (White and Carr, 2005. [See also Chapter 3B. Prevention forWomen: Partner Reduction] In many settings, men also tend to be socialized to be less inclinedthan women to engage in health seeking behavior. Furthermore, the sexual health concerns ofmen living with HIV and AIDS are frequently neglected in program efforts and men often lackinformation on how to lead a healthy sex life (Esplen, 2007). A study in China with ten AIDShealth professionals and 21 adults living with HIV found that “power differentials betweenmen and women, men’s dominant role in sexual life and their ignorance about HIV/AIDSand its prevention contribute to the increasing HIV risk faced by women (Zhou, 2008). Asurvey of 185 young men and women in India found that young men were more likely to havehigher AIDS knowledge, to perceive themselves to be at risk for contracting HIV, have higherself-efficacy of using condoms correctly, buying condoms, having a condom when needed, andbelieve that it is acceptable to have multiple partners (Seth et al., 2008). In Papua New Guinea,in-depth interviews with 86 people, half female, found that women reported that a woman’srefusal of sex would drive the husband to seek sex elsewhere (Dover and Levy, 2008).Ideas that equate masculinity with sexual risk-taking and being in control of women havebeen shown to be associated with less condom use, more partners, more casual partners andmore transactional sex (Greig et al., 2008). A qualitative study of six groups of 5 to 10 partici-290 CHAPTER 11 STRENGTHENING THE ENABLING ENVIRONMENT