What Works for Women and Girls

A study of trends from Demographic and Health Surveys in 1993 and 2001 in 18 countriesin Sub-Saharan Africa shows condom promotion has increased condom use amongfor single women: from 5% in 1993 to 19% in 2001. Preventing pregnancy is a majormotive for single women, suggesting that marketing campaigns positioning condomsfor pregnancy, rather than disease, prevention may be more successful. Condoms arealso beginning to permeate into marriage in East and Southern Africa (“occasional use”reported in 10–21% of both husbands and wives in three national settings—Kenya, SouthAfrica and Uganda), suggesting that promoting condom use within marriage can savelives by preventing HIV transmission within serodiscordant married couples (Clelandet al., 2006a). (Gray V) (condoms, pregnancy, Kenya, South Africa, Uganda, Sub-SaharanAfrica)7. Increasing couple communication about HIV risk can increase preventive behaviors,including condom use.A qualitative and quantitative study in three districts in rural Malawi that analyzed datacollected in 1998, 1999, and 2001 found that both informal and formal sources of informationon HIV/AIDS were important factors influencing AIDS-related communicationbetween spouses. 1,541 ever been married women ages 15–49 and 1,065 husbandswere surveyed in 1998, a randomly chosen sub-sample of the original cohort was interviewedin 1999, and a follow-up interview was conducted in 2001 among 80 men and76 women. Study findings indicated that couples where both the husband and wifehad accessed accurate information about AIDS from sources such as health clinics andsocial networks were significantly more likely to have discussed risk of HIV infectionwith their spouses. Greater levels of exposure and involvement with social programswere significantly associated with the likelihood of having discussed HIV with partners.The size of the woman’s social network was a significantly determinant in whetheror not HIV discussions among couples took place. Discussion between spouses aboutHIV was more likely to have occurred when both spouses had reported being concernedabout infection. Women most often initiated discussion, in response to concern overinfidelity. It is important to note that both women and men reported believing thattheir fates were directly joined with those of their spouses: if one became HIV-positivethan the other would as well. Discussions related to HIV were usually initiated withHIV/AIDS-related information discussed over the radio or in a health clinic. Whenasked, however, if an individual could be satisfied with only one sexual partner, 40%of men and 33% of women did not think it was possible. Lastly, while the importanceof fidelity in marriage was discussed between couples, condoms were never presentedas an option for HIV prevention within marriage. In the one instance where a wife didreport discussing condoms with her husbands, she claimed to have advised him to usecondoms with his “other partners” (Zulu and Chepngeno, 2003). (Gray III) (communication,sexual partners, marriage, Malawi)WHAT WORKS FOR WOMEN AND GIRLS59