What Works for Women and Girls

women are at high risk of acquiring HIV (UNAIDS, 2006: 22; Hirsch et al., 2007; Hagemanet al., 2009; Ugonnet et al., 2002 cited in Matovu et al., 2007), particularly in generalizedepidemics. An estimated 55% to 92% of new heterosexually acquired HIV infections amongsexually active adults in urban Zambia and Rwanda occurwithin serodiscordant martial/cohabitating relationships.“Two kinds of women run thegreatest risk: the one who stayshome and trusts her husband andthe one who turns tricks.”—Brazilian woman (Hebling andGuimaraes, 2004: 1213)Couples interventions to reduce transmission in serodiscordantrelationships could have a large impact on theepidemic (Dunkle et al., 2008).It is critical that partners know their serostatus and practicesafe sex. Both married and unmarried women needbasic knowledge of HIV and how to prevent transmission.However, married women are often not reached by preventionmessages because married women “were not consideredpart of the so-called risk groups. Prevention effortshave been focused on pregnant women, sex workers, and IDUs. Therefore, the majority ofwomen received a message of false security that women who are married and monogamoushave no risk for acquiring HIV” (Ross Quiroga, 2006:1–2). Despite the fact that HIV transmissionoccurs within stable partnerships or marriage, a review of the literature on couples’HIV prevention found that “couples-focused approaches to HIV prevention are still in an earlyphase of development” (Burton et al., 2008: para 8).Changing Gender Norms in Multiple Partnerships is CriticalMultiple partnerships is closely tied to gender norms of masculinity, where men are required tohave multiple sexual partnerships simultaneously, be unfaithful to their regular sexual partnerand buy sex as proof of their masculinity (Peacock et al., 2008). Many women are unawarethat their husbands or sexual partners may have other sexual partners. Married adolescentgirls are particularly vulnerable and are often more at risk of HIV infection than unmarriedsexually active girls. For example, a study analyzing Kenyan and Zambian data from 1997and 1998 found that married adolescent girls living in urban areas had higher incidences ofHIV infection than unmarried sexually active girls in the same age group. “Although marriedgirls are less likely than single girls to have multiple partners, this protective behavior may beoutweighed by their greater exposure via unprotected sex with partners who have higher ratesof infection” (Clark, 2004: 149). In sub-Saharan Africa, both women and men may be theHIV-positive partner. Additional risks are posed by polygyny, i.e. legal or customary marriagewith multiple wives, with low rates of condom use and unequal power relations (Bove andValeggia, 2009).Reducing Concurrent Partnerships Can Reduce HIV TransmissionReduction of concurrent partnerships has been shown to effectively reduce HIV transmission;“there are, however, few demonstrated replicable approaches to reducing multiplesexual partnerships on a large scale” (Potts et al., 2008: 750). There is currently program-64 CHAPTER 3 PREVENTION FOR WOMEN