What Works for Women and Girls

of HIV acquisition, but were either unaware of the risk or did not believe they were at risk.Studies found that extra-relational sex on the part of the husband was common.Gap noted, for example, in Ethiopia (Molla et al., 2008); India (Kumar, 2008; Chatterjeeand Hosain, 2006). Zimbabwe (Callegari et al., 2008; Feldman and Masophere, 2003);Mexico (Hirsch et al., 2007; Pulerwitz et al., 2001); Kenya and Zambia (Glynn et al.,2001; Glynn et al., 2003); Kenya and Zambia (Clark, 2004).2. Interventions are needed to reduce homophobia, which may lead MSM to have partnershipswith women. Studies found that homosexuality was heavily stigmatized and thatgender norms pressured MSM to marry and have families.Gap noted, for example, in China (Zhou, 2006): and India (Hernandez et al., 2006).3C. Prevention for Women: Male CircumcisionMale circumcision has now been shown in three randomized clinical trials to reduce the riskof HIV acquisition for men by 50–60% (Auvert et al., 2005; Bailey et al., 2007; and Gray etal., 2007). Male circumcision at birth as part of postnatal care could result, upon sexual initiationand for his lifetime, in a reduction in the risk of HIV acquisition and transmission. Theevidence for rolling out male circumcision is incontrovertible. However, given evidence thatmale circumcision could potentially put women at an increased risk for HIV under certaincircumstances in the short term, how best to roll out programming through gender-equitableapproaches that do not increase short term HIV risks for women remains to be evaluated.“The roll out of male circumcision presents [an ideal opportunity] to …provide interventionsto transform harmful gender attitudes and behavior as part of programming of the roll out ofmale circumcision… (Greig et al., 2008: S37–8). “Outside the clinical trial setting, the effectthat the decreased perceived risk of HIV infection will have for circumcised men’s willingness(and women’s ability to negotiate) condoms requires close monitoring’ (Gruskin andFerguson, 2008a). Women will benefit in the long run from male circumcision, as fewer oftheir male sexual partners will be HIV-positive. Clear and consistent messages must emphasizethat male circumcision is an additional prevention method for men, but that it does notreplace measures such as delay in the onset of sexual relations, avoidance of penetrative sex,reduction in the number of sexual partners, and correct and consistent use of male or femalecondoms.With roll out of male circumcision, it is critical for men to wait until they are fully healed toengage in sex since sex for an HIV-positive man prior to the wound fully healing increases therisk of transmission to his female partner (Wawer et al., 2009). If a man refuses an HIV test,is circumcised and thinks he is protected, then “his partner is in a worse position than before”(Berer, 2008a: 172). “As sexual partners, women should not abandon negotiation of condomuse with circumcised men, and this will be greatly facilitated if everyone understands that withWHAT WORKS FOR WOMEN AND GIRLS67