Although the Bush administration is pushing an HIV prevention approach overseas that stresses abstinence and monogamy as the best methods to prevent transmission of the virus, U.S. researchers report that approach doesn't take into account violence against women and sexual coercion, which are common in some developing nations. Their research, published in the May 1 edition of The Lancet, came in response to a South African study showing that women reporting violence or control by a sexual partner were almost 50% more likely to be HIV-positive than their peers. Two factors were associated with the higher HIV risk--receiving physical abuse from a male partner and being in a relationship with a controlling partner. Abstinence-based HIV prevention efforts also don't take into account that cultures in many developing countries permit men to have sex outside of marriage or that many migrant workers commonly have sex with prostitutes, then bring HIV back to their spouses.
"We postulate that abusive men are more likely to have HIV and impose risky sexual practices on partners," the researchers say. "Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviors in men as well as effective interventions are urgently needed." In an accompanying editorial in The Lancet, Sandra Martin and Sian Curtis of the University of North Carolina write, "Strong emphasis on abstinence among the young will be of limited use in settings in which many young women are forced to have sex against their will."