‘Be faithful’: Cultural, social, and economic contradictions of the ABC message and married women’s HIV risk in Uganda


Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

5067.0: Wednesday, December 14, 2005 - 9:45 AM

Abstract #116177

‘Be faithful’: Cultural, social, and economic contradictions of the ABC message and married women’s HIV risk in Uganda

Shanti Parikh, PhD, Anthropology, Washington University, McMillan Hall, Campus Box 1114, St. Louis, MO 63130, 314-935-7769, shanti.parikh@wustl.edu

TOPIC: Uganda is cited as the success story for HIV reduction in Africa, and the ABCs are credited for this decline. This paper examines this claim by presenting findings from an ethnographic study exploring married women's HIV risk, changing notions of marital love and infidelity, and economic and social inequalities. METHODS: Data collected for 6 months included 33 marital case histories, 11 key informant interviews, archival research (mass media, legal documents, and marital advice), and participant observation in social spaces and marital socializing. FINDINGS: Data on extramarital sex (EMS) differ depending on the collection technique. While DHS shows a decline in EMS for males, ethnographic methods reveal less decline, but rather indicate a shift in how husbands rationalize and categorize EMS. Most married men in this study engage in EMS, including long-term relationships, casual sex nearby, and casual sex while away at conferences or work. Some forms of EMS are replacing the historical practice of polygyny. Other EMS is enabled by specific economic conditions (poverty, mobility), social factors (kinship organization, lack of marital socializing, availability of unmarried females) and cultural factors (male marital dominance, marital residential patters, limited female sexual autonomy). Examining how EMS changes over the marital life cycle, newly married women are at greater risk of HIV infection. IMPLICATIONS: In Uganda, the ABC approach that narrowly focuses on individual behavior is limited in situations where EMS is a structural aspect of society. For effective marital HIV prevention, interventions need to consider structural sources of married women's HIV risk.

Learning Objectives:

Learning objectives

After having listened to this presentation, audience members will be able to
- • Describe the methods and rationale for using ethnographic methods and extended marital case study (MCS) interviews as part of research on sexuality and HIV transmission
- • Discuss how the MCS interviews combined with participant observation can create a data set from which findings can be generalized to a rural community in east Africa
- • List the primary kinds of extramarital relationships in which men and women in the community engage, including their HIV risk behaviors, social and economic exchanges, and relative levels of public visibility;
- • Discuss the social, economic and cultural factors that underlie and influence these risk behaviors,
- • Discuss how husbands rationalize their extramarital affairs as not falling into the category of infidelity
- • Articulate the implications for prevention policy of these findings on the structural nature of married women’s HIV risk.
Keywords: HIV/AIDS, Gender
Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation

HIV/AIDS Risk for Married Women
The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA