Haitian women"s role in sexual decision-making : the gap between AIDS knowledge and behavior change

This study used the focus group method with 12 groups of women and 6 groups of men in Port-au-Prince and Les Cayes to explore beliefs and practices regarding sexual behaviors that could increase the risk of HIV transmission to women. The study found that both men and women were well aware of the heterosexual nature of AIDS, but held inaccurate views of other modes of transmission; there appeared to be little understanding of the danger of perinatal transmission. Women were keenly aware of the severity of AIDS -- especially its destructive effect on families and children -- and of their own susceptibility. Women agreed that without earning power they receive little respect at home and have little opportunity to negotiate sexual behavior. Women often condone their husbands" sexual errancy in order to maintain a harmonious long-term union. The value of condoms in protecting against HIV transmission was common knowledge, but many women associated condoms with risk of female genital disease and admission of infidelity or HIV infection. Men were more likely than women to believe that men would agree to use a condom, but both tended to place the responsibility on women to convince their partners via demonstrations of affection and tactful persuasion. Women (more often than men) advised that a woman should refrain from sex with a promiscuous partner or even abandon him; however, both men and women acknowledged the risk of male retaliation and loss of financial support. Both men and women believed that women"s refusal of sex would encourage men to seek partners outside the home. Men (and some women) thought women should increase sexual activity with a promiscuous partner to keep him off the street. Women expressed a strong sense of responsibility for counseling sexually active children to protect themselves from AIDS, but they doubted that young people would comply, and other than stern warnings, they had few suggestions or ideas for how to influence adolescent sexual behavior. The majority felt that adults should advise adolescents to use condoms, but some vigorously disagreed. Women also felt responsible for advising other women to protect themselves from HIV by negotiating safe sexual behavior with promiscuous partners or by altering their own risky behavior. However, some feared such advice might be taken as intended to defame character or destroy a relationship. These findings indicate an urgent need to intervene in the advancing AIDS epidemic at the level of behavioral norms and expectations that currently deny most Haitian women the right to protect themselves and their families from the disease. An action plan based on these findings is detailed. Includes references.