Choice is empowering: Getting strategic about preventing HIV infection in women.

Since the late 1980s and early 1990s we have come a considerable distance in recognizing that successful HIV prevention work among women means the adoption of a woman-centered paradigm one that is grounded in womens realities and acknowledges gender roles and gender-based power differentials as critical factors in womens ability to make and effect decisions regarding their health and welfare. We have learned that most women around the world cannot control male condom use and we have begun to understand that womens attitudes toward and use of protective methods are based on personal relational sociocultural and structural factors with a different mix for each woman. HIV prevention has required us to work on two levels: to achieve long-term structural change in womens status and to provide women with tools for protection over the short term. We have now recognized the limits of a sole dependence on the male condom. Although this device is highly effective against sexually transmitted pathogens when used correctly and consistently male control over the male condom undermines its real-world impact. As a result large-scale male condom campaigns over the first two decades of the HIV epidemic have been inadequate as a public health strategy. Recent studies of U.S. women at high HIV risk show that the proportion of protected sex acts rarely exceeds 15% a statistic that has not changed over the past decade. Women in developing countries are often not protected at all. (excerpt)