Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa

Abstract

Background: Women in sub-Saharan Africa bear the brunt of the human immunodeficiency virus (HIV) epidemic, and older married women and those in cohabiting relationships are regarded as the largest HIV risk group. Although preventing HIV infection in married or stable relationships is an international HIV prevention priority, little is known about the influence of sociocultural contexts on safe-sex practice by women, particularly older women in rural communities in South Africa. Objectives: This study aimed to examine how older women in a rural patriarchal society negotiate safer sex within marital and long-term cohabitation relationships, and their perceptions and experiences of barriers that influence condom use. Methods: Focus group discussions were conducted with married and cohabiting women aged 40–60 years recruited from primary health facilities in a rural district in Mpumalanga province, South Africa. A thematic analysis approach was used to analyse the data. Results: We found that although women reported negotiating safe sex in their relationships, they dreaded the possible consequences of suggesting condom use with their partners. Many factors made negotiating safe sex complex for these women: living in a patriarchal society where women play no part in sexual decision making, the fear of possible consequences of insisting on condom use, women’s inferior social position in marital relationships, cultural practices such as bride price, and gender inequality were the main barriers to practising safer sex. Conclusions: Older married and cohabiting women dreaded negotiating safer sex in this patriarchal society where women’s subordination is legitimized. The findings suggest that the women were at high risk of HIV infection because of their inability to negotiate condom use, or to reject forced sex and non-consensual sex. There is a need for interventions targeting older married and cohabiting couples and key stakeholders within communities to create awareness about cultural practices and beliefs that undermine women and HIV prevention efforts.

Modern contraceptive use among female refugee adolescents in Northern Uganda: prevalence and associated factors

“…This is as explained by the gender and power theory (28). The fact that gender and power imbalances deepen with increasing age disparities within couples has been confirmed in previous studies (29,30).…”

“My partner was not fond of using condoms and I was not on contraception”: understanding adolescent mothers’ perspectives of sexual risk behaviour in KwaZulu-Natal, South Africa

“…In recent years, there has been an increasing interest in the 'blesser and blessee' phenomenon as a driver of the HIV epidemic [30]. Older, rich men are known as 'blessers' who tempt young women ('blessees') by providing them with money and gifts for sexual favours [28]. According to the participants in the current study, sex is transacted for money and gifts by older men.…”

“…Adolescent repeat pregnancy is undeniably a symptom of the growing problem of high risk sexual behaviour among previously pregnant adolescent girls and mothers [18]. Patriarchy and gender power imbalances in South Africa have been recorded as influential in the sexual behaviour of and the relationships that young women forge [26][27][28][29]. It is therefore a concern that the most significant public health threat to curbing HIV infection in South Arica seems to be the romantic relationships and transactional sex that are prevalent between older men and younger women [30,31].…”

I’m Not Sure This Is Rape, But: An Exposition of the Stealthing Trend

“…This high prevalence exists despite the placement of age of consent laws that are meant to protect girls at vulnerable ages (Harrison et al, 2017). Madiba and Ngwenya (2017) contend that the hegemony of patriarchy in SSA renders women defenseless against gender and sexual violence and limits the bargaining power that they have to negotiate sexual relations and condom use, which invariably threatens their sexual and reproductive health (Fiaveh et al, 2015). Although socially constructed and culturally sanctioned power relations between men and women mediate the terms on which women engage in sexual relationships, sexual agency is important in how women manage dominant masculinities and their own sexual and reproductive health (Fiaveh et al, 2015).…”