PETRA: Module 1, Chapter 3

Societies and cultures provide individuals with the meanings, practices, and institutions that both inform – and are informed by – their thoughts, feelings, and behaviors. Societies and cultures also attach values to different demographic variables, like race and gender, and determine how resources are distributed. In these ways, sociocultural factors interact with behavioral, biological, psychological, and demographic factors to shape people's risks of giving and getting HIV.

Global Inequality
The world's economic resources are concentrated in a few places--for example, the United States. However, illnesses like HIV/AIDS flourish in places with few economic resources. Currently, rates of HIV mortality are declining the United States, in part because many (although not all) Americans have access to adequate health care and risk information. Also, the United States has enough educated people, technology, and money to discover and manufacture anti-HIV drugs. In other parts of the world that don't have access to adequate knowledge, resources, and technology, however, rates of HIV/AIDS are climbing. CITES? OTHER READINGS ON THIS TOPIC?

Stigma and Discrimination
Different races, ethnicities, genders, sexual orientations, and HIV disease statuses (positive or negative) are not inherently good or bad. Rather, all societies and cultures construct attitudes toward these different groups. Those groups that are less valued, such as racial/ethnic minorities, women, homosexuals, and HIV+ people, are considered stigmatized. Within a society, people are more likely to discriminate against members of stigmatized groups. People who have been stigmatized or discriminated against are often more likely to have greater risk factors for HIV/AIDS.

Gender Roles and Inequalities
Gender roles are a society's ideas about what is "masculine" and "feminine" and are a powerful feature of social organization. They not only describe how men and women are expected to behave, but also influence power relations, decision-making authority, and individual responsibility (3).

To ensure that women are dependent and inexperienced and that men are independent and experienced, younger women in many cultures marry older, more sexually experienced men. This practice puts the young wives at risk of acquiring HIV and other STI/STDs from their husbands (7).
Girls may also be discouraged from seeking the education and employment that would give them the knowledge to protect themselves against HIV/AIDS (7).
Due to their lack of power within sexual relationships, many women find it difficult to negotiate for safer sex with their partners (8). Many gay men also experience difficulties requesting that their sex partners use condoms (9).
Growing economic inequality and eroding social support have driven many women into commercial sex work to support their families (10).

Specific cultural practices that relate to sex

Many cultures circumcise young women and men as a rite of passage into adulthood. When a number of people are circumcised together, using shared razors or knives, the young women and men are at risk of transmitting and contracting HIV via the blood on the unsterilized instruments (3).
Many cultures also value "dry sex," which requires that women dry their vaginas using special powders, herbs, or douches. These practice increase rates of HIV transmission, however, because dry sex is more likely to lead to the cuts and tears through which HIV infected fluids may pass.

References:
1. Albertyn, C. Prevention, treatment, and care in the context of human rights. Presentation at the Expert Group Meeting on the HIV/AIDS Pandemic and its Gender Implications, Windhoek, Namibia, 2000.

2. Aggleton, P. Khan, S. and Parker, R. Men who have sex with men. In: Gibney, L., DiCelmente, R., and Vermund, S. (eds.) Preventing HIV in Developing Countries: Biomedical and behavioural approaches. New York, NY: Kluwer Academic/ Plenum Publishers, 1999.

3. Feinstein, N. and Prentice, B. The UNAIDS Gender and AIDS Almanac. Los Altos, CA: Sociometrics Corporation, 2001.

4. World Health Organization (WHO). Integrating gender into HIV/AIDS programmes, review paper for expert consultation 3 – 5 June 2002. Geneva, Switzerland: World Health Organization, 2002.

5. Joint United Nations Programme on AIDS (UNAIDS). Gender and HIV/AIDS: Taking stock of research and programmes. UNAIDS Best Practice Collection. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 1999.

6. Türmen, T. Gender and HIV/AIDS. International Journal of Gynecology and Obstetrics, 82: 411-418, 2003.

7. Commonwealth Secretariat. HIV/AIDS: An Inherent Gender Issue. London, United Kingdom: The Commonwealth Secretariat/ UNIFEM, 2001.

8. Kippax, S., Crawford, J., Davis, M., Rodden, P. & Dowsett, G. Sustaining safe sex: A longitudinal sample of homosexual men. AIDS, 7, 257-263, 1993.

9. Weiss, E., Whelan, D., and Gupta, G. Vulnerability and Opportunity: Adolescents and HIV/AIDS in the developing world. Washington, DC: International Center for Research on Women, 1996.

10. Mathur, S., Greene, M., & Malhotra, A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center for Research on Women, 2003.