LECTURE 5

FACTORS ENCOURAGING TRANSMISSION OF HIV/AIDS

Multiple Sexual Partners: Gender inequality and patriarchy (social structures where men take

primary responsibility and dominate in their households) encourage multiple sexual partners

for men inside and outside of marriage, while women are required to be faithful and

monogamous. Such socio-cultural practices and norms make men and their partners especially

vulnerable to HIV. Luhya, Luo communities and Kalenjin communities in Kenya take women

as part of children in the house and have to follow the orders of the usually authoritative

husband. The Husband decides on when to sleep with the wife or spend a night elsewhere and

no question from the wife. In a study in Zimbabwe, one in eight married men said they had

casual sex (more than one sexual partner in the previous twelve months), but only one in one

hundred women said they had sex outside marriage. In these circumstances marriage puts

women at the greatest risk of HIV infection instead of protecting them. Further, masculinity

demands that men be sexual risk-takers, with lack of knowledge of HIV and reluctance to use

condoms, these practices put men and female partners at risk of HIV. In this context, the

dangers of multiple sexual partners relates to the fact that if one person in a «circle» of partners

gets infected with HIV, there is a very high likelihood that all persons involved will be

infected.

Behavior factors
Promiscuity

This is a major cause of HIV across the globe, but Africa has its share of challenges as

many individuals have more than one sexual partner. Prostitution is rife in the continent

and people do not take issues to do with infidelity seriously. Multiple sexual partner

risks HIV transmission, as well as having sex with single HIV infected person.

- Unprotected sexual intercourse (infected person)

- Drug and alcohol abuse is rampant among the youth.

- Sharing of injections among drug users is the most common HIV transmission

method.

- Alcoholics are often unable to make wise decisions pertaining engaging in

sexual activities exposing themselves to a myriad of risks.

Single infected person

HIV is spread can be spread from a single infected person through:

 Having oral sex with an HIV-positive partner.

 Receiving blood transfusions, blood products, or organ/tissue transplants that are

contaminated with HIV. However, currently the risk is low due to the rigorous testing

of blood supply and donated organs and tissues.

 Being bitten by a person with HIV cause a risk of HIV transmission especially where

the tissues are damaged. 

 Contact between broken skin, wounds, or mucous membranes and HIV-infected blood

or blood-contaminated body fluids.

 Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from

the HIV-positive partner gets into the bloodstream of the HIV-negative partner.

 Eating food that has been pre-chewed by a person with HIV. The contamination occurs

when infected blood from a caregiver’s mouth mixes with food while chewing. This

risk is more common to the infants.

Contaminated equipments
  Needlestick injuries are most like to happen among healthcare workers who are

accidentally exposed to infected blood (occupational exposure). It is estimated that

around three million such needlestick injuries take place globally each year.

 The risk for getting or transmitting HIV is very high if an HIV-negative person uses

injection equipment that someone with HIV has used. This is because the needles,

syringes, or other injection equipment may have blood in them, and blood can carry

HIV. HIV can survive in a used syringe for up to 42 days, depending on temperature

and other factors

 Blood-borne viruses that could potentially be transmitted this way include hepatitis B

and hepatitis C, as well as HIV. The risk of transmission following a skin puncture

injury is dependent on whether the person who previously used the object had an

infection, the level of virus in their blood, the amount of blood involved, the type of

needle or syringe in question, the time that has elapsed since it was used, and the nature

of the injury.

 The risk of transmission from a needlestick involving HIV-containing blood has been

estimated at 0.23%, or just over one in 500.

 The greatest risk to healthcare workers of acquiring HIV is following a skin puncture

injury involving a hollow needle that has been in the vein or artery of an HIV-positive

person who has late-stage disease and a high viral load.

Circumcision: Circumcision both for boys and for girls because of (1) sharing of knives or
razor blades. (2) the circumcision (cultural) are not always hygienically done.
Tattooing and scarification also expose young people to the risk of HIV/AIDS.

HIV Viral Load Affect Getting or Transmitting HIV?

 Viral load is the amount of HIV in the blood of someone who has HIV. Taking HIV

medicine (called antiretroviral therapy or ART) daily as prescribed can make the viral
 load very low—so low that a test can’t detect it (this is called an undetectable viral

load). People with HIV who take HIV medicine daily as prescribed and get and keep an

undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative

partner through sex.

 HIV medicine is a powerful tool for preventing sexual transmission of HIV. But it

works only as long as the HIV-positive partner gets and keeps an undetectable viral

load. Not everyone taking HIV medicine has an undetectable viral load. To stay

undetectable, people with HIV must take HIV medicine every day as prescribed and

visit their healthcare provider regularly to get a viral load test.

Socio-cultural factors influencing vulnerability to HIV

Marriage: Gender inequality in marital relations, especially in sexual decision-making,

increases vulnerability to HIV transmission. Trends in current data on new HIV infections

suggest that the incidence of HIV is rising among married women and girls worldwide, with

unsafe and unprotected heterosexual intercourse being the single most important factor in the

transmission of HIV among women. Marriage, which greatly increases women’s sexual

exposure, has in itself become a risk factor for women and girls in many countries, for example

it is more dangerous for a woman to getting married to a polygamous husband in the name of

inheritance (Luo and Luhya culture) The dramatic rise in the frequency of unprotected sex after

marriage is driven by the implications of infidelity or distrust associated with certain forms of

contraception such as condoms, a strong desire to become pregnant, and an imbalance in

gender power relations. This results in women’s increased inability to negotiate safer sex. In

spite of having knowledge of their spouse’s extra-marital sexual interactions, women are often

unable to protect themselves due to an imbalance of power within relationships created by

economic and emotional.

communities especially in Africa, allows husbands to have more than one wife. Polygamy

operates to create concurrent sexual networks within marriage between multiple wives and

their husband, and in addition to any extra-marital sexual contacts the spouse may have. Direct

sexual transmission of HIV can occur in these concurrent sexual networks where the virus is

introduced through the spouse’s extra-marital sexual contacts or where a new wife who is

already HIV positive enters the polygamous union. In luo community for example, polygamy

is widely accepted with no room to HIV testing and condom use before picking on a new wife.

Direct sexual transmission of HIV can occur in these concurrent sexual networks where the

virus is introduced through the spouses' extra-marital sexual contacts or where a wife who is

already HIV positive enters the polygamy union. The place of women in society increases the

risk oh HIV transmission by undermining women's ability to negotiate condom use, to insist on

partner fidelity becomes further complicated in polygamous households given that multiple

wives are often reliant on one husband for material survival. The economic hardship, lack of

knowledge and lack of emotional attention associated with polygamy can lead to engage in

extramarital sexual relationships.

Patriarchy: Male domination: It has been observed that male behavior contributes to HIV

infection. They have more power to determine where, when and how sex takes place. Hence

the theme of the year 2000 World AIDS Day-Men Make a Difference. Also, Women's

economic dependence on marriage or prostitution-which rob them of control over the

circumstances of sex or safety of sex. E.g. for a Somali woman to be consulted on any decision

(leave alone about sex) she has to bear her husband two sons first! Male dominance tends to

lead to lack of interpersonal skills to negotiate safe. Even married couples lack the

interpersonal skills to negotiate safe sex- as coitus occurred on average three times a week and
its timing was under the control of the husband (condom use was neglected due to its

association with infidelity

Early Marriage: Early marriage severely increases young girls’ vulnerability to HIV as they

are most likely to be forced into having sexual intercourse with their (usually much older)

husbands. Young girls have softer vaginal membranes which are more prone to tear, especially

on coercion, making them susceptible to HIV and other STIs. Older husbands are more likely

to be sexually experienced and HIV infected. The dramatic rise in young married girls’

exposure to unprotected sex is driven by pressure to bear children and their inability to

negotiate safe sex. The significant age gap in spouses also further intensifies the power

differential between husband and wife, which in turn discourages the open communication

required to ensure uptake of voluntary counseling and testing for HIV, sharing test results and

planning for safe sexual relations throughout the marriage. In Kenya the Turkana community is

struggling with early marriages arranged between an older man with under aged girls in the

name of parents getting cows as wealth. Often girls are under pressure to prove their fertility

and acquire status within the family. Studies show that for many women, marriage equates the

end of condom use and the increase in sexual activity. Married girls are bound to have more

frequent sexual activity than their unmarried counterparts and are less likely to have the power

to be able to control sexual activity. Marriage, which greatly increases women's sexual

exposure, has in itself dramatic rise in the frequency of unprotected sex after marriage since the

use of certain forms of contraception such as condom is associated with infidelity or distrust

among the spouses. At the same time parents are unable to talk to their daughters before their

marriages about sexual matters and sexual relationships. This lack of knowledge and informed

discussion has also led to the spread of HIV. Women have increased inability to negotiate safer

sex. In spite of having knowledge of their extra marital sexual interactions, women are often
unable to protect themselves due to lack of power within relationships created by culture,

economic and emotional dependence.

Harmful Cultural and Traditional Practices: Harmful cultural practices such as

widowhood-related rituals, sexual cleansing and female genital cutting heighten the risk of

HIV transmission. These practices are often justified in the name of cultural values and

traditions. No doubt cultural values and traditions are important to community identities, but it

is important to realize that they cannot be continued at the cost of the right to health of the

individual. Wife inheritance: Is a deep-rooted tradition widely practical by Luo groups in

Kenya, Uganda, Tanzania, Democratic Republic of Congo and in both North and Southern

Sudan. The widows sometimes have sexual intercourse with a male relative of the deceased as

ritual “cleansing” before she can be inherited or remarried. In a situation where either of the

couples have HIV they will pass to one other. This practices leads to sexual networking

whereby men who inherit widows have multiple sex partners. High frequency of exchange

between widows (often with low levels of condom use.) For example a study by Okeyo and

Allen (1994) on the “The influence of widow inheritance on the epidemiology of AIDS in

Africa” published in the Africa Journal of Medical practice found that: 80% of men who

inherited widows were married and that 1/3 of them had histories of inheriting other widows.

Gender-based Violence: Gender-based violence has become common place in almost all

societies. Violence has many facets. Within the household this can include battering by an

intimate partner, marital rape, dowry-related violence, and sexual abuse. Violence outside the

home can include rape, sexual abuse, sexual harassment and assault. Various social, cultural,

and religious norms produce and reinforce gender inequality and the stereotypical gender roles

that underpin gender-based violence. Gender-based violence is a key factor in increasing risk

of contracting HIV. Violence increases vulnerability to HIV infection in several ways. Sexual
violence can result in ‘direct transmission’ of HIV which can be the result of forced or coercive

sexual intercourse with an HIV infected partner. The biological risk of transmission in a violent

sexual encounter is determined by the type of sexual exposure (vaginal, anal or oral). Marriage

by abduction in Luo culture is one way of violence against women that is accepted and

practiced.

Stigma and Taboos: Cultural stigma and taboos (social bans), especially related to sex and

sexual activities, increase men’s and women’s vulnerability to HIV. The taboos associated with

sex and knowledge of sex act as barriers to seeking knowledge of HIV prevention and to

providing the treatment care and support needed by those infected and affected by HIV. HIV-

related stigma is triggered by many forces such as a lack of understanding of HIV, myths about

how it is transmitted, prejudice, lack of treatment, irresponsible media reporting, social fears

about sexuality, fears relating to illness and death, and fears about illicit drugs and injecting

drug use. HIV and AIDS possess all the characteristics associated with stigmatized diseases.

Religion: Religion and religious beliefs are the foundations of community life in a majority of

societies. Religion prescribes ethical guidelines for many aspects of daily life and also

navigates belief systems and norms surrounding sexuality. The majority of religiously tailored

belief systems condemn premarital sex, contraception including condom use, and

homosexuality. Catholic church in Kenya for example does not encourage condom use among

its congregation and up to now, this is a controversial issue with media houses in Kenya. Some

religions also advocate a submissive role for women, foster gender inequality in marital

relations, and promote women’s ignorance in sexual matters as a symbol of purity.

The sexuality and gender stereotypes constructed by religion can inhibit prevention efforts and

increase vulnerability to HIV infection. HIV vulnerability caused by religious beliefs and

practices is the result of religious institutions’ denunciation of HIV infection as sinful. Such
religious judgments play a significant role in generating HIV- and AIDS-related stigma which

increases vulnerability. Religions advocating against condom use pose a serious challenge to

preventing the spread of HIV in the communities where they operate. Similarly, religions that

denounce homosexuality tend to fuel stigma against those who engage in same sex behavior,

thus indirectly increasing their vulnerability to HIV.

Poverty

Poverty impacts men and women differently and is a key factor leading to behaviors that

exposure people to the risk of HIV infections. Poverty increases vulnerability to contracting

HIV through several channels, including increased migration to urban areas; limited access to

education and information; sexual exploitation; and gender inequality.

The risk of HIV infection is also known to be higher among the poorest and most powerless in

society, and as such married adolescent girls, who tend to have much older husband, will be

more at risk of infection than unmarried girls.

Poverty increases the risk of HIV transmission bye limiting access to information related to

HIV prevention. Data available from various countries show that man and women of high

economic status know more about HIV prevention than those economically worse off.

Poverty can also pressure women and men to exchange sex for food or other material favors in

order to ensure daily survival for themselves and their families. Girls and young women who

are able to escape from early marriage are often forced by poverty to go into commercial sex

work to survive. It increases the pressure to resort to higher risk with older «sugar daddies»

who offer the illusion of material security. As more women and girls take the decision to be to

the streets as their only means of survival.

Gender norms that limit women's access to educational and vocational training, and the sexual

division of labor that puts women in lower status, jobs; Increase women's vulnerability to HIV

infection. A close review of the evidence on the links between poverty and the pressure to

marry early reveals that in wealthier countries, where girls have equitable access to education,

further training and other employment opportunities, early marriage are rare The vast majority

of women are employed in low paying, seasonal, and insecure jobs in the informal and semi-

formal sectors of the labor market. An unequal standard in employment and channeling the

majority of women into low status occupations perpetuates and reinforces their inferior status

in economic relations. International human rights conventions provide for governments to

address these discriminatory practices. These circumstances also make it more likely that

women will augment their income by selling se, and without access to legal, social and HIV

prevention services, this limit their ability to negotiate safer sex.

Lack of access to productive resource or income

Women are among those with less access to land, while accounting for a large share in small-

scare food production. Land is a source of food, shelter, social status and power. Land is also a

source of employment opportunities. Hence lack of access to this primary resource is largely

responsible for the poverty that haunts the poor, particularly the women Laws and practices

based on gender norms greatly limit women's access to productive resources such as land,

property, and credit. These practices secure women's financial, material, and social dependence

on men. Research has shown that women who raise the issue of condom use with the men on

whom they are economically dependent risk violent conflict, loss of support, or even

abandonment. Dependent women are hesitant to leave risky relationships as they fear terrible

economic consequences. Because women do not have equal rights to property ownership,
widowhood usually means loss of the right of access to field where their labor has been

invested, and to their homes. Lacking access to land property and income, women are more

likely to sell or exchange sex in unsafe ways for money, goods and favors.

Societal changes

Inadequate and inappropriate Information Education and Communication materials like posters

e.g. Trust condom adverts sound ridiculous and have unrealistic messages. Commoditization

and merchandising of sex by media and entertainment industry e.g. radio, visuals, TV such as

in the soap operas (The Bold and the Beautiful, Ku bhaggia among others) , explicit

pongraphic materials in the internet and sex literature in books and magazines have aggravated

the risks to HIV/AIDS infection.

References

1. Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood

2. Barker D, Ricardo C: Young Men and the Construction of Masculinity in Sub-Saharan

Africa. Social Development Papers No. 26. Washington: The World Bank; 2005.

3. Joint United Nations Programme on HIV/AIDS (UNAIDS) Global 2012 Global Report

on HIV/AIDS

4. Joyce et al. Notes from the Field: Occupationally Acquired HIV Infection Among Health

Care Workers, United States, 1985–2013. MMWR 63(53);1245-1246, 2015

5. Khan, Shaheen. Domestic violence against women and Girls. Innocent Digest: UNICEF,

Italy, 2000.
6. Körner, Henrike. “Negotiating Cultures: Disclosure of HIV-Positive Status among People

from Minority Ethnic Communities in Sydney.” Culture, Health & Sexuality 9.2 (2007)

137-152. Retrieved from http://www.jstor.org/stable/4005515 on 15th April 2011.