“A woman with a husband is in much more danger than a girl in a brothel.”

In many countries across the globe, marriage is a significant risk factor for women contracting HIV. Married women are often unable to negotiate condom use with their husbands; marriage is assumed to give men unlimited sexual access to their wives’ bodies; and the stigma of male infidelity isn’t nearly as strong as the stigma of female infidelity — to the point where in may countries (especially those which use Sharia law), virtually all prosecutions for infidelity are leveled against women, as pregnancy is used as “evidence.”

Which is why the Bush administration’s policy of promoting abstinence and marriage, and de-emphasizing condom use, is deadly.

This is an impoverished, authoritarian, war-ravaged country, but it offers an important lesson for President Bush and American school boards: Don’t fear those lifesaving bits of latex known as condoms.

Cambodia has become one of the world’s few success stories in the struggle against AIDS, and it has achieved that success partly by vigorously promoting condoms. This strategy has saved thousands of lives.

Cambodia has cut the prevalence of H.I.V. in adults from 3 percent in 1997 to about 1.8 percent today. In rural Cambodian towns like this one, billboards and posters promote condoms, and clinics and brothels have buckets of them. Health centers don’t have X-ray machines or oxygen tanks, but they have phalluses to show visitors how to put on condoms.

Nearly having the HIV infection rate is incredible progress. And while pushing abstience and marriage is certainly admirable, it ignores the social realities that many women live:

Here in Poipet, I met a 27-year-old woman with AIDS, Tem Phok. She had been a prostitute in a brothel, so I assumed that that was how she contracted AIDS. “Oh, no,” she said. “I got AIDS later, from my husband,” who has already died.

“In the brothel, I always used condoms,” she said. “But when I was married, I didn’t use a condom. … A woman with a husband is in much more danger than a girl in a brothel.”

That’s an exaggeration, but she has a point: It doesn’t do much good for American officials to preach abstinence and fidelity in places where the big risk of contracting H.I.V. comes with marriage. In countries with a high prevalence of AIDS, just about the most dangerous thing a woman can do is to marry.

Of course, this isn’t just an international issue: The Bush administration is promoting its backwards policies here, too.

But the Bush program has also been undermined by a resistance to condoms. The administration has taken information about condoms off government Web sites, and its AIDS prevention efforts abroad, when aimed at young people, have emphasized abstinence to the exclusion of condoms.

Likewise, in much of the U.S., social conservatives with administration backing have instituted “abstinence only” sex education, so that teens are encouraged to take “virginity pledges” but aren’t given a backup plan.

Careful studies of “abstinence only” programs in the U.S. suggest that they do delay sexual intercourse, but that young people are then less likely to use condoms afterward. The evidence indicates that a balanced approach — encouraging abstinence but also promoting condoms — is far more effective at protecting young people in America or abroad from sexually transmitted infections, including H.I.V.

Religious conservatives have been behind the war on condoms, but it’s important to note that many of the religious people doing the hands-on work with HIV-infected communities agree that condoms are the best way to go. It’s the people who are the mouthpieces for religious groups, and who don’t actually have to dirty their hands with those dead and dying from their policies, who are happy to claim that abstinence-until-marriage programs are successful.

In the past, social conservatives routinely cited Uganda as proof that it’s best to focus just on abstinence. It’s true that Uganda cut H.I.V. rates significantly, partly by promoting abstinence and fidelity — but also by promoting condoms. More recently, Uganda has been backing away from condoms, with U.S. support, and its H.I.V. prevalence is rising again.

Despite the hostility to condoms in Washington (and at the Vatican), in the field, even conservative missionaries tend to endorse them.

“Why should we be afraid of latex, when we see that it can save lives,” a Catholic nun in Cameroon told me, adding that her clinic hands out large numbers of condoms. She explained: “I just don’t mention that in my reports to the bishop.”

Thanks to Matt for emailing me the article, since my cheap ass can’t access TimesSelect.

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9 comments for ““A woman with a husband is in much more danger than a girl in a brothel.”

  1. December 19, 2006 at 6:22 pm

    Don’t create a conservative; wear a condom!

  2. Christen
    December 19, 2006 at 7:10 pm

    Of course, for the right wing their own so-called “morality” is more important than actually saving lives.

  3. Adnan Y.
    December 19, 2006 at 8:25 pm

    I worked with the National AIDS Control Programme in Pakistan for a couple of years before coming back to the UK. We would talk with our Indian counterparts, and they’d stressed the “HIV/AIDS via Husband” problem.

    The women in India, as in Pakistan, had trouble convincing their husbands of the need for condoms, or any form of protection for that matter, after marriage. Since they weren’t dating, there was no need to ‘play safe’ right?

    In Pakistan and India, men who contract HIV/AIDS do so for the most part via unprotected intercourse with hijras (‘transvestites’/transsexuals could be the nearest translation), usually if the men were long-haul truck drivers, married or not. An American example could be the cases of ‘Down Low’ sexual intercourse about African-American males. Prostitutes in Hera Mundi (Diamond Market, a well-known Red Light District in Lahore, Pakistan) are trying to get their clients to wear condoms, but it’s difficult not just when the johns get violent and say that it “ruins the feeling” but also when the Pakistan Government says that prostitution doesn’t exist. the NACP I worked with worked with UNAIDS, and we were greatly hampered in our awareness projects.

    Getting back to the women, though: when their husbands would come back and be intimate with them and thus infect them, the husband would die, and the woman would be blamed by the families of both; they would act as if it were her that infected and killed him, rather than the man being the one at fault.

  4. December 19, 2006 at 10:34 pm

    Kristof’s piece is one of the clearest I’ve ever read at elucidating how condoms succeed in keeping people safe (sidebar — god damn Sulzberger and his Wall).

    The thing that this article makes most clear is that contraception is not some abstract concept only understandable to rich, liberal Westerners. We’re leading the way while obstructing it. We have the ability to ensure that our aid saves lives and we’re pissing this power to do good away on the backs of a minority’s version of morality. Sometimes our policies just make me sick with disgust.

  5. Christopher
    December 20, 2006 at 5:55 am

    This is one of those things that makes veins pop out of my head.

    The scum who rule our country actually think that fucking is worth then dying.

    It’s a profoundly perverse kind of morality, but there’s just no other way to read it; Abstinence-only programs don’t work as well as condom education. More and more data comes in bearing this out, and yet we keep with the anti-condom rhetoric.

    Hey, how about we get the AIDS rate down, and THEN we can address infedelity?

    This whole “pre-marital sex is worse then dying” attitude is so alien to me I can’t wrap my head around it.

  6. December 20, 2006 at 11:38 am

    Just another reason to want to punch the conservative advice book authors that tell women that God says you’re a bad wife for ever turning down your husband’s sexual advances. Does anyone else see those Christian book carrels full of “be the woman of his dreams” stuff in grocery stores and want to sob?

  7. December 20, 2006 at 3:43 pm

    There’s a wonderful play about this issue called In the Continuum that deals with a married women with AIDS in Zimbabwe..

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