The Fidelity Fallacy: The Link between HIV Infection and Marriage

[Guest guest]

The Fidelity Fallacy: The Link between HIV Infection and Marriage

By Serra Sippel. August 9, 2007

With 80 percent of HIV cases worldwide transmitted by sexual contact,

promoting marriage and sexual fidelity would seem to make sense as a

way to limit the spread of AIDS. Yet this politically popular

approach to public health among conservative policymakers in the

United States promotes the false assumption that within marriage, sex

is always safe—and consequently puts unknowing men and women at

increased risk of infection. This fidelity fallacy holds enormous

implications for the effectiveness of our government's global AIDS

prevention program, where almost $400 million was spent last year in

15 focus countries for the President's Emergency Plan for AIDS

Relief, or PEPFAR.

In most societies, cultures, and religions, the institution of

marriage marks an important transition from childhood to adulthood

and plays an essential role in social organization. In addition to

the many social and economic factors that lead (or force) people into

marriage, ideals and judgments about fidelity are pervasive

throughout society and often prioritize marriage and marital

fidelity. Laws often penalize extramarital sex, economic and health

policies encourage fidelity, religious leaders frequently condemn

infidelity as immoral, and in the general population there is often

disapproval of extramarital sex—despite the frequency with which

people fall below the ideal of marital monogamy.

A recent study funded by the National Institutes of Health and

published by the American Journal of Public Health found that while

sexual fidelity is often an ideal, what fidelity means to individuals

may vary and is not seen by all married people in all cultures as

necessary to achieving a satisfactory marriage. In fact, many men

across cultures consider extramarital sex as an important component

to social acceptance, a condition for achieving successful

masculinity, and a reality that coexists with migrant labor

practices. This study underscores the need to fix dangerous

deficiencies within U.S. global AIDS policy, and particularly the

programs that do not address these realities.

Recent findings from the multi-site study in Mexico, Nigeria, Uganda,

Vietnam, and Papua New Guinea indicate that for most women around the

world, marital sex represents their greatest risk for HIV infection.

Responding to the well-documented epidemiological evidence that men's

extramarital sex is a major element of HIV risk for married women,

researchers found that prevention messages that associate infidelity

with immorality simply are not compatible with different cultural

views on marriage.

Specifically, the NIH-funded study shows that keeping affairs secret

and maintaining financial support for a family are important to men.

Men show concern for their reputation as being responsible and

preserving their wives' dignity by keeping their affairs secret

rather than actually abstaining from extramarital sex. What made

them " moral " men was their continued financial support for their

families and an emotional commitment to their wives.

These findings demonstrate that conservative public health programs

that promote the narrow " AB " (Abstain-until-marriage and Be-faithful-

in-marriage) and the " ABC " (Abstain, Be faithful, use Condoms)

prevention programs are incompatible with the diverse experiences and

moral reasoning of men. It also shows the misleading—and potentially

counterproductive—effect that the moralizing " ABC " approach has on

actual prevention.

Indeed, " ABC " programs may be helping to fuel the spread of AIDS

because the approach stigmatizes those who use condoms or those who

ask their marriage partners to use condoms. In " ABC " programs,

abstaining or being faithful in marriage are presented as the most

moral choices, with condoms as a last resort—only to be used if you

are sexually immoral because you failed to choose " A " or " B " or are

part of an " at-risk " population. As a result, women are discouraged

from asking their husbands to use condoms, because asking them to do

so is tantamount to accusing them of infidelity and implicates them

as being immoral. Stigmatizing condoms also discourages men from

using condoms in extramarital sex, because their use demeans those

extramarital relations.

This is why current U.S. global AIDS funding today is so misguided.

In direct conflict with these recent empirical research findings, 56

percent of U.S. global AIDS funding for prevention of sexual

transmission of HIV is spent on programs that promote the narrow " AB "

approach. The assumption behind this approach is that regardless of

the social and economic context, abstinence and mutual fidelity are

choices that individuals readily can make. It also assumes a

universal morality that men and women in all cultures value

abstinence and fidelity as morally good.

Neither of these assumptions is true in practice. Nor are these

practices the only way to stop the sexual transmission of HIV. Public

health programs cannot reduce married women's HIV risk simply by

exhorting men to be faithful. Based on their scientific findings,

researchers recommend a harm-reduction approach to marital risk of

HIV in U.S. global AIDS policy and programming. Their recommendations

include:

Avoid moralistic approaches to extramarital sex, which exacerbate the

stigma of HIV.

Associate condom use with masculinity by building on men's existing

sense of responsibility to their families.

Recognize the impact of economic migration by including workplace

education on HIV risk and providing family housing in migration sites

where possible.

Educate men where they are most likely to engage in extramarital sex,

such as bars and brothels.

There is no silver bullet that will stop the spread of HIV, so it is

no surprise that the United States' one-size-fits-all " ABC " approach

is insufficient. While it is useful and important to create the

conditions necessary for individuals to be able to choose fidelity,

the morality of saving lives must take precedence.

In order to make real progress on HIV prevention, policy makers in

Washington must be able to put aside their own moral judgments and

face the complexities and realities of an imperfect world. There is

an urgent need today for creative, comprehensive, community-based

efforts that address interconnected factors of gender inequality,

masculine ideals, migrant labor, and leisure time activities to

reduce the risk of HIV infection—not only for married women, but for

all women and men.

Serra Sippel is Acting Executive Director of the Center for Health

and Gender Equity. Analysis, information and resources about

restrictions to U.S. global AIDS funding can be found at

www.pepfarwatch.org.

http://www.americanprogress.org/issues/2007/08/fidelity.html