What does the status of women have to do with health outcomes?
Karen Grepin posted an interesting set of statistics a few days ago in her article, Men are Dogs. Aren’t they? Most people intuitively believe that serodiscordancy (when one partner in a steady relationship is HIV-positive and the other is not) is a result of the man’s infidelity or other sexual exploits. However, a new study of serodiscordancy in sub-Saharan Africa puts this assumption in question. Oghenowede Eyawo and co-authors report:
We included data from 27 cohorts of 13 061 couples and DHS data from 14 countries of 1145 couples. The proportion of HIV-positive women in stable heterosexual serodiscordant relationships was 47% (95% CI 43—52), which shows that women are as likely as men to be the index partner in a discordant couple.
If the woman is just as likely to be the partner who brings HIV into the relationship, where does this leave prevention efforts which have frequently assumed the man to be the likely carrier? The study poses interesting questions for HIV prevention programs, which often target men. It also poses interesting possibilities for researching root causes and designing programs to improve health outcomes in countries based on sex and power dynamics.
Let me take this conversation in another direction. In an article focused on the rising status of women in South Africa, the Economist reported earlier this month on the high levels of rape and sexual violence in the country:
In its latest world report, Human Rights Watch, a New York-based lobby, describes the level of physical and sexual violence against South African women as “shockingly high”. South Africa has one of the highest incidences of reported rape in the world. In a study by the World Health Organisation, fully 40% of South African women claimed that their first experience of sex was non-consensual.
What dynamics are at play when nearly half of all women have first experienced sex through a non-consensual encounter? I am not trying to generalize the leap between high rates of sexual violence and the new findings in HIV discordancy. Rather, I am emphasizing how little we know about what goes on behind closed doors, and how that reflects in the crude nature of most prevention programs today. Helen Epstein’s groundbreaking work in The Invisible Cure found that (roughly stated) community efforts were more effective in preventing HIV infection rates than the marketing savvy prevention campaigns that rely on honed and generalized messages. I would posit that this is because community dialogue can better respond to the subtleties of cultural dynamics than marketing-fueled, widespread campaigns that could easily miss the mark.
