Interventions for Sexually Active Heterosexual Women

Abstract

Women have been infected with human immunodeficiency virus (HIV) since the earliest days of the epidemic. Grethe Rask was the first woman now known to have died of acquired immunodeficiency syndrome (AIDS); the year was 1977.^1,2 However, despite their ongoing representation among HIV cases, little attention was paid to heterosexual women by the prevention research community until well into the second decade of the epidemic. This is unfortunate, because research conducted in other populations, for example, men who have sex with men, often generalizes poorly to situations encountered by women at risk through heterosexual encounters. There are two fundamental reasons for this. First, until the relatively recent availability of the female condom, men were in control of condom use: they wore the condoms. Second, in most cultures, women possess less power than men, particularly in sexual relationships and situations.^3-5 These facts, both of which will be discussed more fully below, have conspired often to render condom negotiation difficult for heterosexual women. The difficulty is more pronounced among those women who are at greatest risk of infection: the impoverished, the drug addicted, and those with abusive partners. However, a growing number of studies reporting positive risk reduction effects of behavioral prevention interventions is encouraging and suggests that many women possess or can develop skills to effectively reduce their risk of HIV infection. For other women, it may be necessary to identify new solutions to overcome the significant barriers that they face.