The political economy of marriage and HIV: The ABC approach, "safe" infidelity, and managing moral risk in Uganda

Research has shown that married women's greatest risk for HIV infection is their husbands' extramarital sexual activities. Using 6 months of ethnographic research in southeastern Uganda, I examined how the social and economic contexts surrounding men's extramarital sexuality and the dynamics of marriage put men and women at risk for HIV infection. I found that Uganda's HIV prevention messages may be inadvertently contributing to increased difficulty in acknowledging HIV risk and to newer forms of sexual secrecy and that structural determinants, including persistent poverty, intersect with gender inequalities to shape marital risk. After examining a community effort to regulate men's sexuality, I suggest that HIV prevention strategies should focus more on endogenous forms of risk reduction while simultaneously addressing structural factors that facilitate opportunities for men's extramarital sex.