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Studies Show Marriage Can Be a Risk Factor for Acquiring HIV

Two studies conducted in 2004 and recently published in the American Journal of Public Health discuss the growing concern that for many women, the greatest risk of contracting HIV may occur after they are married.  “Modern Marriage, Men’s Extramarital Sex, and HIV Risk in Southeastern Nigeria” and “The Inevitability of Infidelity: Sexual Reputation, Social Geographies, and Marital HIV Risk in Rural Mexico” show that cultural norms which tolerate a man’s pursuit of extramarital affairs exist throughout the world and serve to increase the risk of HIV transmission to women.  Both studies provide further evidence that HIV-prevention messages that emphasize abstinence and being faithful are insufficient.

According to the studies, couples in Nigeria and Mexico face similar issues despite vast cultural differences.  For example, in both countries men engage in extramarital affairs as a result of labor migration.  In Mexico men often leave for the United States and in Nigeria for neighboring metropolitan areas.  This separation and distance creates an environment in which men are able to engage in sex outside of marriage without damaging their wives’ reputations or their own. 

The studies found that the concept of reputation is central to sex outside of marriage and ultimately the possibility of HIV transmission. In Nigeria men often have affairs in order to assert their masculinity, as these relationships show that they are able to provide for numerous women.  Their wives maintain this secrecy because the community often puts the blame of a male’s infidelity on his wife.  Further, wives cannot risk confronting and possibly losing their husbands because of economic dependence.  In Nigeria, researchers also found that women failed to negotiate condom use because suggesting a condom is “tantamount to asserting that one’s partner is risky and hence guilty of sexual impropriety,” and may also be seen as a sign that the women themselves are engaging in an affair.1  Differences in status or age also make it difficult for women to negotiate condoms.  Moreover, due to the widespread rumors suggesting condoms are ineffective it is unlikely that any party sees them as having an overall impact.  Consequently, women protect their reputation by neither leaving the marriage nor requiring condom use. 

 In Mexico men often engage in extramarital sex in order to satisfy their sexual desires.  There, “gendered ideals for women’s sexual respectability continue to form the backdrop for the extramarital pursuit of sexual variety.”2  These men chose higher risk partners—sex workers or other men—specifically to protect their wives from embarrassment, as there is less of a danger not only of being caught, but also of falling in love.  

At the time of the studies, Nigeria, one of PEPFAR’s 15 focus countries, had at least 3.5 million people affected with the disease, while 15% of Mexicans living in the state of Jalisco had contracted the virus.  Both countries receive funds from the President’s Emergency Plan for AIDS Relief (PEPFAR), which requires prevention messages to focus on abstinence and being faithful.  However, these studies show that telling people marriage and fidelity will keep them safe is not enough. In these countries, “abstinence is impossible, unilateral monogamy is ineffective.”3 Moreover, “women are infected by the very people they are supposed to be having sex with—indeed…the only people with whom they are ever supposed to have sex with.”4


  1. Daniel J. Smith, “Modern Marriage, Men’s Extramarital Sex, and HIV Risk in Southeastern Nigeria,” American Journal of Public Health 97, no. 6 (June 2007).
  2. Hirsch, et al., “The Inevitability of Infidelity: Sexual Reputation, Social Geographies, and Marital HIV Risk in Rural Mexico,” American Journal of Public Health 97, no. 6 (June 2007).
  3. Ibid.
  4. Ibid.

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