Abstinence Isn't Enough: Protecting Married Women from HIV

These are the words of Skytt Nzambu, a Kenyan woman who was infected with HIV by her unfaithful husband.  Tragically, Skytt is only one of an increasing number of HIV infections that are occurring within married couples, according to information reported at last week’s HIV/AIDS Implementers’ Meeting  in Rwanda.  This information highlights yet again the urgent need to continuously re-evaluate prevention programs as new evidence emerges in order to accurately address the needs of a constantly evolving epidemic. PEPFAR’s (the President’s Emergency Plan for AIDS Relief) ABC model, which emphasizes abstinence and provides condoms only for those “who practice high-risk behaviors,” doesn’t do a good enough job with “B” (Be faithful) to provide protection for what is increasingly becoming a “high-risk behavior” for women: sex between a husband and wife.

Dr. David Apuuli, director-general of the Uganda AIDS Commission, indicated that marital sex accounts for 42% of new infections in Uganda. According to Apuuli, “Studies show that a significant number of new infections through marital sex are because, over the past four years, men have increased their number of sexual partners, be it wives or girlfriends.” Sadly, it is these wives and girlfriends who are paying the ultimate price: HIV infection.

Vinod Mishra, director of research at Macro International, warned the attendees not to ignore these findings, saying, “It’s not about laying blame, it’s about saving lives; it’s about preventing future infections within marriage, and marriage is… the primary route of the epidemic, and the primary source of new infections in many of these countries now.” It is clear that prevention strategies that focus on abstinence and faithfulness in lieu of comprehensive, evidence-based prevention programs are not adequate to protect a woman whose husband is unfaithful.

The House of Representatives has taken the first step toward eradicating these flawed prevention strategies by passing H.R. 2764 , the appropriations bill that provides greater effectiveness and flexibility in the fight against HIV/AIDS by allowing the President to waive the restriction under PEPFAR that mandates at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-until-marriage programs.  During House debate of this bill, Congressman Walberg (R-MI) mentioned that he'd met a young woman "with three children who has HIV as a result of behavior issues related specifically to a husband who was unfaithful in many, many ways.” Congresswoman McCollum (D-MN) followed up on that point and said:  "I thought it was very compelling to hear the story that was just shared on the floor by my Republican colleague about how a wife had become infected, not because of her behavior, but because of her husband's behavior."

Now, the Senate has their opportunity to support responsible, evidence-based HIV/AIDS prevention as they debate their own version of the appropriations bill. The language passed by the Senate Appropriations Committee contains a similar provision, which we urge the Senate to maintain to show their commitment to preventing the spread of HIV/AIDS. In addition, it also contains the provision exempting contraceptive donations from the Global Gag Rule . These two provisions will help reduce HIV infections and unintended pregnancies, including among HIV-positive women, strengthening U.S. foreign assistance and improving its ability to save the lives of women and men around the world who don’t currently have the services and supplies they need to protect themselves.

Population Action International (PAI) works to improve individual well-being and preserve global resources by mobilizing political and financial support for population, family planning and reproductive health policies and programs.