Within the Bonds of Marriage: Gender and Aids

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Kimberley Carter Campbell and Dr. Renata Forste, Sociology

Introduction

Past research on AIDS, has focused generally on high risk groups; such as homosexual men and intravenous drug users. In many of these studies the cultural and contextual facts concerning sexual interaction have been ignored (1). Few studies of AIDS have focused on heterosexual men and women and married couples. A recent announcement by the Centers For Disease Control and Prevention (CDC) regarding the rise in the number of heterosexual AIDS cases, suggests a need for more research in this area. The CDC reported that as of 1993, 24% of bisexual men who died from AIDS were married. There is a unique social network in a marriage which causes prevention behavior to differ from the behavior of those in the single population (2). In addition they also acquire specific patterns of behavior due to gender. For example, women may be slightly better informed about AIDS, however women generally are less likely to protect themselves against AIDS within their marriage. For this reason, I predict that although there may be a relationship between knowledge of AIDS, risk perception and protecting oneself against AIDS, the gender based “sexual scripts” that are legitimized in society will have the largest affect on AIDS preventative behaviors. Particularly within a marriage there are certain sexual scripts based on socially constructed gender norms that may cause a spouse to not protect themselves against AIDS, even when they perceive themselves at risk. These dynamics are essential to our understanding of AIDS preventative behavior within the married population. In addition to gender and marital status, other background characteristics have been found to influence sexual behavior; In particular, age, race, religion and education, have been found to influence sexual behavior in past studies (3).

Data and Methods

The analysis is based on data from the 1991 National Survey of Men, and the 1991 National Survey of Women. The National Survey of Men is a stratified, clustered area probability sample of households in the contiguous United States. The total sample includes 3,321 men aged 20-39 years in 1991. Of the total sample, 1,689 were currently married. The National Survey of Women is also a nationally representative, stratified and clustered multistage area probability sample. The total sample consists of 1,669 women aged 20-37 in 1991. Of the total, 603 were married. Thus my analysis is based on a total of 2,292 married individuals. These two surveys are comparable to other national samples and results can be generalized to the adult U.S. population.

The model is estimated using logistic regression techniques. It measures the effect of gender, AIDS knowledge and attitudes, and the perception of risk on protection against AIDS for a sample of married adults. Controls for age, race, religion, and education are also included in the model.

Results

Overall 26% of men and 27% of women in the sample claimed to have protected themselves against AIDS during their marriage. Almost all of the respondents (98%) realized that AIDS was a disease that affected the heterosexual population as well as the homosexual population. Surprisingly, 31% of the sample strongly agreed that a cure for AIDS would be found in the next 5 years. Three-fourths 44 of respondents did not worry frequently about contracting AIDS. The descriptive statistics also indicate that 11% of men and 4% of women reported that they have had other sexual partners during their current marriage. However, 97% of respondents reported that their partner’s chance of having AIDS was, not much chance (20%) or no chance at all (77%). A total of 4% of male respondents indicated that their wives have had other sexual partners since married, whereas 5% of women told interviewers that their husbands had other sexual partners since married.

Logistic regression analyses revealed that black respondents were 2 times more likely to protect themselves against AIDS than white respondents. Those with more than a high school education were 1.3 times more likely to protect themselves compared to those with a high school education or less. Analyses of gender interactions showed that Black men were 2.39 times more likely to protect themselves compared to white men, yet black women were not significantly different than white women. Hispanic men were 1.9 times more likely to protect themselves against AIDS (compared to non-Hispanic men), whereas Hispanic women were 2.7 times less likely than non-Hispanic women to protect themselves from AIDS. Women whose partner’s have had other sex partners while married were 3.5 times more likely to protect themselves against AIDS. Women, however, who themselves had other sex partners while married were 7 times less likely than those who had no other sex partners to protect themselves from AIDS.

Discussion

About half as many women reported that their husbands have had other sex partners while married, compared to self reports of married men with regards to the number of other sexual partners they had since getting married. This gap is dangerous for women. Researchers from the National AIDS behavior survey report that “among women who reported no risk behavior of their own, 17% said they were unsure if their partners were at risk.” Women also may not be aware of their husbands homosexual relationships (4). As previously mentioned , the CDC has reported that as of 1993, 24% of bisexual men who died from AIDS were married. According to previous research men often do not disclose homosexual behavior due to the stigma attached to homosexuality (5).

The problem of women being unaware of their partner’s outside sexual behavior puts many women at risk for contracting AIDS. Even more alarming, however, than not knowing your risk for AIDS, is knowing the risk involved, yet still using no protection. My analyses revealed that women whose husbands had another sex partner while married were 3.5 times more likely (than other women) to protect themselves from AIDS. However, compared to women who had no other sex partners during their marriage, women who themselves had reported another sexual partner (or partners) while married were 7 times less likely than to protect themselves from AIDS. Thus, it is possible that, even if women know their risk of contracting AIDS because of their unique social network in which protection behavior could be seen as a threat to a relationship they do not use protection. According to previous research, condom use among women at risk of HIV infection is very low (6)(7)(8). It is also reported that condoms are used much less consistently with primary partners than with secondary partners (9). This occurrence is due to the fact that, “relationships between primary sexual partners involves a fundamentally different set of assumptions than that between secondary partners. Many couples see no need for disease prevention in a presumably monogamous relationship, and the introduction of condoms could raise the issue of fidelity, which could be emotionally traumatic for the partner or risky for the relationship” (10). Women also may not introduce protection into their 45 primary relationship for fear of physical abuse or loss of economic support (11). Ultimately, whether women are aware of their risk or not, there are still gender barriers to prevention behavior in the heterosexual population.

In some populations gender barriers combine with cultural barriers to make protection against AIDS a daunting task. Of particular concern is the Hispanic population. I found that Hispanic men were 1.9 times more likely than non-Hispanic men to protect themselves against AIDS, whereas Hispanic women were only 2.7 times less likely to protect themselves against AIDS than were non-Hispanic women. This statistic is particularly disturbing when combined with the results of previous research. For example, although they represent approximately 8% of the total United States population, Hispanics account for 16% of AIDS cases (12). Married Hispanic men are more likely to have had two or more heterosexual partners in the previous 12 months than are married non-Hispanic men (13). A much lower proportion of Hispanic women than men report having had two or more sexual partners (14). These results suggests that there is a double standard within the Hispanic population. Traditional Hispanic culture has been characterized by, “a male centered view in which men tend to prove their virility by having multiple sex partners” (15). This traditional Hispanic culture may produce an increase in risk of HIV contraction and therefore a higher prevalence of AIDS among Hispanics in the United States.

Overall the results of my research support the hypothesis that although women contract AIDS more easily and the number of cases of AIDS in women is growing faster than among men (16), we are unable to instill a sense of urgency to prevent AIDS among heterosexual married couples due to gendered scripts, or “cultural and contextual realities” (17) that are involved in heterosexual relationships.

References

  1. Gomez, Cynthia A., Barbara Van Oss Marin. 1996. “Gender, Culture, and Power: Barriers to HIV-Prevention Strategies for Women.” The Journal of Sex Research 33:355-362.
  2.  Laumann, Edward O., John H. Gagnon, Robert T. Michael, and Stuart Michaels. 1994. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press.
  3. Van Oss Marin, Barbara, Cynthia A. Gomez, and Norman Hearst. 1993. “Multiple Heterosexual Partners and Condom Use Among Hispanics and Non-Hispanic Whites.” Family Planning Perspectives 25:170-174.
  4. Stokes, Joseph P., David J. Mckirnan, Lynda Doll, and Rebecca G. Burzette. 1996. “Female Partners of Bisexual Men: What They Don’t Know Might Hurt Them.” Psychology of Women Quarterly 20:267-284.
  5.  Flaskerud, Jacquelyn H., Gwen Uman, Rosa Lara, Lillian Romero, and Karen Taka. 1996. “Sexual Practices, Attitudes and Knowledge Related to HIV Transmission in Low Income Los Angeles Hispanic Women.” The Journal of Sex Research 33:343-353.
  6.  Laumann, Edward O., John H. Gagnon, Robert T. Michael, and Stuart Michaels.
  7.  Gomez, Cynthia A., Barbara Van Oss Marin.
  8. Grinstead, Olga A., Bonnie Faigeles, Diane Binson and Rani Eversley. 1993. “Sexual Risk for Human Immunodeficiency Virus Infection Among Women in High-Risk Cities.” Family Planning Perspectives 25:252-256 & 277.
  9.  VanOss Marin, Barbara, Cynthia A. Gomez and Norman Hearst.
  10.  Ibid
  11. Campbell, Carole A. 1990. “Women and AIDS.” Social Science Medicine 30;407-415.
  12.  Sabogal, Fabio, Bonnie Faigeles and Joseph A. Catania. 1993. “Multiple Sexual Partners Among Hispanics in High-Risk Cities.” Family Planning Perspectives 25:257-262.
  13.  VanOss Marin, Barbara, Cynthia A. Gomez and Norman Hearst.
  14.  Sabogal, Fabio, Bonnie Faigeles and Joseph A. Catania.
  15.  Ibid
  16.  Campbell, Carole A. 1995. “Male Gender Roles and Sexuality: Implications for Women’s AIDS Risk and Prevention.” Social Science Medicine 41;197-210.
  17. Gomez, Cynthia A., Barbara Van Oss Marin.