Factors Affecting Married, Monogamous Women’s Risk of HIV Infection in India: Traditional Gender Roles and Husbands’ High-Risk Sexual Behaviours

The prevalence of HIV in India has been steadily increasing over the last three decades and India is now thought to possess the third largest number of cases out of any country in the world. India is currently experiencing a significant feminization of its HIV epidemic; a large proportion of new HIV infections are observed in women and the majority of all HIV cases in India are contracted by heterosexual transmission. While married, monogamous women were initially considered at low risk for contracting HIV in India, they are now recognized as being a high-risk group, as the prevalence of HIV among women who have ever been married is higher than the national average. Because the vast majority of these women report that unprotected intercourse with their husband is their only risk factor for HIV infection, it can be concluded that they have likely been infected by their husband. This review investigates the principal factors involved in the infection of married, monogamous Indian women with HIV by their husbands, within the context of traditional Indian gender roles and cultural expectations of behaviour. Specifically, this article examines three high-risk sexual behaviour commonly perpetrated by Indian men: extramarital sexual relations, lack of condom use during sex and intimate partner violence. Given the magnitude of the problem of HIV in India and its implications for the spread of HIV throughout the world, the topic of women’s risk of HIV infection in India is clearly of immense public health significance.