It also addresses key psychological and mental health issues, patient perspectives and the role of patient engagement. Get A Copy. Paperback , pages. More Details Original Title. Other Editions Friend Reviews. To see what your friends thought of this book, please sign up. Lists with This Book. This book is not yet featured on Listopia.
Community Reviews. Showing Rating details. More filters. Sort order. Dec 29, Usfromdk rated it it was ok Shelves: non-fiction. Really insufficient, bordering on non-existent coverage of economic aspects of the illness and treatment. If you stick to the chapters dealing with topics like pathophysiology, natural history, immunological effects of the disease, transmission patterns, complications and associated conditions, drug interactions etc. The coverage of 'soft topics' psycho-social challenges faced by people with the diagnosis, disclosure strategies, Simon Exton rated it really liked it Nov 16, Steffi rated it it was amazing Jun 20, Anthony KJ rated it really liked it Sep 04, Barney marked it as to-read Aug 14, Strachan marked it as to-read Aug 28, Haitham Hussein marked it as to-read Jul 12, Liam marked it as to-read Feb 16, Extramarital liaisons provide a venue for men to repossess traditional masculine authority and independence in marriage.
We also found that expectations of modern lifestyles and luxuries require economic means that many men are not able to acquire, yet wealth remains an important part of masculine identity. Engaging in extramarital relationships offers some men an alternative route to masculine identity. My parents used to respect each other.
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But for me, there is a big problem in my marriage. My marriage needs money to make my woman look good. We need a lot of counseling in regards to the behavior of my wife; she needs to be more polite. For this man and others, the trend toward marital communication has, ironically, opened the way for wives to express their grievances and dissatisfaction. Residents of Iganga recognize that poverty drives women into transactional relationships i.
Hence, whereas young men delay marriage to try to secure economic resources, relationships with older or wealthier men provide young women an opportunity for social stability and economic support. Residents of Iganga echo popular culture when they depict attractive, nicely dressed, leisure-seeking women as preying on married men, a construction that stands in stark contrast to public health and feminist analyses. We found important socioeconomic differences in how migration interacts with opportunities for extramarital activities. Wealthier men are more likely to relocate with their families to cities, and those who remain in Iganga take frequent overnight business trips without their wives.
Men explain that loneliness and the desire for companionship while away from home lead them to seek extamarital relationships. If a man has his own living space in the place of migration, it is almost inevitable that he will invite a woman to live with him to tend to his domestic, affective, and sexual needs. Furthermore, overnight workshops and trainings sponsored by the government, nongovernment organizations, and various development agencies have become a regular part of the lives of wealthier and professional residents.
According to interviews and participant observations, these residential workshops that often offer a generous per diem serve as potential opportunities for men and women to engage in extramarital liaisons with local residents such as barmaids or sex workers or each other, yet these HIV transmission opportunities are often overlooked by HIV risk-reduction efforts.
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Finally, it is almost expected that younger men will spend evenings in town socializing, drinking, or mingling before returning home. Your wife quarrels with you about this and that, wonders why you are not looking for money. Or, she and the children have their chores. So you sit alone with nothing to do. Consequently, UTODA developed a peer-based system of sexual regulation in an attempt to hold members accountable to the group and to their wives.
He also elaborated on 2 other sets of concerns.
First, members of UTODA, like other transportation sectors in sub-Saharan Africa, had witnessed many HIV-related deaths since the beginning of the epidemic and had experienced the economic burden of assisting their colleagues with medical expenses, funerals, and caring for surviving dependants.
In many instances, UTODA members did not know if the women were wives or lovers of coworkers, leading to confusion over how to handle such disputes. To actively participate in the program, each member is required to bring his wife or wives to every meeting, stand with her or them and recite her name or their names during the opening roll call.
The master of ceremonies hands the money to the husband and wife together, symbolically signifying joint ownership of household assets. A roar of affirming laughter ensued. Wives became more familiar with each other and less shy about their public role as a wife in social functions. The sexual regulation system created by UTODA attempted to emphasize and reward notions of masculinity that centered on being responsible not only for the economic well-being of the household but also for the affective well-being of the marital bond. The widespread circulation of social, religious, and public health messages that present infidelity and polygyny as risky, immoral, backward, and dishonorable have had the unintended effect of creating new motivations and avenues for sexual secrecy.
Although almost all men and women in this study recognized the health risks of extramarital liaisons, the risk of getting a bad public reputation by being caught in an illicit relationship presented more immediate cause for concern than the distant, unforeseen effects of contracting HIV. To minimize risks to reputations, individuals employed strategies such as secrecy and discretion to manage sexual relationships that were deemed socially immoral. There also has been a gradual transformation from formal polygyny, in which households of co-wives were somewhat interconnected, to a pattern of informal secondary households that often remain autonomous and hidden from each other.
Whereas in the past women in polygynous unions ideally owed fidelity to their husbands, women of informal or secondary households have no reason not to have multiple male partners. In fact, we found that some had other male partners to provide additional economic and affective support, thus intensifying HIV risk for all sexual partners. Furthermore, we found that longer-term liaisons might put people at risk because condom use tends to decline when relationships are based on emotional attachment and intimacy.
On the basis of my findings, I recommend 3 marital HIV risk reduction strategies that emphasize the need to address structures that provide opportunities for extramarital liaisons. First, whereas women in this study acknowledged their own risk for HIV infection, men tended to downplay their own vulnerability.
The emphasis of many HIV prevention campaigns regarding girls, women, and commercial sex workers has allowed men to deny their own susceptibility and perhaps their own responsibility in the spread of HIV. These programs could strengthen alternative social activities or notions of masculinity that are currently available in arenas that encourage men not to engage in extramarital liaisons. Second, although many women and some men in our study expressed anxiety about their own HIV status and that of their spouse, most participants had never been tested for HIV.
Fear of receiving an HIV-positive test result and uncertainty about the location of testing sites were cited as primary reasons for not getting tested. Notably, hardly anyone felt they had had a productive marital dialog—as opposed to accusations and arguments—about possible HIV risks in marriage, including past and current sexual partners. Yet the expressed desire among men and women for better marital communication suggests ideal opportunities for improving voluntary counseling and testing services for married people.
Because extramarital liaisons are embedded within wider structures of inequalities that exist not only between men and women but also within society as a whole, our findings support poverty reduction as an integral element of HIV prevention. Early in the sub-Saharan epidemic, wealthier men were among the first to become infected because their greater resources provided access to greater numbers of sexual partners. In line with more recent studies, however, I suggest that risk is also an element of poverty and economic gender inequality. Poverty is not the only force driving the epidemic; the tremendous gap between the wealthy and the poor that puts all economic sectors at risk is also to blame.
Furthermore, in designing HIV prevention strategies, serious attention should be given to endogenous forms of risk reduction that have emerged in response to locally felt needs and that have the aim of changing existing norms that contribute to negative social, economic, and health consequences. Furthermore, polygynous unions were typically classified according to which of the interviewed married women had been in the marriage longest. Unions were classified according to their current economic status.
In this poster, infidelity is equated with immorality, and married people seduced by potential lovers are represented as weak, immoral, and backward. My greatest debt, however, is to the women and men of Iganga who shared intimate parts of their lives throughout the course of this study and who share my concern about the devastating affects of the HIV epidemic in sub-Saharan Africa. PMID: Affiliation Shanti A. Parikh PhD Shanti A. Louis, Mo. CopyRight Peer Reviewed.
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Herdt Amsterdam: Gordon and Breach Publishers, , 3— On problems associated with measures of HIV prevalence, see J. Wawer et al. Wawer, R. Gray, D.