Paper: Modern Marriage, Men’s Extramarital Sex, and HIV Risk in Southeastern Nigeria

Reference: Smith, D. J. (2007). Modern marriage, men’s extramarital sex, and HIV risk in southeastern Nigeria. American journal of public health, 97(6), 997-1005.

Link: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2006.088583

Abstract

For women in Nigeria, as in many settings, simply being married can contribute to the risk of contracting HIV. I studied men’s extramarital sexual behavior in the context of modern marriage in southeastern Nigeria. The results indicate that the social organization of infidelity is shaped by economic inequality, aspirations for modern lifestyles, gender disparities, and contradictory moralities. It is men’s anxieties and ambivalence about masculinity, sexual morality, and social reputation in the context of seeking modern lifestyles—rather than immoral sexual behavior and traditional culture—that exacerbate the risks of HIV/AIDS.

Conclusion

The implications of these findings for designing appropriate public health interventions to reduce the marital transmission of HIV are complex. In the longer term, the structural underpinnings of economic and gender inequality that undergird a significant proportion of extramarital relationships require social and economic transformations beyond the scope of conventional public health programs. Clearly, many of the unmarried female partners of married men would not participate in these extramarital relationships in contexts of less poverty and greater economic and gender equality. International donors and governments such as Nigeria’s must recognize that public health goals are inextricably intertwined with larger processes of social and economic development. To pretend that Nigeria’s and Africa’s AIDS epidemic can be adequately addressed without also reducing poverty and both economic and gender inequality is unrealistic. But this should not be interpreted by public health practitioners to mean that the root of the problem lies outside the purview of public health. To the contrary, such findings suggest all the more strongly the need for advocates of public health to emphasize the connections between inequality and ill health and to participate in larger processes of political and social transformation.

But reducing the moral stigma of HIV/AIDS must go hand in hand with taking advantage of powerful moralities that guide people’s conduct. Given how entrenched extramarital sex is in larger structures of economic inequality and in the social construction of gender, it seems impractical—and perhaps even counterproductive—to suggest that short-term public health interventions should focus on curtailing men’s extramarital behavior. Even more unrealistic is the idea that women should be encouraged to use condoms with their husbands. But it does appear that men’s peer groups offer a logical locus for intervention. If undertaken in combination with wider efforts to reduce the association of HIV/AIDS with immoral behavior, efforts to reach men with messages that capitalize on their sense of moral responsibility for their families and their wives (and for their extramarital partners) could be effective. Specifically, men could be encouraged—and peer group pressure could be created—to treat their duty to prevent the transmission of HIV with the same obligatory imperative that they see in taking care of their dependents. In short, condom use in extramarital sexual relationships must be associated with demonstrating masculinity.

In southeastern Nigeria, marriage is sacred, and yet men’s infidelity is common. It seems unlikely that anybody—men or women—will be receptive to the idea that wives should leave their cheating husbands or that they should insist on using condoms with their philandering spouses. Much more realistic is building on men’s existing sense of responsibility to their families, a sense of responsibility that already limits infidelity for many men and motivates most men to be very discreet. Encouraging this sense of responsibility takes advantage of men’s concern with their masculinity rather than undermining it. Women’s interests will be best served by creating more responsible men, and larger long-term social and economic transformations are needed to make it less likely that women enter into sexual relationships with men because of poverty, inequality, and gender double standards. But none of these strategies is likely to be effective in reducing the risk of HIV until the disease itself is less stigmatized. Clearly, social inequalities of various dimensions drive the epidemic, but it is often anxieties about morality and reputation that prevent people from protecting themselves. Public health programs must harness morality without simultaneously exacerbating the moral stigma of HIV/AIDS.

This research was funded by the National Institutes of Health (grant 1 RO1 HD041724).

The author is grateful to collaborators in the 5-country project Love, Marriage and HIV: A Multisite Study of Gender and HIV Risk, Jennifer Hirsch, Shanti Parikh, Harriet Phinney, and Holly Wardlow, whose insights from the other sites were invaluable.