Marriage presents the single greatest risk for HIV infection among women in rural Mexico. We drew on 6 months of participant observation, 20 marital case studies, 37 key informant interviews, and archival research to explore the factors that shape HIV risk among married women in one of the country's rural communities. We found that culturally constructed notions of reputation in this community lead to sexual behavior designed to minimize men's social risk (threats to one's social status or relationships), rather than viral risk and that men's desire for companionate intimacy may actually increase women's risk for HIV infection. We also describe the intertwining of reputation-based sexual identities with structurally patterned sexual geographies (i.e. the social spaces that shape sexual behavior). We propose that, because of the structural nature of men's extramarital sexual behavior, intervention development should concentrate on sexual geographies and risky spaces rather than risky behaviors or identities.
Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS.
Studies to evaluate the impact of international migration on distribution of infected persons will be indispensable to establish priorities in prevention and attention among migrants. More information is needed on bi-national health projects to understand the impact they may have in prevention, while continuity of the prevention initiatives must be guaranteed. Attention to migrants in bi-national contexts requires information exchange agreements on migrants living with the HIV/AIDS.
Mobile populations present particular challenges for the delivery of health services. This paper focuses on a highly mobile populationÐtruck drivers who cross the Mexico-Guatemala border through Ciudad Hidalgo in ChiapasÐand examines the impact of an intervention that provided information regarding STD/HIV/AIDS, and promoted condom use. Following an ethnographic study to identify key actors, interaction sites and sexual practices, a baseline questionnaire survey was administered to 307 truck drivers. Information gathered in both the ethnographic study and the survey was used to design a series of interventions to promote condom use and provide information about STD/HIV transmission. Perceptions of risk for HIV/AIDS were lower for truck drivers in the intervention group compared with the baseline survey, an effect associated with greater reported condom use by truck drivers in this group. Border crossings are strategic setting for prevention interventions regarding STD/HIV/AIDS. Strategies must be developed to capitalize upon this as part of broader health promotion efforts.
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