Understanding the Barriers that Reduce the Effectiveness of HIV/AIDS Prevention Strategies for Puerto Rican Women Living in Low-income Households in Ponce, PR: A Qualitative Study

Abstract

Background The HIV/AIDS epidemic has been strongly felt in Hispanic/Latino communities. Estimates of AIDS prevalence among Latinos in the US reveal that just nine States and the Commonwealth of Puerto Rico account for 89% of the Latinos living with AIDS in 2004. Previous research reveals social and cultural factors play an important role in HIV prevention. Methods Four focus groups were conducted, with 39 women, ages 21–67, participating in the discussions. The objectives of this research were to assess knowledge regarding HIV transmission among women living in low-income households, to ascertain barriers to safe sex in this population, and to elicit opinions about effective prevention strategies. Results Our results suggest that participants recognized HIV/AIDS modes of transmission and risk behaviors, as well as their barriers to practicing safe sex. They identified promiscuity, unprotected sex, infidelity, drug and alcohol use, and sharing syringes as behaviors which would place them at risk of HIV/AIDS transmission. They specifically identified lack of negotiating skills, fear of sexual violence, partner refusal to use condoms, and lack of control over their partner’s sexual behavior as barriers to practicing safe sex. Finally results also indicate that current HIV/AIDS prevention strategies in Puerto Rico are inadequate for these women. Discussion To address these issues the authors suggest cultural and social factors to be considered for the development of more effective HIV/AIDS prevention programs.

A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women

“…Other studies found that women who did report asking their partners to use condoms were met with refusal [78,84], mockery [84] and threatened abandonment [78]. In Nicaragua, while three women reported successfully convincing their partners to use condoms after their infidelity had been exposed, for two of them the condom use only lasted two weeks [84].…”

“…So when he wants to do [have sex] I make myself ready" [82] (p. 132) Some women blamed themselves for their partner's infidelity [80,81,84], demonstrating an internalization of patriarchal norms. In some studies, this was compounded by societal beliefs that men are unfaithful because women fail to meet their sexual needs at home, or are not 'desirable' enough to their husbands, forcing them to look for a sexual partner outside the marital relationship [78,80,84]. This quote exemplifies the stigma and discrimination many women faced because of their partner's infidelity due to patriarchal beliefs about male entitlement to sex, and the hopeless tone women took when discussing it.…”

“…In studies from India and Puerto Rico women reported that they had no power to negotiate condom use in their relationships, but underlying this lack of control was an inability to voice their suspicions of infidelity for fear of physical violence (Pathway 2) [78,103]. Evidence that infidelity, HIV and physical violence were intertwined also emerged in sub-Saharan Africa, and in one instance a woman was reportedly murdered after rebuffing her husband's sexual advances and telling him she feared he had been unfaithful and contracted HIV [79,87].…”

Condom-Use Patterns among Women Who Live in Public Housing Developments in Ponce, Puerto Rico

“…24 However, this may be because we identified and listed reasons for not using condoms and had the women select the reasons, giving them an “other” category and providing space for them to elaborate on the reason, whereas in the focus groups, the women all talked together and the moderator/facilitator was able to ask the women to explain their perceived barriers for engaging in safer sex, especially using or introducing condoms into their current relationships. 24 …”

“…24 These women noted feeling a lack of control over partner’s behavior, fear of physical violence, partner’s refusal to use a condom, and lack of negotiation skills. These data were collected through focus groups; the questions used to elicit the data were asked in a fairly general way (such as “What are the barriers to using condoms that you encounter in your sexual relationships?”).…”