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Need for Change in Social Norms to Prevent Spread of HIV

een those who used the product and those who didn’t.’

She quoted the example of Thailand to show the role of the government in preventing the spread of HIV. She said, ‘Information and education are critical, but they’re not enough. When Thailand wanted to stop HIV transmission in the brothels, it didn’t just suggest that people use condoms. It took a proactive approach and adopted a 100 percent rule. Brothels that didn’t enforce condom use were shut down like restaurants with code violations, and it worked. The transmission rate fell and the country averted a disaster.’

She stated that the Bush administration’s ABC approach [abstain, be faithful, use condoms] was effective only if it is part of a balanced and comprehensive prevention strategy as was seen in Uganda. When children started delaying their sexual debut, and people embraced condoms and partner reduction, the infection rate came down.

However she warned that there were limits to that approach, especially for women. She said, ‘Social, cultural and political factors make some people more vulnerable to HIV. If you’re a woman lacking food for your kids, sex may be the only asset you can sell. You’re not in a good position to dictate the terms. Women who are themselves monogamous may be in relations with partners who have multiple partners and won’t use a condom. Women in many societies don’t have the social power to negotiate safer sex or control sexual interaction, including within marriage.’

She hailed the efforts of CARE to address these deeper sources of risks. Gayle said, ‘I just visited a community-based savings-and-loan program that CARE supports in Guatemala. CARE has similar programs in Africa and in Asia. This program provides small loans that women can use to start businesses if they send their daughters to school. Woman after woman described how earning money had raised her stature within her family and marriage. The girls said the same thing about going
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