Women at risk for HIV from a primary partner: balancing risk and intimacy

Women are being devastated by the HIV/AIDS epidemic in the U.S. and all over the world, most infections occurring via heterosexual activity with a primary partner. Although a number of evaluations of behavioral risk-reduction interventions for women have been reported, many suffer from methodological problems that weaken confidence in their findings. It is clear that, despite statistically significant intervention effects, many women are unable to respond to even the most effective interventions that have been tested, a fact that might be attributable to failure to change behavior with primary partners. Achieving consistent condom use with primary partners can be highly challenging for women, for a variety of reasons. In the present paper, I review the literature regarding behavioral interventions for women. I also review data supporting the feasibility of alternative strategies that may be more effective than those usually recommended for women at risk for HIV infection by their primary male partner. The literature on woman-controlled technologies, such as the female condom and vaginal microbicides, is summarized. Alternative messages for condom negotiation and "negotiated safety" are also described. Because it is relevant to negotiated safety, and at the heart of the present topic, a review of the behavioral literature regarding serodiscordant heterosexual couples is also provided.