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Research |
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Haitian Women's Role in Sexual Decision-Making: The Gap Between AIDS Knowledge and Behavior ChangeII. Presentation of Findings |
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4. AIDS Prevention Strategies and Women's Rights If the woman stays only with her husband Focus group discussions confirmed the findings of previous studies that, whether or not they make use of the information, most Haitians know how to prevent HIV transmission. With very few exceptions, women concurred that the only way to protect oneself is to observe "one man - one woman" ("yon sel fi - yon sel gason") or to use condoms. Nevertheless, the transcripts also revealed the gulf between what women know about prevention and what they believe they can realistically do to influence behavior that men have always controlled. When prevention was introduced as a topic for discussion, participants in each group recited as if in unison the rules of safe sex as presented in posters, in the mass media, at health centers and workplaces. Through skillful probing, focus group moderators peeled back the veneer of superficial knowledge, revealing deep-seated contradictions and conflicts between old norms of behavior and new prescriptions for change. Multiple Partners The man is always out ; he does what pleases him Focus group transcripts confirmed the observation that monogamous marriages are the exception rather than the rule for the majority of disadvantaged Haitians and that men, particularly, do not confine themselves to one stable partner. Women focus group participants were well aware of the tendency of men to have "outside women" ("fi deyo") in addition to a woman at home ("fanm fiks"). The perception they shared of men's promiscuous sexual behavior was the backdrop against which they debated the many issues of sexuality and AIDS prevention that formed the substance of the discussions. However, "knowing" the habits of men in general did not necessarily mean that women have such information about the men they lived with. While a few volunteered that their husbands or steady partners had other relationships and others emphatically denied any such possibility, it was apparent that many simply did not know. Participants made it clear that they would prefer monogamous partnerships but repeated references to the sexual freedom men enjoyed uncovered a sense of powerlessness to influence their partners' behavior. Women took the hypothetical Joujou's plight very seriously, defining it as a situation that demanded decisive action on her part. Since Joujou and René lived in the same house, René had the status of "husband," with an obligation to protect Joujou from AIDS, but the women usually did not agree on the best strategy for convincing him to accept this responsibility. Nor was there much expectation that René could ever be convinced to adopt a different sexual lifestyle. Sexual freedom was a recurrent theme in every group, a privilege that men enjoy at women's expense. In a typical exchange on this issue, married women in Savanne spoke resentfully about the ability of men to make their own decisions about leisure time and money:
Some men are sly as cats As discussed in Section 2.2 in relation to women's sense of vulnerability to AIDS, they uniformly did not trust men when it came to sexual relationships. Many women commented that men believe they are in command, "the chief of the woman" with little or no accountability for his sexual behavior outside the home. A Delmas woman complained that a married man feels no obligation to tell his wife about children he has with other women. The pain of uncertainty came through the discussions in many different ways. A married woman in Savanne said resignedly,
"Some men are sly as cats," said another married Savanne woman. "Even if they do have other women, you'll never know until the other woman starts showing off and ridiculing you" Several women spoke of discovering their husbands' infidelity when they found condoms in their pockets. These and similar comments reflected the humiliation women feel when others know their partners are having affairs before they do. At the same time, women observed that to avoid "problems" between them, it is better for a man to think that his woman at home does not know. Several indicated that they would play that game in the interest of family harmony. One of the many ironies for Haitian women is that they are not supposed to know what their men do outside the house, but not knowing may open them to ridicule and eventually to unprotected sex with an HIV-infected partner. He would never throw away the old pot for a new one What can a woman do when she suspects her man of having other partners? Refusing sex was one alternative, but attempts to reason with the man, to cajole him into giving up the other women, seemed a better solution to some. A Delmas participant said, "A woman can talk to a man, and if he is a person who listens he agrees and gives up what he used to do." Women who spoke in support of this strategy hoped that by explaining the danger of AIDS transmission to a man, his wife or regular partner could appeal to his sense of duty to protect her life and the welfare of his family. Some said that words were not enough, that it is the woman's responsibility to satisfy her man so that he will cease to think about other women. The latter position sometimes had overtones of self-blame, as when a married woman in Savanne said,
Most participants, however, took the stand that, in general, men do not listen. "He may listen to you once, but after that he will not listen to you", said a Delmas woman. They do not listen, explained another Delmas woman, because men never want to give up the women they have:
I would refuse Given the reality of sexual freedom for the men in their lives, women gave serious thought to abstinence as a solution to the risk of acquiring AIDS from a promiscuous partner, particularly when the man declines the use of condoms. However, despite many comments that discovering a partner's infidelity would justify refusal because of the threat of AIDS, refusing sex to prevent disease still seemed to be a relatively new and even frightening idea for most women. In general, the women did not regard refusing sex as an unusual event in a relationship, but the reasons they gave for refusing a partner's sexual advances suggested that it is acceptable behavior only if it is infrequent. Common reasons for refusal emerged among all categories of participants, namely fatigue or illness, menstruation, preoccupation with financial or other household worries, and argument between the partners. Women also cited pregnancy prevention and disaffection, abuse and neglect as reasons for at least trying to avoid sexual contact. A Savanne woman in a "vivavek" relationship described using sexual favors to bargain:
Using sex as a bargaining tool was not limited to women in unstable relationships. Women who were "maryé" or "plasé" stated that they also might refuse to sleep with a man who was not supporting them adequately, especially if money were going to another women. "If I need something," said a married woman in Delmas, "I ask my husband for the money, and if he doesn't give it to me, I will not make love with him. Then he gives me the money right away." For other participants, their sense of responsibility to the conjugal relationship made it unthinkable at first to refuse a partner, but when the risk of AIDS entered the discussion, the same women often reversed their position. However, unlike fatigue, illness, anger, and even family planning, AIDS risk as an excuse to avoid sex is not under the woman's control and carries no assumption that the relationship will soon return to normal. Consequently, even women who recommended refusing a promiscuous partner recognized the liabilities. Although they were quick to advise Joujou to refuse René's sexual advances while he was seeing other women, they readily acknowledged that it was a dangerous strategy that was likely to backfire. They were saying, in effect, that in principle a woman has a right to refuse sex for fear of contracting AIDS, but in reality her right may not be recognized by her partner. The following dialogue from a group of women in Delmas illustrates some of the fears that many participants expressed in discussing a woman's right to refuse sex:
I know that I send him to the streets The greatest fear that women expressed was that in refusing sex they would send the man back out to the streets to find a more compliant woman who would infect him with HIV, which he would then carry back to the woman at home. In another Delmas group, the women agreed that refusing sex amounted to little less than a death warrant for themselves.
Women feared other reprisals, too, including physical abuse and loss of spending money for food and clothing.
Physical retaliation was a reality shared by some women, particularly the women in Savanne, as the following exchange between two married ("plasé") women illustrates:
These women were caught in a deadly dilemma. They knew all too well the danger of sex with a man who may have numerous other partners, but the decision to protect oneself they felt would only compound the risk. There was a strong sense that women must inevitably accede to men's sexual desires in order to protect themselves and the welfare of their children. The retaliation that many women feared may have seemed a greater and more immediate risk than the threat of HIV infection itself. It is not surprising that when women talked about saying no to sex for fear of AIDS, they usually suggested deception rather than direct confrontation with a promiscuous partner. At these times, women proposed using familiar excuses such as child spacing, feeling unwell, or "needing a break," usually with the emphasis on temporary indisposition. Some said they would tell a man they were refusing because he had too many partners, but such a direct assault took more courage than many women apparently had. Condoms I heard them say you can protect yourself with condoms On the question of condoms, participants were divided on several issues, namely the acceptability and effectiveness of condoms for HIV prevention, a woman's right to ask a partner to use them, and the kind of response that women anticipated from men. Without exception, women knew that condoms are supposed to prevent HIV transmission, and most accepted it as fact. But some questioned whether even a condom would be sufficient protection if the man were "already infected," also suggesting that a man might somehow carry and transmit the disease without his being infected. Their confusion may stem from incomplete knowledge of the difference between asymptomatic HIV infection and AIDS, which many had seen and could describe in vivid detail. Others, fearing transmission through saliva, doubted that condoms would be adequate protection. A more significant number questioned the quality of condoms and the possibility of perforation or tears. However, according to focus group participants, an even greater deterrent to condom use was women's own perception that condoms were injurious and decreased sexual pleasure. I have a problem with condoms Although most women initially advocated condom use as the only solution to sex with a promiscuous partner, at least half in every group later pointed out the liabilities of condoms, sometimes with reference to personal experience. The following segments illustrate the negative attitudes that participants expressed in response to the moderator's question, "Are women in general willing to use condoms?" (Delmas women, never employed)
(Savanne women, stable relationships)
(Savanne women in "vivavek" relationships)
In contrast to remarks of women in the above three categories, women who had been factory employees were less negative. Factory workers related similar complaints they had heard about condoms, i.e. lack of pleasurable sensation, tearing or retention, and harmful effects of "grease", but they did not seem to identify to the same degree with others' negative attitudes. When speaking for themselves, some cautioned that condoms might not be enough protection, referring to factory defects and tears. As one woman said, "I will not use condoms if I know he has the disease, I will not have sex with him at all. I will leave him." I wouldn't like to use a condom, but Despite their reservations about condoms and personal objections to using them, women in all groups repeatedly and emphatically advised Joujou and others like her to tell their promiscuous partners to use condoms - or move out.
The admonition of this Delmas woman was echoed many times over in every group in all participant categories. Their message was that condoms may have their disadvantages but that they are the only way a woman can continue a sexual relationship with a man who refuses to give up his other partners. Strategies for convincing a man to agree to use them varied from tactful persuasion to ultimatum. Two women factory workers offered the following advice:
Savanne women appealed more directly to the man's responsibility for the consequences of his own behavior:
Other women said they would bargain with the man, offering sex if he used condoms and threatening to sleep in a separate bed or leave him. Several would discontinue a sexual relationship but without neglecting their usual domestic responsibilities. For many women, a man's refusal either to give up his extramarital activity or use condoms was reason to abandon him, despite the economic consequences for themselves and their children. Any woman has a right if she knows he is fooling around How do these women resolve the inconsistencies in their often contradictory perspectives on condoms? Sometimes the same women who advocated condoms for women at risk later expressed personal fear and rejected the idea of using them in their own relationships. The answer may lie in their discussion of whether women have a right to ask a partner to use condoms. This question invariably stimulated vigorous debate on the kinds of women who have - or do not have - such a right. Differences of opinion within groups were greater than differences between participant categories, but even within groups there was little differentiation with age, education, marital status, or other sociodemographic characteristics. Responses tended to follow a pattern in which women at first agreed that any woman has a right to protect herself from AIDS but then began to raise stringent conditions under which "any woman" could properly propose condoms. A minority stated flatly that "you will never find a woman who would ask the man to use condoms" (D1-II,1454). The factory worker who offered this comment went on to explain that if the woman is his wife at home, she might suggest condoms as contraception "if you are making children too quickly." If it is "another woman" who is living promiscuously, "she would not ask, because she does not care about his life." Her solution in that case was to advise the man with a wife at home "to buy condoms whenever he is going to have sexual contact with another woman." Most participants supported the right of at least some women to ask partners to use condoms. A criterion on which most agreed was that she be certain of her risk. Women commonly responded that the woman who has a right is the one who knows that her husband has other partners, or the corollary that if the man is not "fooling around" she will never ask, as in the following comment by a married woman in Savanne:
Other women who have a right to ask are prostitutes and school girls, neither of whom, participants pointed out, would wish to be burdened with children. Women who do not have the right are those in long-term relationships or whose husbands or regular partners are not seeing other women, women who are recently married, and women whose partners might wish to have more children. Several women observed that Christian women do not bring up the subject of condoms, because Christian men do not have affairs with other women. Only one woman, a participant in Delmas, volunteered that she would avoid pregnancy to protect the child if she thought either she or her husband had AIDS. Two common elements that stand out in these criteria are sexual freedom and fertility, traditional values now threatened by the risk of AIDS. Women who question a partner's fidelity may be challenging the validity of the double standard that has governed their relationship. An irony in the "rules" that determine a woman's right to ask for condoms is that women often do not know - and are not supposed to know - whether their men are frequenting prostitutes or having affairs with other women. But in fact, a woman in a "vivavek" relationship said that "there are no women who should not ask men to use condoms, because there are no men who do not 'fool around'." He can do planning with his wife Fertility was another competing value that often overshadowed disease prevention as a priority in decisions about sexuality. First, it was apparent that the link between condoms and contraception was more familiar than the link with disease prevention. Second, while focus group participants tended to deny women the right to ask for condom use if their partners desired children, they frequently turned to the rhetoric of family planning to find culturally acceptable metaphors to justify the use of condoms for AIDS prevention when children were not an issue. For example, in response to Joujou's fear of contracting AIDS, the women often advised her to use "planning", a reference to condoms as a contraceptive barrier method which they knew also prevents transmission of the HIV virus. They felt it easier to convince promiscuous partners to accept condoms under the guise of family planning than to confront the more threatening issue of AIDS prevention. Men who are not beasts will agree As the above suggests, women do not take lightly the public health prescription to use condoms as a precaution against AIDS. They understand and can accept in principle the preventive value of condoms, but there are costs that for many outweigh the benefits. Aside from their own misgivings about condoms and their safety, women were skeptical and even apprehensive about the reaction of men to such a proposal. In focus group discussions, they were quick to recommend that Joujou - and women in general - should demand the use of condoms if they could not trust the fidelity of their regular partners. However, when asked how the same men would react, their opinions varied from the firm belief that "men who are not beasts" will agree, to an equally strong insistence that few if any men will ever be willing to use condoms, especially with wives or regular partners. They don't want to use condoms Women who took the more negative stand on the issue of partner response to condoms were the more numerous and the more vocal. For the most part, their concerns centered on issues of denial and trust. They contended that men refuse to admit having other partners and instead turn the blame on the women at home. They want to know why they are being asked, whether it is because the woman, herself, is sick or because her own behavior is putting him at risk. Women focus group participants said that suggesting to a man that he use a condom provokes him to accuse her of having "other husbands", the only reason, he might allege, that she would make such a demand. If he wishes to take her request for condoms as evidence of infidelity, he may then respond with physical abuse, withdrawal of economic support, or abandonment. If a woman works, she does not submit Fear of physical abuse was not a major theme, but fear of abandonment or economic neglect was. In the Haitian society we studied, women could be manipulated by men who had the power to deprive them of the resources for basic survival. Men who did not get what they wanted could retaliate by withholding money for food, rent, clothing - even child care. Many women expressed their powerlessness to change sexual behavior in terms of their dependency on satisfying men. Women who do not work have no right to make demands; women with jobs earn that right because they have other options for themselves and their children. Commenting on the story of Joujou and René, a married woman in Savanne said:
A Delmas woman echoed these words when she said, "Every decision a woman makes depends on the money she has in her hand. If she does not work and the man does, he will always be the head of the family." "A woman can decide only when she works," agreed another in her group. "Otherwise they (men) call her useless." Comments such as these take the problem of AIDS prevention to a more fundamental level, to the direct link between women's fear and frustration in the face of the epidemic and their sense of powerlessness to control their own lives. For the women in these focus groups, money was as much a symbol of freedom as it was a material resource for achieving independence from male domination. Without access to income, they lacked the self esteem and the financial security to be full partners in critical decisions that could determine their chances of survival in the AIDS epidemic. Then he will be without a partner Even despite the awesome prospect of women losing what little economic security they may have had, many participants still believed that if a man with other partners rejects condoms, a woman should refuse sex or even leave him. There were many references to sleeping in separate beds or on the floor. When a group of Savanne women agreed that wives should be able to insist their husbands use condoms, they kept abandonment as a last resort:
Many such threats were expressed in all participant categories, even from some of the same women who had voiced concern that men would respond with anger and retaliation. Some said that being alone would be preferable to the risk of AIDS and that women who found themselves in that dilemma should try to find domestic work or street vending to support themselves. It was clearly a painful issue and one which illustrated the women's struggle to resolve the contradictions inherent in an old way of life that has left them with the personal resolve but neither the material nor the psychosocial resources to act effectively against AIDS. |
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