Content area
Full Text
Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and men's sexual power and privilege. Conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Although the women's vulnerability paradigm was a radical revision of earlier views of women in the epidemic, mounting challenges undermine its current usefulness. We review the etiology and successes of the paradigm as well as its accruing limitations. We also call for an expanded model that acknowledges biology, gender inequality, and gendered power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men. (Am J Public Health. 2010;100: 435-445. doi:10.2105/AJPH.2009.159723)
Since the first cases of AIDS were diagnosed more than 25 years ago, the depiction of women in the scientific and political discourse of HIV/ AIDS has dramatically transformed. Virtually invisible in the earliest phases of the US epidemic, then treated as stigmatized vectors of the virus, women were expected to protect themselves by insisting on male condom use-despite feminist recognition of the reasons this expectation would fail.1,2 More recently and remarkably, the primary face of AIDS is a woman from the global south-a face deserving both sympathy and support, if not rescue.3 Meanwhile, men who have sex with women remain a forgotten group in the epidemic,4 almost entirely unaddressed in HIV prevention programs.
How, why, and for whom did women become the primary vulnerable victims of the HIV epidemic? More important, does this transformation serve the current needs of those at risk for HIV? Here we consider the etiology and evolution of what we have termed the vulnerability paradigm, a model that has been latent within the research literature and policy lexicon, but a ubiquitous model5-9 that we wish to name explicitly. According to this paradigm, women are susceptible to HIV because of biological differences in susceptibility, reduced sexual autonomy, and men's sexual power and privilege. Conversely, heterosexual men are active transmitters of HIV but not active agents of prevention. The paradigm assumes not only that women (but not men) want to prevent HIV but lack the power to do so, but also that men are more likely than women to bring HIV into the partnership. The model tends...