Barriers to preventing human immunodeficiency virus in women: experiences from KwaZulu-Natal, South Africa.

OBJECTIVE: to determine barriers to the adoption of safer sex practices in women in KwaZulu-Natal, South Africa.
METHODS: This cross-sectional survey was conducted in a peri-urban and a rural community in 1991 to 1993. A structured, pretested questionnaire was administered to consenting women age 15 to 44 years who had been drawn randomly from a 10% systematic sample of households. The questionnaire included the following items: demographic characteristics, sexual relationships, knowledge of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), perception of risk, knowledge of and skills with respect to safer sex practices, and perceptions of rights to safer sex practices.
RESULTS: A total of 219 interviews were conducted. Most respondents had an average of 8 years of schooling and were seeking employment. The majority of the respondents were sexually active (88.1%) and had extensive knowledge of modes of transmission and methods of preventing HIV/AIDS. Although most respondents underestimated their risk of HIV infection, a key reason for women not acting on their knowledge and perception of risk was that many did not believe they had a right to refuse sex with their partners (48.8%) or insist on condom use (46.1%). Most women thought their partners had a right to multiple partners (62.2%). Only 35.2% of respondents had the skills to object to their partners' having multiple partners, and 82.4% lacked the skills to use condoms.
CONCLUSION: Women in these communities are at high risk of HIV infection. Their perceived lack of a right to safer sex, lack of skills to adopt safer sex practices, financial dependence on their sex partners, and the threat of violence influenced their ability to reduce their risk of HIV infection.