Working "upstream": why we shouldn't use heterosexual women as health promotion change agents in HIV-prevention interventions aimed at heterosexual men.

The use of cognitive-behavioral interventions that aim to improve men's health-seeking behaviors via women-a trend that grows increasingly troublesome as gender inequality persists-cannot address the deep-seated social, economic, and political inequalities contributing to the spread of HIV/AIDS, such as sexism and poverty. Such methods often rely on generalizations about men and women and regard female empowerment as a key goal, despite employing shaky definitions of the concept. Here we use the principles of health promotion, particularly determinants of health, to reflect upon and critique current interventions and present alternative programming models that engage both men and women in changing men's health-seeking behaviors and working "upstream" rather than "downstream" of the epidemic.