Sexual decision-making and AIDS: why condom promotion among vulnerable women is likely to fail.

This article examines the reasons for resistance to condom use among high-risk women (primarily intravenous drug users and/or the sexual partners of intravenous drug users) in two New York City AIDS prevention programs. The data collected indicate that a lack of economic, social, cultural, sexual, and technological options combine to lead vulnerable women to concentrate on addressing the more immediate risks in their lives: poverty, homelessness, and the frequent disruption of socioeconomic support systems. Resistance to condom use was also found to be related to its negative associations (promiscuity, for example). The process by which decisions are made about using condoms (and other contraceptives) is related to a complex mixture of social, economic, and cultural influences that promote the role of motherhood for a woman, even when she knows that she might already be infected with human immunodeficiency virus (HIV). The implications of these findings have far-reaching effects, as the socioeconomic context of these women's lives, as well as imbalances in power in the relationships between the women and their male partners, are replicated in many communities where AIDS is already present.