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The Secret: Love, Marriage, and HIV
  1. Gillian Robinson
  1. Associate Specialist, Department of Sexual Health, Southwark PCT, London, UK

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The Secret: Love, Marriage, and HIV Jennifer S Hirsch, Holly Wardlow, Daniel Jordan Smith. . Nashville, TN: Vanderbilt University Press, 2009. ISBN-13: 978-0-82651-683-1. Price: £26.95. Pages 320 (paperback)

This book publishes the results of a 5-year research project entitled ‘Love, marriage and HIV: a multisite study of gender and HIV risk’. It was supported by the USA National Institutes of Health. The proportion of women with HIV varies worldwide; in sub-Saharan Africa nearly 60% of cases occur in women whereas in Asia this figure is 35%. During the study period there was increasing recognition that women were contracting HIV and one of the principal risk factors was marriage.

The book studies sexuality in five settings: Mexico, Nigeria, Uganda, Vietnam and Papua New Guinea. The authors conclude that extramarital sex is a fundamental part of social organisation. Women marry and stay within a marriage because it provides economic security and respectability. After childbirth they are confined to the home looking after the home, their husband and children. Men marry, even if homosexual, as it is often the only means of leaving the parental home. They often have to travel away from home for work. Extramarital relationships are tolerated as long as they do not disgrace the family; women are complicit because their role and reputation depend upon them being married. The conclusion was that women contracted HIV from their husbands.

I am not an anthropologist and so cannot comment upon the novelty or otherwise of the authors' research methods. Many of their observations and conclusions resonated with social situations I have observed in the UK however.

The authors comment that by targeting risky/promiscuous practices public health programmes make it almost impossible for people infected by ‘normal practices’ to acknowledge they have contracted the virus. They also stress that in certain areas HIV risk is connected to social and sexual immorality so it is unlikely that individuals will conceive of their own behaviour as risky.

This was not an easy book to read but it did contain some interesting ideas. I fear that for clinical sexual health practitioners it will not pass the ‘so what’ test.