On the Margin: Power and Women's HIV Risk Reduction Strategies

HIV risk and prevention research has failed to investigate adequately the effects of gender-related factors such as relationship power, sexual communication, abuse, and gender roles on women's abilities to engage in protective actions. We propose that women's HIV risk from heterosexual transmission is embedded in the context of gender, race/ethnicity, and class oppression. This context has central implications for interpersonal relationship factors relevant to women's HIV risk. We suggest a framework for understanding women's HIV risk within the context of oppression and the role of power in intimate sexual relationships. Three common dynamics of oppression are considered: (1) Silencing, (2) Violence and Fear of Violence, and (3) Internalized Oppression. These dynamics are based on characteristics of oppression discussed in the work of Jean Baker Miller on gender, Hussain Bulhan on race, and Paulo Freire on class. These dynamics are discussed in the context of findings reported in this journal issue and those of other authors. Finally, the discussion identifies common patterns across studies, as well as areas of disagreement and directions for future research and public health prevention efforts.