Like dogs in December: Women\u27s perspectives on HIV/AIDS prevention programs and married life in rural northeast Thailand

HIV/AIDS has spread rapidly in Thailand since the first documented cases in 1984, due to the prevalence and nature of the commercial sex industry and the social norms surrounding extramarital sex and condom use. Because the highest incidence of HIV/AIDS continues to be in large cities and resort towns, rural people have been perceived as having low-risk for HIV/AIDS transmission. The economically-disadvantaged rural population faces increasingly higher risk because of its mobility and interaction with urban populations. Married women\u27s risk is primarily found in sexual behavior within marriage; their limited ability to protect themselves relate to the difficulty of obtaining accurate information about their husbands\u27 extramarital sexual behavior. The Multisectoral AIDS Prevention Strategy (MAPS) Program, in coordination with Khon Kaen University and the Thai government, was a program designed to help rural community members assess their HIV/AIDS risk and take preventive action. The program aimed to improve rural women\u27s abilities to protect themselves, using a community-based, culturally-sensitive approach. However, by using traditional methods and systems for delivering health information, in practice the program shifted in focus from women to men in both the dynamics of participation and the AIDS prevention strategies produced by the program. The study was based on interviews and focus groups, emphasizing the points of view of married women who live within the program area but were not directly involved in program activities. The politics of women\u27s participation in program activities and leadership is the initial point of inquiry. Wives\u27 experience with personal risk assessment and how it relates to judgement of their husbands\u27 character are described. Having little success using the methods available through the health infrastructure, women have created their own innovative yet problematic AIDS prevention strategies. The actual practices of women are juxtaposed with the official MAPS-sponsored AIDS prevention strategies. Current perceptions about people with HIV/AIDS are described in so far as they suggest future opportunities and challenges for HIV/AIDS prevention efforts. Recommendations for maintaining a women focus and making better use of indigenous solutions conclude the work