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This Article Full Text Full Text (PDF) Spanish Abstract All Versions of this Article: AJPH.2006.088492v1 97/6/986    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Hirsch, J. S. Articles by del Rio, C. Search for Related Content PubMed PubMed Citation Articles by Hirsch, J. S. Articles by del Rio, C. Related Collections Gender Global Health HIV/AIDS Prevention Sexual Health Qualitative Research

Jennifer S. Hirsch, PhD, Sergio Meneses, MD, MA, Brenda Thompson, MPH, Mirka Negroni, MA, Blanca Pelcastre, PhD and Carlos del Rio, MD

At the time of this study, Jennifer S. Hirsch was with the Mailman School of Public Health, Columbia University, New York, NY. Sergio Meneses was a master’s student at Cento de Investigaciones en Antropología Social (CIESAS-Sureste), San Cristóbal de las Casas, Chiapas, Mexico. Brenda Thompson was a master’s student in the Department of International Health, Emory University, Atlanta Ga. Mirka Negroni and Blanca Pelcastre were with the Mexican National Institute of Public Health, Cuernavaca, Morelos. Carlos del Rio is with the Emory University School of Medicine, Atlanta.

Correspondence: Requests for reprints should be sent to Jennifer S. Hirsch, Columbia University, 722 W 168th St, New York, NY 10032 (e-mail: jsh2124{at}columbia.edu).

Marriage presents the single greatest risk for HIV infection among women in rural Mexico. We drew on 6 months of participant observation, 20 marital case studies, 37 key informant interviews, and archival research to explore the factors that shape HIV risk among married women in one of the country’s rural communities. We found that culturally constructed notions of reputation in this community lead to sexual behavior designed to minimize men’s social risk (threats to one’s social status or relationships), rather than viral risk and that men’s desire for companionate intimacy may actually increase women’s risk for HIV infection. We also describe the intertwining of reputation-based sexual identities with structurally patterned sexual geographies (i.e. the social spaces that shape sexual behavior). We propose that, because of the structural nature of men’s extramarital sexual behavior, intervention development should concentrate on sexual geographies and risky spaces rather than risky behaviors or identities.