Gender, sexuality, and antiretroviral therapy: using social science to enhance outcomes and inform secondary prevention strategies.
OBJECTIVE
To explore how, within the context of antiretroviral therapy (ART) uptake and adherence, social science research on gender and sexuality could complement existing epidemiological and behavioral research on uptake, adherence, disinhibition and reproduction.


METHODS
Bibliographical database searches on ART uptake and adherence, the sexual practices of HIV-positive individuals, and fertility management among HIV-positive men and women were conducted over a 6-month period using ISI Web of Science and Medline. Articles were sorted by main topic and then analysed to reveal the unarticulated assumptions that have framed research to date.


RESULTS
The adoption of more social scientific theoretical frameworks would move research on uptake, adherence, disinhibition, and reproduction among HIV-infected and affected individuals beyond the current overemphasis on how cognitive and ideological factors shape behavior and towards an understanding of how culture and inequality shapes the way people engage with ART and craft their sexual and reproductive lives. Research that pays greater attention to the social processes that create differentials in uptake and adherence, rather than just the quantification of those differentials, will open up new possibilities for community-based interventions. Similarly, social science research on gender and sexuality can provide insight into the social factors shaping reproductive and sexual behavior, and thus enhance our ability to manage the potentially competing priorities of limiting marital sexual risk and increasing access to reproductive choice among HIV-affected couples.


CONCLUSIONS
The ability to produce good clinical outcomes and to develop effective policies for secondary prevention will be enhanced by a deeper understanding of how gender inequality and the social organization of sexuality shape the sexual and reproductive behavior of individuals using ART.
Hirsch
Jennifer S
JS
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. jsh2124@columbia.edu
D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D043762:Reproductive Behavior / Q000523:psychology; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior; D019529:Sexuality; D012962:Sociology, Medical