title: Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions.
abstract: Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.
authors.affiliation: Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK e.mugweni@ucl.ac.uk.
authors.forename: Esther
authors.initials: E
authors.lastname: Mugweni
authors.affiliation: Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors.forename: Mayeh
authors.initials: M
authors.lastname: Omar
authors.affiliation: Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pearson
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008393:Marriage; D008875:Middle Aged; D017008:Negotiating; D011209:Power, Psychological; D036301:Qualitative Research; D021841:Safe Sex; D012725:Sexual Behavior; D055815:Young Adult; D015030:Zimbabwe