Empowering Yoruba Women in Nigeria to Prevent HIV/AIDS: The Relative Significance of Behavioural and Social Determinant Models

摘要

This article uncovers the relevance to practice of behavioural and social determinant models of HIV prevention among Yoruba women in Nigeria. Exploring what factors influence health behaviour in heterosexual relationships, the key question raised was whether the women’s experiences support the assumptions and prescriptions for action of these two dominant public health models. Eight focus group discussions and 39 in-depth interviews were conducted, which involved 121 women and men who were chosen purposefully and through self-nomination technique. This study revealed that the women were very much constrained by social environments in negotiating safe sex, despite having at least a basic knowledge of HIV prevention. Limiting factors included the fear of relationship breakup, economic dependence, violence, and the difficulties in justifying why they feel the need to insist on condom use, especially since initiating condom use is antithetical to trust. Furthermore, evidence suggested that improved access to income and education might be vital but it does not automatically constitute a direct means of empowering women to prevent HIV infection. The limitations of both behavioural and social determinants perspectives thus suggests the need for a combination prevention model, which focuses on how social, behavioural and biomedical factors overlap in shaping health outcomes.