Parejas heterosexuales serodiscordantes en Chiapas, México. La influencia del género en la expresión de la agencia/Heterosexual HIV-Discordant Couples in Chiapas, Mexico. The Influence of Gender in Agency Expression

<p><strong>Español</strong></p><p>Hombres y mujeres heterosexuales con Virus de Inmunodeficiencia Humana (VIH) enfrentan desafíos personales (e.g. miedo a contagiar a otros y al rechazo) y sociales (el rechazo real). Para una persona con VIH (PV), estos son obstáculos en el desarrollo de su vida, especialmente si al formar una pareja, la otra persona no tiene el virus. A partir del supuesto de que las personas no carecen de poder para enfrentar y, ocasionalmente, transformar estructuras sociales, se elaboró este trabajo con el objetivo de explorar y comparar las estrategias seguidas por dos hombres y dos mujeres con VIH, en la formación de pareja, con personas que no tenían reporte (pareja serodiscordante). Los resultados destacan diferencias en las estrategias. Las dos mujeres experimentaron su sexualidad con hombres sin VIH. Sin embargo, ocultaron su diagnóstico a los hombres correspondientes. Tuvieron más dificultades, que los dos hombres, en su afán por mantener una relación de pareja estable. Además, han estado expuestas a riesgos de embarazo no deseado y violencia por ocultar el diagnóstico. Los hombres recurrieron al enamoramiento, para sostener una relación, donde la pareja correspondiente conoció, por información que ellos mismos les proporcionaron, su diagnóstico. Los resultados destacan que hay una inequidad en la disponibilidad de esquemas y recursos, entre hombres y mujeres. Frente al desafío de formar pareja y vivir la sexualidad, después del diagnóstico, las inequidades se reflejan en más dificultades y riesgos en las mujeres.</p><p> </p><p><strong>English </strong></p><p>Heterosexual men and women with Human Immunodeficiency Virus (HIV) face personal challenges (e.g. fear of infecting others and rejection) and social ones (real rejection). For a person with HIV (VP), these are obstacles in the development of their life, especially if forming a couple, where the other person does not have the virus. Based on the assumption that people do not lack the power to confront and occasionally transform social structures, this study was carried out in order to explore and compare the strategies followed by two men and two women with HIV, in forming couples, with people who did not have it (HIV-discordant couple). The results highlight differences in strategies. Although the two women experienced their sexuality with men without HIV, to do so, they hid their diagnosis from their prospective partners. They had more difficulties than the two men, in their eagerness to maintain a stable couple relationship. In addition, they were exposed to risks of unwanted pregnancy and violence, for hiding the diagnosis. The men resorted to falling in love, to sustain a relationship, where the corresponding partner knew their diagnosis, from information that the men themselves gave them. The results highlight that there is inequity in the availability of schemes and resources, between men and women. Faced with the challenge of forming a couple and living their sexuality after the diagnosis, inequities are reflected in more difficulties and risks for women.</p>

HIV, Risky Behavior and Ethno-linguistic Heterogeneity

SummaryEthno-linguistic heterogeneity is associated with indicators of development like civil society, trust, quality of institutions, economic performance and participation. Recently, it has been found to be favorable for optimizing agents who want to engage in risky sexual behavior as they can select partners outside their own network and that of their spouse. This paper augments the literature by arguing that the effect of ethno-linguistic heterogeneity on risky sexual behavior is gender related. In contexts where women have more economic benefits (or losses) from sexual partners, they better internalize the cost of detection. This study shows that, with respect to men, ethno-linguistic heterogeneity significantly affects women’s HIV status and their risky sexual behavior. Accordingly, it also affects positively the probability of being in a discordant couple where the wife is HIV positive.

PREDICTING THE PROBABILITY OF PERSISTENCE OF HIV INFECTION WITH THE STANDARD MODEL

It is not well understood why the transmission of HIV may have a small probability of occurrence despite frequent high risk exposures or ongoing contact between members of a discordant couple. We explore the possible contributions made by distributions of system parameters beginning with the standard three-component differential equation model for the growth of a HIV virion population in an infected host in the absence of drug therapy. The overall dynamical behavior of the model is determined by the set of values of six parameters, some of which describe host immune system properties and others which describe virus properties. There may be one or two critical points whose natures play a key role in determining the outcome of infection and in particular whether the HIV population will persist or become extinct. There are two cases which may arise. In the first case, there is only one critical point P1at biological values and this is an asymptotically stable node. The system ends up with zero virions and so the host becomes HIV-free. In the second case, there are two critical points P1and P2at biological values. Here P1is an unstable saddle point and P2is an asymptotically stable spiral point with a non-zero virion level. In this case the HIV population persists unless parameters change. We let the parameter values take random values from distributions based on empirical data, but suitably truncated, and determine the probabilities of occurrence of the various combinations of critical points. From these simulations the probability that an HIV infection will persist, across a population, is estimated. It is found that with conservatively estimated distributions of parameters, within the framework of the standard 3-component model, the chances that a within-host HIV population will become extinct is between 0.6% and 6.9%. With less conservative parameter estimates, the probability is estimated to be as high as 24%. The many complicating factors related to the transmission and possible spontaneous elimination of the virus and the need for experimental data to clarify whether transient infections may occur are discussed. More realistic yet complicated higher dimensional models are likely to yield smaller probabilities of extinction.

The Missing Premise in the HIV-Condom Debate

In a recent article in this journal, “Condoms and HIV: The State of the Debate,” William Newton argues that there are basically two issues around which parties dispute. The first is whether the use of a condom by a discordant couple amounts to performing a contraceptive act. At issue here is whether a couple's use of a condom to prevent disease transmission renders the act a contraceptive act. The second issue pertains to whether the use of a condom, apart from whatever the intentions of the agents are, is itself a failure to consummate a marital act. It is the second issue that I wish to address in this paper. I aim to argue that the Canon-Law argument, as I will call it, wishes to argue that because condomistic sex fails to consummate a marriage, the sexual act performed is immoral. I argue against this inference on two grounds: the first is that the conclusion succumbs to counterexamples, and second, the inference must rely on a premise that I show is false.