How Male Power Spreads HIV

The roles of gender and stigma in the epidemic in the Mexican state of Chiapas
Sandra Villarreal Martinez speaks openly about HIV in the Mexican state of Chiapas, where it is still stigmatized. (Eva Hershaw)

In a bright pink tank top, a black skirt, and three-inch heels, Sandra Villarreal Martinez walked confidently to the front of a small group of women, ages 38 to 55, sitting in plastic chairs on a cement patio. They are all HIV positive.

She offered them a big smile as beads of sweat accumulated on her forehead. “I’m here to talk to you about condoms,” she said, holding a small package into the air. “How many of you have used one of these before?” she asked. Some women fanned themselves with their notebooks, gazing into the distance. Some looked to the others for consolation, visibly uncomfortable. Finally, María stuck a lonely hand into the air. “Great,” said Sandra. “And do any of you know how to open a condom?”

The group was silent. From the back corner, the sole male attendee stood up. “I can show you how.” The women giggled. “First off, no teeth and no scissors,” he said, taking the condom out of Sandra’s hand. “And remember to check the expiration date.” He tore the package open and pulled the condom into the Chiapas sunshine.

It was 10 a.m. on a Tuesday in La Reforma, a small refinery town in the northeastern corner of Chiapas, the southernmost state in Mexico.

The workshop marked the first time that women living with HIV in La Reforma had ever met or spoke openly about their condition. Over the next hour, each of the five women in attendance told her story. Tears came easy as they described the moment they received their diagnosis, the children and grandchildren who brought meaning to their lives, and the fears that continued to haunt their thoughts. All the stories had one common thread: each of the women at the workshop got HIV from their long-term partners, most of them from their husbands.

The unfortunate reality is that for women living in rural Mexico, marital sex represents the single greatest risk for HIV infection. The state of Chiapas is no exception. Gender inequality is high and economic opportunities available to women in the state are low. Compounding this reality are the stigma and social norms that have prevented effective sexual education campaigns. For married women in Chiapas, abstinence is nearly impossible and condoms are difficult to introduce into relationships where the power balance is stacked against them. In short, men don’t want to wear condoms and women, economically and culturally dependent on their husbands, can’t afford to lose them. For each of the five women in the workshop, the cost was HIV.

“Machismo is deadly,” said Adela Bonilla, 61, the director of Nuevos Códices Compatía A.C., an organization that works statewide to empower women living with the virus. As she talked, she handily swerved her car around large sections of the gravel road to La Reforma that had been washed away by recent rains. The town lies six hours to the northeast of San Cristóbal de las Casas, a colonial city in the central highlands, popular among tourists. Her right mirror dangled by a few strips of duct tape. To the left, tall limestone walls cast long shadows over the road that, to our right, quickly fell away into dark canyons. Over the next two days, together with Sandra, a local organizer, Adela would hold two HIV workshops in La Reforma and Pichucalco.

Adela shook her head as she drove. “The fact is, most women are extremely embarrassed about the fact that they are living with HIV,” she said. “They have been rejected by society and live behind a smoke screen. But in the end, they did nothing wrong.”

The state of Chiapas is the poorest in Mexico. It is home to a highly indigenous, dispersed, and rural population. In 2012, 75 percent of residents lived in poverty. The state also trails the nation in several indicators of public health. For every 100,000 residents, Chiapas has a mere 93 doctors and 45 hospital beds, the lowest rates in Mexico. The lack of medical infrastructure in the state has particularly affected women, leading to high rates of maternal death and the spread of infectious disease, such as HIV.

The first case of HIV in Mexico was recorded in the year 1983, two years after the United States recorded its first instance of the virus. In 2012, 0.3 percent of the total Mexican population was living with HIV as compared to 0.6 percent in the U.S. In Mexico, as in the U.S., the epidemic is concentrated among men, who represent 82 percent of the documented cases in the republic. Nationwide, 54 percent of all HIV cases were transmitted through homosexual or bisexual behavior. By comparison, 61 percent of all new HIV cases in the U.S. are among gay and bisexual men.

But in rural Chiapas, HIV has a different face. Last year it was estimated that 60 percent of all cases in the state were contracted through heterosexual activity. Nationwide, women represent 18 percent of HIV cases. In Chiapas, that number jumps to 27 percent.

Martha Figueroa Mier, of the San Cristóbal Women's Collective, counseling a woman on the phone. (Eva Hershaw)

“AIDS has completely changed the way we think about love, fidelity, and marriage,” said Martha Figueroa Mier, director of the San Cristóbal Women’s Collective. The collective has been operating for 24 years, primarily on cases of domestic abuse and rape. “Whatever problem women have,” she said, “when they come to us our advice is a) file a police report, but only if you want to, and b) definitely take an HIV test.”

In the words of Jennifer Hirsch, professor of sociomedical sciences at Colombia University, in rural Mexico “women are infected by the very people with whom they are supposed to be having sex—indeed, according to social convention in Mexico, the only people with whom they are ever supposed to have sex.” Male infidelity in Mexico does not represent any sort of major social transgression, a statement that is not true for women. Gender ideologies have created relationships of power where decisions about the female body, such as whether or not to use a condom, are commonly in the hands of men. It is a patriarchal set of norms, beliefs, and actions that make women particularly vulnerable to infection. 

“In this state, men get as many women as they want,” Sandra said. “They are the ones who make money, have a car, and can pay for sex outside of the relationship.” It is a simple statement that Sandra knows to be true. As a young woman, she found herself on the other end of this equation.

At the age of 18, Sandra was picked up off the streets of Pichucalco. She was approached in the early morning by a man who promised her a job in his restaurant in the nearby town of Juarez. Uneducated, unemployed, and without many prospects before her, Sandra agreed. For the next three years, the man held her captive and prostituted her against her will to up to 30 men a day. They each paid her boss $20 to $30; she occasionally received $4 or $5.

At some point, Sandra realized that she was also being drugged. Large portions of the day were missing. She tried several times to escape, each attempt more desperate than the last. The clients rarely used protection, a decision that was always out of Sandra’s hands. When she was 21, she got pregnant. In a decision that she still believes was the worst in her life, she aborted. Shortly thereafter, a couple that cooked and did finances for the boss helped her escape. Traumatic as it was, it was not at the brothel that Sandra contracted HIV. Back in Pichucalco, months after escaping, her new boyfriend knowingly infected her with HIV when she was 22.

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Eva Hershaw is a journalist and photographer based in São Paulo.

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