It is fairly easy to slip into the belief that because the virus that causes AIDS is transmitted through sexual relations, acquiring AIDS is primarily the result of choice. AIDS victims chose to engage in unnecessarily risky behavior. Sometimes, that’s true. Oftentimes, however, the factors contributing to that risky decision are much more complex than a disinterested observer might at first assume. For millions of HIV victims around the world, and for HIV+ women in particular, putting oneself at risk is anything but voluntary.

Even if HIV were harmless, women’s lack of cultural power throughout most of sub-Saharan Africa, where HIV+ population density is far higher than anywhere else in the world, is troubling. Men are given extensive cultural dominance over women. By and large, men reserve household decision-making power for themselves—women’s personal autonomy only extends as far as their partners will allow it. By extension, men control how they exercise their sexuality, and women largely do not. If a man wants sex from his wife, or mistress, he has the physical and cultural power to obtain it. No one will deny it to him, and you can imagine how badly he might desire it at any unpredictable moment. You can also imagine the consequences that brave women suffer when they object to sex demands—and, conversely, you can understand the strong pressure to comply.

Add HIV into this women’s rights nightmare. The obvious, and highly commonplace, scenario is one in which a man has contracted HIV through an earlier partner, demands sex of his current one, and gets it. Maybe the new girlfriend would have consented anyway, but maybe she would not have. Maybe she doesn’t even like this man, she’s just acquiescing quietly because she feels threatened. Or maybe, at first, she thought she wanted relations with him, but as she realized her impotence, she began to regret her irreversible decision. Most likely, she’s one of millions of African teenagers who feel obligated to sleep with men more than fifteen years older than they are. Maybe she even worries about HIV, but knowing that the damage of AIDS occurs years after infection, she yields to protect herself from domestic abuse in the here-and-now. Whatever the specifics, and each of the aforementioned possibilities happens all the time, the woman now probably carries HIV.

Since it is common to maintain more than one partner in sub-Saharan Africa, especially for men, the cycle of transmission through sexual relations, whether coerced or voluntary, can be pernicious. A HIV+ man with many partners can be especially dangerous both because he can force sex and because it is easier for men to infect women than vice versa; the female genital tract retains the virus more easily after intercourse.

Well, can’t the woman just use protection then? Doesn’t that solve the problem? They can, but in general, it’s highly culturally discouraged. In innumerable communities throughout Africa, particularly rural and isolated ones, men and more than a few women view condoms as a kind of dishonorable barrier that taints the value of the sexual experience, even as a Western imposition on a particularly community’s indigenous way of life, not as a life-saving preventative measure. For these men, using condoms often means you lose face in front of your buddies, no matter how many lives you endanger. As a result, even if a woman would want to use protection, she may feel unable to suggest it, much less to demand it, for fear of angering the man. Were women more powerful relative to men, there is no question that the incidence rate of HIV in sub-Saharan Africa would go down.

For this reason, HIV is intricately tied to women’s rights, and a large part of preventing the spread of HIV is empowering women throughout Africa and around the world to resist the domestic and cultural pressure to engage in unwanted sexual relations. Women need to feel able to say ‘no’ when it is right to do so, both for their own sake and for the sake of their children, who may end up carrying HIV through them. So often overlooked, women’s empowerment is part of the cultural battle than must be waged against AIDS.