Epidemiology: Forging the Future: Sex, Money and Power In India

For women in developing countries, economic opportunity and sexual independence are supposed to go hand in hand. So why has India--the world's second fastest growing economy, after China--been unable to control the spread of its HIV/AIDS cases, which have ballooned to 5 million, more than in any other nation? The answer, says Suneeta Krishnan, 35, an epidemiologist at the University of California, San Francisco, is that in India, "economic freedom stops at the bedroom door."

As part of a four-year study funded by the U.S. National Institutes of Health, and an additional five years of funding through the Presidential Early Career Award for Scientists and Engineers, Krishnan and her co-workers have been going door to door in Bangalore, interviewing 750 low-wage married women ages 16 to 25. What they've discovered is that in that group, employment and the extra income it provides, rather than empowering women, puts them at greater risk of physical violence and contracting HIV.

Social roles are strongly defined in Indian society, says Krishnan, and people tend not to talk about sex. The social pressure remains intense for men to prove their masculinity and women their fertility. Indian women may be making more decisions about household buying or their children's education, but they remain sexually submissive, still marry early (average age: 17) and tend to defer to men about whether a condom will be used.

Women who marry later, says Krishnan, have more control over their sexual health and are far less likely to contract HIV. She believes that better access to higher education and higher-strata jobs will not only raise women's status but protect their health.