Sex Roles, Vol. 42, Nos. 7/8, 2000
On the Margin: Power and Women’s HIV Risk
and Anita Raj
School of Public Health, Boston University
HIV risk and prevention research has failed to investigate adequately the
effects of gender-related factors such as relationship power, sexual communi-
cation, abuse, and gender roles on women’s abilities to engage in protective
actions. We propose that women’s HIV risk from heterosexual transmission
is embedded in the context of gender, race/ethnicity, and class oppression.
This context has central implications for interpersonal relationship factors
relevant to women’s HIV risk. We suggest a framework for understanding
women’s HIV risk within the context of oppression and the role of power
in intimate sexual relationships. Three common dynamics of oppression
are considered: (1) Silencing, (2) Violence and Fear of Violence, and (3)
Internalized Oppression. These dynamics are based on characteristics of
oppression discussed in the work of Jean Baker Miller on gender, Hussain
Bulhan on race, and Paulo Freire on class. These dynamics are discussed
in the context of ﬁndings reported in this journal issue and those of other
authors. Finally, the discussion identiﬁes common patterns across studies, as
well as areas of disagreement and directions for future research and public
health prevention efforts.
Never doubt that a small group of thoughtful committed citizens can change the
world. Indeed, it is the only thing that ever has.
It has become increasingly evident that a two-part framework is neces-
sary to understand HIV risk behaviors in women and to inform HIV preven-
To whom correspondence should be addressed at School of Public Health, Boston University,
715 Albany St., T2W, Boston, Massachusetts 02188-2337.
0360-0025/00/0400-0723$18.00/0 2000 Plenum Publishing Corporation