What are the obstacles?

What are the obstacles?

It is usually not easy for people to sustain changes in sexual behaviour. In particular, young people often have difficulty remaining abstinent and condoms are often associated with promiscuity or lack of trust.²⁴ Women in male-dominated societies are frequently unable to negotiate condom use, let alone abstinence.

Gender imbalances need to be addressed to prevent HIV transmission among serodiscordant couples (where one partner is HIV positive and one is HIV negative). This group account for many new infections around the world and have become central to prevention programmes for people living with HIV. In addition, many discordant couples are compelled to have unprotected sex in order to have children. Without receiving counselling and treatment the HIV negative partner may be at greater risk of becoming infected with HIV.

Some societies find it difficult to discuss sex openly, and some authorities restrict what subjects can be discussed in the classroom, or in public information campaigns, for moral or religious reasons. Particularly contentious issues include premarital sex, condom use and homosexuality, the last of which is illegal or taboo in much of the world. Marginalisation of groups at high risk - such as sex workers and men who have sex with men - can be a major hindrance to HIV prevention efforts; authorities are often unwilling to allocate adequate resources to programmes targeting these groups.

Safe male circumcision demands considerable medical resources and some cultures are strongly opposed to the procedure.