Gender inequality—the fact that women have less power than men—prevents many women from using condoms or even discussing their use with a sex partner (269, 339, 440, 566, 587). Asking her husband to use condoms requires that the wife play a more assertive role than is the norm in most cultures (237, 563).

In general, when women are dependent on men, it is more difficult for them to protect their own reproductive health (148, 566, 587). For example, in East and Central Africa women who believe that their husbands are infected with HIV still agree to sex without condoms because having children is important to their status in the family and community (62, 310, 357). A study among Thai women found that, in order to be a "good woman" in Thai society, a wife must accept that her husband can have multiple sex partners even though she cannot do so herself (241, 297).

Even wives who know that their husbands have extramarital affairs may feel afraid to suggest condoms (339, 600). For some, the fear of AIDS is less than the fear of reprisal if they suggest using condoms (54, 358). Many wives fear that asking to use condoms would provoke their husbands to accuse them of infidelity, to react violently, or to abandon them (4, 55, 204, 237).

In Nepal a study of nine communities found that women's concerns about having "good character" often prevented them from using condoms. If a woman were even to discuss condom use, her good character and fidelity would be questioned (490). In Kenya wives said that they could not talk with their husbands about sex for fear of being accused that they learned about sex in an extramarital affair (45).

Men's behavior. In most cultures men have more power than women to choose condoms. Yet even when they know that unprotected sex can be dangerous, men often do not protect themselves or their partners because of peer pressure against condoms (289). Conversely, men are more likely to use condoms when they think it is the social norm. For example, men in Ugandan workplaces who agreed that "many of the men who work here are using condoms now" were three times more likely to have used condoms in the last two months than men who did not agree with the statement (345). Also, a study of US adolescents found that they are more likely to use condoms consistently themselves if they think that their peers also use condoms (513).

In Thailand, before the successful 100 Percent Condom Program (see Chapter 7.4, Condom Promotion Works), the rate of condom use was low even among men who frequented CSWs because these men's peers looked down on using condoms. Since the condom campaign began, condom use has been rising, as norms change in response to growing awareness that unprotected sex is risky (241, 297).