Because of their gender roles, many women around the world have trouble talking about sex or mentioning reproductive health concerns (36, 92, 248, 264). They may not be able to ask their partners to use condoms or to refuse sex, even when they know they risk getting pregnant or being infected with an STD, including HIV (36, 79, 106, 110, 154, 202, 248, 292). In Uganda research found that one person in every four believes that a woman cannot refuse sex, even if she knows her partner has AIDS (36).

Women may submit to men because they are afraid of retaliation, such as being beaten or divorced, and because their gender roles place them in subordinate positions in society (24, 36, 67, 248). For women worldwide, the impact of gender inequality is apparent in many of their reproductive health problems (4, 24, 106, 157, 158, 218, 248, 159, 264, 251).

Male gender roles harm men's health as well women's. A mix of cultural norms, social expectations, and men's sex drive encourages men's risky sexual behavior (21, 53, 58, 236). Some societies, as in Haiti and Thailand, accept that married men will have extramarital sex, either with girlfriends or prostitutes (243, 248). Similarly, in many Latin American and Caribbean cultures, the concept of machismo encourages men to be promiscuous to prove their masculinity (21). Such male gender roles can contribute to their contracting STDs and passing them on to their wives or girlfriends. Male gender roles prompt some men to live recklessly in other ways, a fact that is evident in many national health statistics. In Mexico, for example, the top three causes of death for men are accidents, homicides, and cirrhosis of the liver (21).