Balancing risk, interpersonal intimacy and agency: perspectives from marginalised women in Zambia

Cult Health Sex. 2018 Oct;20(10):1102-1116. doi: 10.1080/13691058.2018.1462889. Epub 2018 May 15.


Women are most exposed to sexual health risks within their marital relationships, primarily due to the sexually risky behaviours of their spouses. Studies show that expanding agency is critical for women to mitigate both physical and sexual health risks and is linked to increased psycho-social well-being and economic independence. Drawing on qualitative and quantitative primary data collected from a peri-urban community in Zambia, this paper explores how women exert agency in a community where few educational and economic opportunities and substantial food insecurity exacerbate women's risk for HIV within their marital relationships. It also examines how expressions of agency within marital unions can reduce HIV risk exposure and lead to socio-economic benefits. However, expressions of agency can also create physical, psycho-social and sexual health risks, particularly when spouses do not support independent decision-making and actions that women consider necessary to support the household and maintain intimacy. Findings highlight the importance of community involvement and addressing harmful socio-cultural norms to foster the realisation of women's agency.

Keywords: Africa; HIV/AIDS; intimacy; sexual risk.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Educational Status
  • Employment / psychology
  • Employment / statistics & numerical data
  • Female
  • Food Supply / statistics & numerical data
  • HIV Infections / prevention & control
  • HIV Infections / psychology
  • Humans
  • Interpersonal Relations*
  • Interviews as Topic
  • Male
  • Marriage / psychology
  • Middle Aged
  • Social Marginalization / psychology*
  • Social Support
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Unsafe Sex / psychology*
  • Young Adult
  • Zambia