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Answer to Case Study #3:Many factors place Virginia at risk for infection. Her poverty, lack of education, and lack of access to resources make her vulnerable because they make it difficult for her to learn about ways to protect herself and to obtain the necessary resources to do so. Gender-related factors are also at work here. Carlos and Virginia are in an unequal relationship, with Carlos controlling the resources, determining the nature and timing of their sexual activity, and threatening to leave if Virginia defies him. Prevailing attitudes about masculinity, and femininity perpetuate a situation in which Carlos demands sex from Virginia and she feels that she must comply even when she does not want to. Other attitudes about masculinity, such as men must be good providers, it is acceptable for them to have multiple sex partners, drinking makes men “manly,” and it is a wife’s obligation to provide sex whenever her husband wants it, are all contributing factors. Since Virginia has already experienced one STI, she is at risk for reinfection or infection with another STI, especially because Carlos was not treated. The positive elements in their relationship further complicate the situation because Virginia is even more willing to place herself in risky situations for the “good of the relationship.” Virginia, despite all the factors against her, has had the wherewithal and fortitude to visit a family planning clinic and is aware that condoms could protect her. She could greatly benefit from counseling to help her develop a risk reduction plan and to build skills to follow it through.
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