HIV transmission from husbands to wives in Cambodia: a systematic review of the literature.

HIV transmission in Cambodia has declined considerably in recent years, yet new incidents of HIV transmission within marital relationships have increased. Evidence suggests that the cause of this is transmission from HIV-positive men to their HIV-negative spouses. The objective of this paper is to develop an evidence-based model of HIV transmission from husbands to wives in Cambodia in a context of culture and society, drawing from the published literature. A critical analysis of peer reviewed literature, professional papers, policy reports and reference books identified four plausible factors influencing inter-spousal HIV transmission: (1) a hierarchical male-dominated society, (2) husbands' involvement with sex workers, (3) cultural values concerning the ideal Khmer woman and (4) unprotected sex between an HIV-infected husband and his uninfected wife. This evidence-based explanatory model can be used to inform future culturally appropriate HIV-education and prevention programmes.