Ugandan women’s ability to negotiate the terms and timing of sexual intercourse, such as refusing sex and asking their partner to use condoms, is key to avoiding several reproductive health outcomes, say experts at the Brown School of Washington University in St. Louis.

“The cultural norms that sanction unequal power dynamics in relationships, unfairly value men’s sexual freedom over women’s autonomy, limit women’s mobility, and reinforce women’s submission to their partner’s sexual needs, exacerbate this vulnerability,” the authors of a correspondence wrote in the Aug. 10 issue of the journal. The Lancet.

Sub-Saharan Africa accounts for nearly 30% of all new HIV infections worldwide. Uganda has one of the highest HIV burdens among young people, with HIV rates highest among young women.

This disproportionate burden on young women is partly due to deeply rooted gender norms shaped by Uganda’s patriarchal system, which typically favors men and enforces rigid gender roles and expectations, the authors write.

Authors of the correspondence are Josephine Nabayinda, research associate at the International Center for Child Health and Development (ICHAD) at the Brown School; Samuel Kizito, MD, faculty member at ICHAD; Anita Nagawa, research associate at ICHAD Uganda; and Fred Ssewamala, William E. Gordon Distinguished Professor at the Brown School.