Although it is difficult to distinguish the causes from the consequences of extramarital sex, there is clear cross-cultural evidence that it has a negative impact on the marital dynamic.13
Extramarital sex increases the risk of HIV and STI transmission for husbands and wives and makes the marital unit a location for conflict, propelling men to seek further sexual liaisons outside marriage and thereby creating a marital environment of further risk.
The frequency of ever having extramarital sex in the study communities puts it at the lower to medium point among the 14 countries assessed in a WHO study.27
The frequency drops when men were asked about extramarital sex in the last year, with the majority having a sexual liaison with women who were not sex workers, while a significant minority is having sex with a sex worker. Results show irregular use of condoms with sex workers, that most men perceive low risk with women who are not sex workers, and little or no risk in male to male sex. In summary, extramarital sexuality in these communities is risky sex. Wives seem to know little about husbands' pre- and extramarital liaisons, reducing their ability and opportunity to influence husbands or advocate for safer marital sex.
The multivariate analysis that was conducted examined the demographic characteristics, perceptions and behavior of wives and husbands as they related to extramarital sex. The results support the hypothesis that it is necessary to have data on both members of a marital dyad to fully characterize couple relationships and assess associations with phenomena such as men's extramarital sex.28–30
Five husband variables and four wife variables were found to be significantly related to men's extramarital sex in the multiple logistic regression. Of the demographic variables, younger couples were associated with men's extramarital sex. The greater discordance between husband's and wife's age was also associated with men's extramarital sex; men who were significantly older than their wives (22.6% are older by 6 years or more) were more likely to have extramarital sex. Age discordance primarily reflects the marriage of older men to younger women (23.2% were 15 years of age at marriage or younger) who may not be prepared or mature enough for a marital and/or a sexual relationship.
Those men who consume alcohol daily or weekly are more likely to be involved in extramarital sex. Alcohol is intimately bound-up with extramarital sex. Places to drink including “beer bars” and illegal brewers of country liquor (desi daaru) are also locations to find women available for sex. Many illegal brewers and/or sellers are widowed or divorced women who provide sexual favors in association with providing alcohol. Alcohol with peers is seen as a “dis-inhibitor” and a preferred step toward having extramarital sex.
Two additional men's variables showed a significantly different direction than has been reported in the literature. Men who had less education and men born in Mumbai and were not migrants were more likely to be involved in extramarital sex. Lower education may be associated with men who have low status occupations that provide opportunities for sexual liaisons such as construction, day laborers and truck loaders. Migrants to Mumbai, including those who have left their wives and families in the rural area and are living with other single men do not show a greater degree of extramarital sexual liaisons. The results suggest that men born in Mumbai are more familiar with the environment and have a peer network that facilitates relationships with women in and out of their communities.
Husbands' reports of the nature of marital sexuality are also associated with extramarital sex. Those husbands who report that their wives were less willing to participate in the last marital sex (indicating coercion) showed a trend in which they were more likely to be involved in extramarital sex. In addition, husbands who reported less pre-coital acts in the last marital sex (another indicator of coercion) were more likely to be involved in extramarital sex. In-depth interviews with a subset of women focused on the fact that their husbands did not approach them with love (pyaar karma), did not “get them ready” for sex and coerced them, both physically and/or mentally if they indicated a lack of interest. Fifty-seven percent of men indicated that their wives could not refuse sex when they demanded it.
The final set of variables focuses on wives reporting on their husband's level of violence, with those women reporting greater domestic violence being associated with their husbands' extramarital sex. It is interesting to note that men's reports of violence toward their wives were less forthcoming than women's reports and as a result, men's reports did not show a significant relationship to extramarital sex.
Finally, those women that had a more negative assessment of themselves as spouses had husbands who were more significantly involved in extramarital sex. Our qualitative data provides long narratives of couples who have had difficult relationships that started with the first night after marriage (frequently the day they first meet). As a result, a subset of women describes their husbands as critical and emotionally abusive, leading to a poor perception of themselves as wives.
Unsafe extramarital sex brings with it the risk of HIV and other sexually transmitted infections for men in these communities. It also increases the risk that they will bring these infections to their wives. In addition extramarital sex impacts on and is an indicator of difficulties in marriage that are manifested in social, economic, psychological and sexual interaction between spouses. It is insufficient to simply address men and warn them of the risks of extramarital sex. This issue must be addressed within the context of the marital relationship: first to make women aware that their monogamy does not necessarily protect them from risk and second to improve the marital relationship so that it can serve to prevent husbands' unsafe extramarital sex in the future.
There is a need to target the couple as a unit of both research and intervention to promote the reduction of extramarital sex and its associated HIV/STI risk and to assist couples whose marital relationships had been severely impacted by extramarital sex. Couple-based interventions need to be conducted by skilled male and/or female facilitators (as appropriate), and should involve both partners for several sessions that address sexual relationships and intimacy, gender-based inequities and discrimination, problem-solving skills and strategies, negotiation and communication through couple-communication exercises, and development of trust and confidence within the couple.31–33
The advantage of the couple, rather than the individual, as the unit of intervention is that it allows the dyad to jointly address sensitive issues, which protects women against the risk of violence, stigmatization and separation that is often caused by behavior change introduced by women unilaterally.34,35
Instead of considering men and women as separate targets, research and intervention programs need to address the relationship dynamics, sexual health needs and concerns of the couple, both in India and other parts of the world.