(( VaginaPagina ))

Not the original commentator, and I don't have a source, but I did work in HIV/AIDS education/prevention in Swaziland in southern Africa. I am guessing, based on the worldwide qualifier, it's more influenced by developing nations. Because of the lack of jobs, many men in southern Africa work away from home (usually in mining operations, don't get me started on diamonds...). Because of the largely patriarchal societies, coupled with a cultural norm of polygamy, among other factors, the vast majority of the men I interacted with who worked away from home freely admitted having sex with prostitutes whenever they "needed" to. We spent a lot of time and effort working with prostitutes there to use condoms, but they were quite resistant, mostly because they said it would affect their clients and they wouldn't make enough money. When the miners returned home, their wives were infected by them. There really isn't a realistic way for most women in developing countries to refuse sex with their husbands, or for them to insist on condoms. I only have experience with Swazi, South African, And Lesotho men, but the job and cultural situations are common enough in the developing world to make me think it applies in other places. Also, South Africa has well over 5 million HIV+ citizens, most of whom are married (or were married). That's a goodly chunk of the worldwide HIV+ population.