While Ghanaian advocates of women’s reproductive health rights recognize the recent gains in HIV prevention, they also call attention to the role that gender inequality plays in more and more women becoming infected, Ghana’s Public Agenda reports.

Many consider “ABC”—a slogan created in the late 1990s that defines A as abstinence, B meaning being faithful to one partner and C as correct and consistent condom use—as an unrealistic option for girls and women who are taught to obey men.

“Women are already marginalized, and HIV and AIDS have worsened their plight,” said Bernice Heloo, President of the Society for Women and AIDS in Africa (SWAA International). “It is very difficult for them to negotiate condom use.”

The United States Agency for International Development (USAID) recommends that HIV/AIDS prevention programs should be developed collaboratively with the communities that they serve and must address not only individual behavior change but also social norms, environmental factors and policies that contribute to infections.