A toxic culture of masculinity in Cambodia is contributing to the spread of HIV from husbands to wives, according to a study in the American Journal of Men’s Health.

After interviewing men who contracted HIV outside of their marriage and passed the disease to their wives, researchers discovered that popular notions of what makes a “real man” contributed to risky behaviour leading to infection.

Men reported being pressured into drinking and visiting prostitutes in order to fit into a male peer group, and most contracted HIV after having unprotected sex outside of marriage.

For many Cambodian men, visiting sex workers is considered a normal part of life that contributes to their sense of masculinity, the study found. One participant claimed that visiting sex workers is acceptable because it’s better than raping children.

“Some people raped a child, or even some young girl. However, we don’t have to do that. We can just find out those sex services. There are many places in Cambodia. Just pay them and come back home; that’s OK,” the participant said.

While HIV rates have consistently dipped since their peak in 1998, Cambodia still has the highest rate of infection in Southeast Asia.

Meanwhile, most women living with HIV contracted the disease from their husbands. According to the National AIDS Authority, transmission from a spouse is the most common cause of new HIV infections, counting for around 48 percent.

Communication about sex is commonly considered taboo in the Kingdom, a fact that leads to sexual dissatisfaction, low condom use, extramarital affairs and the spread of sexually transmitted diseases. Participants in the study also said condom use within marriage is low because it’s indicative of a lack of trust.

Meanwhile, Cambodian wo­men often display pride in their sexual ignorance, believing that knowledge of sexuality is the domain of prostitutes. Some men interviewed said they would visit prostitutes less frequently if they could experiment sexually with their wives. But they also said their wives would be upset if they suggested new sexual techniques, claiming their spouses view sex “as work”.

In order to address these issues, the report’s authors suggest incorporating sex education into high school curricula in order to foster “healthy gender norms and attitudes toward sex”.

According to Ros Sopeaph, director of the organisation Gender and Development for Cambodia, a safe space is needed to encourage men and women to discuss sexuality openly.

“We need to break the wall of silence,” she said. “We need to work with men so they can speak with their partners.”

Equal power relationships between husbands and wives should also be fostered, with policymakers acting as role models, Sopheap said.