By Carolyn Dempster
BBC Africa Live!
Despite being at the centre of the worst part of the Aids pandemic, many men in South Africa remain reluctant to change their sexual behaviour.
Miners are at a high risk of contracting the virus
Although there is widespread awareness about the dangers of practising unsafe sex, gender studies show that the majority of South African men believe that in sexual relations, as in life, their manhood is inextricably linked to the dominant role they must play.
As a consequence, they still refuse to wear a condom.
Condoms are viewed, particularly by young men, as "eating the sweets with the wrapper on".
"You have a culture here where men believe they are sexually entitled to women," Dr Rachel Jewkes, a senior scientist with the South African Medical Council, told BBC World Service's Africa Live! programme.
For these men, power and control are paramount. They believe they must be the initiators of sex, so they will dictate the terms of the exchange.
Proof of manhood often requires a man to have multiple sexual partners - it enhances his status in the community.
"Women are like taxis - if one leaves, there is always another one around the corner," argued one participant in a workshop for boys aged 14 to 16.
Some feel that condoms also symbolise a lack of trust - and if a young man cannot get what he wants from one girl, he simply moves on.
Poverty and the legacy of apartheid have also played a key role. Migrant labour has been the cornerstone of South Africa's economy for decades.
Southern Africa has the highest infection rates in the world
Allied to this is the high mobile population in the country - the role that mineworkers and truck drivers have in spreading HIV is well documented.
In a case study of long distance truck drivers travelling the route inland from Africa's busiest port city of Durban, Tessa Marcus found that 95% of truckers interviewed were sexually active, 70% always had penetrative sex - and 71% never used a condom.
Sexual partners ranged from wives to prostitutes at roadside truck-stops.
Adverse working conditions, long hours and a tiring job motivate the drivers to seek solace and intimacy through multiple sexual encounters.
"Just under half of the drivers interviewed ranked HIV and Aids as a small danger or no danger at all relative to the dangers they face on the road," Ms Marcus said.
Working conditions, accidents and being robbed or hijacked were viewed as posing a far greater and more immediate threat.
Poverty also forces women to enter into unequal relationships with men.
A preventative programme targeting sex workers operating on the fringes of one of South Africa's biggest gold-mining towns has failed to bring down the rate of sexually transmitted disease despite running for more than three years.
In her book Letting Them Die - How HIV/AIDS Prevention Programmes Often Fail, Dr Catherine Campbell has argued that the project did succeed in empowering a core group of sex workers to take control and insist on the use of condoms.
Some men say using condoms is 'like eating a sweet with the wrapper on'
However, their clients - the mineworkers - would simply "keep going from shack to shack until eventually they would find somebody who wouldn't use condoms."
"The main reason why the condom programme didn't work was because the mineworker clients refused to use the condoms," Dr Campbell argued.
"The fact was that in this situation, women had very little economic power and they depended on men for their livelihoods.
"It's silly of us to expect women to take responsibility for sexual encounters which are controlled by economically dominant men."