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This ethnographic study explored factors that facilitate or hinder women's participation in health promotion and HIV prevention in the Mt. Selinda area of rural Zimbabwe. Rates of HIV and AIDS in Zimbabwe are among the highest in the world and increasing most quickly among young females. A purposeful convenience sample of 11 Ndau women (key participants) was interviewed twice. Seventeen key informants and four focus groups offered further perspectives. The resulting narrative presents a picture of Ndau women's existence that is difficult and oppressive. Females are socialized early to be workers and mothers within a context of limited voice, subservience, violence, and economic powerlessness. Application of a health promotion framework reinforced the reality that these women are generally unable to use measures for HIV prevention. Socio-cultural and economic factors of gender inequality were analyzed through an ecological approach, showing that cultural beliefs and practices, along with national and international forces, support and sustain gender inequality. If there is to be change in the AIDS crisis, the study's findings suggest that HIV prevention strategies should be integrated within a participatory community development model that includes opportunities for both men and women to carry out gender analysis. While health professionals must understand and be sensitive to culture and context, existing unjust and inequitable structures at all levels of society must be examined and challenged.