by Marcy Bloom
What is a woman worth?
HIV infections among women and girls have risen in every part of the world in recent years. The numbers point to a fundamental and startling reality—the HIV/AIDS pandemic is inextricably linked to the brutal effects of sexism and gender inequality, most pronounced in Africa.
Consider these statistics: The latest reports from the UNAIDS (Dec. 2007) show 33.2 million people are living with HIV throughout the world. Sub-Saharan Africa has more than two-thirds (22.6 million) of the total number of HIV infections. Sixty-two per cent (14 million) of those infected are women and adolescent girls. Seventy-five per cent of all HIV-positive women in the world are African.
Why are we allowing women and girls to die from this preventable and treatable disease? What is a woman worth in our world today?
Gender Discrimination At the Core
“The toll on women and girls presents Africa and the world with a practical and moral challenge, which places gender at the center of the human condition. The practice of ignoring gender analysis has turned out to be lethal…what has happened to women is …a gross and palpable violation of human rights,” said Stephen Lewis, former UN Secretary-General’s Envoy to Africa, at the International AIDS Conference in Barcelona, Spain in 2002.
Many forms of violence against African women contribute to, and worsen, the devastation of women and girls from the HIV/AIDS virus. Women and girls are often ill informed about sexual and reproductive matters and are more likely than men and boys to be uneducated and illiterate. Physiologically, women are two to four times more likely than men to become infected with HIV, but they lack social power to insist on safer sex or to reject sexual advances.
Gender Violence and Poverty are Disease Risks
Gender-based violence and harmful traditional practices are some of the major risks for contracting the HIV virus. These include sexual violence, marital rape, domestic violence, early child marriage of young girls to older men, forced marriage, wife inheritance, widow cleansing, polygamy, and female genital mutilation.
Poverty forces many women into subsistence sex work or transactional relationships that preclude negotiating condom use. For economic reasons, women are often unable to leave a relationship, even if they know that their partner has been infected or exposed to HIV. In many African countries, women are designated as minors, lack their own earning power, are unable to obtain credit and cannot own or inherit property.
The oppressive economic dependency of women on men is a core aspect of gender relations in this region. This critical issue must be taken on with real solutions and basic societal changes by governments, AIDS programs, non-profit groups, and, most importantly, the women themselves.
Thoraya Obaid, the executive director of the United Nations Population Fund (UNFPA), said in 2006: “Women and girls are vulnerable to AIDS not because of their individual behavior, but because of the discrimination and violence they face, the unequal power relations. Even being married is a risk factor for women…Female HIV infections are on the rise in Asia, Eastern Europe, and Latin America, as well as in Africa. And AIDS is the leading cause of death for 25-34-year-old African-American women in the United States…only by addressing the needs and human rights of women and ensuring their full participation will we change the course of this disease.”
Cures To Reverse the Spread of HIV/AIDS
So what is to be done?
To reverse the spread of AIDS, women must have greater control of their decisions, bodies and lives—as well as their governments and public policies.
In 2004, UNAIDS launched the Global Coalition on Women and AIDS, a worldwide alliance of civil society groups, governments, UN organizations and networks of women living with HIV/AIDS. The coalition’s platform calls for education, literacy, and economic rights for women; equal access to antiretroviral treatment; access to sexual and reproductive health services; changes in harmful gender stereotypes; and zero tolerance for gender-based violence.
Three-quarters of all new HIV infections are sexually transmitted between men and women. The behaviors of men are critical to prevention efforts in Africa. They hold overwhelming power in decisions about sexual matters, including whether to have sex or to use condoms. In many societies, women are expected to know little about such matters and those who raise the issue of condom use risk accusations of being unfaithful or promiscuous.
HIV care and contraceptive management programs — two important elements of women’s health — must begin to work together according to UNFPA. For too long they have separated themselves because of the politicizations and funding aspects of both of these issues. This is clearly shortsighted, if women’s lives are to be saved.
Equal access to antiretroviral treatment will help to safeguard a woman’s well being and prevent HIV transmission to her children. Ethics and human rights demand that women who are HIV positive are able to make informed contraceptive decisions, including the ability to prevent unwanted pregnancy. Voluntary contraception is integral to stemming the HIV pandemic.
Hard Choices Make Hard Policy
Some of the most effective steps to stemming the feminization of HIV/AIDS are not about healthcare per se but about broad social changes. Dr. Chinua Akuke of the Board of Directors of the Constituency for Africa in Washington, D.C. and an adjunct professor of public health at George Washington University, said: “The key question is whether African leaders and elite are ready to make hard choices that would slow down the rate of infections among women…The key is to focus on practical solutions to a problem that can only get worse if nothing is done.”
She describes ten critical steps for African leaders.
- Mount a comprehensive information, education and communication campaign against risk-behaving practices of men that put women at risk of HIV infection, with bans on sugar daddies, the rape of young girls by schoolteachers and the molestation of young girls by their own family members.
- Address cultural practices that put women at disadvantage, such as women’s subservience in sexual matters, the lack of property rights for widows and single women, the culture of wife inheritance after widowhood and the lack of opportunity for women to discuss sexual risks with their husbands.
- Invest in the long-term education of girls and women to end women’s disproportionate poverty.
- Build enabling environments for empowering African women to control their own generated income and to overcome cultural taboos and tightly controlled economic choices that severely constrict the capacity of African women to negotiate safer personal behaviors.
- Create political space for women. In order to fight AIDS, women must be in decision-making positions in government and in civil society.
- Develop the necessary legal framework to protect women from discrimination and the lack of due process. Law reform on rape, sexual molestation, domestic violence, favors-for-forced sexual relations and property rights are crucial, as are bans on discrimination of individuals living with HIV/AIDS.
- Establish public health services that are friendly and accessible to women, and run by women for women in a true feminist model. The fear of violence and lack of confidentiality prevent many women from accessing services for HIV or for other sexually transmitted infections and tuberculosis that facilitate HIV transmission.
- Make gender issues a major priority of international development assistance. National budgets should devote resources to ending gender inequalities and creating opportunities and protections for women.
- Lead the fight against sexual violence against women and put in place functional laws that deny sanctuary to the perpetrators of violence. The law must punish rapists and abusers — perpetrators who set off a chain of events that leave women emotionally scarred and at risk of HIV/AIDS.
- Fight against widespread poverty with programs that target women. Poverty is a major reason why women knowingly engage in high-risk behaviors. The feminization of AIDS is closely intertwined with women’s low status, deprivation and harsh living conditions and macroeconomic policies must create the opportunity for women to escape poverty.
Women need gender-focused and women-sensitive approaches to halting HIV/AIDS, according to UNFPA. Solutions must be African-based and African-implemented, and women must be integral to all of it. Women must be able to gain more control in decisions affecting their lives.
Young men who learn to respect women and understand their responsibilities in halting HIV/AIDS are more likely to use condoms. Husbands can — and must — be enlisted to protect their wives and future children against HIV and other sexually transmitted infections.
What we are really addressing in HIV-AIDS is the need to end misogyny—ending sexist attitudes and behaviors against women that violate their very beings.
What is a woman worth in this world? What are 14 million women worth? They are worth absolutely everything to themselves, their families, their communities, their countries—and their world. We desperately need their vitality, contributions, insights, and power. Let us begin with the personal and political empowerment of the women of Africa and let our African sisters know that they are not alone in their struggle for respect, dignity and life.
Marcy Bloom works with the Mexico-City based organization, GIRE – El Grupo de Informacion en Reproduccion Elegida (The Information Group on Reproductive Choice), doing U.S. capacity building. For 18 years, she served as the executive director of Aradia Women’s Health Center in Seattle and was the recipient of the 2006 William O. Douglas Award from the Washington State ACLU. She lives in Seattle.