Bangkok Post - March 9, 2007
Peter Piot

In the most heavily affected countries in Africa, 59% of adults and nearly 75% of young people now living with HIV are female. In Asia, the situation is less dramatic but of serious and growing concern: 30% of adults living with HIV in Asia are women, with rates reaching 39% in Thailand and 46% in Cambodia.

Why are women catching up with men in terms of HIV infections?

One cause is the difference in physical make-up between men and women which makes women almost twice as likely to become infected with HIV from men as men are from women. But apart from the biological inequality there are many deeply rooted social patterns which explain why women are increasingly becoming infected with HIV.

Many social norms and patterns across the world can influence the adoption of behaviour that increases the risk of HIV infection. In many areas of the world, suspicion of immorality and infidelity threaten women's fragile status and scares them away from carrying or insisting on using a condom. For the same reasons, women will also avoid routine reproductive health services where they could be informed about HIV, be tested and if needed receive treatment.

Social norms also encourage men to engage in risky behaviour which puts them, but also their female partners, at greater risk of HIV infection.

For too many men across the world, seeking health care and information, and taking adequate responsibility for their sexual or reproductive health represents a challenge to their masculinity.

On the other hand, a multiplicity of sexual partners and violence against female partners may be considered as expressions of male power and strength.

We need to look carefully at subjects still taboo in many societies - men and women's place in society and their sexuality, often based on privilege and power or burdened by coercion, ignorance and violence. Twenty-five years into the epidemic and 65 million infections later, it is long past time to confront these issues and challenge the nature of relations between men and women which makes both sexes vulnerable to HIV.

To stop the feminisation of the epidemic, as well as the epidemic itself, we have to initiate legal but also social, cultural and economic changes to challenge some of the most pervasive social patterns and gender norms that continue to fuel the Aids epidemic.

We must start judging our responses to HIV by two questions: do they promote the human rights of women and girls and do they promote the responsibilities of men and boys?

For example, do they prioritise sending all girls to school to receive a proper education, including sexual education as well as life skills training? Do they respect women's rights to control when, with whom and under what circumstances they have sexual relations? Do they sanction violence, inside and outside marriage? Do they create room for women to participate in the public debate and decision-making? Do they protect women's economic autonomy by securing their property and inheritance rights? Do they aim to deliver on female-controlled HIV prevention methods?

To succeed against HIV, Asia, like everywhere, must ensure that all its citizens, men and women, girls and boys, are equal and full players in this necessary shift in paradigm.

Women, inside and outside the home, must have the economic, social and political power to stand up for their rights and protect themselves and their families from violence and disease, and men must question those aspects of privilege and power that put themselves, their sexual partners and their offspring at risk.

Above all, men and women have to agree to change together the society they live in for one respectful of the individual and of human rights.

This paradigm shift is necessary to beat HIV, it has become a compulsory requirement to get ahead of this epidemic.

Peter Piot is UNAids Executive Director.

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