Inter Press Service - June 22, 2001
Marwaan Macan-Markar

But this month, as the world marks 20 years since the first reports of AIDS, it was amply clear that the image of this global killer has changed as the death toll and the infection rates are equally common among males and females, homosexuals and heterosexual and children and babies.

Such a shift is reflected in the grim tallies revealed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). Some 22 million people dead from the disease and more than 36 million people are currently living with HIV, the virus that causes AIDS.

What is more, adds UNAIDS, the figures also expose the manner in which women have been impacted by the pandemic. Of the people who died last year due to AIDS, close to 52 percent, or 1.3 million, were women, thus increasing the total of women who have died of HIV/AIDS-related illnesses since the epidemic began to over nine million.

Women also account for close to 47 percent, or nearly 17 million of the 36 million infected persons.

And in sub-Saharan Africa, the region hardest hit by the pandemic, being home to some 24.5 million adults and children living with HIV, an estimated 55 percent of all HIV positive adults are women, while teenage girls are infected at a rate of five to six times greater then their male peers, says UNAIDS.

For women's rights activists, the rapid spread of HIV/AIDS among women and girls reveals shortcomings in the way governments have tried to stem the spread of this pandemic. Among such shortcomings, they point out, is greater emphasis on perceiving the disease as simply a health issue, consequently ignoring the reasons for its spread - which is "a gender issue."

"Gender-related discrimination and a denial of women's economic, social and cultural rights contribute to women's vulnerability to HIV infections," says Geeta Rao Gupta, president of the International Centre for Research on Women (ICRW), a Washington-based non-profit organisation.

"Women are denied their right to free and accurate information about their bodies, and this greatly contributes to their inability to protect themselves from infection."

According to Lydia Cacho, a feminist and journalist in Mexico, governments need to wake up to this reality - that denying women their rights, including their sexual and reproductive rights, will only perpetuate the spread of HIV.

"What is required," she adds, "is a change from the current practice of trying to halt the spread of HIV through only health policies. Women in Latin America have become infected as a result of some of their basic rights being denied, and this needs to be recognised by government policy makers."

Similar thinking is echoed by the UN Development Fund for Women (UNIFEM), which is hoping for a gender-sensitive programme of action to emerge from the UN General Assembly's Special Session on HIV/AIDS, to be held in New York, June 25-27.

Last month, after UNIFEM signed an agreement with UNAIDS to strengthen the UN global response to HIV/AIDS, Noeleen Heyzer, executive director for UNIFEM, remarked that gender inequality was "at the heart of the epidemic, which today is our biggest threat to development."

Furthermore, she said, "We must address power imbalances in every single policy, strategy and programme related to prevention, treatment and care, if we seriously want to tackle this global challenge. It is not simply a matter of justice and fairness. In this case, gender inequality is fatal."

According to the World Health Organisation (WHO), women have become more vulnerable than men due to a range of factors, including social, cultural and biological.

In a document, "Human Rights, Women and HIV/AIDS," the Geneva- based health agency points out that a woman's right to safe sex and to autonomy in all decisions relating to sexuality is "respected almost nowhere."

The WHO says this disregard not only affects female sex workers but women generally. "Women are not expected to discuss or make decisions about sexuality and they cannot request, let alone insist on using a condom or any form of protection," states the WHO.

If women refuse sex or insist on condom use, they often run the risk of abuse, since it gives rise to suspicions of infidelity. "The many forms of violence against women mean that sex is often coerced which is itself a risk factor for HIV infection."

Other social and cultural realities make women more vulnerable. "Men, on average, have more sexual partners than women, and that means men with HIV have more opportunity to transmit the virus to others - and these others are women," says Martin Foreman, of the Panos Institute, a London-based non- profit organisation.

In addition, he affirms, poverty has encouraged women in Africa to use sex as "a form or currency, either to be exchanged for money, or more often, for gifts or security."

Psychologically, too, women are more vulnerable, particularly young women, he adds. This is demonstrated by the trend among older men to seek younger women for sex in "exchange for gifts." And often, "those older men are more likely than younger men to be HIV-positive."

According to Dominique De Santis, a spokeswoman for UNAIDS, women are often younger when they have their first sexual encounter than men. And the likelihood of these young women getting infected is greater because "HIV passes more easily from men to women through sex than from women to men."

And once infected, states the WHO, women endure other forms of discrimination. "Women's access to care and support for HIV/AIDS is much delayed - if it arrives at all - and limited. Family resources are nearly always devoted to caring for the man. Women, even when infected themselves, are providing all the care."

Compounding that reality is the stigma that women endure. Such discrimination is "much stronger against women," affirms the WHO. And in many instances, women with AIDS have experienced "violence, neglect of health and material needs, destitution and ostracism from family and community."

What is more, in a sad twist of irony, WHO studies have revealed that women "are often blamed for spreading the disease, always seen as the 'vector' even though the majority have been infected by (their) partner or husband."

According to De Santis, girls and women need to be protected if the spread of AIDS is to be stalled. UNAIDS encourages the widespread use of male condoms, female condoms and microbicides.

For Gupta, of ICRW, health programmes need to be designed that educate women through information they need about their bodies and sex. In addition, "Women's social and economic vulnerability, and the imbalance in power between women and men that constitute gender inequality, must be addressed in order to guarantee women health and protection from HIV." (END/IPS/HE/mmm/cr/01)

* Editors Advisory. This is one in a series of IPS features previewing the United Nations Special Session on AIDS, to be held in New York June 25-27. It is the first-ever Special Session devoted to a single disease.

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