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HIV & AIDS - Women
Why are women at risk?
Why is it difficult for women to
protect themselves?
Women and children
Women in Africa
Women around the world
HIV+ women
What needs to change?
HIV and AIDS have for a long time been seen as a
problem that affects men, specifically gay men, and as a result of
this preconception, the harm that it does to women around the world
is largely overlooked. In 1997, women represented only 41% of the
people living with HIV. Nowadays that figure has risen, and women
represent almost 50% of the global infection totals.
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A HIV+ mother in
Tanzania
Most HIV+ women have been infected with HIV through
heterosexual sex. Physically, women are more susceptible than men to
HIV infection through heterosexual sex, and this fact alone means
that special attention must be paid to protecting them if they are
not to be disproportionately affected by the epidemic.
Information drawn from different studies shows that
during heterosexual sex, women are about twice as likely to become
infected with HIV from men as men are from women. This is a major
reason why women have caught up so rapidly with men when it comes to
figures for the numbers of HIV+ people.
It seems very possible that, unless something is
done to prevent it happening, women will soon come to overtake men
in these statistics.
This may already be happening - data from the CDC in
America shows that among teens, girls accounted for more than half
of new HIV infections reported in 2001. Globally, women make up 60%
of the 15 - 24 year olds who are HIV+.
Many millions of children around the world have
already been orphaned by AIDS, and become themselves easy prey to
the virus.
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Feminism may have been discussed in the West for
several decades, but in many parts of the world it's impact has not
been felt at all. There still exist major inequalities between women
and men in all aspects of living - from employment opportunities,
availability of education, and choices in relationships. Many
countries still have patriarchal rules governing women's place in
sexual relationships. In some societies, women are unable to choose
their sexual partners or who they marry, these choices being made
for them by men in their families. In situations where the man has
all the power, a woman is unlikely to be able to insist on the use
of condoms, or to take measures to protect herself from HIV.
In many countries, women still have very narrow
career options available to them, and often these are limited to the
prescribed roles of teachers, nurses or curers. These roles,
however, are crucial ones in all societies. A country which loses a
large number of nurses will have great difficulty in keeping it's
medical services running. A country which loses many teachers will
find it hard to educate the young. And both healthcare and education
are absolutely vital anywhere where there is a severe AIDS epidemic.
Women are often required to work harder than men,
even if they are infected with HIV. In many places girls may be
taken out of school to care for family members who are infected, and
a woman who is seen as the main carer for the family will also be
expected to go out to work.
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Even marriage isn't a protection for a woman in many
countries. Women's infidelity is not only frowned upon but actually
criminalized in certain places, whilst men's extramarital sexual
relationships and use of female sex workers are seen as being almost
acceptable, or to be expected. Much of the HIV prevention work in
developing countries now focuses on sexual abstinence until
marriage, but remaining faithful to her husband won't help a woman
to stay safe from HIV if he is the one who infects her. In fact,
this is one of the most common ways in which women are infected in
many places.
'When I got pregnant last year, I found out that I
was HIV+. When I told him about it, he just knew I was messing
around with someone else. I knew I was loyal to him' DQ,33 years old
Additionally, the multiple roles women fill in
society are very important ones. Women as bearers of and carers for
children are crucial to social and family structure. In many
countries women play a vital place in the workforce in addition to
caring for their families. The loss of a mother can be devastating
to a family, often depriving them of a key breadwinner and depriving
children of a vital carer and teacher.
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Another way in which women's lack of economic power
enables their sexual exploitation is via prostitution. Poverty is
the most common cause of prostitution, but whatever it's cause,
female sex workers are in a very high-risk group. Women who
desperately need money to care for their children, many of them
widowed by AIDS, are not in a position to insist that their
customers wear condoms. This means that they are not only at risk of
becoming infected with HIV, but that if they are already HIV+, they
can pass the virus on to their customers. Often, these customers
take AIDS home to their families.
Female sex workers are, in many countries, both
frowned on socially and criminalised. It is very difficult for these
women to access the healthcare services they need in order to stay
healthy if they risk arrest or punishment when their profession is
known. This stigmatization increases the vulnerability of a group
that is already at considerable risk.
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Drug use is a social problem afflicting women just
as much as men. The typical junkie is imagined to be a man, but in
fact many injecting drug users are women. Anyone who becomes
addicted to injected drugs is liable to sexual exploitation and
vulnerable to infection from injecting equipment. Many female
partners of male needle users are also infected with HIV,
transmitted to him by dirty needles.
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In many countries - especially less socially stable
regions - there is a greater likelihood of women's first sex being
forced or in some way coerced. Rape can be a devastating experience
for any woman, and can also carry the risk of HIV infection. Sexual
violence against women is more common in some parts of the world
than in others. South Africa, for example, has one of the highest
rates of sexual violence, coupled with a huge HIV prevalence. In
some parts of Africa there is a belief that having sex with a virgin
can 'cure' HIV infection - leading to the rape of young women and
children by HIV+ men.
I'm a 31 year old heterosexual female that
contracted AIDS as the result of rape. I repressed the events
surrounding the attack until I had undergone hypnotherapy . . . It
had been nearly two years since the rape and I had been HIV positive
without knowing it. Enya
AIDS is also increasingly being used as a weapon in
war and a tool of 'ethnic cleansing'. In parts of the world where
there is a very poor security situation - Uganda, for example, and
the Sudan, and Zimbabwe - there are growing numbers of reports of
women being raped with the intention of deliberately infecting them
with HIV. HIV infection is a weapon which can still have devastating
effects long after a war is over.
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A young HIV+ girl in
Latin America
Another way in which the HIV/AIDS epidemic spreads
is through childbirth. UNAIDS/WHO data says that at the end of 2004
there were an estimated 2.2 million children (under 15 years) who
were living with HIV, many of whom were infected with HIV at birth.
A large number of these children will not live to adulthood. There
are drugs which can reduce the chances of a child becoming infected
with HIV at birth from about 40% to around 2%, but in many parts of
the world these drugs are unavailable. A mother who is HIV+ can pass
on the infection to her child through her breast milk, but again,
suitable substitutes for breast milk, and the education to
understand their importance and how to use them are not being
supplied to women in many countries.
Increasingly, governments are beginning to make an
effort to supply the drugs needed to prevent mother-to-child
transmission from occurring, which is a positive step, but whilst it
is very important that the child's life is saved, the mother must
not be forgotten. UNAIDS estimates that there are 15 million AIDS
orphans in the world, and a great deal of money, planning and energy
is being put into finding the best ways to care for them. The best
way to ensure the well being of children affected by HIV/AIDS is
simply to ensure the well being of their families, something that
unfortunately sometimes doesn't receive the prioritisation it
deserves.
The focus on preventing HIV transmission to babies
is an important and necessary one, but it can lead to a narrowed
perspective. It's equally important to help women who don't have
children as well as those who do. Often, especially in resource-poor
countries, many women live in areas where there is little or no
medical infrastructure, and where they come into contact with HIV
testing and care services only through antenatal care. This is
inadequate, as it excludes women who are not pregnant. There is a
clear need for HIV testing to be more inclusive.
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Just under two-thirds of all people infected with
HIV are living in Sub-Saharan Africa, 57% of whom are women. Around
76% of young people here who are infected with HIV are female.
In South Africa, up to 20 per cent of HIV positive
women were infected within a year of losing their virginity. This
suggests that women now represent the major part of the growing
epidemic. In places where heterosexual sex is the most common form
of transmission, women will soon come to overtake men unless
something is done to prevent this.
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A young HIV+ woman
prays in a hospice
Even in the United States, there is still much more
to be done to protect women. There has been criticism that sex
education in schools in the USA is based on the idea that sexual
fidelity until marriage is the best way to prevent STD infection.
This won't protect a women if she is infected by the man she
marries, and it leaves her vulnerable and ignorant if she changes
her mind, and has sex before marriage. The US government is still
resistant to the distribution of free condoms, which are absolutely
vital if women are to be protected from HIV/AIDS. 80% of the women
infected with HIV in the US are African-American or Hispanic, ethnic
groups which are also unfairly burdened with poverty and poor
education.
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HIV+ women suffer from the same conditions
associated with AIDS as men do, but they also experience separate
conditions, such as severe pelvic inflammatory disease, which
increases the risk of cervical cancer. Women also react differently
to antiretroviral therapy, and may sometimes need different
treatment from men. There is no one treatment method that will
perfectly suit the needs of both men and women.
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Gender roles around the world pin women into
positions where they lack the power to protect themselves from HIV
infection and where, if they are infected, they lack opportunities
to receive treatment. Feminism still has a long way to go before it
can even equalise the risk women are at from HIV compared to men.
Negative assumptions about women's roles and discrimination against
them must be challenged and women must be empowered to help
themselves and to protect themselves.
Women who have been raped need to have access
to post-exposure prophylaxis - medical techniques which can reduce
the chances of HIV infection if the victim of a rape is treated
quickly. In many (mainly African) countries with high levels of
sexual violence against women and high HIV prevalence, this
treatment is not freely available to women.
Women need to have a way to protect themselves
from HIV. Too many women do not have the power in heterosexual
relationships to insist on condom use, and are vulnerable to
infection from their partners. There are plans underway to develop a
microbicide, a gel or cream which can be applied vaginally, without
a partner even knowing, and which would kill HIV, preventing
infection. Tests have been being done for a number of years, but
medical experts say that even if all goes well, such a gel is still
at least 5 years away.
There are many issues surrounding the development
of microbicides . It will be at least five years before any such
product becomes available for use due to the duration of the
safety-testing that needs to be done first. If such a product can be
shown to be both safe and functional, it will then have to be made
palatable to consumers from different countries and cultures.
Firstly, there is the issue of pregnancy. Women in developing
countries may want a microbicide that prevents HIV infection but
which allows pregnancy to occur, whilst other women may want to be
protected against both HIV infection and pregnancy. Given that a
number of faith-based organisations espouse anti-contraception
views, it seems likely that a microbicide which does not prevent
pregnancy will be more easily accepted.
Protecting women from HIV is not solely women's
responsibility. Most HIV+ women were infected by unprotected sex
with an infected man. Preventing infection is the responsibility of
both partners, and men must play an equal role in this. If no HIV+
men had unprotected heterosexual sex, the number of women newly
infected with HIV would plummet.
Violence against women, discrimination, gender-based
inequalities, prostitution - these are all social issues which
undeniably need to be changed, but which might take decades to
alter. Women who have HIV need to be treated immediately, and women
who don't have the virus need to be able to protect themselves. If,
in the short term, it is impossible to empower women to be able to
insist on condom use, then efforts must be made to find an
alternative solution.
Many women may not think they are at risk for HIV
infection. There is still, in some places, a myth that HIV infection
is something that happens to other people - to men, to injecting
drug users, to people from other ethnic groups. This falsehood needs
to be cleared up, and countries around the world need to empower
women to be able to protect themselves.
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