HIV And AIDS Issues Through Gender And Human Rights Lenses
By Sirajul Islam
29 May, 2007
Last week, I have the opportunity
to participate in a workshop on Gender, HIV and AIDS mainstreaming in
NGOs in Bangladesh at IDB Bhaban, Dhaka at the Initiative of HIV and
AIDS Alliance in Bangladesh supported by Oxfam Novib. That workshop
brings together experiences, ideas and strategies for mainstreaming
gender, and HIV and AIDS in particular, but most importantly looked
the HIV and AIDS issue through human rights perspective, which was most
interesting to me and that was the main purpose for this short write-up.
While analysing gender, HIV
and AIDS and human rights, we acknowledged that when men are fighting
a deadly human immunodeficiency virus, women are fighting both a deadly
virus and wide-ranging inequity in trying to defeat the hazards of HIV
and AIDS. We understood that from corner to corner of the world, they
face a number of conditions which swell their possibility of HIV infection
in gender-specific ways. Many women are exposed to sexual violence and
coerced sex inside and outside marriage, as well as from end to end
damaging customary convention such as early marriage, wife inheritance,
and in some cases genital defacement. They commonly lack information
on and entrée to HIV prevention processes and to healthcare as
well as to support and medication after the contagion. They are shorn
of assets, property and inheritance rights, employment and entrée
to finance to some extent, and all these rebuffs which make them dependent
on men, and are often barred from participation in policy-making and
implementation, including on issues which primarily affect them.
However the workshop observed
that the women are ever more protesting successfully for their rights.
Grassroots activism by women, including in particular women living with
STDs, HIV and AIDS, though limited in Bangladesh, has grown for years
with some outstanding successes, and in the face of a whole host of
hindrances. However, now, throughout the world, the HIV epidemic is
increasingly viewed as a strongly gendered health, development and human
rights issue. It is an avoidable disease yet some 40 million people
or more live with this virus in the world now, with 878 known cases
in Bangladesh. But more alarming is that the proportion of women affected
is increasing. As discussed in the workshop, with many other things,
this short paper offers a human rights analysis of the gender-specific
factors which put women at risk of contracting HIV and AIDS and of the
consequences of contracting HIV and AIDS which women face. The common
scenario pointed out below makes clear that:
Hostility against women and
other forms of gender-based discrimination increase women’s probability
of contracting HIV;
Gender-based inequity also
holds back women’s entrée to prevention methods and to
treatment of containing HIV or AIDS;
Inclusive rights-based approach
is essential to successfully deal with the HIV infections, its causes
is needed to tackle the inequities surrounding HIV prevalence and lack
of entrée to treatment.
While looking at the position
of women and men in the world in the case of HIV infection, we saw that
the number of people living with HIV and AIDS in 2003 was estimated
by UNAIDS to be 35.7 million adults of whom 17 million were women. Adults,
for the purposes of the UNAIDS report, means people between the ages
of 15 and 49, the major period of human sexual and reproductive activity.
The highest rates of HIV prevalence are in southern Africa: Botswana
(37.3%), Swaziland (38.8%), Lesotho (28.9%), Zimbabwe (24.6%), South
Africa (21.5%), Namibia (21.3%), and Zambia (16.5%). Prevalence rates
fall where preventive measures are taken as in the case of Uganda where
national prevalence dropped from 12% in the early 1990s to 4.1% in 2003.
In Africa 57% of adults living
with the virus are women, and two thirds of young HIV-positive people
are women and girls. The worldwide proportion of women living with HIV
and AIDS is almost 50 percent. Globally, young women are 1.6 times more
likely to be living with HIV and AIDS than young men. A review of HIV
infection levels among 15 – 24 year-olds which compared the ratio
of young women to young men living with HIV found that in South Africa
twice as many women as men had the virus while in Kenya and Mali the
ratio of HIV-positive young women to young men was 4.5 to 1. Around
five to six million people in low and middle income countries of the
world do not have access to necessary life-saving antiretroviral drugs
(ARVs) including Bangladesh. Though Bangladesh has a fewer number of
HIV carriers, the treatment facility with the ARVs are limited. Square
and Beximco Pharmaceuticals are producing the medicine, but that is
too costly for the HIV positive patients in Bangladesh most of whom
are from poor economic background, and are facing high level of exclusion
from the society and family.
It was disclosed in the workshop that HIV affects not only those living
with the deadly virus but others who depend on, or are related to them.
Women living with the virus
who face disgrace, inequity, hostility, and uneven entrée to
Women at particular danger
through gender-based hostility, risky sex, injecting drug use or living
with people who are injecting drug users, as commercial sex workers,
and through prejudiced customary practices.
Women caring for affected
family members or others.
Women in their roles as campaigners,
NGO activists, human rights defenders and service providers.
We were really rapt while
discovered that women face gender-specific risks from HIV in a number
of ways. The growing proportion of women affected by HIV arises from
a mix of physiological, social and human rights factors. Women and girls
appear to have a higher inherent risk of being infected via heterosexual
activity compared to men because semen contains higher levels of HIV
than vaginal fluids. Moreover the vagina offers a larger area of mucosal
tissue subject to micro-injuries through which the virus can enter the
bloodstream. Women are thus more likely than men to contract HIV through
a single heterosexual encounter. It is also captivating to know that
women face anal sex often, and unprotected anal sex, whether heterosexual
or homosexual bears a considerably higher possibility of HIV infection
for the semen-receiving sex partner.
For many women the most common risk factor they face is living with
an HIV-positive husband or partner whether he is aware of his status
or not. Other risk factors include the level of violence to which women
are subjected, harmful traditional practices which put women at higher
risk, and socio-economic factors which limit women’s capacity
to protect themselves. Although physiology affects women’s greater
risk of HIV transmission, it is women and girl’s relative lack
of power over their bodies and their sexual lives, supported and reinforced
by their social and economic inequality, that make them such a vulnerable
group in contracting, and living with, HIV and AIDS. … The stereotypical
gender roles that underpin sexual inequality and sexual violence are
confirmed and reproduced by social, cultural and religious norms.
Women face a spate of human rights violation in the form of hostility
every day. Human rights violations against women include:
Hostility in the family.
This includes rough treatment by close relatives, sexual abuse of female
children in the household, dowry-related violent behaviour, marital
rape and other customary practices damaging to women. Abuse of domestic
workers including sexual assault etc.
Hostility outside the family.
This includes rape, sexual abuse, sexual harassment and assault at work,
in educational institutions and elsewhere. Trafficking, and coerced
sex fall into this category, which also covers rape and other abuses
by armed groups.
Gender-based violence committed
or ignored by the state or by state actors like police, prison guards,
soldiers, border guards, immigration officials and so on.
Hostility is a key factor
in increasing women’s risk of contracting the human immunodeficiency
virus. Citing examples from studies the workshop told that in many cases
the first sexual experience of a girl is often is forced. Women are
2 to 4 times more likely to contract HIV during unprotected vaginal
intercourse than men both because their sexual physiology places them
at higher risk of injury, especially in the case of young women, and
because they are more likely to be at the receiving end of violent or
coerced sexual intercourse.
Other factors also come into
play, i.e., factors associated with women’s subordinate position
increase the risk of HIV infection. Among them are illiteracy and poverty,
conflict situations, lack of sexual autonomy, rape by relatives or strangers,
multiple sexual partners, trafficking for sexual exploitation, prostitution
and child marriage etc. So, protecting human rights are central to all
aspects of an effective response to HIV and AIDS, the workshop told,
and have been emphasised rightly in most of the international and national
HIV and AIDS prevention programmes since the creation of the World Health
Organisation’s Global Programme on AIDS in the 1980s. A rights-based
approach starts from the argument that respect for human rights forms
a logical basis for programmes to address the deadly disease and that
abuses of human rights contribute to the spread of the HIV and undermine
attempts to control it. When human rights are not promoted and protected,
it is tougher to prevent HIV spread. When these rights are not promoted
and protected, the impact of the scourge on individuals and communities
 The author is working with INAFI, a global network of 300 microfinance
practitioners across Asia, Africa and Latin America, having its headquarter
in Dakar, Senegal. He is also a freelance contributor to a number of
journals at home and abroad.
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