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While HIV and AIDS doesn't discriminate at all, people still do. And women are at high risk of contracting HIV in countries - like ours - where they still do not have the power to choose when and where they have sex. Here is an extract from a fact sheet prepared by the WHO (World Health Organisation) exploring the vulnerability of women to HIV and AIDS because of their poor financial situations.
The right to choose is most violated in those places where women exchange sex for survival as a way of life. We are not talking about prostitution, but rather a basic social and economic arrangement between the sexes that results on the one hand from poverty affecting men and women, and on the other hand, from male control over women's lives in a context of poverty. For example, in many instances the male is the breadwinner and brings the money home. If his wife or partner does not do as he asks, he can use his status as breadwinner to withhold money from her.
By and large, most men - however poor - can choose when, with whom and with what protection (if any) to have sex. Most women cannot. A Minister of Health of one of the Southern African countries recently declared that women should have a right to sexuality which does not endanger their lives.
- Lack of control over own sexuality and sexual relationships (see above).
- Poor reproductive and sexual health, leading to serious morbidity and mortality. Rates of infection in young (15-19) women are between 5 and 6 times higher than in young men (recent studies in various African populations).
- Neglect of health needs, nutrition, medical care etc. Women's access to care and support for HIV and AIDS is much delayed (if it arrives at all) and limited. Family resources are nearly always devoted to caring for the husband or children. Women, even when infected themselves, are the ones who provide all the care.
- Clinical management based on research on men. A module on clinical management of HIV and AIDS in women needs to be designed and implemented.
- All forms of coerced sex - from violent rape to cultural/economic obligations to have sex when it is not really wanted, increases risk of microlesions and therefore of STIs/HIV infection.
- Harmful cultural practices: From genital mutilation to practices such as "dry" sex.
- Stigma and discrimination in relation to AIDS (and all STIss): Discrimination is far stronger against women who risk violence, abandonment, neglect (of health and material needs), destitution, ostracism from family and community. Furthermore, women are often blamed for spread of disease, even though the majority have been infected by only partner/husband.
- Adolescents: Access to education for prevention, (in and out of school and through media campaigns), condoms, and reproductive health services before and after they are sexually active.
- Promotion and protection of adolescent reproductive rights (particularly girls). Obstacles in terms of laws and policies, health service provision, cultural attitudes and expectations of girls and boys' sexual behaviour, cultural practices, and educational and employment opportunities.
- Sexual abuse: There is now evidence that this is an underestimated mode of transmission of HIV infection in children (even very small children). Adult men seek ever-younger female partners (younger than 15 years of age) in order to avoid HIV infection, or if already infected, in order to be "cured". Apparently, there is a (false) belief among some men that sex with a virgin will cure AIDS.
- Disclosure of status, partner notification, confidentiality. These are all more difficult issues for women than for men for the reasons discussed above - negative consequences and the fact that women have usually been infected by their only partner/husband.
Because telling people is more difficult for a woman, women's access to care and support is further decreased. Protection for women when they disclose status must be assured.
Department of Health, October 2005
www.iolhivaids.co.za
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