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| Thursday, 2 December 2004 |
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Fight inequality: Fight AIDS When AIDS first hit the headlines 20 years ago, most of the people infected with HIV were men. Today, nearly half of those living with HIV and AIDS worldwide are women. Female infection rates are on the rise in almost every region of the globe. In sub-Saharan Africa, nearly 60 per cent of adults living with HIV are women. The fastest increases at present, however, are in Eastern Europe, Latin America, and Asia. In parts of Asia, epidemics are spreading within particular population groups and then into the general population. Strikingly, the latest data indicates that one in four newly infected people is Asian; one in six is Indian. As a result, women and girls are becoming increasingly infected. In East Asia, 22 per cent of all adults and 28 per cent of young people (15-24) living with HIV are female. In South and Southeast Asia the figure is even higher: 30 per cent of all adults and 40 per cent of all young people living with HIV are women and girls. In India, women now account for one-quarter of new HIV infections. It is not difficult to work out why so many women are being affected. The vast majority of women lack the social and economic power to avoid being exposed. Far too many women are denied the chance to go to school, earn a living, own or inherit property or have access to healthcare. Moreover, huge numbers of women worldwide suffer violence, abuse and exploitation, all of which make them more prone to infection. So far, efforts to help women have tended to focus on promoting the ABC concept (Abstain, Be faithful, and use Condoms). This has undoubtedly helped reduce the spread of infection in some areas, but now we need to go further. We have to accept that women who are raped do not have the option of abstaining from sex. We must recognize that fidelity is a two-way process that only works if both partners stick to it 100 per cent. And while condom use makes an enormous difference, by no means all women are in a position to negotiate with partners to use them. Furthermore, condoms, particularly female condoms, may not always be available. We must also recognize that marriage, long thought a sure-fire way of protecting men and women from HIV infection, can actually be a risk factor. In many countries in Africa and South Asia, most women marry young, usually before they are 20, and often to husbands who are considerably older than they are. Few have much choice in the matter, their marriage is frequently an economic necessity as their parents cannot afford to keep them at home. Their new husbands will often have had other sexual partners, and may be reluctant to agree to use condoms. Moreover, women's inherent physical susceptibility (a woman is more than twice as likely to become infected via sexual contact with an infected man, than a man is from an encounter with an infected woman) is highest of all among girls and younger women. In India, 90 per cent of the women who test positive for HIV in ante-natal clinics say they are in long-term monogamous relationships. Twelve years ago, approximately 90 per cent of HIV transmission in Thailand was occurring between sex-workers and their clients. Recent estimates reveal that by 2002, 50 per cent of new infections in Thailand were between spouses, as current or former male clients of sex workers transmitted the virus to their wives. If women had more control over their lives and relationships, the risk of getting HIV from older partners, unfaithful husbands, or through forced marriages would drop drastically. If women could choose to get married rather than have marriage forced on them, to decide when and with whom they have sex, and to negotiate condom use with their partners, and if they could live lives free from violence, get an education, have access to healthcare and earn enough to feed their families, they would have a real opportunity to protect themselves from HIV. But this can only happen if we acknowledge the need to make the world a more equal place. This means challenging long-standing but now lethal laws, customs, and traditions, and changing the way much of the world's population (men and women, boys and girls) think and behave. Without a fundamental shift in the gender balance, the impact of AIDS on women and girls will be more and more devastating - not just on those who become infected but on the families, communities and countries in which they live. We have a chance now to make that shift and make a difference for generations of men and women to come. Dr Nafis Sadik, Special Envoy of the United Nations Secretary-General for HIV/AIDS for Asia and Pacific, Dr Suman Mehta, Associate Director, Asia, Pacific and the Middle East,
UNAIDS http://womenandaids.unaids.org |
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