AIDS: AN EXPRESSION OF GENDER-BASED VIOLENCE
The increasing incidence of AIDS in women has clearly revealed the conditions of social and economic inequality in which they live. Throughout the world today, nearly 42% of those infected with HIV are women. Every day, approximately 7,000 people are infected with the virus. 50% of them are women, two-thirds of whom are young, poor and married. In São Paulo, AIDS is the leading cause of death among women aged 15 to 19. (8th International Women and Health Meeting, Río de Janeiro, 1997)
The Human Immunodeficiency Virus (HIV) was first identified in the 1980s. Since then, its control and treatment has represented a global challenge. In 1997, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that there were 5.8 million new cases of HIV infection that year. The regions with the highest rates of transmission are Asia, Africa, and Latin America and the Caribbean. It is estimated that a worldwide total of 30.6 million people are living with HIV/AIDS.
Fifteen years ago, when the first cases of AIDS appeared in the Western world, women, especially Latin American and Caribbean women, viewed themselves as unaffected by this illness. Recognition of the increasing incidence of HIV/AIDS in women first occurred at the end of the 1980s, and women's groups and organizations working in women's health began to involve themselves actively in the issue.
In this context, UNAIDS has implemented prevention campaigns and developed programs offering care and support for people with the virus in the hopes of alleviating the epidemics impact. In Latin America and the Caribbean, an estimated 2 million people are living with HIV/AIDS, and 20% of them are women. (Sánchez Fonseca, PANOS, 1996)
World AIDS Day, December 1, is a opportunity for calling attention to the serious consequences of HIV/AIDS in the lives of millions of women. This year, the motives for this campaign are two-fold as the United Nations commemorates the 50th anniversary of the Universal Declaration of Human Rights and, at the same time, carries out a series of actions through their Campaign for Women's Human Rights, A Life Without Violence is Our Right.
Examining the HIV/AIDS epidemic with a gender perspective allows us to recognize that gender-based discrimination is a determining factor in women's lives. Gender-based discrimination prevents women from making free and autonomous decisions, especially in the area of sexuality and relationships. Since girlhood, women are taught to be the weaker sex and are treated as such by their husbands, families, religions and society in general.
UNAIDS Gender and HIV advisor, Madhu Bala Nath has asked: "Can a woman be sexually assertive? Can she even think of differing from her reliance on mutual fidelity when she has been socialized and brought up on the principle that the husband is supreme? ...Can a woman even suggest safe sex by ensuring that her partner wear a condom... when the very suggestion of condom use carries with it an indication of infidelity that could threaten the security of not only the relationship but her very existence? ...Familial abuse is common all over the world. Do men use condoms when they rape women?" ("Violence Against Girls and Adolescent Women: Regional Campaign for Women's Human Rights and Against Violence," 1998)
Men have the financial power, physical strength and authority granted by their sex with which they can demand specific sexual relations with women. The constant threat of violence makes women feel vulnerable and allows men to maintain control over the decision of when and how to have sex. At the same time, being married, monogamous and/or having a stable relationships does not guarantee women protection against exposure to HIV. In this case, the risk of infection is determined by their partners sexual behavior. In some areas of the world, including Latin America, heterosexual relations are the most common means of transmission, responsible for three-fourths of all new HIV-infections. (Sánchez Fonseca, PANOS, 1996)
As HIV/AIDS expert, Dr. Jonathan Mann asserted: "The central problem of HIV in women can't be solved with posters, information campaigns or condom distribution. The central issue isn't technological or biological: it is the inferior status or role of women. To the extent that, when women's human rights and dignity are not respected, society creates and favors their vulnerability to AIDS." (Desidamos, 1995)
There is a clear link between HIV transmission and acts of sexual violence, rape in particular. Those most affected by this cycle of violence are women sex workers, whose clients accuse them of transmitting the virus while, ironically, many demand services without condoms. With the increasing incidence of sex tourism and migration, more and more women and girls are infected with HIV. Trafficking networks take advantage of the poverty, unemployment and abandonment faced by thousands of women, misleading them with promises of work and money and finally forcing them to work in prostitution.
Another aspect of women's vulnerability to HIV/AIDS is linked to age and economic status. AIDS is more common among young and poor women, and not by chance: the virus mainly affects the sectors of the population that are most discriminated against, those lacking basic education, decent housing, adequate food and access to quality medical care. The drugs used to treat HIV/AIDS are either unavailable or far too expensive for limited budgets. As a result, HIV is the third leading cause of death for men between 25 and 44 years of age and the thirteenth leading cause of death for women of the same age group. (CIMAC 1998)
This situation is compounded by right-wing Catholic campaigns that oppose condom use, increase levels of misinformation and reinforce the ignorance of the general population, especially young people who are potentially at risk. According to statistics from CONASIDA in Mexico, of the 53,000 people registered with HIV/AIDS since January 1998, none used condoms as a form of protection. Of the nearly 10,000 young Mexicans who are living with the virus 8,000 men and 2,000 women 70% were infected as adolescents (CIMAC, 1998). UNAIDS asserts that correct use of condoms reduces the probability of transmission to one in 90,000.
For women, this situation is twice as serious since, in most cases of extreme poverty, they alone bear the burden of providing for their family. It is not unusual for women to have several partners as a survival strategy, which places them at a disadvantage since they must submit to the men's desires with all the risks that this implies for their lives and health. Equally serious is the discrimination and moral censure to which HIV-positive women are subjected. AIDS is often viewed as "a punishment for immorality." Women diagnosed with HIV often suffer abuse, loss of employment, divorce and abandonment by their families, which are all violations of their human rights.
Mother-to-child transmission of HIV infects approximately 300,000 newborns each year, most of them in developing nations. Many are infected through breast-feeding, which is often the only available source of food for the infant. At present rates of infection, maternal deaths due to AIDS in Africa, Asia and Latin American will leave nearly 42 million children orphans by the year 2010 (Noticias Actuales de Población, UNFPA, 1998).
In the Dominican Republic, a recent study indicated that AIDS is now the leading cause of death in women of reproductive age. Of the total number of HIV-positive women, 59.4% are between 15 and 34 years of age. The probability that their children will be born HIV-positive varies between 25 and 50%. The risk of mother-to-child transmission through breast-feeding is between 16 and 25%. (Fempress/Tertulia, 1998) In Bolivia, 13 cases of mother-to-child transmission have been reported; only six of these infants were born with the virus. None of the children survived infancy. (PANOS, 1997)
If our objective is to improve the status of women, including those with HIV/AIDS, we must begin by defending the rights of women within the context of human rights. This implies eliminating gender-based inequality by implementing laws, public policies and programs that guarantee economic welfare for women and their families, access to education, high-quality health care and the right to be free of all forms of violence, to have secure employment, and to decide when, with whom and how they wish to have sexual relations.
The International Conference on Population and Development (Cairo 1994) recognized sexual and reproductive rights as women's human rights. This means that women should have the freedom to make their own decisions about their sexuality and procreation and have access to information and contraception.
At the same time, we must promote HIV/AIDS prevention among all women, based on women's right to express their sexuality as they desire. In the face of the continuing pandemic, it is essential that we support clinical and epidemiological studies on HIV/AIDS in women, guaranteeing their access to methods of HIV prevention. The Colombian health care system recently implemented a model of free, comprehensive care for victims of sexual violence that includes a medical examination, HIV/AIDS testing and psychological counseling (PANOS, 1998).
Some countries in the region are encouraging the organization of HIV-positive women. In Peru, the recently-created Frente Nacional de Mujeres que Viven con el VIH/SIDA (National Front of Women Living with HIV/AIDS) now has at least 75 members. Their objective is to educate the general population about the situation of HIV-positive women through campaigns that encourage society to change discriminatory behavior and attitudes. They also strive to create the conditions to provide for themselves and their families by forming small businesses.
Another, similar experience took place in Colombia. In May of this year, Bogota was the site of the First National Meeting of Women Living with HIV/AIDS. The participants established a national network to mobilize economic resources and encourage social recognition of HIV-positive women's needs and rights. They called for greater promotion of sexual and reproductive rights, respect for their right to chose the legal guardian of their children, and more research on HIV/AIDS. Most importantly, these women renewed their self-esteem and hope; as one of the participants in this event exclaimed, "The meeting filled me with energy for life..., it made me realize that I'm not dead."
Isis Internacional Information and Documentation Center
In Latin America and the Caribbean, more than 80% of all women living with the virus were infected by their partner. The rest were infected by blood transfusion or by sharing contaminated needles. (Desidamos, 1998)
Mexico is third on the list of countries with the highest numbers of estimated cases of HIV/AIDS in the world, and 90% of those infected do not know that they are HIV-positive. (CIMAC, 1998)
In Puerto Rico, AIDS is the leading cause of death for women aged 25 to 34. In 1990, in the hospital of San Juan, one out of every 26 pregnant women was infected with HIV. (SIDA América, 1992)
According to 1997 figures from UNAIDS, after the USA, Brazil has the highest number of reported cases of HIV in the Americas. A report from the recent Pan American Conference on AIDS revealed that many of the new infections occur among children and married women.
Unofficial data from Honduras reports that just over 50,000 people are living with the virus in this Central American country, of these 25,000 are men, 14,000 women and 900 children under five years old.