Conflating And Conflicting: The Centrality Of Rights In HIV And AIDS Responses
FRIDAY FILE: The war against HIV and AIDS cannot be won without a rights based approach.
By Kathambi Kinoti
“Rights Here, Right Now” was the theme of the 2010 World AIDS Conference held in Vienna, Austria in July. It reaffirmed the centrality of rights in addressing HIV and AIDS. Every human being has the universal right to health. How does this right as it is applied intersect with or challenge women’s rights, the rights of sex workers, LGBTQI persons, poor people and those who are otherwise disadvantaged? What rights do HIV positive people have, and what rights do HIV negative people have?
Everyone has the right to appropriate unbiased health care that prevents or treats HIV and AIDS promptly and adequately; they have the right to information that will influence their choices; and they have the right to make those choices. In some contexts these rights converge and in other cases they conflict.
Rights and Stigma
HIV and AIDS are on the whole stigmatized conditions all over the world. They are phenomena that straddle the boundaries of taboo. The highest- risk and most underserved populations remain injecting drug users, sex workers and LGBTQI persons, particularly men who have sex with men. These categories of people are ostracized and blamed for spreading the virus, yet they usually have restricted access , if any at all, to information and treatment.
Although national and international HIV and AIDS responses are becoming more inclusive, laws and social mores remain a barrier in the fight against the pandemic. Same sex relationships and sex work are often stigmatized and this discourages health-seeking behavior: accessing condoms, regular testing; accessing anti-retroviral drugs. Not only are non-heterosexual and transactional sex stigmatized, they are increasingly criminalized, as in the case of the anti-homosexuality bill in Uganda, and legislation that penalizes people who ‘deliberately’ transmit HIV. This trend means that not only may marginalized people avoid seeking treatment, but those already infected may hide their HIV status to the detriment of those around them.
The traditional ‘ABC’ messages of HIV prevention - Abstain, Be faithful, use a Condom - do not work in all contexts. In Kenya, for instance, the riskiest site for HIV infection is now within marriage.
In Asia, men who have unprotected intercourse with sex workers are the main drivers of the pandemic . Since they are usually married or will marry some time in their lifetime, the spouses of these men are directly exposed to the risk of contracting HIV. What does these women’s prior abstinence or faithfulness count for? What are their rights?
Prevention and treatment work has been significantly hampered in by false assumptions about cultural mores – chastity and fidelity - protecting Asians from HIV contraction. How do these assumptions stigmatize women who contract HIV, and affect their access to treatment?
The Effect of Flawed Notions of Masculinities
Women’s rights advocates have long called for gender roles to be examined and changed. Much of this work has been integrated into women’s rights advocacy and programming, and women are continuously interrogating their socially prescribed roles. Increasingly, men are also interrogating their gender roles. Zambian-born journalist Aernout Zevenbergen was prompted to write a book examining African masculinities after participating in a workshop on HIV and AIDS. Some male participants at that workshop expressed their inclination to have sex without a condom to ‘spread their seed,’ a notion tied closely to their understanding of masculinity and one that contributes to the spread of HIV and AIDS. Some men are challenging patriarchal prescriptions of masculinities, but what do these deeply flawed understandings of masculinities mean for women’s rights?
Male circumcision has been shown to reduce men’s vulnerability to HIV. While this is an important development in the fight against HIV and AIDS, it may contribute to an entrenchment of oppressive gender roles for women, and an increase in men’s – and hence many women’s - vulnerability to HIV and AIDS. In some African cultures boys are circumcised as a rite of passage in their early to mid teens. Often this gives them an unspoken licence to be sexually promiscuous and assert their masculinity in other negative ways. Male circumcision as a tool against HIV and AIDS may be scientifically sound, but it has social and cultural limitations. The war against the pandemic cannot be won without addressing the role of concepts of masculinities in fuelling its spread.
The enthusiasm about male circumcision has a potential down-side: resources may be diverted away from women’s rights infused initiatives to male circumcision programmes that do not address the multiple dimensions of HIV and AIDS particularly as it affects women.
An exciting breakthrough was announced at the 2010 AIDS Conference: At last a microbicide trial in South Africa has demonstrated that that it is possible for women to use anti-retrovirals (ARVs) proactively to prevent infection with HIV. The study was a mid-sized one with only modest results – 39 per cent effectiveness- but it was a giant step forward. Pauline Irungu of the Global Campaign for Microbicides predicts that these initial research findings will open the door for greater funding for intensive research on microbicides. The study is therefore a forerunner of greater things to come.
It is well known that violence against women and gender inequalities increase women’s susceptibility to HIV and AIDS. Rape, domestic violence, early marriages and gender stereotypes compromise women’s ability to negotiate for safe sex. Women’s rights advocates say that putting the power of prevention into the hands of women will result in fewer new infections. Improving access to friendly health services for those infected will lead to better management of the condition.
Women have been campaigning for microbicides for years, and the truth is that the news of a successful trial could have come much sooner. According to Irungu, the push for the search for a microbicide did not come from the pharmaceutical companies, HIV and AIDS researchers or even governments. It came from women’s rights advocates. Without their advocacy, this would not have been a priority in the fight against HIV and AIDS. Pharmaceutical companies, who are usually at the forefront of medical innovation and have vast financial and human resources for research have been conspicuously absent in the search for a microbicide. Their main contribution has been to give rights to the researchers in the South Africa study to reformulate their drug in the trials.
The availability of a microbicide will not necessarily tackle broader women’s rights issues around women’s primary agency in their sexual health and rights. How free will women be able to apply the topical gel without being confronted by their partners? In many contexts a woman risks violence or banishment if she suggests to her partner the use of an HIV barrier method. Pauline Irungu suggests that if the antiretroviral was combined with a topical contraceptive, it might be easier for women to explain to their partners why they are applying the gel. “A lot of thought needs to go into the crafting of messages promoting the microbicide,” she says. “We should not lose sight of the factors that make women vulnerable in the first place.”
These issues include the biological vulnerability of women to HIV due to the larger surface area that the virus comes into contact with when there is unprotected sex. They include the social and cultural vulnerabilities that emanate from women’s prescribed chaste and faithful roles as wives, but also the expectation that their sexual health, rights and sexuality are in the hands of outsiders- family, friends , school structures, medical personnel and religious authority figures.
Pauline Irungu says that there is a great need for comprehensive medical services. Unfortunately, health service providers sometimes take a moral position when what is needed is their medical expertise. “They should provide medical services,” she says. “Not moral services.” Sexually transmitted infections and cervical cancer contribute to women’s vulnerability to the scourge of HIV and AIDS. Frequent testing and early treatment have been demonstrated to be effective tools against HIV and AIDS.
According to Irungu, a deep conceptual systemic shift is needed in the way that women are regarded. She gives the example of pre-natal care in Africa which she says is more focused on taking care of the unborn child than the mother. Women are valued as mothers and wives before they are appreciated as individuals in need of healthcare.
Choice as Right
The greater the array of preventative choices, the better women’s rights will be served: female condoms, male condoms , microbicides, abstinence and faithfulness all have implications on women’s rights. Irungu says: “We are asking for new tools so that we can have a wide array of choices. The more choices there are, the better able we will be to prevent HIV/AIDS spread.”
Not enough programming and resources are going into women’s options. The female condom was created several years ago but its scarce availability and its poor marketing have contributed to its low status as an HIV preventative measure.
Prevention of New HIV infections
ARVs are a crucial preventative tool in the HIV and AIDS scourge. Irungu says that as the HIV and AIDS research community does more work on microbicides, they are also moving toward Pre-Exposure Prophylaxis (PREP), which provides an opportunity for users to avoid contracting HIV even when they are involved with an HIV positive partner or have unscheduled sexual encounters. This will contribute to the array of HIV and AIDS treatments.
With reference to the United Nations Human Rights Council Resolution 12/27 on "the promotion and protection of human rights in the context of HIV and AIDS", you are invited to share input to the Secretary General's report, on the steps taken to promote and implement programmes to address HIV/AIDS-related human rights by responding to the questionnaire. Deadline for responses: September 15, 2010. Read more here.