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FRIDAY FILE: This week, the world marked World AIDS Day whose 2011 theme was “Getting to Zero.” AWID explores some of the themes that have either come to the fore or persisted since the last World AIDS Day 2010, and which affect women’s getting to zero.
By Kathambi Kinoti
The 2011 UNAIDS report on World AIDS day is an ambitious pronouncement of the United Nations (UN) body’s resolve to ensure zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2015. Its optimism is buoyed by striking figures that indicate a decline in new infections and AIDS deaths. According to the report:
HIV incidence has fallen in 33 countries, 22 of them in sub-Saharan Africa. The number of new HIV infections has dropped by more than 26% in sub-Saharan Africa since 1997.
At the end of 2010, about 34 million people were living with HIV worldwide, an increase of 17% from 2001. But new infections were down to 2.67 million at the end of 2010 from 3.15 million in 2001, this also represents a 21% decline since the peak in 1997.
More people than ever before have been kept alive by antiretroviral therapy (ARV). Almost half of the people eligible for ARVs are now receiving it. Some 6.6 million people (of the estimated 14.2 million eligible) in low and middle-income countries were receiving treatment at the end of 2010.
In 2010, 48% of pregnant women living with HIV received effective treatment to prevent new HIV infections among children.
New infections in children were down to 390 000 in 2010, from 550 000 in 2001.
There has been an exponential increase in voluntary male circumcision. Clinical trials in Kenya, South Africa and Uganda indicate that voluntary medical male circumcision reduces the risk of female-to-male sexual transmission by about 60%.
But the news is not all good for everyone according to the report. In Eastern Europe and Central Asia the number of new HIV infections rose an astounding 250% between 2001 and 2010, the main victims being injecting drug users.
Moreover, in some places, women continue to be disproportionately infected. The report states: “The proportion of women living with HIV has remained stable at 50% globally, although women are more affected in sub-Saharan Africa (59% of all people living with HIV) and the Caribbean (53%).”
Women and HIV and AIDS
That HIV and AIDS are feminized is nothing new. Since the shift from being perceived as mainly the blight of men who have sex with men, studies and literature have documented women’s disproportionate vulnerability to HIV and AIDS. Quite early on after its discovery, HIV and AIDS began to wear a female countenance: Women have biological, social and economic vulnerabilities to contracting the virus, and a differentiated role in living with the disease.
Interwoven vulnerabilities
Due to their physiology, women are more susceptible than men to contracting HIV. This is because they have a larger surface area of their vagina that is available for HIV infection than men have on their sexual organs. The microbicide can potentially provide primary and secondary protection for women. A 2010 South African study showed that women were 39% less likely to contract HIV if they had applied a microbicide vaginally before intercourse.
In an interview with AWID in 2010, Pauline Irungu of the Global Campaign for Microbicides opined that not enough is being done by researchers to find ways to reduce women’s biological vulnerability to HIV. Indeed the drive for a microbicide came not from medical researchers but from women’s rights advocates. Since the 2010 announcement that microbicides potentially reduce women’s risk of infection with HIV by 39%, no major advances have been announced on the development of microbicides. In fact, in November this year a large international microbicide trial was discontinued as it was concluded that the microbicide was not effective.
Worryingly, it was recently revealed that Depo Provera, a hormone-based contraceptive injection, used by many women in the global South increases their risk of contracting and transmitting HIV two-fold. This contraceptive is convenient for many women for a number of reasons, mainly because it does not have to be taken daily, it is relatively inexpensive and in cases where male partners disapprove of the woman taking contraceptives, it is discreet. The news that Depo Provera increases susceptibility to HIV and AIDS was particularly disappointing for women’s rights advocates because its risks have been known within the scientific community for years without being made known to women, and because insufficient research is being done to develop contraceptives with the benefits of Depo Provera but without its risks.
Female condoms continue to be relatively expensive, less available, and frequently awkward for women. Again, little progress has been made on overcoming these barriers.
Challenging harmful gender norms
According to the UNAIDS report, a 2010 landmark study in South Africa on links between intimate partner violence and relationship power inequity and HIV in young South African women, showed that one in seven young women would not have contracted HIV if it were not for intimate partner violence. The study also showed that some ideals of masculinity such as risky sexual behaviour and having multiple concurrent partners increase women’s chance of contracting HIV. Behavioural change has been shown to be instrumental to fighting HIV and AIDS.
The increased prevalence of male circumcision as spurred on by the HIV and AIDS pandemic straddles the boundary between physiology and culture. The UNAIDS report hails the rise in voluntary male circumcision in Eastern and Southern Africa. Voluntary male circumcision has been shown to promote a 60% reduction risk of HIV transmission to men, which is indeed a good thing. However, it is difficult in some communities that traditionally practice compulsory male circumcision to draw the line between circumcision as a male rite of passage per se and as a health measure. Circumcision as a rite of passage often precedes the exercise of harmful masculinities at the expense of women, for instance dominance over women and sexual exploitation. For previously non-circumcising communities, the challenge is to adopt the physical practice without adopting the flawed notions of masculinities that circumcising communities have perpetuated. For the latter, it is to change behaviour to dissociate circumcision from male dominance.
Male circumcision does not guarantee men who undergo it 100% protection against contracting HIV. But in male dominated cultures the news of a 60% reduction in infection risk could encourage men to demand sex without condoms and promote the blaming of women for passing on the virus particularly if male circumcision is regarded as a barrier to contracting HIV, when the truth is that it simply reduces men’s vulnerability to contracting the virus.
Harmful legislation against people living with HIV and AIDS is another trend that is a setback to women’s rights. In a recent interview with AWID, Lillian Mworeko of the International Community of Women living with HIV and AIDS confirmed that criminalizing HIV and AIDS is detrimental to women’s rights.
Apart from other vulnerabilities women continue to bear the care burden of people living with HIV and AIDS.In Africa, for instance, it is estimated that two thirds of those who care for people living with HIV and AIDS are women.
Little zeroing in on women
While the UN report shows that there has been significant progress in the fight against HIV and AIDS, it does not highlight any significant progress for women’s rights.
It does, however, highlight some models that can be replicated. The Refenste Model for Post-Rape Care in South Africa is a one-stop inexpensive model for lab tests, collection of evidence, counseling, testing and dispensing of post-exposure prophylaxis, available 24 hours. Another model lauded by UNAIDS is an initiative in South Africa’s KwaZulu Natal province that integrates ”programmes to address HIV, TB, breast and cervical cancer, poverty, food security, and a range of other health and social services.” This increases the number of women’s entry points into the health system and their likelihood of being tested and treated for HIV and AIDS.
One of the major obstacles in the war against the pandemic is funding. The UNAIDS report shows a decline in international assistance for AIDS responses from US$7.6 billion in 2009 to US$6.9 billion in 2010. IRIN reports Medecins Sans Frontieres as saying that without increased funding there could be real regression in the fight against the pandemic.
While there have been definite gains in the fight against HIV and AIDS, there has not been enough focus on those most vulnerable to the pandemic physically, socially and economically: women.