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WOMEN AND HIV/AIDS
Facts
and figures
33.6 million people living with
HIV/AIDS, 14.8 million of whom are women
5 million adults newly infected in
1999, 2.3 million are women
2.1 million died of AIDS in 1999,
1.1 million of whom were women
12-13 African women currently
infected for every 10 African men
Half a million infections in
children (under 15), most of which have been transmitted from mother
to child
55% of adult infections in
sub-Saharan Africa are in women, 30% in SE Asia, 20% in Europe and
USA.
Modes of transmission
The AIDS epidemic in women is
overwhelmingly heterosexual – almost entirely so in Africa and South and
South East Asia.
In other areas, a proportion of women
are infected through:
-
sex with a bisexual or drug
injecting partner
-
their own injecting drug use
-
heterosexual sex without these
factors
-
blood transfusion (in developing
countries where blood is not routinely screened).
Why are women more vulnerable to
HIV infection?
Biologically,
Larger mucosal surface; microlesions
which can occur during intercourse may be entry points for the virus;
very young women even more vulnerable in this respect.
More virus in sperm than in vaginal
secretions
As with STIs, women are at least
four times more vulnerable to infection; the presence of untreated
STIs is a risk factor for HIV.
Coerced sex increases risk of
microlesions.
Economically
Financial or material dependence on
men means that women cannot control when, with whom and in what
circumstances they have sex
Many women have to exchange sex for
material favours, for daily survival. There is formal sex work but
there is also this exchange which in many poor settings, is many
women’s only way of providing for themselves and their children.
Socially
and culturally
Women are not expected to discuss or
make decisions about sexuality
They cannot request, let alone
insist on using a condom or any form of protection
If they refuse sex or request condom
use, they often risk abuse, as there is a suspicion of infidelity
The many forms of violence against
women mean that sex is often coerced which is itself a risk factor for
HIV infection
For married and unmarried men,
multiple partners (including sex workers) are culturally accepted
-
Women are expected to have relations
with or marry older men, who are more experienced, and more likely to
be infected. Men are seeking younger and younger partners in order to
avoid infection and in the belief that sex with a virgin cures AIDS
and other diseases.
Why must
the response be gender-based?
Three main reasons:
1. Unequal gender (social, economic,
and power) relations are driving the epidemic
2. Women are disproportionately
affected by the epidemic
-
They are highly vulnerable to
infection
-
They bear the psychosocial and
physical burden of AIDS care
-
They suffer particular
discrimination; are often blamed for spreading infection
3. Sex differences in pathology.
Clinical management, for too long based on research undertaken on men,
must be tailored to women’s particular symptomatology, disease
progression, HIV related illnesses etc.
What will
make a difference?
Physical and material independence and
security for women which is independent of the "protection" of a man or
men
This implies a profound shift in
social and economic power relations between men and women. It cannot be
achieved tomorrow but action must start today, through:
-
Increased educational and employment
opportunities for girls and women
-
Public education campaigns on the
harmful - fatal, in the case of AIDS - effects of unequal gender
relations.
Microbicides: our best hope
The development of a prevention
method which is cheap, safe and effective and under women’s control, is
essential.
-
In the absence of a vaccine, this is
a method likely to have an immediate and significant impact on the
alarming rate of new infections in women.
-
A massive investment in
international research and development of a microbicide is required.
Proven effective interventions
There are a number of proven
interventions (see key interventions) which together, comprise key
strategies to control the spread of the epidemic. They are particularly
important for women.
Treatment
and prevention of sexually transmissible infections:
women are more vulnerable to STIs;
the consequences are more serious
many STIs are asymptomatic in women,
so go untreated
syndromic management of STI in women
is more difficult than in men
stigma associated with STIs is
greater for women (suggests promiscuity), so they are often afraid or
unwilling to seek care.
Safe
blood
Women and children are the chief
recipients of transfusions; women - during and after delivery. The
following action is required:
-
Antenatal care and adequate
nutrition to reduce some of the need for transfusion
-
Appropriate clinical use of blood to
avoid unnecessary transfusion
-
Screening of all blood as the
ultimate aim.
Education
for prevention including the use of condoms
Condoms,
male and female, are currently the only protection methods available.
They need to be more widely accepted,
available and used.
-
Education to promote their use
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Increasing access through free
distribution, subsidies, or social marketing so that they are really
affordable.
It has been shown that even in the
most favourable circumstances, condom use (male and female) is low. The
acceptability of these methods remains problematic. The female condom is
if anything more cumbersome than the male condom and considerably more
expensive. Furthermore, women cannot control their use. Impact will
continue to be low if people’s preferences and therefore their actual
use of methods, are not given due attention.
Women
as carers
Women are responsible for the health
care of all family members.
Care is only one of the many
productive and reproductive activities of women which include farming,
food preparation, collection of firewood and water, child care,
cleaning, etc.
-
Care is provided free but has a
cost! During illness, women’s productive labour is lost; this has
serious impact on long term wellbeing of the household.
-
Care doesn’t end with death of
husband/child/sister. Care of orphans lies with grandmothers and
aunts.
-
Women carers are often HIV positive
themselves.
Making
men more responsible
Little attention has been paid to
men’s participation in efforts to protect women
Men are hard to reach and educate
but some are concerned about sexual health – their own and their
partners
Raising awareness of their own risk
has been shown to change certain behaviours
Interventions must be aimed at men
(as well as at women) if women are to be protected.
For further information, journalists can contact :
WHO Press Spokesperson and Coordinator, Spokesperson's Office,
WHO HQ, Geneva, Switzerland / Tel +41 22 791 4458/2599 / Fax +41 22 791
4858 / e-Mail: [email protected]
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