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Stop AIDS: Ensure
human rights

By Cathryn J. Prince

The widespread subordination and powerlessness of women is at the root of the alarming rise in the number of HIV-infected women around the world, especially in developing countries. Only dealing with the issue at the human rights level can reverse this deadly trend.

A young Moroccan woman, Hafida, asked her husband to use a condom after hearing about the dangers of HIV. He threatened her with violence and abandonment. She became HIV positive and pregnant.

After 17 years of an arranged marriage to a much older man, 30-year-old Myriem became a widow and fell sick with AIDS. When they married, Myriem was a virgin, but her husband was already HIV positive. Like many infected African men, he never told her of his condition. And like many African women raised in a traditional family, Myriem never dreamed of asking her husband to practice safe sex, as that would have been unseemly.

There are thousands of women like Hafida and Myriem around the world. In many countries, women’s social inequality serves as fertile ground for HIV transmission, because all too often, the more immediate needs of economic and social stability take precedence over potential life-saving measures.

“The main factor for the predominance of HIV infection among women in developing countries is their lack of economic autonomy. It is a major impediment to the ability of women to control their own sexual decision-making,’’ says Professor Hakima Himmich, President of the Moroccan Association to Fight AIDS. “Women’s total dependence on men for their survival increases their risk of HIV infection.’’



Closing gap

There are about 23 million HIV-positive adults worldwide, according to the World Health Organization. Of these, about 10 million are women. However, the proportion of affected women is rising. Currently, 1.3 men are infected for each woman. In the mid-to-late 80s it was 2 to 1. Health officials expect a 1 to 1 ratio by the year 2000. The statistics are even more startling when one looks at countries where women have a lower social status than men. Nine out of ten infected women live in developing countries, according to UNAIDS. (1)

In Brazil, in 1984, one woman for 99 men was HIV positive; in 1994 women accounted for 25 per cent of all HIV-positive people. In sub-Saharan Africa, six women for five men are infected; nearly 45 per cent of all women infected in the world are African. Most of these women be-
come infected through heterosexual transmission.

“We’ve made tremendous progress on one level with ideas and the thinking that links rights and health,’’ says Dr Jonathan Mann, François-Xavier Bagnoud Professor of Health and Human Rights at Harvard University. “But on the practical level it will be a much slower path. We have to change deeply ingrained social, political and economic practices.”

Few options

According to UNAIDS, most African women are infected by their one and only sexual partner — their husband. This makes it hard to preach abstinence and safe sex as ways to curb the spread of HIV. In sub-Saharan Africa, women who insist on condoms are perceived as deviant or threatening.

Some African women avoid insisting on condom use for fear of being accused of marital infidelity, while social pressure to have children deters others from asking. In Asian countries, where marital rape is not a crime, refusing to have sex with a husband is not an option.

“We’ve been talking about HIV and AIDS for more than 10 years; but there is still fear, prejudice and a lack of understanding,’’ says Dr Anne Petitgirard, AIDS Coordinator at the Federation. “This all links to human rights. When there is fear, you start to do things that violate human rights, and when human rights are not respected, you make it easier to transmit the disease.’’

It’s been 16 years since governments around the world ratified the United Nations Convention on the Elim-ination of all forms of Discrimination Against Women. The convention stated concern that in situations of poverty, women have less access to food, health, education, training and job opportunities. In response, the signatories called for non-discriminatory health services for women, from yearly check-ups to family planning.

Yet discrimination against women prevails. Many in Arab and African countries can’t work without their husband’s consent. Only six out of 100 Moroccan girls attend school. They are for-bidden to talk about sex, and sexual abuse and rape is tolerated even if it isn’t legal, say many human rights experts.





Earliest prevention

However, while improving women’s status can reduce HIV vulnerability, experts agree that nothing will work unless both men and women are involved. Puan Mehrun Siraj of the Malaysia Red Crescent has written that in India child marriages were once common, but with new laws 85 per cent of marriages now take place after girls reach the legal age. This can help fight HIV transmission because women are more vulnerable to HIV infection before they are sexually developed.

Data from Rwanda supports this. African girls marry young and the younger the age of the first sexual intercourse or of a first pregnancy, the higher the chances of HIV infection. About 25 per cent of young Rwandan women pregnant at the age of 17 or younger are infected.

Despite these obstacles, some associations are trying to change these statistics. In Morocco, the Association to Fight Aids has been reaching out to sex workers in Casablanca to teach them to demand condoms more regularly. The Thai Red Cross has called for programmes to help women strengthen their position in society, and the Pakistani Red Crescent has called for sex education in schools.

“There is a need to act long before the real risk factors come into being. We have to go to the real root of these issues,’’ Mann says. “And the Human Rights Declaration and other treaties are frameworks within which we can work.”

Individual behaviour change has long been a theme for HIV/AIDS prevention policy; but what’s needed are laws that empower women, writes Lynn Freedman, assistant professor of clinical public health at Columbia University School of Public Health in the quarterly Health and Human Rights. (2)

“As a matter of human rights,” she continues, “individuals must be empowered to make the kinds of decisions about their lives that will enable them to protect their health.”

(1) UNAIDS is an acronym for the joint UN Programme on HIV/AIDS; it is the successor to WHO’s Global Programme on Aids (GPA).

(2) Health and Human Rights, Vol. 1, No. 4, 1995, p.314, published by the Harvard School of Public Health.

Cathryn J. Prince
Cathryn J. Prince is a freelance journalist based in Switzerland.

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