By Cathryn J. Prince
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
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
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.’’
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
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
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
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
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.
“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
(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.
Top | Contact
Us | Credits
© 2003 | Copyright