A SPECIAL CONCERN IN HIV/AIDS VULNERABILITY AND GENDER INEQUALITIES

The global trend on HIV/AIDS pandemic has continued to show a disproportionate statistical growth effect on women and adolescent girls who are socially, culturally, biologically and economically more vulnerable, and who shoulder the burden of caring for the sick and dying. Health care providers have taken a special concern towards this because women form a unique place in caring out gender based-expected roles. It may interest you to know that HIV-infected women often face more discrimination than men, especially in some developing lands. If a woman is pregnant, the health of her child is endangered, if she already has children, caring for them becomes a challenge, particularly for a single mother. Further, comparatively little is known about the unique characteristics of HIV-infected women and their clinical care. Certain cultural factors make the situation especially dangerous for women. In many countries women are not expected to discuss sexuality, and they risk abuse if they refuse sex. Men commonly have many sexual partners and unknowingly transmit HIV to them. Some African men have sexual relations with younger women to avoid HIV or in the false belief that sex with virgins can cure AIDS. No wonder WHO states: 'Interventions must be aimed at men (as well as at women) if women are to be protected.'

HIV/AIDS vulnerability affects both men and women simply because of their gender roles that define what it means to be a man or a woman. For example, in many societies women are expected to be innocent and submissive when it comes to sex, preventing them from accessing sexual health information and services. For many men, masculinity is linked with taking risks and being tough, which can increase vulnerability to HIV infection and discourage men from seeking testing and treatment. To tackle this, we need to recognize and challenge harmful gender roles that are crucial to preventing the spread of HIV. Programmes that focus on men are equally important in protecting women from HIV, as they can transform men's attitudes and behaviour towards their partners, families and women in general.

A special international agency concerned with the HIV/AIDS epidemic- UNAIDS latest report states that, 'At the end of 2011 it was estimated that out of the 34 million adults worldwide living with HIV and AIDS, half are women. The HIV/AIDS epidemic has had a unique impact on women, which has been exacerbated by their role within society and their biological vulnerability to HIV infection. It further indicates that, 'Every minute one young woman becomes infected with HIV, with some countries reporting that more than 10 percent of young women aged 15-24 are living with HIV.'

Donor assistance to HIV/AIDS has been increasing substantially over time. According to a Report on the Global HIV/AIDS Epidemic , 2000. UNAIDS: Joint United Nations Programme on HIV/AIDS, indicates that, 'In 1998, 14 of the largest donors in the OECD Development Assistance Committee provided US$ 300 million for HIV/AIDS activities. In 1987 soon after it was first recognized that HIV had spread massively in many developing countries levels of official development assistance (ODA) funding to AIDS were only at 20% of the levels seen a decade later. During the same period, the number of infections had risen from 4 million to over 34 million, a figure that continues to grow given the more than 5 million new infections annually. This increase occurred at the same time that overall ODA contributions to developing countries were steadily declining. Donor support had begun to level off between 1996 and 1998, and it remained less than just 1% of donor countries' total annual ODA budgets. Against the backdrop of soaring infection rates, this trend was of critical concern.' However, recent indications from donors are encouraging. For example, 'funding by the United States for global HIV/AIDS activities increased by US$ 65 million in 2000 and was set to increase by as much as an additional US$ 100 million in 2001,' reports UNAIDS.

The donor response to the International Partnership against AIDS in Africa has been positive. Some important new initiative with the objectives of curtailing the spread of HIV, reduce its impact on human suffering and halt the reversal of social and economic development in Africa includes donors as one of its five key constituencies. Representatives of donor countries are participating in all phases of its development, and their greater understanding of, and involvement in, national planning processes are paying off in increased support.

In addition, there is increasing recognition that HIV/AIDS is not only a major threat to development, but also a threat to peace-building and human security in Africa. This has resulted in higher levels of political awareness and more substantial financial commitments. According to some reliable documentation on global HIV/AIDS, an additional US$ 180 million in donor funding for activities in Africa was announced at the historic Security Council meeting in January 2000. The challenge was to ensure that this growing enthusiasm results in a steady increase in concrete support to national HIV/AIDS prevention and control programmes in Africa and elsewhere. To do this, emphasis has been placed on building partnerships between donors and the most-affected countries. In this way a sense of shared responsibility has been created both for improving prevention and care as well as for addressing the formidable, multifaceted development challenges this epidemic presents. To demonstrate the strength of partnership to some 95% of HIV-infected people who live in developing countries most of them in sub-Saharan Africa which composes some of the world's poorest countries that together owed around US$ 2 trillion in external debt, a Highly Indebted Poor Country initiative (HIPC), supported by all the major creditor governments from the OECD countries and implemented by the World Bank and International Monetary Fund was initiated to reduce the debt burden.

In this typical debt relief agreement, portions of a country's debt were cancelled in exchange for the debtor government's commitment to mobilize domestic resources for specific purposes, such as a poverty eradication scheme or an intensified national AIDS effort. At the heart of debt reduction deals under HIPC laid the challenge of agreeing on significant goals in poverty reduction and on measurable indicators of progress towards these goals. Lending countries had to have greater incentives to reduce debt if there were clear and measurable ways of assessing the benefits. For example, a medium-term AIDS-related target to provide low-cost treatments to a specific percentage of the population suffering from the most common opportunistic infections. Measurable indicators for monitoring progress were likely to include the availability of specific generic medicines in primary health care centres. During the first months of 2000, several countries in Africa started to feature HIV/AIDS programs more prominently in their poverty-reduction strategies and in related HIPC debt relief agreements. This has been encouraging. But a concerted effort by a coalition of interested African government officials, civil society representatives, creditor governments, and United Nations and multilateral agencies has been required to ensure that debt relief is actually used to mobilize substantially increased funding for AIDS as lack of funds for an expanded response to AIDS was worsened by these high levels of foreign indebtedness. Across Africa, national governments where paying out four times more in debt service than they spend on health and education. In order to mount effective national AIDS prevention programmes, countries in Africa needed to spend at least US$ 1-2 billion a year, far more than was currently being invested. Sources that might have to be tapped for these additional resources included increased donations from the private sector and foundations, expansion and redirection of development assistance, and reallocations within countries' own public budgets. Relieving countries' debt burden was one of the more promising new approaches that increased the funds flowing into programmes to roll back the AIDS epidemic in Africa which often has the highest HIV/ AIDS figures.

While international political, financial and technical supports are important, lowering incidence and mitigating the epidemic's impacts must be a nationally driven agenda. To be effective and credible, national responses require the persistent engagement of the highest levels of government. Countries that have adopted forward-looking strategies to fight the epidemic are reaping the rewards in falling incidence. Other countries are yet to see the fruit of their efforts and in the absence of rapid and visible results, sustaining a response becomes more difficult. Globally, HIV/AIDS is the leading cause of death among women of reproductive age. The percentage of women living with HIV and AIDS varies significantly between different regions of the world. In areas such as Western and Central Europe, Eastern Europe and Oceania, women account for a relatively low percentage of HIV infected people. However, in regions such as sub-Saharan Africa and the Caribbean, the percentage is significantly higher. For instance, there is supportive statistical evidence that Sub-Saharan Africa is one region of the world where the majority of HIV transmission occurs during heterosexual contact. As women are twice as likely to acquire HIV from an infected partner during unprotected heterosexual intercourse than men, women are disproportionately infected in this region. Some reliable data also from an international health organization (WHO) indicates that, 'In 1985 in sub-Saharan Africa there were as many HIV infected men as there were women. However as the infection rate increased over the years, the number of women living with HIV and AIDS overtook and remained higher than the number of infected men. In 2011 around 58 percent of people living with HIV in sub-Saharan Africa were women, who equates to around 13.6 million women living with HIV and AIDS, compared to about 9.9 million men.' To augment this fact, UNAIDS have estimated that around three quarters of all women with HIV live in sub-Saharan Africa.

As earlier stated in this write-up, women are at a greater risk of heterosexual transmission of HIV. Biologically women are twice more likely to become infected with HIV through unprotected heterosexual intercourse than men. In many countries women are less likely to be able to negotiate condom use and are more likely to be subjected to non-consensual sex. Additionally, millions of women have been indirectly affected by the HIV and AIDS epidemic. Women's childbearing role means that they have to contend with issues such as mother-to-child transmission of HIV. The responsibility of caring for AIDS patients and orphans is also an issue that has a greater effect on women. In areas with few palliative care facilities, when a person becomes ill from AIDS the care is usually a woman's responsibility. In Africa for example, two thirds of all caregivers for persons living with HIV and AIDS are women. This care giving is usually in addition to many other tasks that women perform within the household, such as cooking, cleaning, and caring for the children and the elderly. Caring for ill parents, children or husbands is unpaid and can increase a person's workload by up to a third. Women often struggle to bring in an income whilst providing care and therefore many families affected by AIDS suffer from increasing poverty. In some areas of sub-Saharan Africa where a family's livelihood relies on growing and maintaining crops, the death of farmers can lead to famine. The AIDS epidemic also affects young girls and elderly women. Often in households where both parents are ill from AIDS, the responsibility of main carer is taken on by a daughter, even if it means that she has to miss school. If both parents die then it tends to be the grandmothers, aunts or cousins who then look after the orphans.

There are a number of things that can be done in order to reduce the burden of the epidemic among women. These include promoting and protecting women's human rights, increasing education and awareness among women and encouraging the development of new preventative technologies such as post-exposure prophylaxis and microbcides. Boosting the educational and economic opportunities of young girls in rural areas not only reduces HIV transmission by providing alternatives to commercial sex, but also contributes to sustainable rural development and an improvement in the status of women. In some societies, women have few rights within sexual relationships and the family. Often men make the majority of decisions, such as whom they will marry and whether they will have more than one sexual partner. This power of imbalance means that it can be more difficult for women to protect themselves from getting infected with HIV. For example, a woman may not be able to insist on the use of a condom if her husband is the one who exclusively makes all the decisions. Of late, it has been recently observed that marriage does not always protect a woman from becoming infected with HIV. Many new infections occur within marriage or long-term relationships as a result of unfaithful partners. In a number of societies, a man having more than one sexual partner is seen as the norm.

In addition, women who are victims of sexual violence are at a higher risk of being exposed to HIV, and the lack of condom use and forced nature of rape means that women are immediately more vulnerable to HIV infection. In some countries, nearly half of women have experienced sexual or physical partner violence. A South African study concluded that women who were beaten or dominated by their partners were much more likely to become infected with HIV than women who were not. Another study of 20,425 couples in India found not only that HIV transmission was much greater in abusive relationships, but also that abusive husbands were more likely to be infected with HIV than non-abusive husbands. In countries where armed conflict is rife, there have been reports of rape being used as a 'tool of war'. Amnesty International reported that between 1999 and 2000 in every armed conflict that they investigated, the torture of women was reported. In some cases, women have been intentionally infected with HIV, with the aim of causing a 'slow death'.

In many parts of the world there exist major inequalities between women and men in all aspects of living from employment opportunities and availability of education, to power inequalities within relationships. These gender roles can confine women to positions where they lack the power to protect themselves from HIV infection. As most of the inequalities that women face are denying them their basic human rights, it is thought that promoting these rights will enhance their status within society and help protect them against the risk of HIV infection. Education is one of the most effective tools in preventing HIV infections. An estimate from the Global Campaign for Education suggests that if every child received a complete primary education, around 700,000 new HIV infections in young adults could be prevented every year.

Education is particularly important for protecting girls against HIV infection. School can teach vital HIV prevention methods, such as condom use, having fewer sexual partners, and the importance of greater communication about HIV prevention between couples. Also, girls who frequently attend school are more likely to be able to make decisions about their sexual lives, are more independent, and are more likely to earn a higher income in the future. Increasing HIV and AIDS education can also help to reduce the stigma that people living with HIV and AIDS face. Eradicating stigma is important in the fight against HIV and AIDS because stigma can increase the vulnerability of a group that may already be at a higher risk of HIV infection. Sex workers, for example, are in many countries still both frowned on socially and criminalized. It is very difficult for these women to access the healthcare services they need in order to stay healthy as they may risk arrest or punishment when their profession is known.

Furthermore, women are particularly vulnerable in many countries around the world as they do not have the same property rights as men. Especially in sub-Saharan Africa, property is typically owned by men and even when married, women still do not have as many property rights as their husbands. Inheritance rights are just as discriminatory, as when a husband dies, his property often goes to his side of the family and not to his wife. The denial of a woman's inheritance and property rights can increase her vulnerability to HIV. Not being able to own property means that women have limited economic stability. This can lead to an increased risk of sexual exploitation and violence, as women may have to endure abusive relationships or resort to informal sex work for economic survival.

The female condom is the only female-initiated HIV prevention method presently available. These condoms can potentially help women to protect themselves from becoming infected with HIV if used correctly and consistently. However, although the female condom allows partners to share the responsibility of condom use, it still requires some degree of male cooperation.

Post exposure prophylaxis is an antiretroviral drug treatment that is thought to decrease the chances of HIV infection after exposure to HIV. This treatment could potentially benefit women who have been raped, if started within 72 hours of exposure. In many countries with high levels of sexual violence against women and high HIV prevalence, this treatment is not always freely available to women.

Research is being carried out into the development of a microbicide - a gel or cream that could be applied to the vagina without a partner knowing which would prevent HIV infection. Trials have been taking place for a number of years, but none have been successful and a microbicide for HIV prevention does not yet exist. However, protecting women from HIV is not solely women's responsibility. Most women with HIV were infected by unprotected sex with an infected man. Preventing transmission is the responsibility of both partners, and men must play an equal role in this.

We would like to echo a message to all women to care about themselves and know they need to understand that men do not always consider themselves accountable for their actions especially when it comes to sex. Women too need to desist from trading their bodies for promotion, record label or any perceived privileges in order to level the playing field in fighting the gender inequalities and susceptibility to contracting HIV. In an uncorrupted woman the sexual impulse does not manifest itself at all, but only love and this love is the natural impulse of a woman to satisfy a man. Sex in itself is an exercise like boxing or wrestling where any of the two people involved in the ring can get bruised physically or emotionally. Physiologically women are more likely to be bruised physically in a sexual intercourse encounter but psychologically it may be situational as to determine who is afflicted the most as it depends on emotional attachment. In unlocking the unused part of our brains that would mysteriously level gender inequalities we need to view each other as equals and embrace the place of gender roles in our communities. There might be no full set of universal trait for a better man or woman but one fact is true for sure that men respect ladies who respect themselves in any culture. A strong, confident, secure woman is what every man wants as wife as such kind of women know what they are worth in avoiding exploitation that are gender bias. There is much to life than riches and firm which both of us whether man or woman needs to embrace which is neither tangible to our naked eyes nor have a price tag on it and that is our dignity. Whether labelled poor or in poverty we can fight and conquer HIV/AIDS with the right altitude, knowledge and practice. While it is essential that individual countries 'own' their response there is a great deal of evidence that some policies, strategies and technologies are particularly effective: that which UNAIDS calls 'best practice'. Redirecting to AIDS existing project resources already programmed for social funds, education and health projects, infrastructure and rural development is fully justified, as the AIDS epidemic is undermining the very goals of these other investments. Even though international financial assistance is not always necessary, international assistance is crucial in many poor countries with limited public budgets.

FOR COMMENTS & QUESTIONS
JONES. H. MUNANG'ANDU (author)
Motivational speaker, health commentator &
Health practitioner
Mobile; 0966565670/0979362525
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