Thursday, March 4, 2010

Women Are Not Mere Instruments in the Fight Against Aids

One of the recurring themes on this blog is my claim that HIV transmission is not just about sex. In fact, sexual transmission of HIV is not just about sex. What I mean is that there are circumstances surrounding sexual behaviour that determine whether the risk of HIV transmission is higher or lower. And if those circumstances are ignored by the many so called HIV prevention programmes, those programmes will fail.

So far, most HIV prevention programmes have been designed with the assumption that reducing HIV transmission is all about influencing sexual behaviour. This is sometimes referred to as the 'behavioural paradigm'. And most HIV prevention programmes have failed. UNAIDS emphasizes the fact that HIV is now the leading cause of death in women of reproductive age. Considering current rates of maternal illness and death from non Aids related causes in developing countries, this is truly shocking.

But here is the more shocking bit: "up to 70% of women worldwide have been forced to have unprotected sex". If women are subjected to violence to this extent, this is the real outrage. That women do not have the right to choose when to have sex, whether to have sex, with whom to have sex or any of the other circumstances is horrifying. These are the sorts of circumstances surrounding sexual behaviour that I am talking about.

But these rights are not just about sex. If a woman doesn't have these rights, you can be sure there are many other rights she doesn't have. The problem here is that the rights of a huge proportion of women are being denied. Women do not have rights just so that they don't contract HIV or any other sexually transmitted infection. And if a woman does have these rights, the issue of whether she does or doesn't have a say in the circumstances surrounding sexual intercourse will not arise. Not everyone will make the best decisions, of course. But the problem is that at present, some parties are being denied this right.

Michel Sidibe, the executive director of UNAIDS, is wrong on several counts. 'Gender issues' do not need to be addressed because this is a way of reducing transmission of HIV. Gender issues need to be addressed because they have so long been ignored. Ensuring rights for women is not just a useful way of ensuring that the Millennium Development Goals are realised. Women are not mere instruments in the fight against Aids.

In Africa, 60% of the people living with Aids are women. Women are far more vulnerable to being infected than men. Yet so much HIV programming ignores the circumstances in which people live and work. The recent emphasis on mass male circumcision is a good example of an intervention that falls for this behavioural paradigm. It also purports to protect men, to some extent, from HIV. The extent to which it protects women is very unclear.

But most HIV prevention programming uses the same paradigm and has done ever since HIV was found to be mainly a sexually transmitted infection. Women's rights have been mentioned, often in this instrumental way that UNAIDS seems to favour. Even economic, health and educational inequalities have been mentioned. Well these are the issues that need to be targeted, not just mentioned. But most of the big money goes into the tired old finger wagging about what people should and shouldn't do in bed.

The issue of violence against women does not need to be 'integrated into HIV prevention programmes'. This is completely the wrong way around. The issue of HIV prevention needs to be integrated into programming that addresses gender inequalities in social intercourse, marriage, work, education and health. HIV is not bigger than all these and until these are successfully targeted, HIV will continue to elude our best efforts.


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