Tuesday, June 22, 2010

UNAIDS: Deadly Omissions

UNAIDS, a well known publisher of glossy brochures written by highly paid professionals, have come out with one called "Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV". It's a worthy sounding name and there's a lot of worthy stuff in it. UNAIDS recognises, to some extent, that more women than men are infected with and probably affected by HIV. The seem to accept that women are, for several reasons, more susceptible to HIV.

But for UNAIDS, the answer to every question about HIV assumes the truth of the 'behavioural paradigm', which holds that the bulk of HIV transmission in African countries occurs through heterosexual sex. Instead of asking why women are being infected with HIV in such high numbers in some places and such low numbers in other places, the document in question assumes that women are becoming infected because they are engaging in unsafe sex. Any action advocated to reduce HIV transmission is based on this assumption.

There were gender inequalities and human rights violations before HIV, and there will be after HIV is eradicated, if that ever happens. The fact that women become more susceptible to HIV as a result of these inequalities and violations is not a reason for objecting to them. The fact that they are gender inequalities and human rights violations is a reason for objecting to them. Equality and human rights are not just instrumentally good, they are good in themselves. Their absence is to be abhorred, regardless of the consequences.

People become infected with HIV by exposure to a virus. One way of becoming infected is by having sex with someone who is infected. Another is by some kind of blood exposure, such as sharing needles when injecting drugs. A third is through unsafe healthcare practices, a fourth is through unsafe cosmetic procedures and a fifth is when a fetus or baby becomes infected by their mother. To prevent HIV transmission, a number of precautions need to be taken, depending on the risks in question.

The UNAIDS 'action framework' focuses on three areas to contribute to HIV prevention: first, countries should 'know their epidemic and know their response' to meet the needs of women and girls. This means that a country should measure the exact contribution of unsafe sex to HIV prevalence. They should also know the extent of non-sexual transmission. But this document simply assumes that non-sexual modes of transmission are irrelevant. There are clearly some inequalities and human rights violations involved here but they are not the ones that are relevant to sexual transmission.

The document goes on to say that they (UNAIDS) and their partners will ensure that countries' strategies, plans, frameworks and budgets will address the rights and needs of women and girls in the context of HIV. But this is not so, they will only address rights and needs that pertain to sexual transmission of HIV. So all their 'Advocacy, capacity strengthening and mobilization of resources to deliver a comprehensive set of measures to address the needs and rights of women and girls in the context of HIV' will also be similarly limited.

There are many women who are mystified as to how they became infected with HIV. If they are not mystified, it's because they have been assured that they must have become infected by their partners. But some have had no partners. And others have partners who are not infected. UNAIDS, in this and other documents, assumes the applicability of the behavioural paradigm and concludes that almost everybody in African countries, male and female, was infected sexually. And then they go to great pains to say to women, who are infected in far greater numbers than men, that it is not their fault.

Women who are infected with HIV do not want to be told that it wasn't their fault that they had unsafe sex, that it's because they suffer from multiple inequalities and violations of their human rights. They don't want to be told how to protect themselves from sexually transmitting HIV when they are not engaging in unsafe sex and will not be in the future. The want to be told how to protect themselves from HIV, whether sexually or non-sexually transmitted. And if they are infected, they need to know how to protect their partner, their children and anyone else around them.

UNAIDS likes to use words such as 'participation', 'engagement' and 'decision-making', but this kind of documentation doesn't appear to have had any time for these concepts. They are not creating an 'enabling environment' or 'empowerment', rather, they are doing the opposite. They are brainwashing the world, and HIV positive women in developing countries in particular, into believing that HIV is mainly spread by heterosexual sex when it is quite clear that some transmission is by non-sexual modes. A genuinely 'evidence informed' and 'ethical' response would be to establish exactly how people are being infected and what contribution each mode of transmission makes in every country.

If UNAIDS are so concerned about gender inequalities and violations of women's human rights, they should do some genuine participative research in the field, rather than publishing pseudo-academic, platitudinous half-truths. HIV is a virus, a disease, it is a subject for epidemiologists, not moralists or politicians. HIV positive people are victims of the disease, not mere 'disease vectors'. If you want HIV to be seen as a disease and HIV positive people to be seen as victims of an epidemic, rather than being stigmatized and reviled, dump the behavioural paradigm. It's not all about sex.


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