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SRHR Sit Report: Women and HIV/AIDS

December 14, 2009

The Sexual and Reproductive Health and Rights Situation Report is a monthly column highlighting SRHR issues internationally.  In honor of World AIDS Day, December 1st, this month’s column will focus on Women and HIV/AIDS worldwide.

Halting the spread of HIV/AIDS is part of Millennium Development Goal 6, linked with “malaria and other diseases.”  The major international funding body for AIDS, the Global Fund works on HIV/AIDS, Tuberculosis and Malaria, as the epidemiological issues are similar.  Health outcomes for women and girls lag behind those of men for all of these diseases, but women face added vulnerability and stigma in the case of HIV/AIDS.  According to UNAIDS, “gender inequality both fuels and intensifies the impact of the HIV epidemic,” and “women often experience the impact of HIV more severely than men.”  This is for a variety of reasons, which as in the case of maternal mortality, can only be truly addressed through the empowerment of women.

A global epidemic

An estimated 33 million people worldwide were infected with HIV/AIDS as of 2007, and in many areas infection rates are growing disproportionately among women and girls.  Women represent 60% of new infections in Sub-Saharan Africa, and “globally, HIV is the leading cause of death in women of reproductive age,” according to the AIDS Accountability International Scorecard on Women 2009.  The UNAIDS Report on the Global AIDS Epidemic 2008 has stats on infection and mortality rates as well as a variety of related social factors.  For instance,  some countries including gender considerations in planning and funding HIV/AIDS program, but the vast majority still fall short.  The Report identifies the oppression of women as a major factor contributing to women’s increased vulnerability, and recommends programs to “forge norms on gender equity.”

Vulnerability related to social power

Both the Scorecard and the UNAIDS Report identify gender inequality as a root of increased risk and vulnerability to HIV infection.  As the Scorecard points out, “[gender] inequality may, for example, deny women the opportunity to negotiate safe sex, or force women and girls into abusive transactional sexual relationships in order to obtain food and other necessities.have access to the information, education and services needed to reduce their vulnerability to HIV infection. ”  In other words, many women don’t have the power to decide when they have sex, or to demand that their partner use a condom.
the UNAIDS Report explicitly identifies the kinds of programs that could lead to the empowerment of women and lead to lowered infection rates among women and girls, recommending that “strategies to increase women’s economic independence and legal reforms to recognize women’s property and inheritance rights, should be prioritized by national governments and international donors.”  The Report sites as evidence a study in Botswana and Swaziland that found that “women who lack sufficient food are 70% less likely to perceive personal control in sexual relationships, 50% more likely to engage in intergenerational sex, 80% more likely to engage in survival sex, and 70% more likely to have unprotected sex than women receiving adequate nutrition.”  Survival sex. That’s some serious oppression!

A SWEAT Workshop

Sex workers, a further marginalized group in most societies, are at elevated risk of contracting STIs.  Because of their stigmatized social status, they are also at elevated risk for receiving sub-par public health care.  Check out this IRIN report on the effect the FIFA World Cup will have on sex workers in South Africa, and on the failure of the South African government to effectively address the issue of HIV/AIDS for sex workers, in spite of high rates of infection in the country.  The upshot is that various advocacy groups are working specifically on the issue, including the Sex Workers Education and Advocacy Taskforce (SWEAT).  This quote from a testimonial on SWEAT’s blog exemplifies the compounded risks of sex work, and why their organizing and advocacy is so important.

While working this job, I met a certain man in the hotel where I reside, as there is a bar on its ground floor. This man told me he wanted to take me home with him and so having agreed to his proposition, he then left money for me where I reside. So we went together where he lives, without him telling me he lived there with many other men. I was to find out the hard way as all six men then slept with me without putting on condoms. I cried helplessly as I had nowhere to go and report. I was afraid to go to the police for fear of being returned home as my papers are not in order. In addition, sometimes going to the police when you are a prostitute they do not listen to you and instead say ‘she who goes looking for scars will get them, you got what you were looking for.

In one state in India, a rights-based advocacy group called SANGRAM works closely with local communities, and advocates for the inclusion of the needs of marginalized communities in sexual and reproductive health policy.  Their empowerment bent is reflected in their mission: “People should believe that they can change things. It is not about a few activists fighting for other people’s rights. Anybody who has imbibed this understanding should be able to go and fight for their rights.”

Here’s a powerful video highlighting SANGRAM’s work with sex workers.

At Risk: Rights Violations of HIV-Positive Women in Kenyan Health Facilities, a report published by the Center for Reproductive Rights (CRR) and the Federation of Women Lawyers-Kenya, provides an excellent case study of what gender-based discrimination can mean in the HIV/AIDS context.  In addition to health systems failures affecting women living with HIV/AIDS, the report details abuses including violations of confidentiality, detention for failure to pay healthcare fees, and nonconsensual HIV testing.  The report also does a great job of outlining how HIV/AIDS and reproductive rights dovetail for women.  CRR also points out that such conditions represent violations of a variety of human rights, including the right to health and the right to freedom from discrimination.

The AIDS epidemic affects women and girls in other ways too.  According to the UNAIDS Report, there will be a projected 14 million AIDS orphans by 2015, and AIDS orphans are far less likely to attend school then their counterparts.  We already know that girl children are far less likely to be sent to school than boys, so the marginalization of female AIDS orphans is compounded.  Zimbabwe, with the highest rate of HIV infection in the world, has had a rash of child rapes because of the myth, widespread in several African countries, that having sex with a virgin can “cleanse” you of AIDS.  Obviously, the bodily and psychic integrity of the girls and women who are violated has little value for their attackers.

In a recent post here on Gender Across Borders, Jessica Mack tells the story of a woman whose husband intentionally infected her with HIV.  She points out that the core of this incident “is a serious lack of respect for women as humans with rights.”  That’s right, sister.  Women’s sexual and reproductive rights are violated at the intra-personal and the systemic levels every day because of fundamental lack of respect for them (us!) as full human beings deserving of full rights and agency.  Policies and programs to empower women and challenge gender norms are necessary in every community to empower women, and comprehensive sexuality education is required to give women, men, boys and girls the tools to make health sexual choices.  HIV/AIDs, like maternal mortality, education and health are issues that will not be resolved without full respect for women’s rights and the full participation of healthy, empowered women.

Some actions you can take to help fight HIV/AIDS and empower women:

Sign With Women Worldwide: A Compact to End AIDS and keep up with the International Women’s Health Coalition (WHC)’s Action Alerts.  IWHC’s HIV/AIDS work seeks to “empower women and girls to stand up for themselves and make healthy choices about their lives and those of their families.”

Donate to AIDS Accountability International, and NGO doing advocacy for HIV/AIDS programming through research and assessing compliance with international standards and compromises.

Brook Elliott-Buettner is a freelance human rights policy researcher and writer living in New York.  More information and work can be found at

  1. alicia permalink
    December 15, 2009 10:47 pm

    I absolutely agree with everything you wrote. And for this reason I think it is important to also note how critical it is to actively engage men in HIV prevention work. Involving men in meaningful ways is essential if rates of transmission are to be reduced and if women rights are to be respected. In terms of changing gender norms, there needs to be meaningful discussions of masculinities. For many men, societal norms of masculinity (and therefore their individual sense of self-worth and acceptance) is predicated on the very things that make both women and men vulnerable to HIV/AIDS (e.g. having a sex without a condom, having numerous sexual partners, etc.). It is critical to both promote women’s right and understand the nuanced gender dynamics behind the epidemic.


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