CAIRO: Enara, age 11 of Dandara, Zimbabwe, cried in 2002 as she described the difficulties of daily living after being left orphaned by AIDS.
More than 20 years after the breakout of the Human-Immunodeficiency Virus (HIV), the pandemic still shows no sign of receding. The shocking figures all over the world leave many scared of the implications the virus may have on all aspects of life. However, as people struggle with the day-to-day burden of living with HIV/AIDS, it seems that women are the ones who take the heaviest toll whether infected or not.
According to the “UNAIDS/WHO AIDS Epidemic Update: December 2006 , globally, more adult women – 15 years and older – than ever before are now living with HIV. Africa in particular bears the greatest burden with 75 percent of all infected women in the world residing in sub-Saharan Africa. The picture is even grimmer among young people. Three in every four youths who are infected with AIDS are girls.
However, this was not always the case. In the 1980s, HIV was first identified by the Centers for Disease Control and Prevention (CDC) in the USA. Back then, it was predominant among the male homosexual population and intravenous drug users. It was hardly a problem associated with women.
But reports presented during the International AIDS Conference (AIDS 2006) that took place from Aug. 13-18, 2006, in Canada, show a completely different picture. Reports now claim that 57 percent of adults in sub-Saharan Africa living with HIV are women.
Physiologically, women are more prone to contract the virus than men. The larger amount of exposed mucosal tissues in women s genital tracts, as well as the greater amount of fluids transferred from men to women during sexual intercourse, are part of the reason.
The male semen also contains higher concentrations of the virus. In addition, microtears (microscopic ruptures) in the vaginal tissues put women at an increased susceptibility to infection. This is especially true in young women.
However, not all reasons are physiological. Karen Suzanne Leiter, a researcher with Physicians for Human Rights (PHR), Cambridge, Massachusetts, presented a different perspective. She believes that gender discriminatory beliefs are associated with sexual risk-taking. This increases the exposure of women to HIV.
According to Leiter s research, which was presented at AIDS 2006, 95 percent of women and 90 percent of men in Botswana hold one or more gender-discriminatory attitudes. These include issues ranging from male superiority and having multiple sexual partners to domestic violence and rape.
Dr. Nafis Sadik, Special Advisor to the UN Secretary General, and the UN Secretary General s Special Envoy for HIV/AIDS in Asia and the Pacific, acknowledged this in an interview. She explained the presence of gender inequality, pointing out it is because they [the women] do not have rights in general, and do not perceive themselves to have rights.
Even though many civil laws are being passed in developing countries to protect against discrimination and promote women s rights, they are often bypassed for customary laws. These laws are passed by men while women have little opportunity to influence or question them. Faghmeda Miller, a Muslim HIV-positive woman living in South Africa, stressed that though there are laws in place to protect women, they are not very effective.
Discriminatory beliefs also leave women in a weaker position to negotiate safe sex or protection. Even with all the awareness campaigns that take place in Africa and South Asia, condom use remains low there due to the refusal of men to adopt their use. Miller explained that a woman may refrain from negotiating condom use out of fear of being beaten by her husband or thrown out and stranded.
According to Sadik, even with sex workers, when they do know how to protect themselves, they can t tell their clients to condomize.
[The problem is] actually the increased vulnerability of women since you know they don t really have a choice in the sex manner, they don t have a decision in the sexual relationship in marriage or who they will marry and so on, said Sadik. She explained that in many developing countries, such as India, women have no power to negotiate arranged marriages, even if they have doubts about their future husband s health.
Between Stigma and Myth
As if the discrimination against them is not enough, Miller says women must also endure stigma and false myths that surround AIDS. This is especially evident in the developing world. She stressed how women living with HIV/AIDS in Africa were subject to much more stigma than their male counterparts. Men have the belief that they are immune to HIV, believing that it is the women that infected them, she said, yet 90 percent of the time it is the other way around.
The prevalent idea in many developing communities, such as in sub-Saharan Africa and the Middle East, is that a woman who contracts HIV does not deserve support or sympathy. She is seen as a culprit, having brought shame to her family and community. Miller, who founded Positive Muslims, a support group for Muslims living with HIV/AIDS, has different ideas. My husband infected me; I didn t know at the time he died that he infected me with HIV.
From her experience with her group, she says that the vast majority of infected women she works with caught the virus from their husbands.
Dr Ehab El-Kharrat, Senior Technical Advisor of the HIV/AIDS Regional Program in the Arab States (Harpas) confirmed Miller s observation. Four-fifths of the infected women in the Arab region acquired the virus within marriage. In Egypt, more than 90 percent of women living with HIV were infected from their husbands, he said.
In spite of this, whole communities still associate HIV with shame.
The most tragic example is that of Gugu Dlamini. She acquired HIV as a result of a rape attack when she was 17. Determined to help others, she became an activist and volunteer field worker for the National Association of People Living with HIV/AIDS (also known as Napwa) in South Africa. Dlamini went public on World AIDS Day back in 1998, announcing her infection with HIV on Zulu-speaking national radio and television. After that, she was threatened by people from her town several times.
This finally ended with an angry mob torching her house, and stoning and beating her to death at the age of 36. That is how strong the stigma against women living with AIDS can get.
I always tell people that it s not HIV that s killing us, it s the stigma attached to it and the ignorance of people. Faghmeda Miller
A popular myth in Africa is that having sex with a virgin could cure a man of HIV. This leads to many rape crimes as well as to old men forcing young women into sexual relationships. There are too many myths about HIV, said Miller. That is why people are confused and ignorant, still believing that HIV itself is just a myth so they don t need to take it seriously.
It is these stigmas and stories such as Dlamini s that leave people, especially women, in fear of even taking the HIV test. The biggest problems still remain stigma and discrimination which prevent people from coming over to be tested and treated, explained Sadik, the UN Secretary General s Special Envoy for HIV/AIDS in Asia and the Pacific.
This fear is so strong that they would even risk infecting their own babies to protect themselves. Even women who know they are HIV-positive won t take the treatment to prevent transmission to their babies because they don t want their families to know. Same thing with refusing artificial feeding and choosing to breastfeed, argued Sadik. The virus causing AIDS can pass from an infected mother in the milk while she is breastfeeding.
El-Kharrat, Senior Technical Advisor of Harpas, confirmed the power of fear of stigmatization and its repercussions.
Even when antiretroviral drugs are available for free, people don t apply to take them in fear of the stigma in spite of the assured confidentiality.
The stigma against people living with HIV/AIDS mi
ght be the most dangerous part of the disease. I always tell people that it s not HIV that s killing us, said Miller, founder of the support group Positive Muslims. It s the stigma attached to it and the ignorance of people. That s what really gets to you, not the disease itself. Sadik agreed, saying that increasing vulnerability of women is increasing part of the infection.
Even if women were not a direct risk group, that would not make them safe from AIDS. There are many ways that HIV can find its way to someone who does not seem to be in danger of infection. Sadik explains that migrant labor can be a serious problem. Men who travel for work in other countries sometimes contract the virus, and then bring it home to their wives when they get back. Ninety-eight percent of homosexuals are married and they continue to be a source of infection for women, added Sadik.
In most developing countries such as India and South Africa, women do not get all the health care they need. In addition, Sadik explained that when there is a selection between men and women for health care services, the priority usually goes to men. El-Kharrat confirmed the situation. If a family has three men and two women all infected with HIV, who do you think the medications will go to? he asked.
The need to eliminate the discrimination is high but that s easier said than done, said Sadik. There has to be some attempts to economically empower women who were unequally treated within their marriage and who are now living with HIV.
Miller said that since she went public about her HIV status, many women have come forward to her asking for help. She tries to guide them on how to deal with the discrimination and the fear they face. However, there are a few of us who know our rights and we stand up for those who cannot or do not have the power to do so. But still, it is a struggle, she explained. You learn how to live with HIV but the stigma just gets to you sometimes.
Instead of pretending the high-risk groups are not there, addressing them is inevitable, if AIDS is to be stopped. In Asia, the highest risk groups are groups that are not accepted such as men that have sex with other men. But people are coming to [realize] the fact that if you really want to prevent and deal with HIV, you have to address these groups, said Sadik.
El-Kharrat said, If we keep on discriminating against HIV-positive people, they will disappear further, and less of them will announce their HIV status. This will lead to a further increase and spread of the virus.
When asked what HIV-positive people need most, Miller said it was equality. We just need the support of people making us feel comfortable in our own zones, she explained. We just want them to accept us as normal people, because in most cases you can t tell who is HIV-positive unless they go for a test. So why discriminate against me just because I now told you I m HIV-positive?
Mohammed Yahia is an editor in the Health & Science section at IslamOnline.net. He has a degree in pharmacology from Cairo University, Egypt. This article, which was previously published at www.islamonline.net has been reprinted with prior agreement.
