AIDS linked to poverty, violence, discrimination
Maria Jose Alcala calls AIDS a “feminized” disease.
Maria Jose Alcala works for the United Nations Population Fund. She was the lead author of a report released in October, 2005 titled State of the World Population 2005." The report concludes that a key to reducing extreme poverty around the world – and addressing the glolbal AIDS epidemic – is to promote gender equality – women and men sharing the same rights and opportunities. Earth & Sky’s Marc Airhart spoke with Alcala in Fall 2005.
Airhart: You often refer to AIDS as a “feminized” disease. What do you mean by that?
Alcala: The reason we refer to it that way, is that if you look at the 1980?s when the AIDS epidemic first emerged, it was mostly men who were affected. But today, we have women rising as a proportion of people infected with HIV at alarming rates and we’re particularly concerned with the rising rates among young women and what’s fueling the epidemic is poverty, discrimination and violence.
Airhart: So what’s the connection between AIDS and poverty, discrimination and violence?
Alcala: There are alarming levels of sexual violence against women. A woman who lives in a situation of domestic abuse is obviously not in a good position to discuss much less insist on condom use issues or discuss faithfulness and all the issues being promoted for prevention.
A young woman who is struggling with poverty, who is struggling to get her school fees together so she can complete her education is going to be vulnerable to engaging in what we call “survival sex.” This is a phenomenon that is happening in countries such as in sub–Saharan Africa and the Caribbean – girls that are so poor and so desperate to stay in school that they are involved in very risky relationships. We have the same situation if you look at countries where widows – either widows because of AIDS or widows because of war – who are discriminated against in terms of employment and income opportunities. They too are left vulnerable because of poverty to engage in sex for survival.
These are some of the key issues happening. And one of the telling indicators is the fact that today, 75 percent of all new cases of HIV are sexually transmitted between women and men. And this is what points to men’s decision making control and women’s lack of power to negotiate relations at the center of the epidemic and we’ve done too little too late to pay attention to gender inequality in the context of reducing HIV/AIDS.
And another factor to remember is that a lot of the new cases of women infected, they’ve been infected by their only life partner – their husbands. So clearly we need to do a lot more to reach out to men as responsible partners and to empower women to say no or to insist on the terms of protection from HIV.
Airhart: So, what are some solutions?
Alcala: We’re calling for a set of key interventions. The first one is to insure that every girl gets to school and stays in school. Here for example, you have a lot of poor countries that have put cash into parents’ hands explicitly to send girls to school. They’re giving girls scholarships. We have to remember education for girls especially at the secondary level is one of the most powerful ways to accelerate poverty reduction. Girls that have secondary education, know how to prevent HIV better, are better able to to negotiate relationships, they’re more likely to have less children, they’re more likely to have better income earning prospects, so education for girls is absolutely central.
A second key investment is the area of reproductive health. Reproductive health is the leading cause, along with HIV/AIDS, of death and disability for women between the ages of 15 and 44 worldwide. So, in addition, to the suffering these reproductive health problems cause, early pregnancy for girls, repeated pregnancies that are bad for the health outcomes of mothers and newborns, the limited access to family planning – a fundamental human right – that many poor women around the world they still don’t have access to such fundamental things as family planning.
All of these problems are preventable and we have to remember that for poor families, the loss of a mother’s income and nurturing for her children – the cost of trying to figure out how to resolve a reproductive health problem can push families deeper into poverty and in addition to how reproductive health exacerbates poverty for poor families, we should also remember the tremendous cost for productivity, for workforce participation. If you want to end poverty, you have to have a healthy population, but if you have reproductive health such a huge burden on people’s productivity, you clearly have an obstacle in your way. So the report is calling for lifting the barriers of discrimination and of access to reproductive health to make sure that every body can benefit from prevention. Most of these problems are preventable, but they pose huge costs to societies and economies.
And of course, the issue of violence against women, which is a silent epidemic of alarming proportions globally. And in addition to the suffering violence against women causes, it also erodes female workforce participation. It also poses huge costs to public budgets in terms of health services, policing, courts, etcetera. So there are clear obstacles that can be prevented. They are problems that are preventable. And they can be lifted as a cost to society and as a cost to poor families who are working to get out of poverty.
Airhart: It makes sense that education and access to reporductive health will help. But how do you tackle discrimination and violence against women?
Alcala: At the root of the issue is changing the way people view girls and women in many societies – and understanding that girls and women are very valuable and already play very important roles in their country’s social and economic development. Societies must value women and men as equal citizens with equal voice in decisions, whether those are decisions in the family or in the world of politics.
Money is key in terms of very poor countries that simply don’t have the resources and there are a lot of governments out there that are doing a lot of work to try to save mothers and children from poor health outcomes that are really struggling to halt the AIDS epidemic.
But at the root is understanding that we must promote equal respect for the rights of girls and women. So, you do need societal transformations and you need the right strategies in place, including to bring men and boys in as supportive partners, which is another key message of our report. There are a lot of emergent initiatives out there trying to engage men and boys to help stop violence against women, to help stop HIV/AIDS and take responsibility. And these are the kinds of transformations that are already happening in communities around the world. But they need an infusion of political leadership and resources to make sure they’re reaching the poorest of the poor and those who are most in need of such services and programs.
The good news is that there are some very, very strong and good initiatives that are showing how when you address gender roles, gender norms, attitudes about gender, both working with men and with women, you can see change for the better, you can see young men taking responsibility. You can see young men seeing that they need to respect women’s choices and you can see adolescent girls, that women can become more assertive, they can learn to discuss these issues. We have to overcome social taboos. We have to use humor sometimes to discuss these issues and foster better dialogue between men and women.
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According to the State of World Population 2005 report, “In sub–Saharan Africa, an estimated 60 to 80 percent of HIV positive women have been infected by their husbands – their sole partner.”
In June 2000, the National Institutes of Health (NIH), in collaboration with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the United States Agency for International Development (USAID), convened a workshop to evaluate the published evidence establishing the effectiveness of latex male condoms in preventing STDs, including HIV. A report from that workshop was completed in July 2001. According to a summary of the workshop findings, “Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS.”
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Read a fact sheet about violence against women.
Read a fact sheet about youth and HIV/AIDS.
To learn more about HIV/AIDS, come to the World Health Organization.
Read about the 8 U.N. Millennium Development Goals.
