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The female face of AIDS

By Max Martin

World leaders and policymakers are concerned that an increasing number of women are getting infected with the HIV virus. Latest trends show that nearly half of all people living with HIV/AIDS worldwide are women

Experts are alarmed at the rapid pace at which HIV is spreading from high-risk groups to young women and married, monogamous housewives, especially in sub-Saharan Africa where women and girls account for 57% of people living with HIV/AIDS. UN secretary general Kofi Annan called it a “terrifying pattern”.

“And yet, one-third of all countries still have no policies to ensure that women have access to prevention and care,” said Annan in his inaugural address to the 15th International AIDS Conference that was held in Bangkok between July 11-16, 2004.

Unlike in the early days of the epidemic, when men vastly outnumbered women in the number of people infected with HIV, females now account for nearly half of all people living with the virus, says a UNAIDS report published just before the conference.

The report, titled ‘2004 Report on the Global AIDS Epidemic’, notes that 38 million people worldwide are infected with HIV, 25 million of them in sub-Saharan Africa and 7.6 million in Asia. A record 5 million people were infected last year. “In southern Africa, where almost every family has been touched by AIDS, infected females outnumber males by as much as two to one in some age-groups,” says the report.

In sub-Saharan Africa today there are, on average, 13 infected women for every 10 infected men -- up from 12 for 10 in 2002, the report adds.

The difference in infection levels between women and men is even more pronounced among young people in the age-group 15-24. The ratio of young women living with HIV/AIDS to young infected men ranges from 20 women for every 10 men in South Africa to 45 women for every 10 men in Kenya and Mali.

Elsewhere too, the trend is disturbing. In Trinidad and Tobago, the number of women between 15 and 19 years of age living with HIV is five times higher than adolescent males.

Experts say a range of factors make women more vulnerable. These include poverty, abuse, lack of information and relationships with promiscuous older men. “Women lack a voice and often there is violence against them,” says Mary Sandasi who works with people living with HIV/AIDS in Harare, the capital of Zimbabwe, a sub-Saharan African country where 24.6% of people between the ages of 15 and 49 are HIV-positive.

“From a very early age many young women experience rape and forced sex,” the UNAIDS report notes in its section on Africa. “For example, 20% of all young girls interviewed in Sisumu, Kenya, and Ndola, Zambia, said their first sexual encounter involved physical force…Similarly, around 25% of 15-24-year-old girls in KwaZulu-Natal, South Africa, said they had been ‘tricked’ or ‘persuaded’ into their first sexual experience,” the report says.

Violent or forced sex can increase the risk of HIV transmission as forced vaginal penetration commonly causes abrasions and cuts that allow the virus to enter the bloodstream more easily.

“Gender power imbalances, patterns of sexual networking and age maximising age-mixing are important factors that tip the balance further against them (girls), the report states.

The most common explanation for girls in sub-Saharan Africa having much older sexual partners is that poverty and hardship drive girls into transactional sex with older men, the report says. But, many girls also sought older men because they were viewed as good marriage partners and providers of a better life.

Though specific patterns differ, women are at a disadvantage in most parts of the developing world that accounts for a bulk of HIV infections.

Biologically, HIV affects men and women in different ways. A woman’s immune system may respond differently to the virus, say scientists. “When women are on anti-retroviral treatment, they may experience stronger side effects,” says the UNAIDS report. Hormones and women’s comparatively lower body weight may play a role in this, explain scientists.

“Besides being the majority of those infected, women and girls are now bearing the brunt of the epidemic in other ways too -- it is they who principally take care of the sick people, and they are the most likely to lose jobs, income and schooling,” the report says.

“Back home, there are funerals every week,” says Sandasi. “Often children drop out (of school) to look after their parents or look after the entire household after their death.”

Children orphaned by AIDS are found across the globe. There are 15 million children worldwide who have lost one or more parents to AIDS, 12 million in sub-Saharan Africa. It is girls who are expected to take up the homemaker’s role at a very early age.

Often even adult women are virtually abandoned after they become infected. “Women may even lose their homes and other assets if they are widowed,” the report says.

Sharing this global concern is Sheba, a woman in her early 20s living with HIV/AIDS, a delegate at the conference. “Living as a woman with HIV involves a lot of social problems,” Sheba explains.

Back at Sheba’s home in Karnataka, one of the four Indian states where 1% of pregnant women have tested positive for HIV at antenatal clinics, women bear the brunt of stigma and discrimination. “Once detected positive or widowed, women are often turned away from their husbands’ joint-family homes where they live,” says Meena, a woman living with HIV in Karnataka. Meena and her children were left at a care home by her husband’s family. Many women say that their husbands’ family blames them even when it is clearly a case of the man bringing home the disease.

Interventions aimed at spreading HIV are hampered by anti-woman attitudes. “In many countries, prevailing gender attitudes mean women and girls are the least priority for healthcare,” notes the UNAIDS report. “Husbands and elders often decide whether to spend family resources on healthcare, or whether a woman can take time away from her household duties to visit a health centre.” Education levels too are lower among girls compared with boys.

In India, where pre-marital sex and pregnancy are more common than is generally acknowledged, two factors affect reproductive health services for young people -- silence about sexuality and an overall lack of information about it. India has the second largest number of people living with HIV/AIDS (estimated at 4.6 million in 2002) after South Africa.

“Since sexual health services frequently offer little privacy or confidentiality, girls often seek substandard or illegal services,” the report says. “This (trend) can only be prevented by empowering women and girls to protect themselves against the virus,” said UN secretary general Kofi Annan at the HIV/AIDS conference in Bangkok.

(Max Martin is a freelance writer based in Bangalore)

InfoChange News & Features, July 2004

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