Girls and women in our society must be made aware of diseases like Aids
The sexually transmitted diseases (STI), including the human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (Aids), are now an increasing health problem in every country, particularly in the developing ones. According to Human Development in South East Asia, in 2000, more than 40 million women and men were affected by HIV and every year about 12 million new infections add to the list. The pandemic is concentrated in the poorest parts of the world with 90 per cent of those are HIV-positive living in the developing world.
The WHO 2004 also finds that around 90 per cent of adults and children living with HIV/Aids belong to the developing countries with 64 per cent from Sub-Saharan Africa, 18 per cent from South and South East Asia an over four per cent from Latin America. Also, women and girls are highly exposed to HIV infection and to the impact of Aids. According to it, around 50 per cent people in the world suffering from HIV infection are female. Studies have found that young women and girls are 2.5 times more likely to be HIV-infected as compared to their male counterparts. According to a UNADIS estimation, by 2004 women accounted for 47 per cent of all people living with HIV worldwide. The rate with which HIV infection is increasing in South Asia is given in the following table.
In the developing countries, women and girls are highly vulnerable to HIV infection and to the impact of Aids, primarily because of their subordinate position in society and the socio-economic inequalities that exist. According to a UNDP report, 1987 was the year when the first case of Aids (a Pakistani citizen) was reported in Lahore. The first recognized transmission of HIV inflection through breast-feeding in Pakistan was reported in the city of Rawalpindi in 1993. During the ‘90s, cases of HIV and Aids began to appear among groups such as commercial sex workers (CSWs), drug abusers and jail inmates. Since the official recognition of the first case in 1987, the number of officially reported HIV infections and Aids cases has increased.
Aids is caused by the human immunodeficiency virus (HIV). By killing or damaging cells of the body’s immune system, HIV progressively destroys the body’s ability to fight infections and certain cancers. HIV infections spread through three major ways: sexual intercourse with an infected person, contact with contaminated blood, and transmission from an infected mother to her child before or during birth or through breast-feeding. Studies conducted by Unicef showed that most of the HIV-infected are women commercial sex workers.
Direct contact with HIV infected blood occurs when people who use heroin or other injected drugs share hypodermic needles or syringes contaminated with infected blood. Sharing of contaminated needles among intravenous drug users is the primary cause of HIV infections in eastern Europe. Epidemics of HIV infection among drug users have also emerged in Central Asia. HIV infection also occurs when health professionals accidentally prick themselves with needles containing HIV-infected blood or expose an open cut to contaminated blood. HIV can be transmitted from an infected mother to her baby while the baby is still in the woman’s uterus or, commonly, during childbirth. The virus can also be transmitted through the mother’s milk during breast-feeding. The mother-to-child transmission accounts for 90 per cent of all cases of Aids in children. It is particularly prevalent in Africa, where the number of women infected with HIV is 10 times higher than the rate found in other regions. Studies conducted in several cities in southern Africa in 1998 indicate that up to 45 per cent of pregnant women in these cities carry HIV.
SOCIO-ECONOMIC FACTORS: The introduction of socio-economic factors as a determinant of susceptibility draws attention to the fact that not only is HIV/Aids purely a health issue but also a developmental one. Poverty is considered to be a strong determinant of the spread of HIV. However, it’s what it represents that is critical to an understanding of its influence on spreading the epidemic. The poor are trapped in a cycle of poverty as a result of which they face marginalization. This cycle is sometimes referred to as the deprivation trap, with five clusters of disadvantaged poverty, physical weakness, isolation, vulnerability, and powerlessness. Men and women are vulnerable in different ways and this vulnerability is influenced by the interaction of a wide range of factors. There is the specific population group experience which increases risk due to their particular socio-economic circumstances or other special characteristics. Included among these groups are women, adolescents, migrant workers, injecting drug users (IDUs) and commercial sex workers (CSWs). While Pakistan’s attention to the issue of HIV/Aids must be on the reduction of the vulnerability of all of its citizens, focused attention on these groups could inhibit the broader spread of the epidemic.
Gender analysis shows that HIV/Aids and STIs focus on how different social expectations, roles, status and economic power of men and women get affected by the epidemic. There is a need to reduce inequalities between women and men so that a supportive environment can be created, enabling both to undertake prevention and cope better with the epidemic. HIV and Aids cause specific and serious implications to women health and the gender-related social norms increase women’s risk of HIV/Aids in many ways. Firstly, the high social value placed on virginity in which unmarried girls may also pressure parents and the communities to ensure girls are kept ignorant about sexual matters. Female ignorance of sexual matters is often viewed as a sign of purity and innocence. Young women are discouraged from discussing sex too openly for safer sex.
Secondly, women’s lack of autonomy over their “self”, — physically, mentally, and morally — not only relates to decisions and choices about reproduction and sexuality, but also relates to the moral autonomy more broadly and to the freedom from physical or emotional violence. This area is particularly addressed by a range of rights and laws encompassed in reproductive and sexual rights and violence against women. It relates directly to women’s ability to protect themselves from HIV infection in sexual relationships.
Thirdly, the matter of equal rights in relationships. In some cases, women are still subjected to forced arranged marriages, often at an early age. Women may also be denied equal rights to marital property and may lack the authority or equal ability to initiate or oppose divorce. Inequality within the family emerges from and is reinforced by subordinating stereotypes of women that portray them vulnerable to violence and coercive sex in marriage. Such inequality reinforces women’s powerlessness in sexual relationships and their economic dependence on men. For example, in Pakistan, the legal status of women in practically all spheres of law such as consent to sex, marriage, divorce, maintenance, and inheritance is subordinate to that of men on the basis of profound gender discrimination.
Children and adolescents are no less at the risk of HIV/Aids than are adults in Pakistan. Mobility and migration sometimes become risk factors because they can create conditions in which people are vulnerable to infection.
TAKING ACTION: Preventing ill-health and indeed the spread of HIV require two broad strategies. The first is to influence behaviour that predisposes the individual to ill health. The second is to attempt to modify the social context in ways that are conducive and supportive of behavioural change. There is a need to have both medical interventions that focus on HIV/Aids as a biomedical condition an social strategies which aim at influencing behavioural change, supported by social development programmes.
Poor social and economic conditions in Pakistan have a broad impact on overall health situation, which increases the vulnerability of the general population to HIV. Recent estimates indicate that 34 per cent of Pakistan’s population live below the poverty line, and this percentage is even higher for those who live in the rural areas.
Women have low socio-economic status and lack of power in sexual relationships, especially in the Third World countries. For example, as mothers they do not have control over decisions around childbearing. As sex workers, economic necessity makes safer sex negotiation with clients very difficult. As people with a low status in society, access to education and healthcare, both of which might protect them from HIV infection, is often denied.
TARGETS AND DIRECTIONS: In Pakistan, time has come to accelerate activities for gender equity. HIV/Aids should become a good vehicle for lobby groups to push for the said agenda. To get rid of the threat of HIV/Aids efforts are being made at the global level. Goal 6 of the Millennium Development Goals (2000) aims to combat HIV. The World Health Organization (WHO) initiated campaigns for 16 days of activism focussed on violence against women and HIV/Aids. The 2004 World Aids Day had its theme women and girls and HIV/Aids through the focus on women and girls.
TO ACCELERATE THE PROCESS: The awareness raising campaign, particularly in the rural areas and among women should be increased through the media and FP clinics. In the awareness raising campaign they must be provided with the information on self-protective skills. It must also include the information about easy access, ways and means which can keep themselves risk-free.
Raising awareness in schools is one of the essential ways of dealing with the situation. Schoolgirls must be provided with the information on preventive measure through school curriculum.
The sexually transmitted diseases (STI), including the human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (Aids), are now an increasing health problem in every country, particularly in the developing ones. According to Human Development in South East Asia, in 2000, more than 40 million women and men were affected by HIV and every year about 12 million new infections add to the list. The pandemic is concentrated in the poorest parts of the world with 90 per cent of those are HIV-positive living in the developing world.
