THE CULTURAL PERSPECTIVE
Almost 60 percent of the people living with HIV or AIDS in the world are girls and women. (More than 60 percent of women in the sub-Saharan Africa.) Women are more vulnerable to HIV than men and have often less information, knowledge and power to be in a situation where they have a life with reduced risks of transmission. Women are also less involved in the planning of prevention, care and treatment, and evaluation of programmes and activities, meaning that activities and programmes planned and run by men only in general are less skilled to deal with a comprehensive work on HIV/AIDS. The same goes with activities only run by girls or women.
Lack of information is just one of the problems with life-threatening consequences that women with HIV or AIDS are confronted with, especially in countries with scarce resources. Women are both biologically and socially more vulnerable than men to HIV infection. The risk for transmission of the virus is eight times higher from an HIV-positive man to a woman than vice versa. Gender, social and economic injustice often results in women being negotiable inferior in terms of safer sex and choice of sexual partner. Many young girls and women are raped and subjected to the risk of infection. Sex and sexuality are taboo for men and women in many countries, which mean that it could be difficult to talk about these issues openly, even though there exists good pedagogic methods to handle it. It is important to educate women so they are able to make informed decisions about their sexual and reproductive health, at the same time it is important to strengthen women's rights in these matters. A related concern is women's control over their own sexual relations; young women are particularly vulnerable to sexual exploitation. Financial problems and lack of options is forcing many young women to sell themselves. For programs specifically directed towards women to be effective, gender-related issues such as education, equality and access to extensive information need to be integrated into various activities and programs.
Without having any scientific support, I have during the past 20 years of working on HIV Prevention, observed a division in the work carried out connected to HIV prevention where heterosexual men are more involved in the medical work/activities of HIV/AIDS, and women and gay men are more involved in the social awareness prevention work. There is an apparent status gap? This is also something interesting to reflect on when it comes to how the financial funds are directed and what is regarded as important in the fight against HIV and AIDS. We all know that the medical perspective has been getting most of the attention and resources, and now more and more AIDS programmes are striving to address the epidemic in a comprehensive way, meaning the prevention activities (behaviour change) should become more highlighted.
Gender inequalities are key drivers of the epidemic in several ways: Gender norms related to masculinity can encourage men to have more sexual partners and older men to have sexual relations with much younger women. In some settings, this contributes to higher infection rates among young women (15-24 years) compared to young men. Norms related to masculinity, i.e. homophobia, stigmatises men having sex with men, and makes them and their partners vulnerable to HIV.
Norms related to femininity can prevent women – especially young women – from accessing HIV information and services. And only 38 percent of young women have accurate, comprehensive knowledge of HIV and AIDS according to the 2008 UNAIDS global figures. AIDS programmes can address harmful gender norms and stereotypes by working with men and boys to change norms related to fatherhood, sexual responsibility, decision-making and violence, as well as by providing comprehensive, age-appropriate AIDS education for young people where gender norms are addressed.
10 to 60 percent of the world’s women in the age of 15-49 experiences physical, sexual and emotional violence, which increases their vulnerability to HIV. Forced sex can contribute to HIV transmission due to scars and lacerations resulting from the use of force. Women who fear or
experience violence often lacks power to ask their partners to use condoms or to refuse unprotected sex. Fear of violence can also prevent women from learning and/or sharing their HIV status and accessing treatment. Here programmes can address violence against women by offering safer sex negotiation and life skills training, helping women who fear or experience violence to safely disclose their HIV status, providing comprehensive medico-legal services to victims of sexual violence. Countries should also develop, strengthen and enforce laws prohibiting violence against women, and make practice of the legislation.
Gender-related barriers in access to services can prevent women and men from accessing HIV prevention, treatment and care.
Women may face barriers due to their lack of access to and control over resources, child-care responsibilities, restricted mobility and limited decision-making power. The socialisation of men may reduce the willingness to seek HIV services due to a fear of stigma and discrimination, losing their jobs and of being perceived as "weak" or "unmanly". Programmes can improve access to services for women and men by removing financial barriers in access to services, bringing services closer to the community, and addressing HIV-related stigma and discrimination, including in health care settings.
Another gender related area is home care. Women assume the major share of care giving in the family, including for those living with and affected by HIV. This care giving is often unpaid and is based on the assumption that women "naturally" fill this role. In order to support women, programmes can facilitate them in their care-giving roles by offering community-based care and support, and by increasing men's involvement in the care giving.
Lack of education and economic security affects millions of women and girls, whose literacy levels are generally lower than men and boys'. Many women (especially those living with HIV or AIDS) lose their homes, inheritance, possessions, livelihoods and even their children when their partners die. This forces many women to adopt survival strategies, which increase the risks of contracting or spreading HIV. Educating girls makes them more equipped to make safer sexual decisions.
In this area programmes can promote economic opportunities for women (e.g. through microfinance and micro-credit, vocational and skills training as well as other income generation activities), advocate for the protection and promote their inheritance rights, and expand efforts to keep girls in school.
In 2008, only 52 percent of countries reporting to the UN General Assembly included specific, budgeted support for women-focused AIDS programmes, meaning that many national AIDS programmes fail to address underlying gender inequalities. AIDS programmes should collect and use sex and age disaggregated data to monitor and evaluate impact of programmes on different populations, build capacity of key stakeholders to address gender inequalities, facilitate meaningful participation of women's groups, women living with HIV or AIDS and young people, and allocate resources for programme elements addressing gender inequalities.
Addressing gender inequalities might be hard for some men, depending on their attitudes and values towards women, and if we who work on HIV prevention, care and treatment do not recognise or take this into practice, we will never be able to reach the results we are aiming for.