Men should be a primary focus
It
is a biological fact that women, and especially
younger women, are more vulnerable to HIV/AIDS
than men.
These
biological factors are exacerbated by the gender
roles and expectations that society
places on women and men –and the economic,
social and political factors that create an “enabling
environment”for the pandemic.
Biological
facts
» Women are far more likely to become infected through heterosexual
intercourse than they are through any other means of transmission.
» The vagina and anus have larger areas of exposed,
sensitive skin.
» The virus has an easier time surviving in the vagina
and anus than it does on the surface of the penis.
» There is a higher presence of the virus in a man’s
semen than in the fluids of the vagina or anus.
» More cuts and scrapes occur during vaginal or anal
intercourse. Cuts and scrapes are especially likely during
violent or coerced sex or when a woman is very young,
since her cervix is not fully developed.
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Gender
roles
» Women are often not able to negotiate safer sex
with their partners, especially in marriage.
» Traditional practices such as “dry sex”
and Female Genital Mutilation (FGM), aimed in the one
instance at maximising men’s sexual pleasure and
in the other minimising women’s sexual pleasure,
add to women’s vulnerability.
» Women bear the majority of the responsibility of
caring for the sick as one of the many forms
of unwaged
work
that
they
perform.
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Gender
expectations
» In many countries, women are under great pressure to demonstrate
their fertility and become mothers. Women who seek to
become pregnant may have no real options to protect themselves
against HIV/AIDS.
» Poor men may be unable to provide for their families, an important
gender role that they feel obliged to fill. This may lead
to alcoholism, violence, or seeking to exert sexual control
over those whom they perceive to be weaker.
» Diagnosis of TB in HIV-infected patients is therefore
more difficult. TB patients who are early in their HIV
disease with intact immune systems will present with a
similar clinical picture as those who are not infected
with HIV.
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Gender
dimensions of the enabling environment
» Economic
o Facilitate
collaboration between TB/HIV public and private stakeholders
at district level.
o Increase
access to voluntary HIV counselling and rapid testing
(VCT).
» Political
o Women
are poorly represented in decision-making structures at
all levels. Their voices are not heard where policies
regarding HIV/AIDS are being made.
o War
and social upheaval can result in the disintegration of
the family, the loss of local social systems and mass
migration, creating an enabling environment for the transmission
of HIV. Rape and atrocities often accompany the violence
of war.
» Legal
Many
laws contribute wittingly or unwittingly to the "enabling"
environment. These include:
o Prevention
and suppression of commercial sex work.
o Homosexuality,
categorised under sodomy, that is punishable by law.
o Laws
that reduce women’s access to property and economic
security.
o Policies
regulating sex education in school.
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Men
should be a primary focus
The
promotion of behaviour change is an important element
in preventing the spread of the epidemic as well as minimising
impact. The tacit and explicit acceptance in many societies
that men should have multiple sexual partners contributes
to the spread of HIV/AIDS to women.
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Sources:
Gender
and AIDS Almanac: UNAIDS
Gender,
HIV and Human Rights: A Training
Manual: UNIFEM
The
HIV/AIDS Epidemic: An Inherent Gender Issue: Commonwealth
Secretariat
