Strengthening Gender Equality Strategy in HIV Response

According to the latest (2008) WHO and UNAIDS global estimates, women comprise 50% of people living with HIV. The proportion of women living with HIV has been increasing in the last 10 years. This includes married or regular partners of clients of commercial sex workers, IDU and MSM, as well as female sex workers and injecting drug users. Gender inequalities are a key driver of the epidemic in several ways. The 9th ICAAP hosted a pre-congress forum for Women (including Lesbian) on 8th August 2009 at Inna Grand Bali Beach Hotel in Sanur, Bali. The Women’s Forum was one of the seven pre-congress community forums hosted during the congress. The main them of the forum being “Building Gender Equity Strategy in HIV Response,” discussions included issues around Sexual Rights; Personal and Body Autonomy; and Gender Mainstreaming in HIV Response.

The objective of the forum was to integrate HIV/AIDS and Gender issues into the focus of Asia Pacific women networks. Exchange views, knowledge and experiences among participants and develop a good plan of action on HIV and gender issues. The forum’s aim was to provide comprehensive recommendations to all stakeholders to achieve partnership and responses on women and HIV, thus ensuring that needs and issues of women will be heard in the congress. The breakout session included discussion around Sexual Health and Rights, participants discussed that sexual health is a state of physical emotional mental and social well being in relation to sexuality and not merely the absence of disease, dysfunction and infirmity. There should be a positive and respectful approach to sexuality and that the sexual experience should be pleasurable and safe, free of coercion, discrimination and violence. Relationships between men and women can be enhanced using positive sexual health talk and communication.

Violence against women (physical, sexual and emotional), which is experienced by 10 to 60% of women (ages 15-49 years) worldwide, increases their vulnerability to HIV. Forced sex can contribute to HIV transmission due to tears and lacerations resulting from the use of force. Women who fear or experience violence lack the power to ask their partners to use condoms or refuse unprotected sex. Fear of violence can prevent women from learning and/or sharing their HIV status and accessing treatment. Programmes need to address violence against women by offering safer sex negotiation and life skills training. Help train women who are living with HIV to safely disclose their HIV status. Provide comprehensive medical and legal services to victims of sexual violence, and work with countries to develop, strengthen and enforce laws that eliminate violence against women.

Sexual rights means to attain the highest attainable standard of sexual health including access to sexual and reproductive health services. This includes rights to sexual education and the right to pursue a satisfying and pleasurable sexual life with integrity. Sexual autonomy is the right of a woman to make decisions concerning her fertility and security free of any coercion and violence. Woman seeking health care in relation to her fertility and sexuality is entitled to be treated as an individual in her own right, for example she should be able to decide on her choice of contraceptive and abortion rights. In many Asian countries often health care providers seek permission from the husband for a woman’s contraception needs. Women should be fully competent to make decisions concerning her sexual health. Sexual and reproductive rights apply to all individuals, regardless of their HIV status. Yet more often than not, the rights of HIV positive women and adolescent girls are not recognized or given priority.

Sexual and reproductive health (SRH) services for HIV positive women and adolescent girls often are limited in scope, access, and quality. With HIV related care and treatment services becoming more accessible, HIV positive women are regaining their health, living longer, and planning for their future. This includes making decisions about their sexuality. Women living with HIV want to enjoy a positive sexual health life with dignity. All women including HIV positive women, adolescent girls, elderly women, lesbians need to access high quality SRH services and information about sexual health that take into account their particular needs.

The AIDS epidemic is integrally linked to sexual and reproductive health: The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding. Both HIV/AIDS and poor sexual and reproductive health are driven by common root causes, including poverty, gender inequality and social marginalization of the most vulnerable populations. Responses to both health issues should be closely linked and mutually reinforcing.

Ishdeep Kohli-CNS