Women in Asia Risk HIV Transmission from their Intimate Partners

The evidence from almost all the countries in Asia indicates that women are acquiring HIV not because of their own sexual behaviours but because of the unsafe behaviours that their partners engage in. The intimate partners of men who have sex with men, injecting drug users or clients of sex workers constitute the largest vulnerable population in Asia. The report ‘HIV Transmission in Intimate Partner Relationships in Asia’, by UNAIDS, its Cosponsors and civil society partners, released at the 9th International Congress on AIDS in Asia and the Pacific in Bali, examines the issue of married or in long-term relationships women who are at risk of HIV infection due to their partners’ high-risk behaviours.

It is estimated that more than 90% of the 1.7 million living with HIV in the Asia became infected from their husbands and partners while in long-term relationships. These women are often percieved as ‘low risk’. At least 75 million men regularly buy sex from sex workers in Asia, and a further 20 million men have sex with other men or are injecting drug users. Many of these men are in steady relationships. As noted by the Report of the Commission on AID in Asia (2008), about 50 million women in Asia are at risk of infection from their partners who engage in risky sexual behaviours.

Dr Prasada Rao, Director, UNAIDS Regional Support Team Asia and the Pacific stressed, “HIV prevention programmes targetting the female partners of men with high-risk behaviours have yet to be developed in Asia, but are clearly essential”. It must be ensured that the health care infrastructure that many countries have built to take care of the reproductive health needs of women also provide information on sexual health and rights and render services to protect women from getting infected with HIV. The report calls for strong horizontal integration of reproductive health services and AIDS programmes at the grass roots level.

The report discusses the myriad issues that are at the root of the problem. The strong patriarchal culture in the countries of Asia, intimate partner violence, including sexual violence, delayed partner notification, disabling socio-cultural and gender norms, the large-scale migration and mobility of populations in Asia and HIV-related stigma and discrimination all play a role in the vulnerability of women to HIV.

Research from several Asian countries indicates that between 15% and 65% of women experience physical and/or sexual violence in intimate partner relationships, placing them at increased risk of HIV infection. According to studies in Bangladesh, India and Nepal, women exposed to intimate partner violence from husbands infected with HIV through unprotected sex with multiple partners were seven times more likely to acquire HIV compared to women not exposed to violence and whose husband did not have sex with multiple partners.

The strong patriarchal culture in Asian countries severely limits a woman’s ability to negotiate sex in intimate partner relationships, according to the report. While there is a societal toleration of extramarital sex and multiple partners for men, women are generally expected to refrain sex until marriage and remain monogamous thereafter.

“Discrimination and violence against women and girls, endemic to our social fabric, are both the cause and consequence of AIDS,” said Dr Jean D’Cunha, Regional Director, UNIFEM South Asia. “Striking at the root of gender inequalities and striving to transform male behaviors are key to effectively addressing the pandemic.”

To prevent HIV transmission among intimate partner relationships, the report outlines four key recommendations:

1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.

2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programs to include services for male sexual health.

3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.

4. Operational research must be conducted to obtain a better understanding of the dynamics of HIV transmission among intimate partners.

The report has been inspired by the ground breaking recommendations of the Commission on AIDS in Asia and developed through an extensive collaborative process between UNAIDS and it’s cosponsors UNDP, UNIFEM, UNFPA, WHO, WAPN+ and ICW.

Critical policy and programme action are urgently needed at scale to reduce intimate partner transmission. The challenge of addressing the vulnerability of the 50 million women at risk of intimate partner transmission of HIV calls for bold collective action. It calls for working with communities, joining the tremendous power of the women movements, need to rethink gender norms and engaging men in the response.

Ishdeep Kohli-CNS