Woman Empowerment Is Crucial In The War Against HIV/AIDS

It is being increasingly felt that women should be the focal point of all programmes targeted at achieving the goal of ‘getting to zero new infections, zero new deaths and zero discrimination in HIV/AIDS.’ Whether they are monogamous housewives, or sex workers or the partners of injecting drug users, they continue to remain the most at risk population. So their needs have to be addressed, and their capabilities harnessed, to prevent the spread of the disease. They will have to be considered as an integral part of the solution to the problem which is besetting not only millions of them but others too. India needs to focus more on women and prioritize their interests as human beings, in order to reach the Millennium  Development Goal of ‘getting to zero’.
In 2009, we had 2.39 million people living with HIV in India, of which 39% were females and 4.4% were children. In the opinion of Dr Hoosen Coovadia, Scientific Director of Doris Duke Research Institute Durban, unless women are liberated from poverty, malnutrition, gender inequality and male dominance, it would be difficult to reduce HIV transmissions in India and elsewhere. According to him it is not enough to boast about the number of women parliamentarians, women CEOs and women scientists a country has. Unless the common woman at the grass roots level has freedom from oppression/discrimination in her home, her community and her work place, we will not be able to have the freedom from the epidemic of HIV.

Dr I S Gilada, Secretary of AIDS Society of India, also agrees that even the so called low risk population of women is very vulnerable to the disease in a country like India, where women do not have a control over their own sexuality and reproductive health and are unequal partners in conjugal relationships. The unsuspecting housewife can get infected by her husband, as she is not in a position to insist upon the use of male controlled prevention methods, like the condom, for safe sex. Once she gets infected, there are high chances that the virus is transmitted to her child (in utero, during delivery, or during breastfeeding). Parent to child transmissions account for 5.4% HIV infections in India, and in 2009, 18,000 children were infected with HIV through this vertical route. Although there are strategies and drugs to prevent parent to child transmissions (PPTCT), but in resource poor settings like India, PPTCT services are often unavailable or inaccessible to most women. In our country, 75% women are not covered for PPTCT, and 43% of those who are eligible do not receive Anti Retroviral Treatment.

The problems get compounded if the woman happens to be a sex worker. Dr Gilada, who is also the Secretary of People’s Health Organisation of India, the first NGO in India that started AIDS awareness and intervention programme amongst Mumbai sex workers, has worked relentlessly for several years to mitigate the problems of this neglected and despised section of society. According to him, “When I started working with sex workers in Mumbai, people said it was an impossible task as most of them were illiterate. But I believed that although they had not gone to school, they were human beings with brains. We convinced them that the use of condoms was in the interest of their own well being, and not in the interest of their clients. Initially there was resistance, but their unified stand on ‘no condoms no sex’ eventually increased the rate of condom usage to 95% in the areas where we were working.”

Dr RR Gangakhedkar, Deputy Director of National AIDS Research Institute (NARI), insists upon the need to reach individual sex workers, and have community led interventions which will have minimum number of gatekeepers, so that sex workers themselves manage to reach the invisible ones in their community. He finds it worrisome that the typology of sex workers is changing; as they are moving from brothels to venue based sex work, and are even becoming mobile, thus making outreach still more difficult. This mobility would also result in the spread of HIV to small towns. In Maharashtra alone, two thirds of the sex workers had at least one large move during last 12 months.

Dr Jana, who has worked in the field of HIV/AIDS for over 30 years, feels that, “We cannot treat a sex worker simply as a focussed target of HIV. She is also a human being like any of us—whether it is for accessing credit, or getting her child educated, or protecting herself from structural and domestic violence. Unless the program encompasses all categories of people irrespective of their social and economic status and occupation, we will not be able to reach zero. If a change in social attitudes and practices can happen in our society it would be good for all of us.”

Social, economic and political empowerment of women is crucial which alone will allow them to overcome the barriers in their personal life to insist upon safe sex practices, demand better prevention options and access the treatment facilities available. If a woman has to depend upon a man for condom use, then her chances of protection are reduced tremendously, spiralling more new infections. About 87 % of the HIV infections in India are due to unprotected sex. If we want to achieve zero new infections then HIV prevention strategies cannot remain male dominated. We need to develop and popularise more women controlled protection devices like the female condom, microbicides etc. which will go a long way in eliminating new HIV infections and deaths.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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