By Theresa Braine
Friday, August 8, 2008
Health officials at a global AIDS conference in Mexico City this week highlighted the growing feminization of the pandemic and its link to gender violence. The U.N. may form a women's agency that advocates say could mount a more effective response.
MEXICO CITY (WOMENSENEWS)--Worldwide the rate of HIV infection is rising faster among women than men, and the link between AIDS rates and violence against women is becoming even clearer, said health advocates and officials gathered here this week for the XVII International AIDS Conference, which concludes today.
"Violence against women is both a cause and consequence of HIV and AIDS," said Ines Alberdi, executive director of UNIFEM, the United Nations Development Fund for Women, at a press conference preceding the international gathering, held in Latin America for the first time. "In order to successfully tackle AIDS, we must address violence against women. Both pandemics are intertwined in a vicious cycle."
The U.N. General Assembly is set to vote in September on the creation of a unified women's agency to streamline its fragmented approach to women's issues and programs. Many activists say the new agency would strengthen the world body's response to issues affecting women, including violence and AIDS. Several groups lobbied actively for the creation of this agency during the Aug. 3-8 conference.
On Thursday UNIFEM released a report detailing the lack of women's involvement in anti-AIDS initiatives, even as they become more burdened by the pandemic, and offered a road map to increase female participation by making women key stakeholders in efforts to combat the spread of AIDS.
The feminization of AIDS has been well documented in sub-Saharan Africa, where two-thirds of the world's HIV-positive people live and where the pandemic has taken its heaviest toll. Outside Africa the disease has affected more men than women and was once concentrated in populations of male drug users, men who have sex with men and sex workers.
But the percentage of infected women has risen steadily over the years. In the Caribbean region overall, the female-male ratio is now 1-to-1 among 230,000 infected people. In Haiti, which now has 170,000 HIV-positive people, unprotected heterosexual intercourse is the main driver of the pandemic.
Nearly one-third, or 32 percent, of newly diagnosed HIV infections and cases of AIDS in the United States stem from high-risk sexual intercourse, although male-to-male sex still remains the main transmission mode. In Western Europe, 42 percent of new infections are attributed to unprotected heterosexual sex.
The international gathering--which drew about 22,000 attendees from around the world--was held in Mexico partly to highlight the AIDS pandemic's spread in Latin America.
In the region overall, a majority of women now acquire the virus from their partners in stable relationships, expanding the feminization of AIDS beyond Africa. The twin drivers of high-risk behavior and violence means an increasing encroachment of AIDS into the female population, Nils Kastberg, UNICEF's director for Latin America and the Caribbean, and other health officials said.
"First, physically the transmission from male to female is 2.5 times more likely than the transmission from a woman to a man," Kastberg said in an interview. "So already physically speaking we have a situation that will gradually drive the pandemic toward an increasing proportion of women."
Ten to 15 years ago, he said, there were 10, 20, 25 or up to 30 infected men for every infected woman in Latin America and the Caribbean. "Now we are coming down to proportions of five men to a woman, four men to a woman, three men to a woman," Kastberg said, adding that in some parts of the Caribbean, "We are down to 1-to-1. So the tendency is totally clear."
The U.N. AIDS agency, the Joint United Nations Program on HIV/AIDS, estimated in a July 29 report that 33 million people worldwide were living with HIV in 2007. Two million people died of complications related to AIDS, and 2.7 million became infected. About 2 million children are infected, nearly 90 percent of them living in sub-Saharan Africa.
"Globally, the percentage of women among people living with HIV has remained stable at 50 percent for several years. However, women's share of infections is increasing in several countries," the U.N. report said. In Latin America 1.7 million people had the disease in 2007, 33 percent of them women, up from 16 percent in 1990.
A number of cultural norms make women more vulnerable to the violence that can lead to HIV infection, many speakers at the conference emphasized. In Latin America, for instance, there is the cultural influence of "machismo" and women's difficulty in negotiating condom use.
Women also contract HIV in violent encounters, often from abusive partners, because rough or violent sex is more likely to produce tears that let the HIV virus in. Moreover recent studies find abusive men more likely to practice high-risk behaviors, such as unprotected sex with multiple partners or intravenous drug use.
Another route of AIDS into the female population is migration, panelists discussing risk behaviors of migrants noted. Men contract AIDS in their new country and then infect their female partners when they return home, and the trend is beginning to crop up in rural Mexico, they said. Women are also at higher risk of being raped, and thus exposed to the virus, when migrating to new countries.
In Mexico about 200,000 men, women and children were living with HIV in 2007, up from 180,000 in 2001, according to the U.N. AIDS agency. About 57,000 of them were women, up from 46,000 in 2001.
The statistics don't necessarily reflect the increasing prevalence of violence-related infection. But speaker after speaker at the conference noted the correlation and the many facets of violence against women.
Childhood sexual abuse, which can seed a lifetime of high-risk behaviors; partner and non-partner sexual violence; and physical, psychological and emotional violence all "make it incredibly difficult for women to protect themselves from HIV," said Charlotte Watts, head of the Health Policy Unit at the London School of Hygiene and Tropical Medicine.
The United Nations estimates that 1 in 3 women worldwide will suffer abuse in her lifetime.
Younger women, who are most likely to be infected, are the least likely to have information about and access to preventive measures because of disparities in education and a lack of ability to negotiate safe-sex practices.
The key, speakers emphasized, is to combat both violence and discrimination and make that part of an AIDS strategy.
However, laws are one thing but enforcement still another. Mexico's 2007 anti-violence law, for instance, aims to integrate federal, state and local programs and agencies to combat violence against women, but a related penal code is still being developed. No punishment now exists for violations of the new law, widely hailed when it was passed last year.
Health officials stressed the need for commitments to long-term strategies. "No hemos vencido. It's not over," said Magdy Martinez, head of the U.N.'s Mexico office, during a press conference. Several sessions were devoted to planning anti-AIDS strategy over the next 25 to 30 years.
Theresa Braine is a freelance journalist in Mexico City who covers global health and other topics.
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