VIENNA, Austria (WOMENSENEWS)–The preventive benefits of an HIV vaginal gel dominated the headlines of the International AIDS Conference in Vienna last week, but failed to allay the concerns that Mabel Bianco has about the public-health response to the epidemic.
Like many other women’s advocates at the meeting, Bianco, an Argentinean feminist and member of Women ARISE, an international coalition of women’s HIV networks, thinks women’s problems negotiating safe sex and other HIV-AIDS preventions are intrinsically linked to the abrogation of their rights in other areas, such as land ownership, access to education and participation in politics.
"I’m afraid the response to the epidemic is very medicalized," Bianco said. "There is not a pill for gender equity."
Women continue to carry the weight of the HIV epidemic, numerous advocacy groups said, noting that the proportion of women infected with HIV has been rising.
In sub-Saharan Africa, which hosts two-thirds of the world’s HIV-positive population, 60 percent of people living with HIV are women. In the Caribbean and the Middle East, women are more than 50 percent of the HIV-positive population.
While medical research news is welcome, Purnima Mane, deputy executive director of the United Nations Population Fund, said that women’s infection risks are often aggravated by social, rather than medical, issues.
"The vulnerability of women, the issues that are impacting women, haven’t changed as much as they should because they are not related to HIV, they are related to women’s situations in general," she said in an interview.
Vulnerabilities Heighten Risk
Women still struggle to negotiate condom use, are vulnerable to sexual violence, often lack education and access to prevention information and when economically disadvantaged are more likely to use transactional sex or sex work to support themselves. All of these vulnerabilities heighten their risk of contracting HIV.
Women who are free of HIV also bear the disproportionate brunt of caretaking that the disease brings.
"As women we are young women, we are positive, we are sex workers, we are drug users, we are mothers, we are caregivers, we are everything," said Bianco.
The CAPRISA study of the vaginal gel produced the first positive results for this new technology. Unlike condoms, the gel, called a microbicide, does not require the consent of a male sex partner.
With further research advances, women could hypothetically apply the vaginal gel before and after sex to decrease their risk of getting HIV. In the study, the gel was only 39 percent effective, and effectiveness decreased over time. Women who applied the gel regularly were 54 percent less likely to be infected with HIV. But it is a useful first step for scientists to build on, researchers widely agreed.
While some heralded the gel as an advance for women’s control over their own protection, others worried that it might be treated as a substitute remedy for an underlying and deeper social issue: women’s lack of agency to negotiate condom use or other protection measures.
Some activists see CAPRISA as emblematic of a wider simplification of women’s risks and roles in the epidemic.
Given women’s wide exposure to HIV risks, activists want to see an approach that stops focusing on individual women’s risk groups and makes a broader link to women’s overall rights.
"We will be talked about as mothers, we will be talked about as partners, they will talk about our roles…but they forget about our rights," said Everjoice Win, the international head of women’s rights at ActionAid, an international anti-poverty agency.
Tackling Issues Surrounding HIV
Kiren, an HIV-positive woman from Malaysia, agreed with that criticism. "In order to tackle HIV we need to tackle the other issues surrounding HIV."
Part of the problem, according to a report published by UNIFEM at the conference, is that women are not included in the design and appraisal of HIV programs.
"Positive women, in particular, are actually not involved in the response in a meaningful way," said Nazneen Damji, co-author of the report. At best, women are involved "tokenistically or formally" but are not empowered to be in leadership or decision-making roles.
The report found a significant lack of documentation of women’s participation as decision-makers in national and international HIV responses. One hundred women interviewed for the report cited barriers, including cultural factors and gender norms (79 percent) and economic disempowerment (58 percent) that prevented their full participation.
A broader, more integrated connection of women’s rights to the anti-HIV agenda should be sought through coalition building among the various populations of affected women, said Meena Seshu, founder of SANGRAM, an HIV organization in India.
"Women who just identify as women, sex workers who identify as sex workers and…transgender women who identify as transgender women; these are not natural alliances," said Seshu. "But over the years I think one has started realizing that alliances…will have to be made if all women are to benefit."
Some organizations are seeking entry points for more integrative community care of HIV-AIDS.
Robin Smalley, international director of Mothers2Mothers, a multi-national nongovernmental organization that supports HIV-positive mothers in Africa, said that in countries with limited health infrastructure, prenatal checkups can be the only time women seek medical care.
"If we can take that time and engage her in a relationship of trust and support then through her we can engage her whole family," she said.
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Allyn Gaestel is an international freelance journalist.
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Women ARISE at AIDS 2010: