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Women and Girls Are Increasingly Infected by HIV

and AIDS

In 2010, an estimated 2.7 million people became


newly infected with HIV. Today, some 34 million
people are living with HIV, which killed about 2
million in 2010, and over 30 million since the first
cases of AIDS were identified in 1981.

In late 1980s, researchers throughout the world


suggested that women and girls might be a
special risk of HIV infection because of cultural,
psychosocial and legal barriers towards protection,
economic vulnerabilities and attitudes regarding
sexuality.

In 2005, the world witnessed Women and Girls


increasingly infected by HIV/AIDS.
Sociology of gender discourse
It is now widely established that Women and Girls
are more physically susceptible to HIV infection
than men. Data from a number of studies suggest
that male-to-female transmission during sex is

about twice as likely to occur as female-to-male


transmission, if no other sexually transmitted
infections are present.
Moreover, young women are biologically more
susceptible to infection than older women before
menopause.
Womens increased risk is also a reflection of
gender inequalities. In most societies, the rules
governing sexual relationships differ for women
and men, with men holding most of the power.

This means that for many women, including


married women, their male partners sexual
behavior is the most important HIV-risk factor.
Challenging negative gender roles is critical to the
global AIDS response. The 2001 UN Declaration of
Commitment on HIV/AIDS recognized that gender
inequality is fuelling the epidemic.

In the Declaration, governments pledged to create


multisectoral strategies to reduce girls and
womens vulnerabilities. Its 20032005
benchmarks include:

addressing the epidemics gender dimensions


(article 37);
accelerating national strategies that promote
womens advancement and their full enjoyment of
all human rights; the sharing of responsibility by
men and women to ensure safer sexual behavior
and empowering women to make decisions about
their sexuality and protect themselves from HIV
(article 59);

eliminating discrimination against women,


including violence against women, harmful
traditional practices, trafficking and sexual
exploitation (articles 612);
reducing mother-to-child HIV transmission by
increasing womens access to antenatal care,
information, counselling and testing, other
prevention services, and treatment (article 54);
and
reviewing the epidemics social and economic
impact, especially on women in their role as
caregivers (article 68).
Since 2001, a variety of regional, national and
international initiatives have emerged.

The United Nations Development Fund for Women


launched a programme to intensify gender and
human rights activities within 10 highly affected
countries national responses.

Among other activities, the programme aims to


enhance national capacity to review legislation or
policies with implications for the epidemics gender
dimensions.

In Bangladesh we have not heard anything in this


regard. Women face greater riskDuring the last few
years, the overall proportion of HIV-positive women
has remarkably increased.

In 1997, women were 41% of people living with


HIV; by 2004, this figure rose to almost 50%. This
trend is most marked in places where heterosexual
sex is the dominant mode of transmission.
In sub-Saharan Africa 57% of adults infected are
women, and 75% of young people infected are
women and girls. Several sociocultural factors are
driving this trend.

Young African women tend to have male partners


much older than themselvespartners who are
more likely than young men to be HIV-infected.

Gender inequalities in the region make it much


more difficult for African women to negotiate
condom use. Furthermore, sexual violence, which
damages tissues and increases the risk of HIV
transmission, is widespread, particularly in the
context of violent conflict.
According to recent UN press conference women in
South and South-East Asia are becoming
increasingly vulnerable to HIV infection because of
their poor education, dominance and physical
susceptibility.

At the end of 2004, women accounted for 30% of


infections in this region. In South Asia, womens
low economic and social position has profound
implications.

In this region, women typically have limited access


to reproductive health services and are often

ignorant about HIV, the ways in which it can spread


and prevention options.

Social and cultural norms often prevent them from


insisting on prevention methods such as use of
condoms in their relations with their husbands.
Women and girls affected more than men
The epidemics impact on women and girls is
especially marked. Most women in the hardest- hit
countries face heavy economic, legal, cultural and
social disadvantages which increase their
vulnerability to the epidemics impact. (see boxes
on gender beginning each chapter).
In many countries, women are the carers,
producers and guardians of family life. This means
they bear the largest AIDS burden. Families may
withdraw young girls from school to care for ill
family members with HIV.

Older women often shoulder the burden of care


when their adult children fall ill. Later they may
become surrogate parents to their bereaved
grandchildren.

Young women widowed by AIDS may lose their land


and property after their husbands diewhether or
not inheritance laws are designed to protect them.

Widows are often responsible for producing their


families food and may be unable to manage alone.
As a result, some are driven to transactional sex in
exchange for food and other commodities.

When the male head of a household becomes ill,


women invariably take on the additional care
duties. Providing care to an AIDS patient is arduous
and time-consuming; even more so when it is done
on top of other household duties.

A caregivers burden is especially heavy when


water must be fetched from a distance, and
sanitation and washing chores cannot be carried
out in or near the home.

South Africa aptly illustrates this. It is one of the


most developed countries on the continent.

Yet, a 2002 survey of AIDS-affected households


found fewer than half had running water in the
dwelling and almost a quarter of rural households
had no toilet (Steinberg et al., 2002).

Stigma has concrete repercussions for people living


with HIV. Family support and solidarity cannot be
assumed. A woman who discloses her HIV status
may be stigmatized and rejected by her family.

In most cases, women are the first in the family to


be diagnosed with HIV and may be accused of
being the source of it in the family.
In Bangladesh patriarchal social structures have
historically and systematically excluded women
from those aspects of society that are responsible
for leadership, policy formation, resource allocation
and decision making.

In the light of the above discussion, the following


sections will highlight the risk and vulnerabilities of
Bangladeshi women in contracting HIV/AIDS.

Perceived Invulnerability: Reality of Bangladeshi


Adolescents Girls and Women at Risk
Despite strong religiosity and sociocultural norms,
several qualitative and quantitative studies show
that promiscuity, illicit sexual behavior, and
multiple sex partners are much common among
Bangladeshi population (UNFPA, 2004; BCCP, 2004;
Amanullah, 2002; Caldwell and Pieris, 1999; Aziz
and Maloney, 1985).

Young adolescents girls and women are often


victims of these pre-marital sexual activities.
In a study, 50% of young men had engaged in
intercourse before their marriage, adolescents
were not punished for their premarital sex, and
such acts were related to respondents
socioeconomic status. Families were not worried
about pre-marital discreet sexual relationships of
their sons. Social and religious sanctions against
pre-marital sexual relations are weak if it happens
between a powerful man and a poor woman
(Amanullah, 2004; Aziz and Maloney,1985).
The practice of extra-marital sex is much frequent
among adolescents and young boys and girls as

well as small professional groups (UNFPA, 2004;


BCCP, 2004; Amanullah, 1998; 2002). It is now
well established that the presence of both
ulcerative and non-ulcerative STDs increases the
risk of HIV transmission as much as 3 to 5 folds.

In a Save the Children (USA) (1992), 54% of the


women visiting a four-day free health clinic
conducted in Rangunia, a conservative,
predominantly Muslim rural area about 30 km from
port city Chittagong, had a history of present or
past STDs, 61%, having current symptoms of STDs,
had an abnormal vaginal discharge, 5% had genital
ulcers, 34% had lower abdominal tenderness, and
4% had genital warts.

The study warned that in absence of adequate


testing and treatment facilities, the high incidence
of STDs in such a poor and remote rural community
would provide a fertile ground for explosive and
unchecked outbreak of HIV (SCF, 1993).
Several national studies show that the awareness
and usefulness of condoms have risen in
Bangladesh for last few decades among ever-

married women/men (Mitra et al., 2001),


adolescents (Mitra, Islam and Amanullah, 1996)
and SWs and their clients (Amanullah and Islam,
1996; Jenkins, 1999).

Overall 40% Bangladeshi ever married women do


not know of HIV/AIDS. The ignorance was higher
among women with no education (63%); only 8%
of them know about condom as a way to avoid HIV
infection (BDHS, 2004).

However, the most discoursing fact for HIV


program planners is that, of those women who
were currently using FP methods, only 4.2%
women stated that they were using condoms and
the practice was strikingly related to their
education and place of residence (BDHS, 2004).
Overall, as of the end of 2004, an estimated 7.1
million adults and children have become infected
with HIV in South and Southeast Asia (UNAIDS,
2004).

It is feared that the explosive sex trade, abject


poverty, illiteracy, patriarchy and large scale
population movements have already made this
region a fertile ground for rapid expansion of HIV
epidemic.
The success achieved in Thailand and many other
African Muslim and Non-Muslim countries such as
Senegal, Zimbabwe and Uganda reveals that,
despite structural and cultural barriers such as
poverty, illiteracy, stigma and male dominance,
there is still some hope to increase safe sex
practices through culturally sustainable HIV/AIDS
prevention programs and providing support
services to vulnerable groups, specially riskpracticing women and children.