Situation Critical: Women, Girls, and the Key to Defeating HIV/AIDBusiness Action on HIV/AIDS, TB and Malaria, Winter/Spring 2008
By Shana Ward-Ryzowy
The statistics are staggering: close to two-thirds of the more than one million Kenyans infected with HIV are female, according to data released by the National AIDS Control Council in 2007. Newly revised UNAIDS estimates show that women and girls in Lesotho are 50 percent more likely to be HIV positive than their male counterparts.
Far from being the exception, the Kenya and Lesotho examples are indicative of an alarming trend in sub-Saharan Africa: in the hardest hit countries in southern Africa, more than 60 percent of adults living with HIV are female. Twenty-seven years into the epidemic, women and girls have become the new face of AIDS.
Powerful cultural, social, and economic factors have fueled the feminization of the HIV/AIDS epidemic. And now, there’s no stopping HIV without taking the crisis among women and girls head on.
Businesses find that it’s a daunting task. But many companies are racking up major successes. The result is a range of culture—and situation—specific paths forward, most often starting on companies’ home turf—the workplace.
What’s the opportunity? Economic and social stability and lives saved. Through advocacy for social change and implementation of HIV/AIDS workplace policies and programs throughout operations in high-prevalence areas, businesses will not only empower women to make active contributions vital to a thriving economy, but will also help them break the vicious cycle fueling their vulnerability.
To move forward, businesses start by taking stock of the context of the epidemic among women and girls.
Fueling the Feminization
Ultimately, the feminization of HIV/AIDS in sub-Saharan Africa can be traced to one key factor: gender inequity.
“AIDS is primarily an epidemic among women, spread by men,” said Ben Plumley, Vice President of Communications and Public Affairs of Tibotec, a biomedical subsidiary of Johnson & Johnson that has been actively engaged in fighting this trend. “Women are uniquely vulnerable to HIV. That’s a question of education, social and economic empowerment. HIV just exploits every vulnerability that women face, particularly in developing countries.”
This vulnerability is the result of a complex set of factors, including low societal status; exposure to sexual violence and coercion; and unequal access to legal protection, education, economic opportunities, health services and information.
Women face physiological vulnerabilities as well as social ones. Their bodies have more exposed reproductive surface tissues than male systems, which heighten their risk for HIV transmission.
A recent New York Times editorial underscored the crisis and its root causes: “Marginalized in the economy and under the law, women in developing nations are often left with sex as their only marketable resource. In some parts of Africa, older men who take young lovers commonly help the girl’s family by paying for school fees and food. Young women who are bartered this way have no standing to refuse sex or ask their partners to use condoms. Marriage and fidelity offer little protection from disease for these women, who typically marry older men who have been sexually active for decades. In some areas, infection rates for young married women who remain faithful are actually higher than for single women not yet in permanent relationships.”
Despite widespread knowledge of the trend, the feminization of HIV/AIDS has gone largely unchecked for much of the epidemic’s history, though in recent years, a number of players from the public and private sectors and civil society have stepped up to the plate.
Private Sector Impact
HIV/AIDS is particularly dangerous to business. It is well documented that the disease decimates skilled workers and produces high absenteeism rates, staff turnover, training and replacement costs, and employee health care costs. At the same time, it decreases morale among workers who fear transmission from infected colleagues and also increases food insecurity and social security costs.
But a number of companies are acting to undo this damage, rolling out interventions and initiatives to address the feminization of HIV/AIDS.
A recent conference held by Tibotec and the Global Coalition on Women and AIDS (GCWA) yielded an agreement with two other pharmaceutical companies—Merck and GlaxoSmithKline—to incorporate women into more HIV clinical trials.
“The whole global AIDS movement has not adequately involved women and girls in the response,” said Plumley. “I think that’s changing, I think we’re seeing more companies now looking at how they can engage women and girls both in the development of technologies and in clinical trials.”
Plumley points to the lack of current HIV technologies addressing the needs of women and girls as proof of the private sector’s sluggish response. “The technologies have not really been devised with women in mind: The condom is a technology for men; the female condom has had some mileage, but is not widely supported. And we are still at the early stages of microbicide development,” he said.
The feminization of HIV/AIDS is not only an issue for individual businesses, but also has far-reaching ramifications for economic growth and stability. Women represent 43 percent of the workforce in sub-Saharan Africa; in developing countries, they account for a disproportionately large percentage of the export manufacturing workforce. Without intervention, it is estimated that 14 sub-Saharan African countries will lose 10 to 30 percent of their workforce, and 4 countries will suffer losses of more than 30 percent.
Action to prevent such dire scenarios will also have a powerful effect not only on women and girls but on societies as a whole. Females typically play an instrumental role in lifting their families out of poverty through workforce participation and are more likely than men to invest their earnings in their children.
Mounting evidence suggests that the extent to which women and girls benefit from development policies has a direct impact on a country’s overall success and growth prospects.
Making the Workplace Work
For companies working in high prevalence areas, the most critical contribution they can make is to set up workplace policies and programs that are tailored to women and girls both in their workplace and in the broader community.
The Levi Strauss Foundation has made HIV prevention among its female stakeholders a priority. Nine years ago, Levi Strauss began working with the Asia Foundation, an NGO operating in China since 1978, to educate migrant workers, especially women, on health issues. Some of the education provided has been on basic subjects like nutrition, though the program now encompasses a wide range of health issues faced by female workers, including HIV/AIDS.
Levi Strauss found that by partnering with an established civil society player on the ground, its outreach efforts escaped most of the bureaucratic obstacles that block other intervention efforts in China. Furthermore, because the Asia Foundation breached the factory floor in tandem with one of the largest apparel customers in the world, factory managers and local government officials had an incentive to play ball.
“It’s really important for us to use a variety of approaches not only at the community level but the factory level,” said Daniel Lee, Director of Grantmaking Programs at the San Francisco-based Levi Strauss Foundation. “The workplace is a really key player to reach people. When this program was first started, the kind of training that was provided focused on just discipline, first aid, and fire safety. HIV education became an entry point in introducing sensitive programs.”
Kate Bourne, Vice President for International Policy and Regional Programs at the International Women’s Health Coalition, adamantly agreed that companies in highly affected areas have a key role in the fight through their programmatic abilities in the workplace.
“The business sector can be hugely valuable, both by really speaking out and [by ensuring that the private sector leaders are incredibly influential,” said Bourne. “And also by doing programmatic work, whether it’s with their own employees, if they have a large female workforce, or in the larger community if they have a larger male workforce.”
Having workplace policies that directly address the needs of women and ensure both access to treatment and non-discrimination on the job, is also critical, she adds.
“There are a number of things that one could do in a workplace setting. For example, if it’s a female workforce, you might ensure that there are clinical services on-site or nearby. If it’s a larger male workforce, talk about violence against women.”
Despite many companies’ best efforts, the workplace, unfortunately, is not always the safe space it should be.
A 2002 study by the International Labor Organization found that women are significantly more likely than men to experience sexual abuse at work, a trend that facilitates HIV transmission. Rather than providing a safe space, in such circumstances the workplace often introduces additional HIV/AIDS risks for women and girls.
Another study by the Labor rights Fund found that women working in Kenya’s export-oriented sectors (which includes coffee, tea, flowers, and light manufacturing industries) routinely experience violence and harassment).
Seventy percent of men interviewed in the same study viewed sexual harassment of women workers as normal and natural behavior.
As gender discrimination increases and as women’s societal position decreases, the effects of HIV/AIDS become increasingly pronounced.
Bourne cautions that, to gain traction, action from businesses must both address younger populations, focusing on behavior change relating to gender relations, and simultaneously deal with the large population of adult women who are in need of treatment today.
“We need to work at the direct intervention level, as well as the underlying root cause. We can’t just work on gender inequality, because that leaves a generation of women unaddressed,” she said, emphasizing the need for action on multiple fronts.
Still, Bourne reiterated that educational programs to combat the root cause of the feminization are still key.
“We need to support programs that work on fundamental gender inequality, for example comprehensive gender education and rights programs in schools”
The private sector is ultimately well-poised to mitigate gender discrimination and the subsequent burden of HIV/AIDS. Businesses can build or strengthen employee training on gender sensitivity and can create gender-sensitive policies and programs. They can also integrate gender into HIV/AIDS-related workplace policies and prevention programs.
Fortunately for companies seeking to address the feminization, a number of new tools have been rolled out to help them in their efforts.
A first-of-its-kind set of case studies has just been published by the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) in collaboration with the GCWA (pg. 12). The publication includes ten examples from around the world and provides actionable recommendations for further private sector engagement.
“AIDS has shown that the health of a society and the health of the business community are intimately linked,” said Kristan Schoultz, Director of GCWA.
“These case studies highlight ways that the creativity, technical expertise, and management skills of the business community can make a real difference in the lives of women and girls across the globe.”
The publication offers clear action steps to help develop and launch programs that produce results.
The case studies show that HIV/AIDS workplace programs must address the differing risks faced by male and female workers, particularly the special vulnerability of young women. Appropriate HIV/AIDS programs should include, but are not limited to: improved access to reproductive health information and services, condom programming, micro enterprise opportunities for female employees, equal pay for equal work, and zero tolerance for sexual harassment or violence against women.
Though it’s a tall order, education can help women and men to understand and resolve the unequal power relations between them in employment and personal situations, as well as help women to understand their rights and protect themselves inside and outside their place of work. Education efforts targeting men and boys should include raising awareness, risk assessment, and strategies to promote responsible behavior.
It has been 27 years since the first HIV/AIDS diagnosis. Turning the tide will depend in no small part on strong execution of a clear strategy to address the global pandemic.
Originally published in Business action on HIV/AIDS, TB and Malaria, Winter/Spring 2008. Reprinted with permission.