|World AIDS Day and the Hidden Face of AIDS in Asia|
December 1, 2002
By Adrienne Germain
On a recent trip to India and Bangladesh, I looked into the face of AIDS in Asia, which is increasingly adolescent and female.
World AIDS Day and the Hidden Face of AIDS in Asia
I saw the face of Kamla, a young girl from a remote village in Rajasthan, India, married to a boy from a neighboring village who did not tell her he had AIDS. Not long after their 16-month-old child died of unknown causes, her husband died. Just 15 days before his death, the child was diagnosed HIV-positive. Now Kamla is a widow and HIV-positive. She will suffer not only the stigma of HIV/AIDS but also severe isolation as a widowed, childless woman.
I saw the face of Sharifa, a young woman from Rangpur, Bangladesh, who was sent into domestic labor at the age of 13. She was raped by her employer's drug-addicted son, then blamed for the attack and fired. Her family will not take her back, and she has been forced into prostitution to survive. Only 14 years old, she is likely to be HIV-positive (as is one in five sex workers in the country, according to UNAIDS), but there is no way of knowing for certain because no testing services exist in her town.
Today is World AIDS Day, and we need to pay more attention to adolescent girls like Kamla and Sharifa.
(A United Nations report last week noted that for the first time in the 20-year history of the AIDS epidemic, half of all AIDS patients are women. More than 5 million people worldwide will have contracted HIV in 2002, bringing the total number of those infected to 42 million, up 2 million from a year ago, according to the report.)
Asia is on the verge of an AIDS crisis of pandemic proportions. With close to 4 billion people, Asia is home to 60% of the world's population. Although many countries in the region have yet to record significant levels of HIV infection, large populations and inadequate sexual education and health programs mean that the number of infections could dwarf anything we have yet seen in Africa—unless we act now.
The National Intelligence Council projects that India alone could have 20 million to 25 million people living with HIV/AIDS by 2010 and that China could have 10 million to 15 million.
This year, World AIDS Day calls for the elimination of stigma and discrimination, which intensify the AIDS crisis. On the one hand, people with AIDS are disgraced for having the disease. Add gender discrimination to the mix, and women's chances of obtaining treatment and social services become increasingly small. Pervasive gender inequalities in Asia place girls at a particular disadvantage in access to education and income, and in their ability to choose when, with whom and under what conditions to have sexual relations.
Many girls in India and Bangladesh are married at a young age to older men. Child marriages are meant to "protect" girls, yet, in fact, marriage is one of the highest risk factors for HIV. Young men sometimes have sex with men before marriage and commonly engage in affairs or visit prostitutes afterward. Women are usually strictly monogamous and have no power to insist on condoms.
In India, 90 percent of HIV-positive women are married and have sex only with their husbands, according to JAMA Medical News and Perspectives.
Comprehensive sex education, health information and services are scarce. Often, the programs take a narrow approach tailored to specific concerns such as contraception or child health. Little attention is paid to social and cultural norms that deny young women health services.
Worldwide, governments, international agencies, non-governmental organizations and donors are increasingly recognizing the urgent need for more extensive and effective approaches to adolescent sexuality, health and development. However, in many countries, including the United States under the current administration, strong opposition to comprehensive sex education and health services persists.
The threat to adolescent girls in Asia is only a microcosm of the worldwide HIV/AIDS crisis. If preventing this crisis is not recognized as a global priority, many adolescent girls have little hope of growing up healthy—or growing up at all.
Adrienne Germain is president of the International Women's Health Coalition.
This article appeared in The Charlotte Observer, The Milwaukee Journal-Sentinel, and The Record (Bergen County, NJ).