| Double Discrimination and Denial Facing Women with AIDS |
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New York Newsday, December 1, 2002 By Mabel Bianco A United Nations report released last week announced that women have caught up with men as far as AIDS is concerned. Half the adults affected with HIV worldwide are now women. This shouldn't come as much of a surprise. It was just a matter of time before the disease shifted from one originally affecting gay white men to one transmitted heterosexually all over the world. In the past decade, HIV infection rates for women in Latin America have increased exponentially. In Argentina, for example, between 1988 and 2001, the infection rate changed from one woman for every 20 men to one woman for every three men. The majority of women infected with HIV are heterosexual and do not use intravenous drugs. Many are married or in long-term relationships. Others are young women forced into the sex trade by poverty. Despite the statistics, there has been no shift in the way we discuss or confront the disease and little recognition that the epidemic's spread is fueled by pervasive gender inequalities. Machismo and the stigma of AIDS in Latin America as a "gay" disease pose a deadly problem for women. Prevailing views about masculinity encourage men to demonstrate sexual prowess by having multiple sexual partners, and social norms allow them to impose their will upon others through violence and sexual coercion. Many men treat women as sex objects, with no rights in marriage and limited access to equal education and employment. Often, men infected with HIV are unwilling to tell their wives or refuse to be tested. These men are told by their doctors to use protection, whereas women with HIV are discouraged from having sexual relations, and denied the right to have children for fear of mother-to-child transmission. Instead of being offered treatment such as the drug nevarapine, which blocks transmission, they are often pushed to undergo sterilization. The threat to women in Latin America mirrors the devastating toll AIDS is having on women all over the world. Of the roughly 42 million people living with HIV/AIDS worldwide, half are women, up from 41 percent in 1997. The area most affected is Africa. In sub-Saharan Africa, 58 percent of adults living with HIV/AIDS are women, and the rates of infection in young women between the ages of 15 and 19 are five to six times higher than in young men. These women face increased marginalization and stigma, particularly because their HIV status raises suspicions about their sexual behavior rather than their partner's. Women the world over are denied their sexual and reproductive rights, generally being expected to forgo childbearing to avoid transmitting the virus. Until we admit that a commitment to eradicating gender inequalities lies at the center of the struggle, we cannot move forward against the epidemic. Fortunately, we know what needs to happen, and international agreements exist to convert our knowledge into action. Ending HIV/AIDS requires women and men to make informed and freely chosen decisions about their reproductive lives. It requires improved access to sexuality education beyond that which is severely limited by cultural barriers or ideological considerations, such as abstinence-only-until- marriage. It requires more investment in microbicides and greater distribution of condoms, including female condoms. It requires an end to sexual abuse and violence. It requires increased opportunities for women's and girls' education and employment, respect for women's rights, and a redefinition of masculinity. And it requires access to affordable medical assistance, in accordance with established treatment protocols, and social services for those who are infected. All of these goals were agreed upon at the 1994 International Conference on Population and Development in Cairo, embraced by 179 countries and reaffirmed several times during the past decade. But today the sustained international consensus needed to achieve these goals is beginning to erode. Led by the Bush administration, conservative forces are threatening to roll back the progress made at Cairo by adopting repressive global measures and withdrawing support for international agreements. They seek to withhold information from adolescent girls about how they can protect themselves, replacing it with the directive that they abstain from sexual intercourse. This strategy is simply not sufficient to protect the millions of women and girls who contract the disease through violence, coercion and the sexual habits of their partners, over which they have no control. Unless societies oppose these conservative forces and instead move forward on the agreements established at Cairo, the epidemic will defeat us. European governments and leaders worldwide must not allow the will of an extremist minority to eradicate the past 10 years of progress for women's rights. Only when we stop letting discrimination dictate our policies, and allow women to make decisions about their own sexual health, will our combined efforts to stem HIV/AIDS stand a chance. Mabel Bianco, M.D., an epidemiologist in Argentina, is a former director of that country's AIDS program and president of the Foundation for Studies and Research on Women. She is also a member of the International Women's Health Coalition's Board of Directors. This article appeared in Newsday (New York, NY).
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