GENDER AND HIV/AIDS

Definitions

 Gender refers to sexually constructed roles, responsibilities and power relations

between men and women, boys and girls.
 It is related to how men and women, boys and girls are perceived and expected
to do, act and think in different circumstances.
 Gender is human and changes from time to time and from culture to culture.
Gender roles

Gender roles are tasks/functions assigned to women/men, boys/girls within a society

and they are learnt. They vary from culture to culture as well as within the same culture
among social groups. These roles change from time to time.

The women gender role of nurturing and taking care of the family has become a
challenging role in the era of HIV/AIDS.

The role has endangered women’s lives especially when they take care of AIDS patients
without protective gadgets. Further, when they themselves are AIDS patients, they are
given inadequate care because the society does not think that those who give care also
need it. At the same time, grandparents, especially grandmothers are left to take care of
the orphans when they themselves need that care.
Sex roles

Sex roles are tasks or functions performed by males and females that are biologically
determined such as breastfeeding, childbirth and carrying the pregnancy.
FACTOR INFLUENCING GENDER DISPARITY IN HIV/AIDS INFECTION
Globally, an estimated 17.3 million out of 36 million (47%) HIV-positive adults are
women, and the overwhelming majority of these women, more than 13 million, live in
sub-Saharan Africa (UNAIDS2006).

In sub-Saharan Africa the overall proportion of women living with HIV⁄AIDS is still
rising and is now at 59%. Apart from sub-Saharan Africa, women in the Caribbean,
Oceania and North Africa/Middle East also form about half or more of all people living
with HIV.

Although women are making efforts towards equality with men, a lot of them still do
not have control over their lives. Cultural, social, biological and economic pressures
make women more vulnerable to HIV infection than men.
 1. Biological makeup and reproductive anatomy of the female body

Biological makeup and reproductive anatomy of the female body makes her more
vulnerable to contract HIV than men. Sex takes place inside the body of the woman and
the female genitalia is prone to tear and wear. These tears and wears and/or sores
provide entry route for the virus. The female reproductive system is also in direct and
longer contact with the male semen deposited during sexual intercourse. If the semen
has HIV, then it becomes easier for her to contract the virus Changes associated with
female reproduction explain to a larger extent the differential infections.

Studies indicate that men could be having similar challenges like women. For instance,
uncircumcised men are likely to be torn during intercourse and this exposes them to
HIV. One preventive measure to circumcise the male.

Studies further indicate that the concentration of the virus in the semen is about 8 times
more than it is in the vaginal fluid. Thus men are more likely to transmit HIV than
women.

2. Social cultural functions

 The barriers that prevent women from being able to access quality healthcare
services include denial of access to services, discrimination from the service
providers, and poor quality services. This results in women being less able to
control their sexual and reproductive health and rights (SRHR) and reduce
the risk of HIV infection.
 The low status of women in the society prevents them from demanding for
protection/ condom use from their husbands.

 Men dictate matters regarding sex irrespective if a woman wants sex or not in
some societies and countries.

 Male predominance – here male are left with matters about the house (sex)
and they are allowed to have multiple sexual partners.

 Cultural practices – wife inheritance, polygamy, early marriages and

resistance to use of condom are some gender inequalities making women
vulnerable to HIV/AIDS.

 The gender role assigned to women especially care-taking roles compromise

their HIV status especially when they are taking care of PLWHAs.

 Social evils/ills – rape, sodomy, homosexuality, premarital sex, extramarital

sex and drug/alcohol abuse.
  Limited access to educational opportunities – women not given opportunity
to exploit their talents in education. Young women and adolescent girls who
lack a formal education are less likely to receive information on their SRHR
and are more likely to be at risk of believing serious misconceptions and
myths about HIV. Uneducated girls are twice as likely to acquire HIV as
those who attended school. Studies have shown that increasing educational
achievement among young women and girls leads to better SRH outcomes,
including lower rates of STIs, fewer unintended pregnancies, and reduced
risk of intimate partner violence.
 Wife inheritance and other forms of cohabitation for economic support.

 Early marriages especially for the girl-child exposing them to already infected
older partners. Girls married as children are more likely to suffer intimate
partner violence than those who marry later. As minors, child brides are less
likely to able to exert agency and learn how to protect themselves against
HIV.

 Cultural practices e.g traditional circumcision and FGM expose initiates to

HIV due to use of unsterilized instruments.

 Men have a lot of free time for leisure. This exposes them to risky behavior.

 Studies indicate that many women experienced violence after disclosing their
HIV status to their partners. For men, the fear of rejection has kept them silent
on their HIV status.

3. Economic factors

 Most men work outside their homes thus exposing them to HIV.

 Men employed as service men for women thus exposing them to HIV.

 Women depend on men and some have discreet relationships with men in
order to support their children.

 The society assigns economic resources to men. Women have little control
and depend on men.

 Women are not entitled to inheritance and cannot make decisions of the
family resources especially if she need to get protective devices such as a
female condom.

 Lack of enough capital – sexual working for livelihoods

 Cases of forced marriage for capital

  Old boys/girls provide sex to opposite due to lack of negotiation

 Women have limited access to family resources and security e.g. land for
financial negotiations.

 Financial inequalities determine who has protective devices such as a condom

in a household setting.

 Are not able to meet health needs e.g. drugs for opportunistic infections

 Family property inheritance – some society do not pass them e.g. land to
women. In some societies, when husband dies, relatives of deceased are to be
in charge of property and not wives.

 In such cases that women cannot provide for family due to poverty, they
resort to commercial sex working.

 Poverty has led to men abandoning family and resort into drugs/alcohol and
in event contract HIV exposing self and family to HIV.

 Poverty leads women not to question even when asked for sex without
condom. Poverty increases both vulnerability to and the impact of HIV.
Women affected by poverty may be less knowledgeable about the threat of
infection and how to reduce it, and often have no choice but to adopt
behaviours that put them at risk, such as early marriage, transactional and
intergenerational sex, and entering into an abusive relationship

 Multiple sex roles of women limit the time they have to attend support
groups if infected and also the time to attend workshops where information
on HIV/AIDS is shared. Time is thus a resource that women have no control
of.

4. Gender – based violence

 Gender-based violence (GBV) is fuelling the spread of HIV. GBV is any act of
partner physical violence and sexual violence. Both sexes may be victims of
GBV. The fear of being beaten interferes with the ability to negotiate
protection during sex. It also results in the fear to visit the VCT centres.

 One in three women experiences physical or sexual violence from a partner,

or sexual violence from a non-partner, in their lifetime. In conflict zones and
among populations of refugees, seven out of ten women experience sexual
and/or gender-based violence. Violence prevents many women from
protecting themselves against HIV.

 In places with a high prevalence of HIV, women who experience intimate

partner violence are 50% more likely to acquire HIV than those who do not.
 The reason for this is because women who have suffered physical or sexual
abuse are more likely to experience mental health issues, abuse alcohol, and
lack control over their sexual decision-making – all of these factors increase
the risk of HIV.

 GBV be physical, emotional or sexual abuses

 Manifested in:

- Rape

- Sodomy

- Coerced sex

- Sexual assault

 Although both sex suffer the same, women are more vulnerable

 GBV is a global issue

 Studies/available evidence shows one in three women have at one time or

another experienced gender – based violence i.e. beating, incest, sodomy,
rape and sexual assaults

 Problem acute in conflict, post conflict and refugee settings where women are
subjected to increased rates of sexual harassment that expose them to
HIV/AIDS.

REDRESSING GENDER ISSUE IN HIV/AIDS

1. Reinforce women’s economic independence

2. Combating ignorance

 Improve the access of girls to education

 Ensure they have information on their bodies, HIV/AIDS and other STDs

 Equip them with skills to say ‘NO’ to unsafe sex

 Cultural believe that ‘NO’ to sex means ‘YES’ and therefore must be
forced to have sex since they in any case will say ‘YES’

3. Provide women friendly services

 Girls and women should have access to appropriate health care and
HIV/STD prevention services
  Make condoms and STDs care available where women don’t feel
embarrassed

4. Make female condoms available

 Though expensive, they should be availed

5. Build safer norms

 Support organizations advocating against behavioral traditions which

have become deadly with the advent of HIV/AIDS e.g. genital mutilation,
child abuse, rape, sexual coercion

6. Educate boys and men to respect girls and women

 This enables them to engage in responsible sexual behaviour and to share

their responsibility themselves, their partners and their children from
HIV/AIDS and STDs.

7. Reduce vulnerability through policy changes

 Policies from communities to national level must be reshaped if women’s

vulnerability is to be reduced. Human rights and legal rights should be
improved.

8. Integrating gender perspectives in planning programmes in order to respond to

specific needs of men/women, boys/girls.

9. Strategies against gender-based violence

Widespread public discussion and awareness raising, and improved care of rape
victims (including post-rape HIV prophylaxis), are necessary elements to curb and
mitigate effects of violence against women. Effective strategies to control and reduce
gender-based violence can also include legislation, effective legal enforcement, female
police stations, supporting women’s shelters through non-governmental organisations
and formative and operational research.

10. Non-discrimination
Currently, HIV testing in seriously affected countries is most common among women,
often in connection with pregnancy as a step towards preventing mother-to-child
transmission (UNAIDS/ WHO 1998). One effect of testing during pregnancy is often
the disclosure of HIV infection to the partner/family with ensuing severe consequences,
such as blame and eviction. Discrimination, related to HIV in a wide sense, needs to be
systematically combated. This includes not only discrimination of people with
HIV⁄AIDS, but also those who are already vulnerable such as prostitutes, injecting drug
users, MSM, victims of human trafficking and sexual exploitation/abuse

11. Legal protection

The vulnerable groups mentioned above need systematic steps to improve their legal
protection: adequate legislation and policy; and the systematic
introduction/implementation and monitoring of these legal instruments. It involves
increasing judicial capacity, implementation capacity, and raising public awareness.
Without proactive interventions, women usually have a much weaker de facto legal
status than men, and extra efforts are therefore needed to heighten their legal protection
in many areas. The vulnerable groups mentioned above need systematic steps to
improve their legal protection: adequate legislation and policy; and the systematic
introduction/implementation and monitoring of these legal instruments. It involves
increasing judicial capacity, implementation capacity, and raising public awareness.
Without proactive interventions, women usually have a much weaker de facto legal
status than men, and extra efforts are therefore needed to heighten their legal protection
in many areas.

12. Research
Formative, action-oriented, social science research in key areas is essential in order to
bring hidden issues related to gender inequity and HIV to the fore in society: e.g.
violence and rape, sexual exploitation, the situation of high-risk groups and the
mechanisms of discrimination. The situation of high-risk groups and the mechanisms of
discrimination.

13. Improve/increase gender awareness in political responses

To have any chance to move in the direction of fulfilling the Millennium Development
Goals, many countries, and notably the hardest hit in sub- Saharan Africa, need very
significant and consistent international support to reduce poverty through debt relief,
fair trade and development cooperation. Poverty reduction will increase possibilities to
improve gender equity but effective poverty reduction also requires systematic
“engendering of development”. Starting to control HIV⁄AIDS, also through gender-
focused approaches, will act in synergy with such poverty reduction efforts.