HIV/AIDS involves complex issues
HIV/AIDS involves Complex Issues
1 Background to the report
HIV/AIDS involves complex issues of gender and sexuality. Here, the primary focus is with the implications of HIV/AIDS for women, particularly heterosexual women. This is because of the growing incidence of heterosexual tranmission, and the relative lack of power of women in most societies. This is not, however, to deny the importance of involving men in AIDS prevention – in fact this is crucial to preventing AIDS among women, as emphasised below. There is relatively little activity among, or information about, gay men and male sex workers (many of whom do not identify as homosexual and have female as well as male sexual partners), although one or two examples are given. Homosexual women are not explicitly mentioned in any of the literature reviewed, and the organisations focusing on gay people seem to be mainly geared towards men. Thus the issues for lesbian women are not discussed.
South East Asia and the South Pacific in the global context
Added to this, the implications for women (and children) of the global AIDS pandemic are increasingly being recognised as extremely serious. ‘During its first decade, the HIV infection/AIDS pandemic has caused an estimated 500,000 cases of AIDS in women and children, most of which have been unrecognised. During the 1990s, WHO estimates that the pandemic will kill an additional three million or more women and children throughout the world.’ (Chin, 1990: 24.)
Gender and age breakdown of HIV/AIDS cases
As well as epidemiological and behavioural and other factors which increase the likelihood of a rapid spread of HIV infection, socio-cultural and socio-economic factors may also hamper HIV/AIDS prevention work. Many instances of such factors are highlighted in this report, which lead to gender biases in responses to HIV/AIDS.
Evidence suggests that there is greater potential to alter the behaviour and attitudes of younger people with regard to sexuality and HIV/AIDS, because their opinions and behaviour patterns are less well established, so that preventive activities aimed at young people are not only highly necessary but may also be particularly effective.
Women in general, as well as sex workers, are at increasingly high risk of infection, largely due to the high risk behaviour of their partners, rather than their own. A low use of condoms puts many of these women at risk through their relationships with higher risk male partners.’ (Sittitrai et al, 1991, quotation from abstract.)
Sexual behaviour and sexual bargaining
The advent of the HIV/AIDS epidemic is itself modifying patterns of sexual behaviour as the sex industry responds to changing demands, brought about by the fear of AIDS. Rather than adopt safe sex practices, as men become more aware of the risk of infection, they may demand younger and younger women – particularly virgins – for commercial sex, as well as for casual sex and marriage. Thus there is a need for ongoing longitudinal research into patterns of sexual behaviour and its social context.
– various factors, related indirectly and directly to gender, place women at increased risk of exposure to HIV infection;
– the psychological and social burdens are greater for women than for men;
– women’s social position makes it difficult for them to undertake prevention measures.’ (de Bruyn, 1992: 249.)
Knowledge and perceptions of HIV/AIDS
Women may be at greater risk of infection than men because of their lesser awareness of the possible risks. Whilst knowledge of the risks is not sufficient to prevent high risk behaviour, it is a prerequisite for behavioural change.
Another study of levels of knowledge and perceptions of AIDS, as well as sexual attitudes and practices, among nursing and medical students in Manila in 1991, revealed some small but significant differences in knowledge and perception of HIV/AIDS by gender.
Even among these highly educated groups, women, compared to men, relied more on family and friends for information, tended to have slightly greater erroneous knowledge of HIV/AIDS and somewhat more pronounced tendencies to blame the spread of the disease on specific groups, notably female prostitutes. The research also suggested that women were slightly less likely than men to use ‘hotlines’. (HAIN, Health Alert, Jan 1992, 125.)
The evidence was clear than we do not know how to translate knowledge about prevention into practice, we do not know how to supply condoms and to maintain that supply at afforable levels, and that health promotion messages such as “stick to one partner” are not the whole answer.’ (AIDS Newsletter, 1992, 7(12): 1.)
Prevention and care
In many cultures, there are double standards about sexuality which tolerate and even promote male promiscuity whilst condemning female promiscuity. In these circumstances, women are not expected to challenge or even raise the issue of their partner’s sexual behaviour. In these circumstances, for a woman to suggest using a condom is very difficult. It implies either than she does not trust her partner and fears he might be infected, or that she herself has slept with others and might be infected. Moreover, condoms must be used at each encounter, so these dilemmas for women are continually raised.
It is clear that heterosexual transmission is already, or is rapidly becoming, the dominant mode of transmission of HIV/AIDS in South East Asia and the South Pacific. Female sex workers have already been badly affected by the epidemic, and women generally – and through them children – are increasingly at risk of infection.