The Female Face of HIV and AIDS

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The Female Face of HIV and AIDS
Annual Lecture March 2007
Trócaire and St. Patricks College,
Maynooth mjkelly_at_jesuits.org.zm
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Perspective

• Todays global agenda focuses heavily on central
  issues of our time war and terrorism, global
  warming and climate change, globalisation and
  prosperity, nuclear proliferation and the rights
  of nations
• These may be so compelling that they deflect
  attention from one of the most disastrous health
  and development events in our world, the AIDS
  epidemic that sees
• Between 5 and 6 deaths every minute, one of them
  being a child below the age of 15
• 500 new HIV infections every hour
• Millions of children left without parents

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Global HIV Dynamics, 2006
New HIV infections 4.3 million
PLWHA 39.5 million
AIDS-related deaths 2.9 million
PLWHA People Living with HIV or AIDS
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Graves Waiting for their Dead
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HIV and AIDS Still Have the Upper Hand

• The epidemic has progressed faster than anybody
  expected
• It has doubled in size in just ten years
• 1996 about 20 million PLWHA
• 2006 almost 40 million
• Straightforward prevention measures have very low
  coverage e.g. globally, less than 10 of
  infected women receive the medications that will
  greatly reduce HIV transmission to their children
• Although there have been some achievements, the
  epidemic remains out of control

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What is Needed to Make Progress against HIV and
AIDS

• Pay more attention to the social, economic and
  cultural environment within which HIV flourishes
• Address the fundamental drivers of the epidemic
• The low status of women
• Homophobia
• HIV-related stigma
• Poverty and inequality
• Lack of seriousness about human rights
• Address justice issues An AIDS response that is
  not as embedded in advancing social justice as in
  advancing science is doomed to failure (Peter
  Piot)

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Gender Inequalities
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The Global Disadvantage of Women

• Of the worlds one billion poorest people,
  three-fifths are women and girls
• Of the 960 million adults in the world who cannot
  read, two-thirds are women
• Seventy percent of the 130 million children who
  are out of school are girls
• Although women spend about 70 percent of their
  unpaid time caring for family members, that
  contribution to the global economy remains
  invisible

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The Unequal Status of Women

• In developing countries, women have less access
  to information, education, employment and
  productive resources (land, property, credit,
  etc)
• Globally, women are conspicuously absent from
  parliaments, making up, on average, only 16
  percent of parliamentarians worldwide
• Women everywhere typically earn less than men,
  both because they are concentrated in low-paying
  jobs and because they earn less for the same work

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Gender Inequalities in Ireland

• Most countries have reduced their gender gaps,
  but no country has totally eliminated them
• Ireland is estimated to have closed 73 of its
  gender gap and is seen as a leader in this area,
  ranking 10th out of 115 countries.
  Nevertheless
• Women receive about 70 of what men receive for
  equal work
• Womens average annual income (17,000) is just
  40 of mens (41,200)
• Women comprise only 29 of legislators, senior
  officials and managers
• Only 13 of those in the Dáil and 21 of
  Government Ministers are women
• Data taken from Global Gender Gap Report 2006

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Women and AIDS
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The Feminisation of AIDS

• The female face of HIV and AIDS refers to the
  increasing and disproportionate impact of the
  epidemic on women and girls
• The proportion of women and girls living with HIV
  is increasing steadily
• Women and girls become infected at younger ages
  than men and boys
• The negative impacts of the AIDS epidemic are
  more severe for women and girls than for men and
  boys

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Proportion of Women Living with HIV

• Globally, and in every region of the world, more
  adult women than ever before are living with HIV
• In 1997, 41 of the adults living with HIV were
  women by 2006 this had increased to 48
• In 2006, there were 17.7 million women living
  with the virus compared with 16.5 million in 2004
• In sub-Saharan Africa, 59 of infected adults are
  women - for every 10 infected adult men, there
  are 14 infected adult women
• In Europe and Central Asia, the number of
  infected women increased by 20 between 2004 and
  2006, and in North America by over 16

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More and More Women are Becoming Infected with
HIV in Sub-Saharan Africa
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Women and girls are becoming HIV infected at
younger ages than boys and men
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Young People (aged 15 to 24) Living with HIV/AIDS
at the End of 2003
W. Europe 57,000
E.Europe/Central Asia 630,000
East Asia 340,000
North America 130,000
North Africa Middle East 120,000
Caribbean 130,000
South SE Asia 1,800,000
Oceania 7,200
Sub-Saharan Africa 6,200,000
Latin America 610,000
World 10 m. 6.2 m. young women 3.8 m. young men
Africa 6.2 m. 4.7 m. young women 1.5 m. young men
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Women and girls are dying at younger ages than
men and boys
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The Gender Reversal in Life Expectancy in
Southern Africa
Life Expectancy for Women
Life Expectancy for Men
1998
61 54
48 46
2004
42 44
2010
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One result is more children left without mothers
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(No Transcript)
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A second result is an increasing burden of orphan
care on elderly grandparents
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How can a lone elderly grandmother provide
physically, socially and emotionally for many
young children?
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What Makes Women so Vulnerable?

• HIV and AIDS affect women in different ways than
  men
• On physiological and health grounds women are at
  higher risk of infection
• On social and economic grounds they are more
  vulnerable to infection
• When AIDS is present women are more extensively
  affected
• But although AIDS has a womans face, in general
  it is women who are leading an effective response

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Physiological and Health Factors Put Women at
Greater Risk of HIV Infection

• More extensive and fragile tissues in female
  genital areas, with greater exposure over a
  significant period of time to large volumes of
  high risk body fluids, make HIV transmission from
  male to female seven times more likely than
  transmission from female to male
• Sexually transmitted infections (STIs) are less
  visible in the female body and more likely to go
  undetected
• Risk of HIV infection doubles during and after
  pregnancy
• Often under-nourished and in run-down health
  condition (because of poverty and/or pregnancies)

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The Social Vulnerability of Women to HIV Infection

• Very few can negotiate the when and how of sex
• Double standards in society, expecting sexual
  naiveté from women and experience from men
  (distorted social meaning of masculinity and
  femininity)
• Economic and geographic freedom and mobility of
  male partner place the woman at risk
• A woman is vulnerable if she is married and
  remains faithful to her husband
• A woman is vulnerable if she is single or has no
  partner

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Social Practices Increase Womens Vulnerability
to HIV Infection

• Harmful practices in society (age-mixing
  concurrent partnerships sugar daddies)
• Damaging customary practices (early marriage
  wife inheritance dry sex female genital
  mutilation)
• Retrogressive child-rearing practices (girls
  reared to a submissive, non-assertive,
  subordinate status)
• Message communicated at time of initiation and at
  kitchen parties please your husband at all costs
• Girls restricted access to, progress in,
  opportunities after school
• Society concurs in according inferior status to
  women

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Ruth married an older man who was unfaithful.
When he died, she brought their children home to
her parents tiny, crowded house and sold small
items at the market to help buy food. Then, just
24, she fell ill with AIDS. Who will take care
of my children? she asked visitors the day
before she died
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The Economic Vulnerability of Women to HIV
Infection

• Economically subordinate
• Limited access to capital, credit, education
• Many who receive inadequate financial support
  from partners have to apply their own ingenuity
  and resources to maintaining household
• Bear greater part of burden of child care
  (financially and otherwise)
• Sale of sex (survival sex) may be the only way to
  meet household survival needs (and husband may
  acquiesce in this)

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The HIV/AIDS Burden that Women Carry

• Triple burden on women as 1) major producers of
  food, 2) carers of the sick, and 3) caretakers of
  children, including orphans
• Even if personally HIV infected, or ailing from
  some other illness, women must continue to manage
  a household, provide care, produce food and
  generate income
• Massive pressure on women to ensure availability
  of food for the household, no matter what the
  cost, even the cost of sex and its risks
• Upon the death of a spouse due to AIDS, women are
  often stigmatized and driven from their
  communities, losing land and other assets

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The Feminisation of AIDS Care

• Because hospital care is inaccessible or
  unaffordable, home care is the only option
  available to millions showing AIDS symptoms
• Home care services are provided principally by
  communities and families mostly by women
• Home-based care imposes enormous human and
  financial costs on households, especially women
• Can be provided only because of the veritable
  army of women volunteers
• The implications for women are not adequately
  appreciated by male-dominated state and church
  organs

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Gender-Based Violence
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Ivone lives with her mother and grandmother She
was infected with HIV after being raped by her
brother-in-law when she was eight
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An Epidemic of Violence

• Violence against women is the most pervasive of
  all human rights violations
• Globally, violence against women within
  relationships is often seen as normal
• Up to half of all adult women have experienced
  violence at the hands of their intimate partners
• Systematic sexual violence against women has
  characterized almost all recent armed conflicts
  and is used as a tool of terror and ethnic
  cleansing
• Many justice systems are not victim-friendly,
  resulting in women and girls being blamed for
  rather than protected from gender-based violence

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Violence against Women

• 1 in 3 women worldwide will experience violence
  in her lifetime
• 1 in 5 women worldwide will survive rape or
  attempted rape
• Some 30 of women are forced into their first
  sexual experience
• Up to 60 of youth in certain locations feel that
  forced sex with someone known to you is not
  sexual violence
• Women who have experienced violence may be up to
  3 times more likely to acquire HIV than those who
  have not

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Violence against Children

• Globally, 20 of girls and 10 of boys experience
  sexual abuse as a child
• Nearly 50 of all sexual assaults in the world
  are against girls aged 15 or younger
• Violence against children takes place in the
  home, school, community perpetrators are
  frequently individuals the children know and
  trust
• As many as 50 of school-children in some
  countries report having been physically or
  sexually assaulted while at school
• Violence against children increases their
  vulnerability to HIV infection

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Finding a Way Forward
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The Basic Problem

• HIV and AIDS bring unspeakable additional
  sufferings and problems to women and girls
• They also bring out in stark relief that
  prejudice against women is a universal reality
• They show how the legacy of systematic
  discrimination against women is embedded in the
  economic, social, political, religious and
  linguistic structures of our societies
• The AIDS epidemic casts a very powerful spotlight
  on this fault-line in all of our societies

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The Status of Women is at the Heart of the AIDS
Epidemic

• The central issue isnt technological or
  biological it is the inferior status or role of
  women
• When womens human rights and dignity are not
  respected, society creates and favours their
  vulnerability to AIDS
• (Jonathan Mann, 1995)

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The Concerns of Pope Benedict XVI

• The unjust inequalities still tragically present
  in our world
• The persistent inequalities between men and women
  in the exercise of their basic human rights
• The exploitation of women who are treated as
  objects
• The mindset persisting in some cultures, where
  women are still firmly subordinated to the
  arbitrary decisions of men
• The many ways that a lack of respect is shown for
  the dignity of women and girls

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The Goal of Equality between Women and Men

• The Church, the United Nations, UNAIDS, Irish Aid
  and other bodies have stressed the need to move
  towards the goal of gender equality
• This is needed in order to combat HIV and AIDS
• Even more fundamentally, it is necessary in its
  own right
• AIDS or no AIDS, women and men are essentially
  equal
• Making that equality a lived reality is a major
  challenge for every individual, community,
  institution and country

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A Concrete Step

• In June 2006, Kofi Annan proposed to the UN
  General Assembly that to reverse the AIDS
  epidemic high priority should be given to girls
  education
• Irelands achievement of gender equality in
  education is integral to its world class
  performance in narrowing the gender gap and in
  promoting its social and economic well-being
• Can Irish human and financial resources be
  extended to spearheading similar achievements
  across the world, so as to reduce the education
  gender gaps and promote the social economic
  well-being of women men alike?
• This would be enormously valuable both against
  AIDS and in promoting the lived equality of women

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The Challenge to the Church
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What the Church has Done

• Massive concern for solidarity, compassion and
  effective response for those who experience
  sickness, loss, or any form of discrimination
• Stress on the sacredness of the person as made in
  the image and likeness of God and the sanctity of
  each individual human life
• Globally, provides about one-third of AIDS care
• Faith-based organizations provide some of the
  most consistent and far-reaching responses to
  orphans and vulnerable children
• Unfaltering in its teaching on abstinence and
  fidelity within marriage

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Can the Church Do More?

• Our Mother the Church has AIDS
• Our sisters carry the brunt of the epidemic
• Our sisters provide the most significant response
• Does the increasingly female face of the AIDS
  epidemic challenge us to become a Church with a
  more female face and identity?
• Does the feminisation of the epidemic challenge
  the Church to move more boldly towards the
  feminisation of ecclesial identity, with an
  increasing and eventually equal role for women in
  the exercise of ministry, authority and
  decision-making ?

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AIDS a Moment of Special Grace

• The moment of AIDS is undoubtedly a moment of
  monumental human suffering and anguish
• It is also a moment of grace a kairos moment
  and a kenosis moment, emptying out gender
  discriminations
• It impels us to work towards a Church that
• Actively values the contributions of women in
  situations of HIV and AIDS
• Gives women more freedom in representing to the
  rest of society the reality of the Church as
  Mother
• Strives to dismantle the structures of
  gender-based discrimination in Church and society
• Works to promote the active empowerment of women,
  in Church and society, as full equals of men

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In this way the feminisation of AIDS may help
bring the Church closer to the vision of Saint
Paul, neither male nor female, but all one in
Christ (Gal., 3 28)
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The Challenge to Each One of Us

• Trócaires Lenten campaign stresses the
  importance of making the essential equality
  between women and men a lived reality
• The vicious assault of HIV and AIDS on women is a
  further compelling reason for action
• Each of us should constantly ask ourselves
• What have we done in order to overcome the
  persistent inequalities between women and men?
• What are we doing about this right now?
• What more can each one of us do in the future?

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Zikomo kwambili
Thank you
Go raibh mile maith agaibh