Women, the girl child and human immunodeficiency virus/acquired
immunodeficiency Syndrome (HIV/AIDS)
Mabel Bianco

Women and girls are nowadays more vulnerable to sexual transmission of HIV/AIDS, particularly in developing countries as those of Latin America and the Caribbean.

Poverty is not the only cause, it’s also an effect of HIV/AIDS. Families with people living with HIV/AIDS become poor, not only because they decrease their incomes but because they increase their expenses to take care of the sick people. Proportionally poorer families invest more money in health care than others.

Current macro economic policies and globalization increase poverty worldwide. The gap between rich and poor grows up within and between countries. Latin America and the Caribbean is the continent that has the worst performance in this trend. The feminization of poverty is a trend observed since the last decades and it will continue so if no special action is adopted. The feminization of the epidemic which took place simultaneously expressed the direct relationship between poverty and HIV/AIDS. Poor girls, adolescents and women are more vulnerable to HIV/AIDS due to gender imbalance. This has been frequently said in the last ten years , but has not yet been translated in actions to prevent HIV/AIDS and to achieve gender balance.

Worldwide women’s inequality is a reality and, it is significantly higher among poorer groups. Social, cultural and religious norms often contribute to perpetuate the men’s capacity to hold the balance of power, with independence of the individual power status of women and men in any given situation.

Although since the 70’s efforts were made to decrease women’s subordination and improve equity, still norms and traditions in societies remained unchanged. Women, and particularly girls , often do not have the bargaining power to decide about their lives and specially about sexual issues. In developing countries, as well as in poor groups in developed countries women’s equality has not yet been achieved and the required positive policies have not yet been adopted or are insufficient.

In 1985 in Nairobi, while the Third World Conference on Women took place, HIV/AIDS existed and was a problem for many African women but this fact had not yet been recognized in the Conference. Many years after, the problem still was not sufficiently recognized. In Beijing, 10 years later, the issue was incorporated and many proposals of action were submitted and adopted.

Nevertheless very few policies or specific measures were adopted by governments to prevent and reduce the impact on girls and women. The lack of political commitment and adequate policies allowed the growth of the epidemic and many girls and women became infected worldwide

In many countries, particularly in Latin America and the Caribbean governments still deny the impact of HIV/AIDS, particularly among women and girls. We have then the right to ask how many more women and girls have to become infected to convince governments of the need to reach a political will enabling them to adopt the correct measures?

Since 1985 the epidemic increased geometrically specially among women. On December 2000, UNAIDS estimates show that 16,4 millions women were living with HIV/AIDS worldwide and 9 million had died of AIDS. In the year 2000 2,2 million new infections in women were recorded. While 46,8% of all new infections were females, 52% of deaths caused by AIDS in the world were also females in the world. How many girls and women's lives could have been saved if social awareness had developed itself in 1985 and preventive policies had been adopted?

The world has no more time to loose, governments and societies must act now!. Clearly AIDS is killing more women than men, and this difference is higher in poor countries. This is a gender issue: to be a woman involves a different risk than to be a man. Biological vulnerability of women to HIV infection is reinforced by economic, social and cultural vulnerability due to the status of women in society. When infected, women, and girls are much vulnerable to illness and death. That’s why a gender perspective is necessary: to prevent HIV/AIDS on women, to decrease the impact on them and to be able to cope with it.

In many countries, most women and particularly girls cannot say "no" to a man ; girls and women are more exposed to sexual harassment than men in all societies. Often they cannot negotiate safer sex; if they depend economically on men they feel, and often really are, powerless. Poverty exposes women and girls to be abused and to higher risk behavior. Sexual exploitation of girls and women in poor groups is today a family survival strategy. In many Latin America and Caribbean countries unemployment and extreme poverty pushed families to tolerate and even promote girls and women prostitution to survive. Girls and women have difficulties to obtain sexual information due to cultural norms. When they are poor they find much more difficult the access to knowledge and to adopt preventive measures than other women and girls.

Machismo is an important factor to increase women's vulnerability to HIV/AIDS; associated to others as poverty, illiteracy and unemployment the result is a catastrophe. This is one of the reasons for the growth of the epidemic among women, in Latin America and the Caribbean. Machismo promotes and perpetuates gender disparities in power. Men as a social group are allowed to hold power and to impose on others, specially women and children. That power often leads to violence and coercion.

Gender-based violence including sexual abuse and domestic violence are real concerns worldwide. Studies show adolescent girls are often pressured and coerced to have sex by their boyfriends and other men. Nowadays they are more frequent victims of sexual harassment and rape. A study undertaken in five countries in Latin America in

1998-99 by the Latin American and Caribbean Women's Health Network (LACWHN)shows an increase of sexual abuse of girls observed in almost all of the countries. The magnitude of the problem, however, cannot be easily measured because most of the victims do not report to the authorities. When claims took place it resulted that sexual abuse had been caused by a close relative in a range of percentages between 40 and 75% according to the country. Respect for sexual rights is the basis for eliminating violence against women, including genital mutilation, sexual harassment, abuse and rape, domestic battering, prostitution and trafficking in woman.

Sexual domination and violence associated to sex are current images in today’s media. They alternate with unrealistic romanticism and soft pornography, and the mixture is very dangerous particularly for young people. Sexual violence is frequently considered as a natural and attractive fashion, and it is difficult for young people to recognize the destructiveness and risks associated to these behaviours. Serious injuries and danger for their lives as well as murder of young women and adolescents by their boyfriends is a frequent risk in Latin America and the Caribbean, according to many studies.

Risk behaviors became "natural" when sexual violence was adopted early in life. Women are more frequently victims of sexual violence, particularly girls and adolescents. The LACWHN study shows girls at younger ages prevailed in the cases reported. In Nicaragua 78% of claims correspond to girls aged between 9 and 13 . The prevailing images and messages of sex associated to violence do not promote equality and autonomy in sexual relations nor mutual respect and protection. So today, to combat gender-based violence it’s necessary to change prevailing images and messages. And this constitutes an HIV/AIDS women’s prevention task.

In such an environment, formal sexual education in school and informal ways do it (out of school) for children and adolescents, particularly before they start having sex, are important tools for eliminating gender violence. It will help them to postpone unwanted sex and protect them when they begin to have sex. Sexual education must recognize violence as a risk behavior and promote equality, respect and autonomy in sexual relationships, but also self-esteem. In Latin America and the Caribbean few countries included sexual violence in sex education. Gender perspective is necessary to promote power balance among men and women based on the elimination of men’s exclusive capacity to hold the balance of power in the group. So sexual education is a proved an effective tool to promote awareness in girls and boys of gender roles and to be able to recognize media sexual images and messages jeopardizing respect and autonomy.

A gender sensitive lens must be used to re-examine laws which promote sexual violence as those condoning girls rape if the violator marries them, or do not consider nor punish rape inside marriage, among others. Also legal procedures need to be adjusted to improve implementation of the law. Those legal changes will contribute to women HIV/AIDS prevention, as well as to the promotion of access to specific prevention methods as: female condoms, substances that kill microbes, voluntary and free HIV testing including counseling.

In Latin America and the Caribbean women are still stigmatized as "vectors of diseases". When a woman is detected HIV positive she often suffers violence and discrimination. HIV/AIDS tends to promote the violation of women’s rights as the right to employment, property, marriage, body integrity, childbirth and others.

Frequently in countries where abortion is not legal, as in LAC countries, HIV positive women are often forced to do an abortion if pregnant. Compulsory sterilization is another frequent practice imposed to women living with HIV/AIDS in LAC.

Still in our countries compulsory testing for pregnant women generally was justified as a need to prevent mother-to-child transmission while not always treatment was available after childbirth. In many countries mother-to-child transmission prevention programs have the prime aim to benefit the fetus not the mother. In those societies women are often only valued by their reproductive capacity and not for their value as human beings. So when their self esteem is very low, sexual education in school has an important role in promoting women’s self esteem.

HIV/AIDS must be included in reproductive health services. Women living with HIV/AIDS face special sexual and reproductive health risks, but do not always have access to care for STTS cervical cancer and unwanted pregnancies. Adequate prenatal and delivery services are also necessary not only to avoid HIV transmission from mother to child, but also to improve the quality of life of both: mother and child

The access to health care and treatment for women living with HIV/AIDS is more difficult in many cases in LAC, not only due to economic reasons but also to social and cultural norms, particularly gender roles. Women traditionally privilege to take more care of others than themselves, so often they postpone their health care or interrupt their treatment if their children or husband are ill. This is more frequent among poor families due to limited resources. In poor families with scarce resources women often do not allow to take care of themselves as they do in wealthy families. If resources are sufficient to take care of all the family, women more frequently tend to adopt prevention and care measures, but still in those groups special emphasis to women’s care is needed.

Adolescents girls is a specific group whose basic rights are often violated, such as their rights to education, confidentiality, access to sexual and reproductive health services and to prevention methods among others. Special attention is needed to ensure adolescent rights particularly considering that nowadays families are not always a safe environment. In many countries sexual abuse and rape of children occurred in the household and the violator is a relative or a close friend of the family. The household is a double dangerous environment because girls and boys didn’t suspect of any possible danger in their home nor caused by a relative or family friend. So in many countries, as in LAC, governments must apply specific policies to ensure all children -girls and boys- a safe environment, protecting them from all forms of sexual violence or coercion.

In 1999, a special session of the General Assembly reviewed what had happened in the five years since the adoption of the Cairo Programme of Action.

It was firmly avoided to condition girls and adolescent’s rights to their parent’s rights.

Women’s rights are critical to ensure HIV/AIDS prevention. Disclosure of HIV status, partner notification and confidentiality are other dimensions of HIV/AIDS and human rights for women that are often ignored. Gender differences are present and require women and men’s awareness as well as human rights education to reach a balance of power and to develop an attitude of tolerance. This is the challenge of HIV/AIDS for women and girls and for the entire society. Future generations depend on today’s decisions!