Elhadj Sy

Human security presumes freedom from want and from fear, as well as access to and control of resources and opportunities. The basic elements of human security include survival, safety, opportunity, dignity, agency and autonomy. These preconditions for human security are essential in reducing vulnerability to HIV infection and its impact. However, gender differences and inequalities affect the extent to which men and women, boys and girls are able to enjoy these basic security needs. Those most deprived of these needs are themselves most highly vulnerable to HIV infection and most disadvantaged in coping with its impact.

• Women make up almost two-thirds of the world 876 million illiterates.
• Women receive an average of 30-40% less pay than men for the same work.
• Worldwide, there are 90 young women in secondary school for every 100 young men. In some countries, there are only 60 young women in secondary school for every 100 young men.

• All over the world, there are strong social pressures to ensure that women and girls remain ignorant about gender, safer sex, sexuality and relationships as well as HIV/AIDS. They lack access to relevant information, resources and opportunities to develop skills needed to apply that information to avoid HIV infection. Boys also have limited access to accurate information because of the common assumption that they are already knowledgeable about sex or will learn about it from their peers.

• HIV/AIDS has become a major challenge to gender equality and the advancement of women. Yet the same gender roles and relations that enhance women’s vulnerability to HIV/AIDS also increase some of the risks for men. Prevailing views about masculinity and manliness encourage men to demonstrate sexual prowess by having multiple sexual partners, and by consuming alcohol and other substances that may lead to risk-taking and violence.

• An HIV-related illness in the family affects men and women differently, and its impact also varies depending on whether the person who falls ill is female or male. In many instances, when a man falls ill there is likely to be a drop in disposable household income. In cultures where women are the primary source of food for the household, if a woman becomes ill there is more likely to be a problem with food security. The direct provision of care for the young or the sick is often seen primarily as women’s responsibility, and girls may be withdrawn from school to assist with household tasks which men have never learned, or which are considered unacceptable for men.

• The majority of people with HIV in developing countries do not have access to treatments for opportunistic infections, or necessary dietary and food supplements to strengthen the immune system. Such a situation impacts seriously upon women because in some of the poorest countries, women outnumber men among those infected. Gender inequalities in access to medical treatments and health services also limit women’s access to HIV/AIDS treatment, care and support, including anti-retroviral therapies. In many parts of the world, men may also have difficulty accessing HIV/AIDS services because these services are typically located in health facilities that primarily serve women, such as pre-natal and family planning clinics.

HIV prevention and care.

• Poverty has created an environment of risk to HIV. Firstly, it aggravates lack of access to education and health services and other economic resources, dislocation due to cross-border or internal migration in pursuit of work, engagement in risk occupations for survival reasons -- factors that increase vulnerability. Secondly, those living with and affected by HIV/AIDS are further pushed into poverty due to, among others, loss of gainful livelihood, inability to afford health care, and alienation from community support.

• The poverty experienced by women and men in developing countries has been deepened by increasing global economic inequalities. This global economic order has increased the vulnerability of developing countries to HIV/AIDS both in terms of infection and impact.

• Macro-economic policies which have resulted in diminished resources for social spending, such as health-care, education and social protection, have not only created conditions that heighten vulnerability and risk, but have also impacted unequally on women and men. In many communities, women have a key role in ensuring economic security for their families. But unequal gender relations and unequal access to economic resources have made women poorer than men.

• Sex-for-survival greatly reduces women’s ability to freely choose when sex should take place or to negotiate safe sex. There is evidence from all regions globally that the major driving force behind sex work, whether commercial or occasional, is economic opportunity. Sex work that is poverty-driven is likely to encourage greater risk-taking behaviors, such as non-use of condoms with clients.

• The epidemic jeopardizes the spirit behind the provisions of the Convention on the Rights of the Child (CRC) and the Convention on the Elimination on All Forms of Discrimination against Women (CEDAW), which emphasize the responsibility of all national governments to ensure that education is offered and availed of without discrimination. Education is key to sustainable social and economic development and is a central element in AIDS prevention, care, and impact mitigation. It establishes conditions that reduce HIV vulnerability – poverty reduction, gender equity, empowerment -- and provides a mechanism for delivery of AIDS education, care, and support-

• However, in countries most severely affected by the epidemic, education becomes less accessible and extremely constrained. Many Sub-Saharan African countries are witnessing decreases in enrolment rates. Some 4 million children are infected with HIV, and in some countries, the number of primary school aged children will be reduced by 20%. The epidemic has also affected the capacity of the education system to deliver educational services. Large numbers of teachers, administrators and other educational employees are becoming infected, with substantial impacts on the supply and quality of education.

• School drop-outs have increased because of AIDS-related demands. Most affected are girls who are withdrawn or drop out due to caring responsibilities in the family, trauma related to illness and death in the family, and reduced family income resulting in the need to engage in income-generating activities.

• The epidemic will also cause significant reductions in government funding for education, as economies decline and other AIDS-related priorities such as health care compete for available resources. This situation will endanger national development due to the depletion of educated human resources, thus fuelling the vicious cycle of poverty as a factor in HIV vulnerability.

• The loss through AIDS of adult labour, whether on- or off-farm, causes labour shortages and leads to a decrease in productivity. FAO estimates a major agricultural labour shortage in the future, with 7 million workers already lost and at least 16 million more that could die before 2020 in sub-Saharan Africa. A decrease in productivity leads to a decline in household income, as well as a loss of assets and savings

• With women’s decreasing productivity in agricultural production, food security at the household and community levels is seriously threatened. Additionally, inter-generational knowledge, specialized skills, practices and customs of indigenous farming methods are lost. HIV/AIDS undermines the sustainability of the agricultural sector, and leaves a bleak future to the rural communities that can no longer survive as they used to. FAO reports that over the past five years communal agricultural output in Zimbabwe has been cut in half, largely due to AIDS.

• The interlinkages between the increase of HIV/AIDS-related mortality, the lack of farm labour, the breakdown of the household economy lead to a breakdown of traditional structures and coping mechanisms. For example, in most affected countries, elderly women are compelled to assume the responsibility of caring for their grandchildren when their own children die of AIDS. Deprived of economic resources and support, impaired by poor health, and unprepared to assume such a role with the family system, they experience tremendous difficulty in carrying out these new obligations.

• Violence against women contributes directly and indirectly to women’s vulnerability to HIV and their ability to cope with infection. In population-based studies world wide, anywhere from 10 to over 50 per cent of women report physical assault by an intimate partner. Violence against women is deeply rooted in stereotypical gender beliefs and roles. Physical violence, the threat of violence, and the fear of abandonment act as significant barriers for women who have to negotiate the use of a condom, discuss fidelity with their partners, or leave relationships that they perceive to be risky. Those who are at special risk to violence are: women known or suspected to be HIV positive, young women and girls, sex workers, trafficked women, street children and AIDS orphans.

• We know of cases of women with HIV who have been killed and abandoned. Young women and girls have an enhanced risk of rape and sexual coercion because they are perceived to be more likely to be free from infection, or because of the erroneous but widespread belief in some regions that sex with a virgin can cleanse a man of infection. AIDS orphans, who are often forced to fend for themselves, are also easy prey for sexual abuse and violence.

• The trafficking of girls into prostitution and sexual slavery is another deeply entrenched form of violence against young women fuelled by widespread poverty, international tourism and the forces of globalization. Because many enter receiving countries illegally and are in settings where commercial sex work is illegal, they are not protected by the law, experience greater social stigma as foreign sex workers, and have even less access to social services.

• Wars and other conflicts increase the vulnerability of women and girls to HIV/AIDS, particularly through systematic rape and other war crimes. It is interesting to note that practically all of the countries in Eastern and Southern Africa, where the epidemic is most severe, have experienced major civil conflict. Conflict settings increase local and regional insecurity, increase poverty, and can lead to the breakdown of social services, infrastructure and a lack of food, shelter, medicines and health care workers. Countries engaged in conflict allocate huge portions of their limited resources to military spending, rather than social services.

• Girls and boys are particularly vulnerable to abuse and exploitation both as civilians and as child soldiers. In the genocide in Rwanda, it is reported that virtually every adult woman or girl past puberty who had not been killed in the massacre had been raped. As many as 5,000 Rwandan women have borne children resulting from rape, many of whom have been abandoned.

• In post-conflict situations, local women and girls are at increased risk as they barter or sell sex for survival to occupying or peace-keeping forces. Life in refugee camps poses great hazards for girls and women. A high incidence of rape was reported among Somali refugees in Kenya in 1993. Often refugee communities become centres of sex work. HIV/AIDS also hinders the process of post-war reconstruction and reconciliation. As many rape survivors are infected with HIV, the pursuit of justice is hindered, the basic building block of human security.

• The impact of peace-keeping operations on the HIV/AIDS epidemic is of such concern that in July 2000 the UN Security Council addressed the issue and adopted resolution 1308 with special recommendations for states on prevention measures to be taken. HIV prevalence rates among military forces are extremely high, which pose threats to HIV infection to the local community.

• A gender approach to HIV/AIDS in the context of human security emphasizes the role of women and women’s organizations in HIV/AIDS policy development, programming and implementation at all levels of government. We must recognize that similar gender factors also increase risks and vulnerabilities of men. Thus, actions need to focus on empowering both women and men, so that they can work as individuals and as partners in making the changes necessary to reduce the spread of HIV/AIDS.

• Engaging men as partners is a critical component in AIDS prevention and care, as in many contexts, men are the decision-makers in matters related to reproductive and sexual health. Programmes for men and boys should seek to complement work with women and girls. Parallel programmes are crucial that men protect not only their own health , but also the health of their families. In this way, men will part of the solution to curbing the spread of the epidemic.

• An expanded response to the epidemic must be in the context of the implementation of the Beijing Platform for Action. Such a response must advocate for women’s rights as basic human rights and must urge for structural changes, including the transformation of social norms and practices that do not uphold these rights.

• An HIV/AIDS component is an essential element in gender-responsive health programmes in order to reach greater numbers of women and men and to ensure sustainability. An AIDS component will include, among others, AIDS prevention education, voluntary counseling and testing, and diagnosis and treatment of STDs.

• The maintenance of human security requires a minimum level of good governance. Good governance in the context of HIV/AIDS will aim towards:

1. strengthening civil and political rights to encourage community discussion and advocacy. To tackle the difficult issues related to AIDS will require an environment of non-discrimination and freedom.
2. building resources and skills of affected communities, facilitating their partnerships with other advocates, and including them in programme planning.
3. mobilizing all levels and sectors of government to act in unity on the social, economic, and cultural obstacles to preventing HIV/AIDS and mitigating its impact.

• AIDS responses that are within the framework of human security and gender will need cooperation within countries across all sectors of society, in particular civil society organizations, and cooperation among countries because some threats to human security result from forces beyond or across national borders.