South African women still have scant choices when it comes to avoiding HIV/Aids
Khadija Magardie Women have unequal power in society, resulting in less control of their lives, particularly their sexual health choices. This has had dire consequences for their susceptibility to HIV/Aids infection. According to the latest UNAids report on the global status of the epidemic, women comprise a Omarginalised groupO in society who have an increased vulnerability to the virus. This is due to a variety of factors, but mainly because of fewer contraceptive choices, unequal health care access, and, for many women, physical and psychological violence that critically affects their health. In an open letter addressed to President Thabo Mbeki just prior to the opening of the 13th International Aids Conference in Durban last month, a group of womenOs organisations, under the umbrella of the influential feminist journal Agenda, said that HIV/Aids had become Oa political issueO for women. The letter called on Mbeki to take decisive action in responding to what it called the Ogender- specific concerns of women in the epidemicO.
Emphasising the close correlation between the spiralling numbers of women being infected with the virus, and inequality when it came to sexual and reproductive rights, the letter argued that studies into the promotion of female-controlled barrier methods (as opposed to using condoms, which men have to agree to) should be given sufficient attention and financial backing. It also touched on the highly politicised issue of anti-Aids drugs for pregnant women infected with the virus calling on the government to devote more time to listening to the arguments in favour of the treatment.
The politicisation of the issues around HIV/Aids, say feminists, is detracting from the stark reality that the majority of infections are women, and because of the link between poverty and gender in most parts of the developed world, this often compromises womenOs ability to both fight and protect themselves from the virus. In an article published in the latest issue of Agenda, entitled Aids Global Concerns for Women, writer Vicci Tallis argues that gender inequality is the primary impediment to HIV/Aids prevention. Listing issues like possibilities of prevention, access to appropriate information and quality of care as avenues to which women are often barred access because of gendered poverty, she argues that women who have little control in sexual interactions are those most at risk to contracting the virus from non- consensual or unprotected sexual intercourse.
According to statistics released by the United Nations to commemorate International WomenOs Day in March, there are an estimated 14,8-million women living with HIV in the world. Up to 55% of adult infections in sub- Saharan Africa are women. The inextricable relationship between HIV/Aids and sexually transmitted diseases (STDs) is evident if one considers that women cannot protect themselves and have to rely on the OgoodwillO of a male partner, who may choose whether or not to use a condom. Despite alleged years of research, no reliable, effective and woman- friendly barrier contraceptive has reached the market. The closest is the so-called female condom, which research has indicated is still not widely accepted or used, mostly due to its exorbitant price it costs more than triple the price of the male condom. Women who contract STDs from male partners are open to a host of opportunistic infections, including HIV. Because of their biology, women are naturally more vulnerable than men to the virus. This is especially marked in girls whose genital tracts are still not fully mature. Compounding biological vulnerability is the fact that women are far more likely to be coerced into sex, or raped often by someone older, who has had greater exposure to the virus. UNAids has listed a lack of education about the virus as Oa growing liabilityO. In a study conducted among 15-19 year olds in some African and Latin American countries, it was found that better-educated young girls tend to start having sexual relationships later. In many parts of the world, especially in the developing world, cultural, religious or other impediments prevent girl children and women from receiving education and thus becoming informed about their sexual and reproductive rights and options. There is also a close correlation between gender violence and the spread of STDs, which increase womenOs vulnerability .Two years ago, at a conference organised by the Aids Law Project and the Tswaranang Legal Advocacy Center found that violence against women, including domestic violence and rape, was strongly linked to their exposure to sexually transmitted infections like HIV/Aids. Sexual violence like rape can increase womenOs susceptibility to the virus due to the likely presence of blood. Moreover, men who refuse to wear condoms may even turn violent against a partner insisting on their use a problem prostitutes often encounter. There have been several indicators to suggest that HIV/Aids has placed an enormous psychological burden on women who are inevitably the ones who have to care for the sick and the dying. In some cases women who are themselves sick, have to care for family and/or community members who are dying from opportunistic infections like tuberculosis. There is an urgent need not only for trauma counselling for women in such positions, but adequate training for women who are involved in home-based care for people with Aids. The increasing prominence of pharmaceutical companies jostling for a place to test and market anti-Aids drugs has also placed women in a position of vulnerability. Many countries in the developing world have become fertile ground for researchers conducting clinical trials into drug therapies, as well as for drug companies to market patented, often costly drugs. The issue of standards of care for participants in clinical trials, as well as the high cost of anti-Aids drugs in the developing world they are considerably cheaper in the developed world have particular consequences for indigent, poor, uneducated rural women who are often recruited into clinical trials. The ethics around Aids research and testing of anti-Aids drugs in the developing world was a less prominent, but vital issue raised at the 13th International Aids Conference. This was in response to speculation that researchers in the developed world are trying to amend the Helsinki Declaration (an established protocol which sets international guidelines relating to clinical trials) to introduce the notion of Orelativity in standards of careO. This would basically mean that participants in developing countries are not entitled to a standard of care above and beyond what is generally available. This has particular consequences for trials involving mother- to-child transmission of the virus. A central principle being promoted by the womenOs movement with regards to tackling HIV/Aids is that women have the right to control over their own bodies a matter which has not been promoted vigorously enough by several governments in the developing world. Following on this, women should have access to fully informed choice and consent concerning medical interventionsparticulary when therapeutic alternatives are presented to women for Aids treatment. Women are still not adequately informed of the full range of risks and benefits outlined, on alternatives available, and on the consequences of refusing treatment or therapy.
All these raise the potential human rights questions arising from the testing and treatment of women for infections both indirectly and directly related to HIV/Aids.