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Gender and HIV/AIDS – the Human Rights and Security Perspectives
Sharifah H. Shahabudin

The seriousness of the HIV/AIDS pandemic has been pinpointed on several occasions at the international level. In June 2000 the United Nations Security Council declared that, if unchecked, HIV/AIDS is likely to pose a major threat to economic, social and political stability as well as human security. Two reasons underlie this declaration. Firstly, HIV/AIDS is escalating at an alarming pace in the highly populated developing world (see appendix 1) even though there are reports of prevented, curtailed or reversed epidemics mainly in developed countries. Secondly, HIV/AIDS cannot be viewed as just a serious health issue because it challenges all critical areas of development and impacts on all levels of society. Since HIV/AIDS affects mainly those in the productive age, depletion of skilled work force jeopardises national development. If left unchecked there will be consequences that invariably spill over to threaten the well-being and security of other counties as well.

In countries that are badly hit, the loss of breadwinners and decimation of the extended family leave many families, often headed by children who have been orphaned, with an uncertain and impoverished future that further increases their vulnerability to HIV/AIDS. The burden of caring for the sick and dying drains the physical and financial resources of families as well as place a heavier burden of family support and care on women and girls. The orphans are likely to be malnourished, poorly educated, emotionally traumatized and alienated from society. As adults, they may have multiple partners and be unable to adequately parent the next generation, with serious implications for peace and security both within and between states. The reduced productivity worsens the social, economic and political situation of countries and people already beset by poverty. The consequent decline in national food security, deteriorating living conditions with malnutrition and starvation, increased illiteracy as children drop out of school, strained health services, general social instability and malaise endanger national development, governance and political stability. Abject poverty, migration, war and civil conflicts are some of the trans border consequences that threaten the well-being and security of the entire community of nations and the future of humankind.

Countries vary in the stage of the epidemic, depending on their socio-economic status, the political commitment, organisational capacities of the government machinery, resource availability, mobilisation of NGOs/civil society/community and the extent of the participation of the private sector in the fight against HIV/AIDS. While many countries like those in Asia, have the gift of time to learn from the HIV/AIDS epidemic in Africa, that time is precariously short because of the very rapid spread of the virus, the big populations of Asia and the specificity of the spread of the virus in the local social and cultural contexts.

Long held cultural expectations and beliefs, as well as contemporary transformations within these, structure the vulnerability of individuals and communities. In addition, historical factors as diverse as colonisation, exploitation, contract and migrant labour systems, war and civil conflict shape the vulnerability to infection as well as impact of HIV/AIDS in communities. More recently global economic order and macro-economic policies of restructuring have worsened the plight of people in countries struggling under debt burden when they are unable to cope with the resultant breakdown of social services such as health care, welfare and education. Restructuring in many countries have also had a disproportionate negative impact on women (1994 and 1999 World Survey on the Role of Women in Development ) who now have to bear the burden of providing these services at the household level.

HIV/AIDS therefore is a problem that does not respect national borders and there is evidence that unless prevention efforts are sustained, new epidemics of HIV can readily arise to threaten peace, human rights, security and survival. A new approach is required to halt and begin to reverse the epidemic. This approach must acknowledge that HIV/AIDS is a development, security and rights issue which threatens the survival not only of individuals but also communities and nations.

The primary Rights response to HIV/AIDS is set out in the "HIV/AIDS and Human Rights International Guidelines", which also contain many of the substantive aspects of human security. From the gender perspective however, HIV/AIDS has only been addressed in relation to health in relevant core international documents on women’s human rights: the Convention on the Elimination of All Forms of Violence against Women, the Programme of Action of the International Conference on Population and Development (ICPD), the Beijing Declaration and Platform for Action and the United Nations special session of the General Assembly on ICPD+5 (1999) and Beijing+5 (2000). What is lacking is the gender dimensions of human security and human rights in the context of HIV/AIDS, which are only partially formulated. The links between increased vulnerability to, and impact of HIV/AIDS with the various dimensions of the pandemic such as cultural, social and economic development, human rights and human security have to be clarified from a gender perspective as well and mainstreamed as a cross-cutting concern. Since 70% of the worldwide infection is now occurring through unprotected sexual intercourse, the interplay between gender and the HIV/AIDS pandemic has to be seriously examined as a key vulnerability factor that influences prevention, treatment, care and support in the context of human rights and security.

Culturally accepted and socially constructed gender roles leave women in a subordinate position to men in many ways including decisions concerning sexual relations. Power is central to the construction and expression of gender, affecting individual autonomy and sense of self, the experience of sex, and the opportunities open to women and men. Differing economic opportunities, roles and expectations create gender divisions in society whereby women’s economic dependence on men seriously compromises their ability to negotiate protection or leave risky relationships. In addition, the same gender roles and relations that enhance women’s vulnerabilities to HIV/AIDS also increase some of the risks for men, thus multiplying the risks for women. Dominant ideologies of masculinity and ‘manliness’ encourage men to seek multiple partners, participate in risk-related sexual activity and violence and encourage men to see the direct provision of care as a woman’s (rather than a man’s) responsibility.

The wide-spread abuse of human rights and fundamental freedoms associated with HIV/AIDS has emerged globally in the wake of the pandemic. Of particular concern is the strong link between violation of the human rights of women and girls and the HIV/AIDS pandemic which has not only been one of the root causes of women and girls’ infection but also one reason why women are particularly severely affected by the pandemic. Women’s and girls’ relative lack of autonomy over their selves and their sexual lives, and the social and economic inequality, violate a range of human rights including rights to life, privacy, freedom and security of the person and health. Gender-specific examples of the limitation or denial of human rights include:

• Stigmatization and discrimination whereby women tend to be blamed as vectors of the epidemic (to partners and children), labeled as ‘promiscuous’ and morally unworthy and even abandoned by their families, in addition to being marginalised, publicly censured, abused and denied access to services such as testing, counseling, treatment and care, education, accommodation, employment and in their enjoyment of other rights.

• Limited access by women, girls and boys to relevant information and education about HIV/AIDS, gender roles, sexuality and reproductive health including safe sex because of social pressures and cultural norms. Significant gender gaps in school enrolment and retention as well as withdrawal of girls from school to look after sick relatives or to earn money to support their family further aggravate the lack of access to information and the resources and skills needed to apply that information to avoid HIV infection, and to reduce the impact if infected and affected.

• The right to health and to life being compromised by under-investment in research and product development of affordable female-controlled methods of protection and prevention (such as microbicides and vaccines) coupled with the general lack of access to treatments for HIV/AIDS and opportunistic infections, or the dietary and food supplement inputs to strengthen the immune system for the majority of people in developing countries. Such a situation impacts seriously upon women who outnumber men among those infected in some of the poorest countries and in situations of rape. If in addition, women suffer from anemia or other conditions stemming from repeated pregnancies and childbirth, their immune system is rapidly depleted. Lack of political commitment is also denying women the treatment to prevent mother-to-child transmission of HIV.

• Perpetuation of poverty which is a high risk factor for HIV infection and its impact because it depletes families of all resources and income to maintain their health and well-being after infection, thus endangering the survival of future generations. The intersection of poverty with gender inequality makes women very vulnerable because of unequal access to economic resources, inequality in the sphere of work, problems faced by the girl-child, burden of care, inability to negotiate safe sex because of their economic dependence on men, having to resort to sex work in order to survive and spousal separation in migration. Whilst poverty has many root causes, the global economic inequalities, driven by international macro-economic policies that prioritize the strategic and economic interests of developed countries, have deepened and maintained the poverty experienced by women and men in developing countries. The breakdown of social services such as heath-care, education and social welfare, have not only increased the burden of poverty in the developing world, but have also increased the burden on women. This global economic order has increased the vulnerability of developing countries to HIV/AIDS both in terms of infection and impact.

• Widespread malnutrition and starvation in countries most affected by the HIV/AIDS pandemic because household and national food security (enshrined as a right in Article 11 of the Covenant on Economic, Social and Cultural Rights) are threatened by the decimation of the agricultural workforce, a substantial number of whom are women. Weakness and exhaustion caused by HIV infection can lead to the inability to perform agricultural tasks resulting in reduced crop yields and a shift away from nutritious but labour-intensive crops. Women who have limited or no land rights and the prospective loss of access to land when husbands die face particular constraints as farmers, processors and marketers of food. Their attention is also diverted away from important farm tasks when they have to care for dying relatives. Due to their poverty, illiteracy and cultural constraints on using ‘masculine’ protective clothing, women are at increased risk from contamination by organophosphate pesticides and this has implications for their survival when infected with HIV.

• The lack of good governance in the form of effective policies and laws that address gender inequality so as to bring about more democratic and stable social relations and enhancing the possibilities of social change to address HIV/AIDS. Good governance also includes political will and commitment that manifest in strong public voices on the epidemic, an effective government based on the rule of law, freedom from corruption, commitment to respecting, protecting and fulfilling human rights and human security, and the participation of a strong and active civil society, particularly the Greater Involvement of People Living with HIV/AIDS (GIPA) at all levels of policy formulation, programme implementation, monitoring and evaluation. An absence of good governance increases social and political insecurity, which increases the vulnerability of the population to HIV/AIDS.

• Increasing role of women, including young girls and elderly women as caregivers, draining them of their energies and isolating them from their usual social activities because they have to cope with the demands of caring for infected people who have been pushed into home-based care due to the failure of the State health care systems. This usually results in loss of productivity and livelihood by families, made worse when meagre resources have to be diverted into providing treatment and care. If the caregiver is herself infected with HIV, her health might deteriorate quickly under the strain of care giving. In many cases, young girls are withdrawn from school to care for sick family members or younger siblings, if they are orphans. In the absence of good information and suitable forms of protection while caring, many elderly women and care providers may themselves be exposed to the risk of HIV infection.

• The threat of violence, physical violence, and abandonment are some of the consequences faced by women who have to negotiate the use of a condom, discuss fidelity with their partners, leave relationships that they perceive to be risky or disclose their HIV status. During armed conflict and political instability, women and girls may face systematic rape and other gender-specific war crimes. Young women and girls face special risks because of the erroneous but widespread belief 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 women and 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. Recent research shows that young men too express their fear of the potential for violence within themselves, the threat of violence from other men and of the violence inflicted on them.

• War and other armed conflicts which often increase local and regional insecurity, worsen poverty, encourage violence against women and frequently lead to the breakdown of social services, infrastructure and a lack of food, shelter, medicines and health care professionals. These factors also increase the vulnerability of entire populations and threaten national security and stability.

A gendered understanding of HIV/AIDS suggests that it is women’s and girls’ relative lack of power over their bodies and their sexual lives, supported and reinforced by their social and economic inequality, that make them vulnerable in contracting and living with HIV/AIDS. Concern for human rights and security should encourage efforts as well as the obligations of both state and non-state actors to promote the agency and autonomy of individuals, their dignity and safety, and equality of opportunity internationally, regionally, nationally and at the local level.

The Human Rights approach emphasizes the claims or entitlements that all people have to a full and satisfying life, in which each person is able to develop to her or his full human potential. Importantly, human rights set standards for human well being and development, and constitute important means for the achievement of this. Central to this is the indivisibility and interdependence of political, civil, social, economic and cultural rights. In particular cultural and religious practices should promote the well-being and security of women and men. An environment in which human rights are respected ensures that vulnerability to HIV/AIDS is reduced, those infected and affected by HIV/AIDS live a life of dignity without discrimination and the personal and societal impact of HIV infection is alleviated. Respect of human rights also require that these rights are protected and fulfilled at all levels in the family, community, the workplace and the State as well as during armed conflict, thus affirming democratic principles of accountability and participation. More specifically, a gendered approach to HIV/AIDS and human rights should ensure that the experience of women and men infected and affected by HIV/AIDS is reflected in the interpretation and application of human rights in various international and national documents with a variety of legal and non-legal strategies for the achievement of rights. Any effective response to the epidemic has to address these interrelated levels of gender inequality, as well as the global inequalities that frame them.

The Human Security approach presumes freedom from want and fear, as well as access to and control of resources and opportunities by the people. This includes survival (food, water, shelter, health); safety (freedom from violence); opportunity (education, employment, information); dignity (tolerance, respect); and agency and autonomy (participation in decision-making, self-determination, individual agency). The human security approach recognises that threats to human rights often result from forces beyond or across national borders, emphasises the obligations of States and international institutions to respect the self-determination of States and be accountable for violations of human rights and humanitarian law. It also acknowledges the need for multi-faceted responses in times of peace and conflict, including conflict prevention and post-conflict reconstruction and transformation. Such responses require co-operation between states, and between states and inter-governmental organisations, trans-national corporations and civil society organizations, and promote anticipation and prevention of problems, rather than later intervention. Integrating a gender perspective into the linkage between HIV/AIDS and human security means addressing the gender differences and inequalities (dominant constructions of femininity and masculinity) in relation to social and occupational roles, access to and control of economic and social resources and how these increase vulnerability to infection and the impact on individuals, communities and nations. For example, a gendered discussion of food security might examine rights to life, health, freedom from hunger, adequate food, and access to knowledge of the principles of nutrition; explore how this lack of rights differentially impacts on women and girls as compared to men and boys; note the corresponding responsibility of states and non-state actors to respect, protect and fulfill these rights. It might also examine how factors such as HIV/AIDS and globalization have resulted in changed food production and market patterns which impact negatively on the ability of women, men and their families to secure an adequate food supply. A weakened physical condition in turn increases the vulnerability to HIV infection and the impact of AIDS. As this pattern is repeated across regions, collective human security is endangered.

The HIV/AIDS pandemic must now be regarded as a disaster and as such requires both short-term relief measures and long-term actions aimed at addressing the rights and security issues of HIV/AIDS, and mainstreaming gender as a cross-cutting concern of human rights and security. This would mean incorporating the gender and HIV/AIDS approach with that of the rights and security approach to transform relations between women and men that will eliminate gender inequality, reduce the risk of infection and foster an enabling environment that ensures true partnership in opportunities for both women and men to prevent HIV infection and cope with the pandemic more successfully. To achieve this there is a need for strong political commitment, adequate resources, good governance and democratic participation to provide a lasting solution. It also needs the concerted effort and partnership of Governments, civil society, international organizations, non-governmental organizations and the private sector in resolving these problems.

Based on the human rights and security approaches which are mainstreamed with gender, several time-targeted actions were recommended by the Expert Group Meeting on "The HIV/AIDS Pandemic and its Gender Implications", organised by the United Nations Division for the Advancement of Women, in collaboration with the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Windhoek, Namibia, from 13 to 17 November 2000. Important ones include:

1. Disaster relief measures for AIDS-affected areas.
2. Economic empowerment of women, in particular equal rights to inheritance and ownership of property, including land.
3. Provision of accurate, culturally and gender sensitive prevention, education, services and technologies, with particular emphasis on adolescents and young adults, that promote gender equality in relationships, the practice of safer sex and human rights.
4. Access to treatment and care including free and voluntary counseling and testing for HIV infection, affordable treatments for opportunistic infections and anti-retroviral therapies and nutrient supplements.
5. Working with formal, informal and traditional men’s groups, targeting couples, rather than individuals, to challenge gender inequalities in relation to HIV and AIDS, and to encourage men’s fuller participation in prevention, impact alleviation and care.
6. Working together with religious and traditional leaders to identify the cultural and religious practices that influence gender relations, to eliminate practices that increase the vulnerability of women, young girls and children to HIV/AIDS and to work with the positive core values and practices of respective cultures and religions in HIV/AIDS education including sex and sexuality education, prevention, treatment and care, within the framework of the Vienna Programme of Action adopted at the World Conference on Human Rights (1993).
7. Introducing measures including training and a comprehensive code of conduct (and measures for its enforcement) to ensure that peacekeeping and military personnel respect the rights of women and girls in all aspects of their operations.

By the end of 2000, the number of adults and children newly infected worldwide was estimated at 5.3 million and the total number of people living with HIV/AIDS had grown from 10 million in 1990 to 36.1 million. Of those infected, 95% are living in developing countries: 25.3 million (70.1%) in Sub-Saharan Africa, 6.44 million (17.8%) in South, Southeast and East Asia and the Pacific and 1.4 million (3.9%) in Latin America. It is estimated that there are 15,000 new infections every day, 95% again in developing countries whilst 11.3% are in children below 15 years of age and 86.6% are in people in the productive age group (15-49 years). While men continue to represent the majority of cases, recent data show that women now represent 47% of all infected adults. In sub-Saharan Africa women constitute 55 per cent of all adult HIV infections. In 16 countries of Sub-Saharan Africa more than one-tenth of the population aged 15-49 is infected. Uganda, which has successfully reversed the upward trend in HIV infection still has an estimated prevalence rate of 8%. No country in Asia has a prevalence rate of more than 5% but the large population of Asia (60% of the world’s population) and the rapid spread of the virus make small changes in prevalence rate epidemiologically significant in terms of numbers affected. Since the beginning of the pandemic, an estimated 21.8 million have died of AIDS, and the disease is now the fourth leading cause of death in the world and the number one cause of mortality in Africa, exceeding the number killed in armed conflict. Three million people died from AIDS in year 2000, 80% from Sub-Saharan Africa and 16.5% from the Asia-Pacific region. Over 13.2 million children have been orphaned as a result of AIDS, over 12 million of whom are in Africa¹. The major mode of transmission is heterosexual transmission (70%) and injecting drug use in some parts of Asia. From the natural history, it is known that it takes a long time to develop full blown AIDS and thus many people do not even know they are carrying the virus and so continue to infect their partners.