HIV/AIDS Prevention Starts with Combating Gender Inequality

Written by: Hayley Trinh, Communications and Development Intern, Education for Equality International

Since the first known case of HIV in India was diagnosed in 1986, the number of people infected with the virus has continued to grow. According the most recent UNAIDS Gap Report, India has the third-highest number of people living with HIV in the world, with 2.1 million Indians accounting for four of every 10 people infected in Asia.

Rajasthan, where EEI’s girls’ education and empowerment efforts are currently focused, is considered a low prevalence state by National AIDS Control Organization (NACO), but the population is considered highly vulnerable because of its high percentage of migrant labor. People from Rajasthan migrate to high prevalence states like Maharashtra and Gujarat and return with the disease. Rajasthan also accounts for 19% of all mines in India, employing over 500,000 workers, many of them are from other states. The situation in the state has become critical due to increase of traffic on national highways, tourists, and laborers coming in search for jobs. Due to its large population of over 74 million, even a small increase in HIV/AIDS prevalence would translate into a large number of cases. These factors strongly suggest that Rajasthan is indeed a highly vulnerable, high-priority state.

Young girls and women in Rajasthan, especially in rural areas, constitute a particularly vulnerable group with high risk of contracting HIV and face many obstacles in making informed sexual and reproductive health decisions. The deeply-rooted custom of child marriage is a huge contributor to this. Rajasthan has some of the highest rates of early marriage in India, with 65% of girls married before their 18th birthday. Exposure to regular, unprotected sex within marriage means these girls are faced with an elevated risk of infection that would not occur in the absence of early marriage.

Gender norms and power imbalances also play a considerable role in increasing the vulnerability of adolescent and young women in Rajasthan. Double standards that condone and even encourage premarital relations for males but not for females are widespread. These norms increase the likelihood that many men already have a STI or are HIV-positive prior to marriage. Since the Indian society grants more freedom to men, many often indulge in extramarital sex, putting young girls and women at risk if their husbands return home having become HIV-positive. Gender norms also associate masculinity with toughness and dominance, and femininity with submissiveness, limiting women’s ability to deny sex or negotiate condom use with their partners.

Low female literacy rate (52.1% compared to 79.2% in males) also indicates the lack of power on the part of girls and women. Despite having increased significantly in recent decades, Rajasthan’s female literacy rate remains the lowest in the country, contributing to inferior access to economic opportunities and resources for women. Such economic dependency makes it less likely that young girls and women will succeed in negotiating protection during sexual activities, making them even more vulnerable to HIV and other STI.

Because of the culture of silence that surrounds sex, it is difficult for adolescent and young women to be informed about safe sex practices and risk reduction. Accessing treatment and services for STI can be highly stigmatizing for them. Given such taboos and stigmas, it is not surprising that studies by NACO show little awareness and knowledge of HIV in rural areas and among women. A survey of 30,000 married women in 13 states (including the high HIV prevalence states) showed that only one in six women had heard of HIV/AIDS, and even then with very poor knowledge of its transmission and prevention. The study reported numerous misconceptions, including that HIV can be transmitted by mosquito bites, living in the same room, shaking hands, and sharing food. When EEI led a sexual health education training in Rajasthan in 2015, none of the participating girls (all aged 15-20) knew what HIV/AIDS or STI were.

It is clear that young girls and women in India in general and in Rajasthan in particular are a high-risk subgroup that require special attention from the government and NGOs. Child brides are more vulnerable to HIV, and India needs measures that delay marriage or at least enforce existing laws on the minimum age for marriage in a more committed way. Efforts should be made to increase awareness and understanding of HIV/AIDS and encourage behavioral change among the population. Most importantly, HIV/AIDS prevention programs must focus on economic and social aspects of society, not just on the virus as a public health threat. The status and empowerment of women are important variables in combating the disease. Literacy, education, exposure to the media, awareness of HIV/AIDS, labor market participation, and economic independence are important considerations in improving the status of women in India. Policymakers need to focus on gender inequality and other underlying socioeconomic factors to effectively combat the pandemic.

Please visit us at www.eduequal.org and follow us on Twitter or Facebook.

 

Girls’ Globe is present at the 2016 International AIDS Conference in Durban, South Africa (17-22nd of July). Follow our team on social media @GirlsGlobe, @FHI360 & @JNJGlobalHealth and by using the hashtag #EndHIV4Her for inspiring blog posts, interviews and updates! To sign up for the daily In Focus Newsletter visit crowd360.org/aids2016/.

Cover photo credit: Fonda Sanchez, Founder of EEI.

What We Need to Know About HIV & Adolescent Girls

The term ‘adolescent girls’ encompasses, in theory, all those aged 10-24. In reality, the lower section of that age bracket – the 10-19 year olds specifically – receive the least attention and are therefore the least comprehensively catered for when it comes to HIV/AIDS information and services.

So what do we know?

  • There is no country in the world where we don’t have adolescents living with HIV, and adolescent girls remain disproportionately affected.
  • There are 990,000 girls between 10-19 years old living with HIV globally. For boys of the same age, that figure drops to 770, 000.
  • Every hour, 26 adolescents are infected with HIV – two thirds of these are girls.
  • Adolescent AIDS-related deaths are increasing.
  • Very young adolescents are generally overlooked, since at this age they face a relatively low burden of disease. However, 10-14 is a critical life phase for shaping future health and development.

And what don’t we know?

  • There are HUGE differences between 10, 11, 12, 13 and 14 year old girls, but we don’t have data that represents those differences by being divided up into specific age intervals.
  • There are considerable barriers to conducting research with adolescent girls which we don’t know how to overcome. For example, adults are often uncomfortable when dealing with adolescents in general, as well as with sexuality in general. This makes dealing with adolescent sexuality pretty problematic for many.
  • We are confused about adolescent’s ability to provide informed consent. Too often we think of them as children and judge their capacity to consent to research accordingly.

What can we do?

ROLE MODELS
Having a positive image of someone who is older, but not too much older, motivates young adolescents to feel that they belong to a kind of community, and that their hopes and dreams are worth spending time on.

PEER-TO-PEER SUPPORT
Very young adolescents find it more comfortable and easier to receive information from a peer. Well-informed peer educators can disperse knowledge and skills in a non-intimidating, non-alienating way.

SAFE SPACES
There need to be places for young people to start talking about their sexual and fertility needs. An adolescent girl needs to feel that it’s ok to walk up to another person and say “I’m sexually active”, or “I’m thinking about having sex.” It requires physical space; whether it’s actual chairs where you sit and talk or virtual space that exists online, where dialogues can happen comfortably and openly.

SHIFTING MINDSETS
We need to enable and support a shift in  the mindsets of those providing information and care, because too often the values and mindsets of providers conflict with the needs of young people. In many countries, a 14 year old girl coming to a clinic looking for contraception will be met first and foremost with an interrogation about why she is thinking about having sex at her age at all.

FAMILY PLANNING
The very term ‘family planning’ alienates adolescents, since the whole point is that they’re trying to avoid having a family. What young girls are looking for is contraception and protection.

SEX EDUCATION
We need information that isn’t so broad, that’s more age specific. There is no other subject that you’d approach in the same with with a 10 year old and a 13 year old. The best case scenario is that information is either too complex or too simple, and the worst is that it’s patronising, alienating, intimidating, or confusing.

If we truly want to #EndHIV4Her, we need to zoom in on very young adolescent girls and acknowledge their specific needs.

Girls’ Globe is present at the 2016 International AIDS Conference in Durban, South Africa (17-22nd of July). Follow our team on social media @GirlsGlobe, @FHI360 & @JNJGlobalHealth and by using the hashtag #EndHIV4Her for inspiring blog posts, interviews and updates! To sign up for the daily In Focus Newsletter visit crowd360.org/aids2016/.

Cover Photo Credit: World Bank, Flickr Creative Commons

Youth Speak Out About HIV/AIDS!

Today, Girls’ Globe blogger, Eleanor met up with several young people at the 2016 International AIDS Conference. It’s the last full day of the conference and these inspiring young activists had a lot to say about the work they are accomplishing to combat the HIV/AIDS epidemic in their countries. They also shared key takeaways they have learned from the conference and their goals going forward in their work.

Watch this Inspiring Video:

 

Girls’ Globe is present at the 2016 International AIDS Conference in Durban, South Africa (17-22nd of July). Follow our team on social media @GirlsGlobe, @FHI360 & @JNJGlobalHealth and by using the hashtag #EndHIV4Her for inspiring blog posts, interviews and updates! To sign up for the daily In Focus Newsletter visit crowd360.org/aids2016/.

Video Blog: HIV Prevention among Women and Girls in South Africa

In this video blog, Zanele Mabaso speaks about the importance of HIV prevention among adolescents, specifically girls and young women. She talks about the importance of adolescents knowing their rights and understanding HIV, how to get tested and having adequate knowledge of their sexual health and rights.

To #EndHIV4Her: Tackle Child Marriage

To say that child marriage and HIV among adolescents are linked feels a lot like stating the obvious. But I learned today, at Day 3 of the 2016 International AIDS Conference, there is very little formal knowledge to back that claim up.

The overarching message from this morning’s discussion was a simple one; it is really difficult, if not totally impossible, to tackle HIV unless you tackle child marriage. On the one hand, girls and young women make up approximately two out of every 3 new HIV infections among people aged 10-24 years. On the other, 15 million girls per year are married before they turn 18. Two global problems of colossal scale with two sets of similar causes; gender inequality, poverty, rigid social norms, lack of education, inaccessible health information and services. And yet until recently, the relationship between the two has remained pretty much ignored. It was even suggested at one point that this session may well be a historic moment – recognition at last of their interwoven nature.

Girls Not Brides, who hosted the panel, have created a fact sheet explaining 5 reasons why child brides are more likely to be infected with HIV than their unmarried peers. It also suggests 3 things that need to be done in order to end child marriage, and therefore make progress in tackling HIV. It’s comprehensive and clear, and you can read it here.

 The facts and statistics are, of course, vital. But it was the stories of, and comments from, individuals this morning that seemed most powerful and most useful for advocates wondering how best to talk about the link between child marriage and HIV in girls and young women.

One of the panel members was Julia Omondi, a young woman representing Kenyan NGO Family Health Options Kenya. She spoke openly and honestly about real people from her community in a way that powerfully illustrated her arguments for action.

Julia used this story to stress the importance of including already-respected religious leaders in community advocacy and education:

“Where I live, there’s actually a pastor who preaches to the community against child marriage. And because of him, change is happening. Teachers in one school have now said that they don’t want older men hanging around outside the school, as they are luring girls into child marriage. The teachers are taking a stand because the know the pastor. So religious leaders have to be brought in too, they have an important part to play.”

To emphasize the need for education that reaches beyond basic primary education, Julia shared a story of a friend from secondary school. This friend, upon returning to the village she grew up in during school holidays, found that all of her friends had been married. She was the only one from her friendship group who remained un-married, and she was also the only one who had progressed into secondary education.

By grounding arguments in people’s real lives, Julia put forward a case for tackling adolescent HIV by simultaneously tackling child marriage that seemed difficult to contest. So, while more facts and figures are necessary and important, it’s ultimately stories, not statistics, that help us to piece together our view of the world.

Was this a historic moment? It may well prove to be. But only if more people now talk about the ways that child marriage and HIV exist in tandem, and share more stories that humanize the numbers and percentages the way Julia Omondi did today.

More voices are louder and more stories mean a stronger narrative that is more difficult to ignore. And the increased research, the prioritization of adolescent girls in HIV programming, the multi-sectoral national initiatives, the resources needed to empower girls, all of these are changes that will happen when the voices and the stories and the narrative become impossible to ignore.

Cover Photo Credit: Aresenie Coseac, Flickr Creative Commons 

Girls’ Globe is present at the 2016 International AIDS Conference in Durban, South Africa (17-22nd of July). Follow our team on social media @GirlsGlobe, @FHI360@JNJGlobalHealth and by using the hashtag #EndHIV4Her for inspiring blog posts, interviews and updates! To sign up for the daily In Focus Newsletter visit crowd360.org/aids2016/.

 

 

Leveraging Social Media to Address the AIDS Epidemic

Yesterday, the Girls’ Globe team attended a session on how digital and social media champions are creating change around the world. The session covered practical ways that HIV/AIDS activists, thought leaders, people young and old can utilize social media to create more reach in their networks and work.

Girls’ Globe blogger, Zanele Mabaso spoke with HIV/AIDS activist, Erica Woodland and Tommy Lobben, Manager of HIV and Digital Health Programs for Johnson & Johnson, after a #AIDS2016 session about the power of digital and social media to create change for those affected by the HIV/AIDS epidemic. Zanele asks them what they learned in the session as well as how they are using social media in their work.

Watch the Video: