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.

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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

Liberty and Justice for All

Post written by: Alicia Weigel

I believe all people should feel empowered to make their own decisions. I believe all people should have access to health and safety as basic human rights. I believe all women have a right to life. I believe all women must be treated as full members of society.

Most feminists would agree with the above statements. Replace “women” with a more specific subgroup, however, and the statements become problematic.

I believe all sex workers should feel empowered to make their own decisions. I believe all sex workers should have access to health and safety as basic human rights. I believe all sex workers have a right to life. I believe all sex workers must be treated as full members of society.

Although not all sex workers are women, this community includes some of the most marginalized women on our planet. Many face legal repercussions for their line of work in places where it is defined as criminal behavior. They all face stigma in their daily lives, preventing them from accessing sufficient healthcare.

Regardless of one’s feelings on the profession – whether or not they would partake in the industry themselves – it is not my, or anyone’s, right to make this decision for another human.

Here’s why:

Promoting the abolition of sex work via criminalization is not effective.

Sex work is the oldest profession in existence. Many historical attempts to persecute those who participate in this ancient industry have not erased it. They have, rather, pushed it further into the margins of society where it cannot be regulated, putting the safety buyers and sellers at risk.

In environments where sex work is illegal, workers fall victim to abuse, often by those who are meant to protect the wellbeing of all citizens: the police. A U.S.-based voluntary sex worker confirms, “I’ve had to provide services more than once in exchange for not being arrested.”

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Bringing sex work into the open actually decreases trafficking and child exploitation.

Because prostitution is illegal in most countries, the most reliable data on the proportion of underage sex workers comes from places where the industry is legal and it can be studied openly, like New Zealand – where estimates put the figure of underage workers at only 3.5%. After legalizing prostitution in 2003, a study by the New Zealand Ministry of Justice found “no incidence of trafficking” five years later.

Voluntary sex workers are also natural allies in the fight against trafficking, based on their knowledge of the local network of individuals involved in sex work and the systems in which they operate. They often, thus, are able to refer trafficking victims to appropriate services. I can vouch for this firsthand.

In Cape Town, South Africa, I volunteered for SWEAT, a South African sex worker advocacy organization. In my time with the organization, I saw SWEAT service users identify a sex worker who had been trafficked from Zimbabwe. They subsequently brought her to the Saartjie Baartman Center for victims of violence and abuse, where she was able to take control of her and her daughter’s lives in a safe environment. She ultimately left the world of sex work, a profession she had not chosen for herself.

Promoting the abolition of sex work via criminalization is in no one’s best interest.

Sex workers operating in a criminalized environment cannot legally declare their occupation at most clinics. As a result, they often end up receiving insufficient care or inadequate sexual health education, leaving them unable to protect themselves and others from sexually transmitted infections.

Working in the absence of a regulated system also means sex workers cannot legally enforce condom use with their clients, which further facilitates the spread of HIV and other sexually transmitted infections and diseases amongst the community in which they operate.

Promoting the abolition of sex work via criminalization is not ethical.

GG_Liberty 3Engaging in sex work is the choice of the consenting individuals involved. If it is not consensual, then it should not happen. Voluntary sex work and sex trafficking are two different concepts, and should be treated differently – just like consensual sex vs. rape.

Fenton PostHuman rights should apply to all people regardless of age, sex, gender, occupation, sexual orientation or HIV status. It is my belief that one cannot be considered a true feminist if one is advocating against the rights of arguably the most marginalized women in most global societies. Whether viewed from a lens of compassion for others, or the preservation of personal freedoms, sex worker rights are human rights and should be upheld as such.

 

*Editors Note: Views expressed in this post aren’t representative of Girls’ Globe but rather the individual author.

Finding Perspective on World Water Day

Post Written by Jennifer Iacovelli

Three weeks after I realized my marriage was ending, I traveled to Nicaragua with WaterAid on an insight trip representing Mom Bloggers for Social Good. We visited the most remote areas of the country to see the work that WaterAid was doing with communities lacking clean water access and basic sanitation. It was a life-changing experience that allowed me to gain a tremendous amount of perspective.

I met women and teens who were trained by WaterAid to build wells and toilets for their communities. These were women whose husbands were typically away during the week working in the city, and teen girls who missed a tremendous amount of school, if they went at all, because of their household responsibilities. Fetching water from the river took up valuable time that they could have used to work or go to school. The training allowed them to not only gain valuable skills and earn money, but it also empowered them to become leaders in their community.

A few of the women even got to hire their own husbands for work when they needed extra help on projects. They beamed when they gave me this information.

I remember asking Linda what she purchased with the extra cash she earned by building and maintaining wells in her small community. She told me that she was able to purchase things like shoes and books for her children. Rarely did she purchase anything for herself.

I was struck by how similar I was to these women. While our circumstances were most certainly different, as mothers all we wanted was to provide for our children. To keep them happy and give them the basic things they needed in life.

Once my divorce was finalized, I started to focus more on taking care of myself. I joined a gym and decided that I wanted my physical strength to match my mental strength. After going through a tumultuous seven months, I was ready to take control of my life again. I did just that. The result? I gained more strength than I ever thought possible.

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Photo Credit: Wolfpack Fitness

Along the way, I found a caring and supportive community in WolfPack Fitness that didn’t judge me for my small size or marital status. I found a trainer that challenged me and showed me what my body was capable of. I found women and men who lifted each other up. I found a place where “like a girl” was not an insult.

WaterAid2
Photo Credit: Wolfpack Fitness

I also found a place where I could bring my passion for clean water for everyone. This past weekend we honored the strong, empowered women and teens I met in Nicaragua with a water-themed outdoor workout to celebrate World Water Day. We went #blue4water, wearing the color blue and turning our non-traditional gym equipment – cinderblocks, sledgehammers, tires and buckets – blue. We told a Nicaragua-inspired water story through our movements, even pushing a car up a hill to mimic how my team and I would often have to get our car going during our trip. Together, we raised $250 for WaterAid America.

My kids asked me the other day if I was stronger than their dad. They didn’t wait for an answer. They were already convinced I am. They see me work day in and day out to keep everything going. Though it’s not all that pretty or organized, I get the job done.

As mothers and women we do extraordinary things every day. I am thankful to have met Linda and the other women and girls in Nicaragua who are making the most of the opportunities in front of them so that they can live the best life possible. I only wish they didn’t have to live in an area where finding clean water and a toilet was such a challenge.

I hope you will join me in celebrating World Water Day by wearing blue and raising awareness of the fact that 650 million people around the world are still lacking access to safe, clean water.