HIV/AIDS is now the leading cause of death worldwide in women of reproductive age. UNAids has launched a five year plan to deal with the gender inequality and human rights violations behind this epidemic.
The plan by the joint United Nations Programme is called Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV (2010-2014).
One of the main drivers of the epidemic is violence against women. According to the factsheet, some 70% of women worldwide have experienced violence. Country studies indicate that women suffering it have a risk of becoming HIV positive three times higher than women who haven't. In South Africa, UNAids say, a woman is raped every minute. Forced sex increases the risk of infection through tears and lacerations. Too often, violent crimes against women and girls are committed with impunity. Violence against women is one of the clearest indicators of gender inequality and the status of women in a society.
There are many social and cultural factors that put women at risk. For example, in some countries it's common for men to have sex with much younger women. In some settings (for example Southern Africa) this contributes to a three times higher infection rate for women 15-24 than it does for men the same age. In the Caribbean, young women are around 2.5 times more likely to be HIV infected than young men. Men are expected to have multiple sexual partners and often refuse to use condoms.
Women are likely to have problems accessing HIV prevention, treatment and care services due to limited decision-making power, lack of control over financial resources, restricted mobility and child-care responsibilities.
When their partners die, many women lose their homes, inheritance, livelihoods and sometimes even their children. Many of them are forced to become sex workers to survive.
Lack of education can also be a barrier both to avoiding infection and to living with it. Two thirds of the children not in school worldwide are girls and two thirds of illiterate adults in the world are women. In Africa and Latin America, girls with more education tend to delay their first sexual experience and are more likely to insist that their partner uses a condom.
The Agenda contains plans to
- produce better, evidence-based, research and data on the specific needs of women and girls and the socio-cultural and economic factors that prevent them effectively protecting themselves
- push governments to act on their stated commitment
- work with key strategic partners
- support women's groups and networks
- encourage men's organizations to support the rights of women and girls.
- work with influential religious leaders to use their influence to support the rights and needs of women, to reduce the stigma of HIV and the right of women to live without violence
Many governments have made a commitment to improve human rights and gender equality for women but so far have done little or nothing about it. The Agenda will encourage them to reform and enact legislation to guarantee impartial, immediate and serious legal consequences for acts of violence against women - including rape both within and outside of marriage.
UNAids recognises that it's essential to work with women, using their experience, knowledge and expertise to help them take control of their own HIV prevention. A lot of these women are marginalised, living with HIV, sex workers, disabled women, women of diverse sexual orientation, migrants, refugees, drug users, racial and ethnic minorities, women in prison and so on.
Changing the attitudes and behaviour of men and boys is another essential part of prevention. This could prove difficult as ideas are so deeply entrenched in many cultures of gender roles, identity, status and rights. Any incentive to change needs to be framed in terms of improving men's health and other social benefits as well as improving women's lot. Strongly patriarchal societies are not going change easily.
Despite the intention to work with religious leaders, there is no mention in the Agenda that it will address the promotion of abstinence as the first and only defence against infection or the opposition of the Catholic church and some evangelical churches to condom use. This is a major problem in some parts of the world, denying information and even lying about the effectiveness of condoms. It also means that many people have to choose between their faith and their health. Religion in some areas also clearly casts women as second class citizens, worth less than men.
Although the Agenda focusses on the developing world, this is not a problem exclusive to those areas. For example, it is acceptable in most parts of the world - and even expected - that young men will have multiple sex partners, many men still refuse to use condoms, many young women are not well-informed about infection risks and sex education in some countries (including the UK) is patchy at best.
Violence against women is not limited to the third world either. Statistics for rape convictions are still depressing reading, date rape and marital rape are contentious areas, it is only comparatively recently that the law in the UK started paying serious attention to spousal abuse and some religious groups still promote the idea that women should be subservient to their men (the latest edition of The Freethinker carries a story about two vicars preaching that women should be subservient to their husbands and one of those stories is reported in The Guardian).
The UNAids Executive Director said: "Violence against women is unacceptable and must not be tolerated. By robbing them of their dignity we are losing the opportunity to tap half the potential of mankind. Women and girls are not victims, they are the driving force that brings about social transformation".