Transcript Gender and HIV/AIDS in the LAC Region Women, Health and Development Program Pan-American Health Organization.

Gender and HIV/AIDS in
the LAC Region
Women, Health and Development Program
Pan-American Health Organization
The gap between the number of women and
men infected with HIV/AIDS is narrowing
In some countries in the region, the number of newlyinfected women now outnumbers men.
Trinidad and Tobago (2.5%)
Suriname (1.2%)
Panama (1.5%)
Jamaica (1.2%)
Honduras (1.6%)
Hait i (6.1%)
Guyana (2.7%)
Guat emala (1.0%)
Dominican Republic (2.5%)
Belize (2.0%)
Bahamas (3.5%)
# of Wom en
Infected w ith
HIV/AIDS
WHAT IS GENDER?
Gender is the social construction of the biological
differences between men and women
Gender is not “Sex”
Gender is not “Women”
Gender is learned, socially
determined behaviour
Gender is a focus on the unequal
relations between men and women
GENDER DETERMINES …
“MASCULINITY” AND
“FEMININITY”
(GENDER ROLES)
Roles, status,
norms, values
Responsibilities,
needs, expectations
Sexuality and Sexual
behaviour
GENDER
THE DIVISION OF
LABOUR, POWER AND
RESPONSIBILITIES
THE DISTRIBUTION OF
RESOURCES AND
REWARDS
Gender has a significant impact on:
Male and female sexual activity, vulnerability,
and risk behaviour
The transmission of HIV/AIDS in both
heterosexual and homosexual relationships
The differential experiences of infected and
affected women and men
Men’s Vulnerability to HIV…
Is derived primarily from their risk-taking behaviour…
Boys/Men are taught to associate prolific sexual activity
with masculinity
Young men have the greatest number of sexual partners
and feel least at risk from HIV/AIDS
Men are more likely than women to engage in substance
use, which is highly associated with more prolific sexual
activity and sexual violence.
Men are less likely to seek health care than women, since
they are socialized to believe that men do not get sick.
Women are more vulnerable to HIV
Physiologically…
Soft tissue in the female reproductive tract tears
easily, producing a transmission route for the
virus;
Vaginal tissue absorbs fluids more easily,
including sperm, which has a higher
concentration of the HIV virus
Women are more likely than men to have other
untreated STIs, a risk factor for HIV
Women are more vulnerable to HIV
Socially…
Women often cannot control with whom or under
what circumstances they have sex
Women are not always empowered to discuss use
of protection or the existence of other sexual
partners
Women have less access to sexual health
information and services
Women are more vulnerable to HIV
Economically…
Economically vulnerable women are less likely to terminate a
potentially dangerous relationship,
In economically desperate circumstances, women may
exchange sex for money, food or other favours.
Women’s economic dependence gives priority to the man’s
decisions on matters such as sexual relations, use of
protection, household spending on health and access to
health care,
Women employed in the informal economy, and women who
work at home are less likely to have access to health
insurance to cover the costs of testing, counseling and
prescription drugs.
Gender affects Women’s Vulnerability
Gender-Based Violence
GBV increases women’s vulnerability to HIV by limiting their physical
and mental freedom
Women have less control than their male partners over the
use of protection, distribution of resources and access to
health services, it’s more dangerous for them to refuse unsafe
sex
Women are the majority of rape victims, a direct risk factor for
HIV
Girls and boys who are victims of physical and/or sexual
abuse during childhood are more likely to exhibit high-risk
sexual behaviour later in life, lowered self-esteem, and
decreased ability to negotiate safer sex.
Gender affects Women’s Vulnerability
Commercial Sex-Work and Sex Tourism
Poverty, economic disparity and urban migration
are forcing women and men into commercial sex
work, often with tourists.
The interaction between the client/tourist and the
local people is frequently founded on economic
dependence and necessity.
Health insurance, information and services are
often out of reach of this crucial population.
Gender affects Women’s Vulnerability
Trafficking for Sexual Exploitation
Trafficked women present many of the same
vulnerabilities and risks for HIV as commercial sex
workers.
Their situation is complicated by the fact that they
are often unable to access health information and
services because:
– They are being held captive
– They are unfamiliar with their local environment, do not speak the
local language
– They are afraid of being deported
– They have been threatened with violence or deportation by their
traffickers, pimps, or brothel owners.
Gender affects Women’s Vulnerability
Migration and Displacement
Voluntary Migration…
Male and female migrants are isolated from family and
community relations and social support networks, and may
engage in sexual activity with sex-workers and/or multiple
partners
The marginalized status of migrants increases their
vulnerability to HIVAIDS
Cultural and linguistic barriers often prevent migrants,
especially indigenous men and women from accessing
health and social services
Gender affects Women’s Vulnerability
Migration and Displacement
Crisis, Forced Migration and Internal Displacement…
The risk of HIV transmission, barriers to care and women’s
burden of work are all increased during crisis and postcrisis periods.
The risk factors for HIV which are present in voluntary
migration (unprotected sexual contact with other partners)
continue to apply in periods of forced migration, or internal
displacement, but they are compounded by the
psychological trauma, economic deprivation and stress
which is associated with a crisis situation,
Gender affects Women’s Vulnerability
Migration and Displacement
Inter and Intra-State Conflict…
Rape has been used as weapon of war to degrade
and debilitate communities
Armed forces personnel of all types have a rate of HIV
infection between 2 to 5 times higher than the general
population,
Women and girls may, or may be forced, to ally
themselves with paramilitaries, offering sex in
exchange for money or protection
Women - Infected and Affected
Infected…
Women face a number of barriers to HIV prevention, testing and
counseling, including:
–
–
–
–
Embarrassment or fear of rejection and stigma,
Partner’s objection to testing
Lack of access to financial resources, time or transportation
Lack of access to reliable information or health services
Until recently, women have been excluded from most clinical
trials of antiretroviral therapy (ARV) and other drugs and
significantly more funds have been provided for research on
men.
Women’s differential access to medical care, counseling, and
information means that they are less likely than men to receive
accurate prognosis and treatment of HIV.
Women - Infected and Affected
Affected…
As the principal care-givers in the vast majority of homes,
women carry the greatest psychosocial and physical
burden of care for HIV/AIDS infected individuals
Care-giving is a 24-hour-a-day job for many women,
leaving them with little or no time to pursue their own
interests, continue paid labour or care for their own
physical and psychological health
Current trends in health sector reform shift more
responsibility for health care from hospitals and other
institutions to the home, and this shift is not gender neutral
Responding to Women’s Needs
Vertical or Mother-to-Child Transmission
(MTCT)
Female-Controlled Methods of Protection
The Female Condom
Microbicides
What do we do?
Recommendations and Program Responses
Empower couples to communicate and negotiate
openly about sexual needs, desires and perceived
risks.
Empower girls/women and boys/men by
increasing their access to education, literacy and
information about sexual and reproductive health.
Work with men to explore the effects of
masculinity, violence, power and control on
relationships and sexual health.
What do we do? (cont’d)
Improve sexual and reproductive health services for all,
their coverage, accessibility and gender sensitivity.
Create more male-friendly sexual and reproductive health
services. Women and men should be encouraged to
access health services and monitor their own risk factors
and behaviour.
Empower women to participate in community and national
decision-making about HIV/AIDS issues
Incorporate a gender perspective and sexual and
reproductive health services into crisis response plans, in
order to ensure that a crisis does not worsen the spread of
HIV.
What do we do? (cont’d)
Increase the advocacy for microbicides and develop more
female-controlled prevention methods
Address the impact of gender norms and stereotypes on
women living with HIV/AIDS and the barriers to services which
they face
Improve health workers understanding of HIV positive women’s
distinct physical and psychological needs.
Acknowledge that women are the primary caregivers within the
family and community, and that this work is unpaid.
Approach women’s health from a holistic perspective. Women’s
vulnerability to HIV/ AIDS is directly related to her gendered
social status
Work with key population groups which are at a high risk for HIV
transmission, including sex-workers, intravenous drug users,
men who have sex with men and adolescents.
What do we do?
For there to be any hope of success in the fight against
HIV/AIDS, the world must join together in a great
global alliance.
Kofi Annan