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Epidemiological data
For the
past several years, the data shows an increase in the cases of AIDS
diagnosed in women, while at the same time, the number of cases diagnosed
in men is decreasing. In the general population, the sex-ratio of AIDS
cases (= number of masculine cases for a feminine case) went down between
1999 et 2000, passing from 3,2 to 2,7.
This phenomenon is to be crossed with other data, to make it more relevant:
 a preponderance
of heterosexual contamination
a strong increase
in the number of cases diagnosed in African women.
Heterosexual contamination
Heterosexual
contamination is the most frequent means of contamination among the
cases of AIDS diagnosed since 1997. In 2000, it represented 44%
of diagnosed AIDS cases. Furthermore, among the heterosexual cases diagnosed
in 2000, the contamination the most probable for the partner is also
attributable to heterosexual relations in 67% of cases (unknown: 30%
of cases, sharing syringes: 3% of cases, homosexuals relations of the
partner: 1% of cases).
Also, among people who know their serology status, it was shown that
women received a preventive antiretroviral treatment less often than
men (58% of women and 52% of men for which the means of contamination
is heterosexual are in this situation).
Why
are women so vulnerable?
This epidemiological
data clearly says that, in the case of transmission during heterosexual
relations, women present a greater vulnerability than men. This
vulnerability is explained by several factors:
Direct
factors of a biological and physiological order: a larger surface of
mucous (vagina and col of the uterus) and the fragility at the level
of the col facilitates the penetration of HIV. This fragility is aggravated
on the one hand with the occurrence of MST, which often remains untreated
(as it is not visible) and on the other hand in the scope of undesired,
violent and traumatizing relations. Finally, the concentration of HIV
is higher in sperm than in vaginal secretions.
Indirect factors
linked to sexual, cultural and legal norms, but also to social and economic
contexts: the inequality of status, insecurity and socio-economic dependence,
the taboos that guide feminine sexuality (in particular in certain cultures)
account for as many determinants as the risk taking.
Doctor Erica Gollub, Scientific Director of the HIV contamination risk-reduction
program carried out in the scope of the EMIPS in the Bouches du Rhône
defined the criteria of vulnerability of women to HIV/AIDS like
this, in addition to the criteria of biological vulnerability:
POLITICAL
VULNERABILITY
Lack of political representation; health politics is often planned without
feminine representation or consideration; women's needs for good health
is hardly recognized; string gap between family and social responsibilities
of women and the political power exercised; discrimination in the workforce;
the violence they are subject to …
ECONOMIC
VULNERABILITY
Unpaid and unrecognized for their work in the home and with their children;
paid less than men; women are not welcome in certain professional fields
and are the first to be fired during times of crisis, which renders
the majority of them dependant; they have less possibility / capacity
to end unwholesome, dangerous, violent relations; cases of prostitution
to live …
INFORMATIONAL
/ EDUCATIONAL VULNERABILITY
Lack of sexual education, discouragement of women to know their body
and seek pleasure, to take care of herself, … Absence of incitation
to girls to do sports, to acquire confidence and pride in their body;
lack of good resource people for young people (people who aren't themselves
embarrassed by these subjects) …
CULTURAL
/ SOCIAL VULNERABILITY
Social sex roles; dependence instilled for decision making; it seems
to be the norm that women shouldn't take the initiative, that she should
be submissive, should please men, that she doesn't have her own value
(unmarried or without children …).
The difficulties and obstacles faced by women faced by HIV/AIDS.
1.
In the elaboration of a personal strategy of risk-reduction.
Certain
elements are and obstacle to the reinforcement of a woman's capacity
to reduce her risks. Indeed, there are situations and factors specific
to women that can be classified into 3 major typologies :
General
difficulties.
Women need more time to speak about and to put words on their sexuality
(a woman's sexual organs are hidden as is the expression of her sexuality).
Also, speaking about herself is often secondary: a woman speaks first
as a mother, a wife, an ill women, etc. This mode of access to a voice
of course diminishes the possibilities to consider a woman's global
life trajectory. Finally, the need for more time is even more important
as it is written in an historical process having caused women to be
deprived of their voice for a long time. In conjunction with this privation,
there exists an unfavorable socio-economic context in relation to men
(dependence on a man, language obstacle more important non-integrated
foreign women, etc.)
A context
of violence.
In general, many women are subject to multiple situations of violence,
starting with the violence in the couple. This phenomenon can only accentuate
the fragilities of women in their construction of a personal risk-reduction
strategy.
The
obstacles linked to the selection available of prevention tools.
The prevention tools available for women are too limited: the feminine
condom has been available in France since June 1998, but
it is far less available than the masculine condom (few pharmacies sell
it and its price is high: environ 2 ). Also, there is still no
effective virucide available.
NB: the limitation of the selection available of prevention tools isn't
specific to women, but it has more serious consequences for women (the
masculine condom being most often controlled by the man).
2. In
the access to healthcare for women infected with HIV.
There exists
a real difficulty of consideration of the specificities of the HIV infection
in women. Seropositivity creates an increased risk of occurrence of
pathologies and of specific difficulties concerning women (osteoporosis,
hormonal irregularities, uterine cancer, metabolic troubles …). Also,
real difficulties are noticed with health professionals (including HIV
specialists) for gynaecological coverage of seropositive women.
Annexes:
Articles
and files that can be consulted on the internet :
Cathi
Albertyn "The law and human rights to reduce women's vulnerability
to HIV" (" Le droit et les droits humains pour réduire
la vulnérabilité des femmes au VIH ") in: The last
will be the first - crucial legal themes and HIV/AIDS (Les derniers
seront les premiers - thèmes légaux cruciaux et VIH/sida),
Conference in Durban - July 7, 2000
CCathi
Albertyn is a Professor and head of Gender Research Project, Center
for Applied Legal Studies, University of the Witwatersrand, Johannesburg,
South Africa.
In her article entitled "The law and human rights to reduce women's
vulnerability to HIV ", she asserts that personal rights and the
law can play an important although limited role at the heart of a set
of national and international strategies to reduce the vulnerability
of women to HIV. She analyses the nature of women's vulnerability to
HIV/AIDS, then highlights certain issues and lessons of recourse to
these elements to help equality progress between the sexes and to reduce
women's vulnerability faced with HIV/AIDS.
This article can be consulted at the following address:
http://www.aidslaw.ca/francais/Contenu/
docautres/bulletincanadien/Vol5no42000/f-durban2000femmes.htm
Geeta
Rao Gupta " Gender, sexuality and HIV/AIDS - What ? How? Why?"
(" Genre, sexualité et VIH/sida - Quoi ? Comment ? Pourquoi
? ")
Speech given at the international plenary conference on AIDS in Durban,
July 12, 2000.
Doctor Rao Gupta discussed vulnerability factors of women to HIV, then
the manners by which the imbalance of power in gender relations increase
not only women's vulnerability to HIV, but also men's vulnerability,
despite- or rather because - of their greater power. She then asked
herself how it would be possible to overcome the apparently insurmountable
barriers that are the inequality of gender and of sexuality. How to
modify the cultural norms which create disparities and harmful, even
fatal roles? According to Mme Rao Gupta, an important first step is
the acknowledgement, understanding and public discussion of the ways
by which the imbalance of power, to the chapter on sexuality and gender
relations, worsen the epidemic. She gave some examples of sensible approaches,
enabling and favorable to change, then she concluded that in the final
analysis, the reduction of the imbalance of power between women and
men requires policies conceived to give power to women - policies which
target reducing the gulf between genders concerning education, to improve
women's access to economic resources, to increase women's political
participation and to protect them against violence.
This article
can be consulted at the following address:
http://www.aidslaw.ca/francais/Contenu/docautres/
bulletincanadien/Vol5no42000/f-guptadurban2000.htm
The
ONUSIDA report on the situation of epidemic diseases in France in 2000
:
http://www.unaids.org/hivaidsinfo/statistics/
fact_sheets/pdfs/France_fr.pdf
The ONUSIDA
report on the situation of epidemic diseases in the world in December
2001 :
http://www.unaids.org/worldaidsday/2001/Epiupdate2001/
Epiupdate2001_fr.pdf
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