Ending Gender Inequality: A Key to Stopping HIV

Hi, my name is [PRESENTER NAME]. I’m [PRESENTER ROLE]. Welcome to “Ending Gender Inequality: A Key to Stopping HIV.” This video will discuss how gender inequality contributes to the spread of HIV and why ending it is a key to stopping the pandemic.  We will be addressing the gender inequality that exists in both the developed and developing worlds.  The issues we will discuss occur in both places.

Women are often advised to reduce their risk of HIV by abstaining from sex until marriage, being faithful to their sexual partner, and always using a condom. However, these recommendations do not address the social barriers women often face when it comes to HIV prevention.

For women in many cultures, particularly in the developing world, gender inequality denies them these options and leaves them at greatly increased risk of contracting HIV. Abstaining from sex won’t help a woman if she is raped by an HIV positive man. Guidance about mutual fidelity and using condoms won’t help if a woman is in an unequal marriage or relationship where she can’t get the man to agree to be faithful, use condoms, or not have sex. In cultures where women don’t have equal economic opportunity and the option of supporting themselves independently, women may find themselves trapped in abusive relationships to men who are unfaithful with either men or women, increasing their risk of acquiring any number of sexually transmitted diseases, including HIV. Any of these situations can also be found in the developed world.

Let’s look at these issues one by one and discuss how gender inequality and related problems are contributing to the spread of HIV.

Rape
If a woman has no control over her sexual rights, she is at increased risk of contracting HIV through rape. In most developed countries, if a woman is raped and knows her attacker, she can seek to have the attacker brought to justice through the legal system.  It is clearly not that easy and many cases are not reported or are tied up in the courts.  But in many parts of the world, legal systems don't exist or don't work. Women may be discouraged from using the legal system or be unable to afford its fees and the cost of an attorney. 

When there is no trustworthy, reliable, functioning legal system, the rule of law provides no protection and women are placed at increased risk of having all of their rights violated, increasing their risk of being raped and possibly contracting HIV.

Pressure to Have Sex or Marry for Cultural Reasons

In some cultures, women experience peer pressure to have sex with a man when they don’t want to. One example is a custom known as “sexual cleansing.” According to this custom, a woman whose husband has died is expected to have sex with a male relative to purify her. Additionally, she may be expected to marry a male relative. In either case, it is possible that one partner will expose the other to HIV if they are HIV positive.

Cultural Acceptance of Male Infidelity

There is often a double standard regarding fidelity in marriage: women are expected to be faithful to their husbands, but men are allowed or even expected to have additional sexual partners outside of the marriage. If the husband chooses not to use a condom when having sex outside of marriage, the woman may not be able to discuss it with him due to fear of physical or economic consequences. Obviously, such cultural expectations place faithful married women at high risk of contracting HIV. 

No Legal Definition or Enforcement of Marital Rape

A married woman must be able to refuse sex from her husband without fear of retaliation. If a legal system does not include a law defining marital rape or such laws are not enforced, a woman may find herself  unable to refuse sex with her husband, which will increase her risk of contracting HIV.

Domestic Abuse

In some cultures, there is acceptance of domestic violence. A study in South Africa showed that “Women with violent or controlling male partners are at increased risk of HIV infection.” 

Unequal Property Rights

When a woman’s husband is unfaithful, refuses to use condoms, is abusive, and insists on having sex anyway, a woman’s best option to protect herself may be to separate and seek a divorce. But if legal systems favor the husband in the case of divorce, women can become trapped in abusive or dangerous marriages and may face loss of all marital assets and income. When women have equal status in a marriage and are able to negotiate terms for safer sex with their husband as an equal, they can markedly reduce their risk of contracting HIV.

Economic Inequalities
Women often experience economic inequalities. They may out of sheer desperation turn to commercial sex work to pay for food for themselves and their children. Commercial sex work places a woman at a greatly increased risk of contracting HIV and transmitting it to clients and to any children she bears thereafter. Women need to be provided equal economic opportunity with men to reduce the pressure to turn to commercial sex work for survival.

HIV Stigma and Discrimination

Women who suspect they may be HIV positive and want to seek testing may be deterred by the fear of stigma and discrimination, which are some of the most insidious factors that help spread HIV. Even if women have the option of getting tested, counseled, and treated, possibly saving their own life, their partner’s life, and the lives of any future children, they may choose not to do so out of fear. The spread of HIV will not be stopped until every person who wishes to be tested feels free to do so.

Let’s finish by reviewing some of the most important lessons from this video. HIV thrives and spreads in an environment of gender inequality, stigma, and discrimination. By improving the rights and opportunities of women both in the developed and  developing worlds,  we can make progress in the fight against HIV.
No matter who you are, you are a valuable individual, and your life matters as do the lives of those in your community. Take care of yourself and those around you. As you take a stand for women’s rights and gender equality, you also take a stand against the stigma and discrimination that contribute to the spread of HIV.
Thank you for your help in the fight against HIV. This is [PRESENTER NAME].

Script by Eric Krock of AIDSvideos.org and Becky Kuhn, M.D. of Global Lifeworks. 

This script was reviewed for accuracy and approved by Becky Kuhn, M.D. on July 30, 2011.

WORKS CITED
AVERT.org. “Women HIV & AIDS.” http://www.avert.org/women-hiv-aids.htm. Accessed 30 July 2011.
AVERT.org. “HIV & AIDS Stigma and Discrimination.” http://www.avert.org/hiv-aids-stigma.htm. Accessed 30 July 2011.
Dunkle KL, et al. "Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa." The Lancet, Volume 363, Issue 9419, Pages 1415 - 1421, 1 May 2004. doi:10.1016/S0140-6736(04)16098-4. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16098-4/fulltext Accessed 30 July 2011.
LaFraniere, Sharon. “AIDS Now Compels Africa to Challenge Widows’ ‘Cleansing.’” 11 May 2005 New York Times. 
FOR MORE INFORMATION
World Health Organization, “Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants in Resource-Limited Settings: Towards Universal Access,” 2006 version, http://www.who.int/hiv/pub/guidelines/pmtct/en/index.html