The enemy within - Moniza Inam analyses the growing phenomenon of ‘feminisation’ of Aids

Now a widow and a mother of three young children, Najma Bano’s life changed last year after the death of her husband from whom she contracted the HIV virus. Her deteriorating health is coupled with no steady source of income and consequential social isolation and stigma.

A former pilot, who expired from Aids soon after his marriage, also has a widow Meher Ali in her 20s, who too has contracted the virus. Meher’s in-laws hold her responsible for their son’s death and have banished her from their home. She is currently in a prolonged legal battle to receive her rightful share of inheritance.

Now divorced, Naila Baloch, a 30-year-old woman living in Gwadar, has contracted the virus from her husband who worked in the Gulf. Upon learning of her health status, he divorced her and remarried a younger woman.

These women are casualties of the feminisation of Aids, a state of affairs where poverty, cultural practices and bigotry supplement one another to undermine the well-being of women. Dr Naseem Salahuddin, an infectious diseases specialist at Indus Hospital, Karachi, considers these women as the innocent bystanders as they acquired the disease passively through transmission from their spouses.

A recent study estimates that in the South Asia a staggering 40 per cent of the new HIV/Aids cases are women. Social exclusion, discrimination and denial of rights have contributed to this rising menace, whereas solution for reducing HIV statistics cannot be approached in seclusion to these issues.

Important factors including poverty, cultural practices, promiscuity, violence, legal structures and physiological factors, all contribute to rising numbers of HIV female patients. Perhaps more important than these factors is the issue of gender equality and disparity of power between men and women. A research by World Bank strongly concludes that ‘the more unequal the relations between men and women in a country or region, the higher its HIV prevalence rate; as it is largely fuelled by gender-based vulnerabilities and risks’.

Huma Khawar, a development journalist adds to this view, “Gender inequality, poverty and HIV/Aids are closely associated with each other. Young women from the age bracket of 15-24 years are more prone to the infection compared to the men from the same age group due to many reasons.”

Girls and young women usually lack access to appropriate information and resources to take preventive measures. Violation of women’s rights and asymmetrical power relations result in exerting less control over their bodies, and choices regarding sexual and reproductive health and rights. Being economically dependent, they are deprived of the liberty and control needed to make informed decisions about their health.

Research has proved and confirmed a strong correlation between various forms of abuse and its link to contracting the virus.
Violence against women often results in non-consensual, unsafe sex which increases the likelihood of transmission. Inequality in relationships and power dynamics prevent women from asking their partners to use safe measures, get tested and seek treatment, explains Khawar.

This phenomenon is a direct consequence of unequal power and gender relations prevalent in our society, whereby women receive less education, healthcare, employment and decision making power in an average household. Elaborating the issue, Farhat Firdous, senior manager communication at Aahung, adds, “Apart from pervasive discrimination, women face gender subordination in marital life. They are supposed to submit their body and soul to their husbands even if they are terminally ill, suffering form STIs (sexually transmitted infections) or in the extreme cases, Aids.”

Dr Tahira Aftab, former Director of Women Studies Centre and founding editor of Journal for Women Studies/ Alam-i-Niswan, describes such marital relations as sexual slavery, and adds, “The emerging epidemic of the HIV/Aids is a direct result of this school of thought in which women have no control or rights over their own bodies.”

Economic and social empowerment is yet another factor in the prevention of the virus among women. Due to the patriarchal organisation of society, girls are provided with little or no education and are married off at an early age. This dependence can force women to accept the sexual demands of unfaithful husbands and even if they are aware that their husbands are infected they cannot move out of the relationship.

Dr Nashmia Mahmood, a health officer with Unicef, says, “Financially independent women who are aware of their rights, and can make their own decisions are much more capable of protecting themselves against the virus.” However, Mahmood has also stressed the importance of legal protection as it would help the vulnerable groups, including women, significantly. She cites the Malaysian model as a best example in which men are legally bound to disclose their HIV/Aids positive status to their wives.

Dr Shazra Abbass, a health officer on HIV/Aids with Unicef, concurs with this model and adds that the disease, in fact, has become an issue of gender equity and equality as women’s rights are, by and large, violated in our society. Initially information about reproductive health and the virus is not given to them due to social and cultural taboos and eventually if they are infected the treatment is denied and female patients have to face prejudice, exclusion and in some cases they are even thrown out of the house.

Gender inequality is indeed an overriding issue which has aggravated the spread of HIV, and stalled controlling the feminisation of HIV/Aids. Women’s health should not be compartmentalised and it should be looked at on a broader and structural level keeping in view all such underlying factors.