The United Nation states that in many parts of the world women are most likely to be exposed to HIV infection in their marriage beds. Women’s fertility and her relationship to her husband are often the source of an Indian woman’s social identity. Besides biological influences, the HIV/ AIDS epidemic in India is inextricably tied to the cultural and social values and economic relationships between men and women and within communities. While social inequalities facilitate its spread in India, the HIV virus, in turn, reflects and reinforces these inequalities.
“There are many social precursors for the rapid spread of HIV in the country, including the inability to talk openly and learn about sex and sexuality, pressures from family to give birth to an heir and an implicit threat to the marriage when a woman is unable to become a mother, the high prevalence and acceptability of domestic violence against women, the moral double standard imposed on men and women, and the lower status of women in general. The pressure to be a mother is so intense that when a woman has to choose between being HIV-seronegative but without children and possible conception with possible HIV infection, she often chooses the latter.” (S.Solomon and A.K.Ganesh, 21)
For a majority of people in India, it is still hard to believe that heterosexual transmission accounts for 80 percent of all infections. Generally speaking – 39 percent of PLWHA (people living with HIV and AIDS) in India are women. Data indicates that 7 of 10 women affected by HIV are from poor rural and poor urban communities. Yet, at least 70 percent of women in rural areas have not heard of the virus. The only sexual contact 75 percent of HIV positive women have had is with their husbands.
Why are women in India more likely to be exposed to HIV infection than men? Let’s look at the major factors:
- Male-to-female HIV transmission occurs more easily. Young girls and women are more susceptible to HIV than boys and men. In numbers, it means that they are 2.5 times more likely to be HIV-infected as their male counterparts.
- Women are more likely to be sexually exploited. Statistics show that 1 of 3 women around the world is raped, beaten, coerced into sex, or otherwise abused in her lifetime. A strong link was established between unwanted sex and marital violence.
- Women are generally less educated. According to the International Women’s Health Coalition in India, if HIV and AIDS education is even offered in schools, it is to young people 15 years and older. Yet 42 percent of boys and 69 percent of girls (15-17) are not in school. Even the so-called educated women are not aware of HIV and AIDS. There are myths prevalent about sexually transmitted diseases (STD) such as having sex with a ‘virgin’ can cure a man suffering from STD and many believe that certain symptoms of STD such as white discharge is the effect of body heat or overwork and do not go for check-ups.
- Women have fewer rights. The general standard of life of Indian women is lower than that of men. Often, a HIV positive woman is subjected to greater levels of hostility and stigma than their male counterparts.
- Women have less economic independence. The economic vulnerability of women makes it more likely that they will exchange sex for money or favors and less likely that they will succeed in negotiating protection.
- Some traditions are harmful to women. In many rural areas, there are traditional forms of sex work. One such example is the tradition of the devadasi, in which young women are “married” to a temple or deity and then provide sexual services to patrons and priests. In India, 27 percent of male clients of male sex workers are married or living with a female partner.
- Men determine sexual behaviour. Indian society praises patriarchy and male sexuality. There is an absence of choice at the individual and systemic levels for women. It is difficult for women to be informed about risk reduction.
Prevention of HIV transmission is hindered by gaps in knowledge and by cultural, legal, and medical factors. In 2004, only an estimated four percent of all pregnant women received HIV counseling and testing, and only about two percent of HIV positive pregnant women received antiretroviral prophylaxis. This tendency is supported by the fact that many deliveries are not attended by medical personnel.
The most common method of contraception in India, particularly in the south, has historically been the sterilisation of women, typically done before they turn 30. In Andhra Pradesh, female sterilisation is used for family planning by 62.9 percent of married women and condoms by only 0.5 percent. Advocating the use of condoms has been viewed as promoting promiscuity. The acceptance, availability, and use of condoms are increasing, but primarily among sex workers and outside of marriage.
Mortality and morbidity data indicate that women in India remain providers rather than receivers of health care. Shalini Bharat of the Tata Institute of Social Sciences (TISS), Mumbai, revealed in a 2001 study that while the majority of those who shared their HIV status with their families were looked after by family members, it was largely men who received such care.
Women with HIV are often subjected to various forms of violence and discrimination based on gender. Usually they are those ones considered responsible for a husband’s HIV diagnosis. They are often refused a share of household property, denied access to treatment and care or even physically abused. Deaths due to injury and sexual violence of women with HIV are on the increase. A study by K. Sathiamoorthy and Suniti Solomon showed 48.7 percent of women living with HIV experienced violence in their home.
In the last few years, prevention experts have shifted from looking at the HIV and AIDS epidemic solely as a health issue to focusing on other factors. Focus on social inequalities and empowerment is important in dealing with HIV and AIDS.
Empowerment is the key
Health officials in India recognize the need to frame strategies to address women’s health care, including HIV vulnerabilities, in the context of rights. Generally there is a need to deal with a virus which is more dangerous than HIV. It is the virus which is affecting people’s minds and cultures and makes us look at women as inferior to men.
Besides the importance of safer practices, abstinence and voluntary testing, empowerment of women is essential. There is a need to design policies to empower women in India. Decreasing the gender gap in education, improving women’s access to economic resources, increasing women’s political participation, and protecting women from violence are key.
Happonen O. Hannu, Opportunity in crisis. Basic Lessons on HIV and AIDS.
Maria Cimperman, When Gods people have HIV and AIDS. An approach to ethics. New York, 2006
Suniti Solomon, MD, and Aylur Kailasam Ganesh, ACA, Special Contribution – HIV in India. Volume 10 Issue 3 July/August, 2002