Focus on women

MORE FOCUS needs to be placed on the crisis, National AIDS Council representative, Verity Rushton, opines. "Very little work is being done on women," she says, noting that the research in this area is far from adequate. "It is a growing trend that more young female adolescents are being infected, they are being infected by older men. There is no research on why they are having more relationships with these men."

She posits that the reasons could be financial. Many women are not in a position to say, "I would like to use the condom. He is the breadwinner, or he might be verbally abusive or violent."

The trend is the same in Africa where the spread of the HIV virus is at its highest. Gender inequality is fuelling the rapid spread of HIV with women divested of control over their lives and their bodies. Many women and girls are not in a position to say no to unwanted sex, nor can they negotiate condom use. The United Nations Development Fund for Women (UNIFEM) reports that in 2000, 1.3 million women died of AIDS and that over 16.4 million women today are living with HIV/AIDS.

"In Sub-Saharan Africa," the report said, "teenage girls are five times more likely to be infected than boys, since girls are mostly infected not by boys their own age, but by older men."

In Zimbabwe, a UNIFEM focus group revealed that of those who had experienced a negative income shock due to HIV, 77.6 per cent were female. Fifty-five per cent of all HIV positive adults in Sub-Saharan Africa are women. In the last three years, the per centage of people infected with HIV that are women has risen from 41 to 47 per cent. Many women are infected with HIV by their husband or intimate partner. A study in Zambia confirmed that fewer than 25 per cent of the women interviewed believe that a married woman could refuse to have sex with her husband, even if he had been demonstrably unfaithful and was infected. Only 11 per cent thought that a woman could ask her husband to use a condom in the circumstances. Transmission from men to women is two times more likely than from women to men. The risk is especially high in the case of unwilling sex with an infected partner since condom use is unlikely.

In Jamaica, the situation of women is similar to what occurs in Africa. More will have to be done in communities to change the types of behaviour that lend itself to women becoming victims of HIV.

The Caribbean Group for Co-operation in Economic Development reported in 2000 that "women are often economically and emotionally dependent on their male partner and are expected to defer to male demands and decision-making even when they know their partner may be infected through outside relationships." How can a woman who knows that her sole source of income may disappear if she demands condom rights set about changing her life-threatening situation?

Less bargaining power

Women, based on the fact that they earn less than men and are confined to minimum wage jobs, have less bargaining power. It is easier for a man to demand condom use, than for a woman to ask for it. Although the status of women is improving, they still do not have the financial independence that will permit them to make the best choices for their sexual health. They are dependent on men for housing, for emotional support and so compromise easier. For comfort, reassurance and love, for the welfare of their children, they compromise. Women who are heads of single parent households are at risk. They often engage in relationships with not one but two partners in order to support the child. Women in long-term relationships who consider themselves safer may not be. More and more housewives are being infected. For those engaged in risky behaviour, very often they do not perceive the risk. They say it's just two men. They engage in unprotected sex which may be anal or vaginal.

Cognisant of the problems many women face, the Ministry of Health has assigned workers to at risk communities, where women are helped to develop the communications skills they need to conclude a sexual transaction in their favour. Still, more resources may have to be poured into this effort, as the negative statistics indicate that current education efforts may not be effective enough. In other areas where the epidemic has taken hold, change has been effected through accelerated community intervention and education. UNIFEM studies in Senegal showed that the combination of availability, training in the use of female condoms and training in negotiating skills resulted in 80 per cent of the women being able to protect themselves from unsafe sex.

In Uganda, which has one of the most comprehensive prevention programmes in Africa, infection rates among educated women dropped by more than half between 1995 and 1997.

- File photos

A participant in a march against AIDS hands out condoms.

Caring through
CHARES

NURSE HOPE Ramsay, administrator in charge of C.H.A.R.E.S (Centre for HIV Research and Education Services) at the University Hospital of the West Indies, states that about 60 per cent of the 500-client case load of the centre is made up of females. About half die each year. Those who survive benefit from skills training and other support activities run at the centre.

"Women are more open to coming in for help," she said. "The men are in denial and also are more self-sufficient." Clients at CHARES are from the lower middle class and lower working class.

Nurse Ramsay explained that women are also more concerned about their children. They are driven to make arrangements to ensure that their children will be taken care of. Most also exhibit deep depression.

"It is not a depression which needs psychiatric care. Very often counselling helps," she said.

According to her, women are worried mainly about their children and about housing. They want to ensure that their children can go through school.

"Most of those who we have seen have been able to stay in their relationships. Anger is there, but through counselling they are able to have some reconciliation. We teach their families about transmission and about what is safe and what is not safe. We use video tapes and go in and train them on how to be caregivers without exposing themselves."

Most of the clients try to keep their jobs as long as possible. Others show great resourcefulness compared to many "men who just throw their hands up into the air."

CHARES runs a skills training programme for those who become unemployed.

"We encourage them to find markets for what they make. We are trying to empower them to help themselves. Eighty per cent of the centre's clientele fall into the category of need, but many are assisted by family members. Some receive nutritional supplements and anti-retrovirals from the centre. It is a big strain on us," she admitted.

The back-to-school period was predictably demanding. With the help for the National Aids Committee the association raised $50,000 to service over $100,000 worth of requests. Everybody was able to receive something. They paid the school fees of over 25 children and assisted with some books.

"I feel very encouraged," says Nurse Ramsay about her work with HIV positive women and children. "One family put out their child, and after four years of counselling, we got them to take her back. We have prevented others from committing suicide."

She is satisfied that CHARES as a support network, is serving as the support service that it was meant to be.

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