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GUEST COLUMN |
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| The unheard voices |
| By Sonam Yangchen Rana |
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| Two factors in the Asia Pacific region look more overwhelming
than ever before: the rapidly rising rate of HIV infection and
the increasing feminisation of the epidemic. |
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| With 8.2 million people infected, Asia Pacific has more people
living with HIV/AIDS than any other region in the world except
Sub Saharan Africa. More than half a million people died due
to AIDS-related illnesses in 2004 and twice as many people were
newly infected during the same period - a disturbing epidemic
momentum, particularly in view of the fact that until the late
1980s no country in the region had a major HIV epidemic. |
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| What causes graver concern is the uneven rise of infection
among women. About one third of people living with HIV/AIDS
in the region now are women compared to about 20 per cent a
decade ago. In fact, the number of women living with HIV grew
by 13 per cent between 2001 and 2003. |
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| Women and HIV: the multiple jeopardy |
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| Surveillance systems tell us how the epidemic is spreading.
But what they often fail to tell us is that the spread of HIV
is closely linked to relationships and power dynamics between
individuals and within communities that are grossly unfavourable
to women. The low economic and social status of women; the endemic
abuse and violence against them; lack of recourse measures,
and limited legal and social protection increase their vulnerability
to HIV. For many women in the region, sexual intercourse is
not a question of choice, but rather a question of survival
and duty. A woman's fertility and her relationship to her husband
is often the source of her social identity. As the UN Secretary
General, Mr. Kofi Annan says, social inequalities put them at
risk - unjust, unconscionable and untenable. |
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| Dominant social constructs in the region dictate that a married
woman has little or no power to negotiate the nature of her
sexual relationship with her husband. We also know that increased
income alone does not lead to empowerment and autonomy of women
in the absence of legal, ethical and social environment that
will allow them to gain better control of their lives. |
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| More than half the new infections in the world are among people
of 15-24 years of age. Among them, women face the highest risk.
In addition, younger girls are increasingly being forced into
sexual relations and prostitution in an attempt by men to avoid
infection and also from a mistaken belief that intercourse with
a virgin can cure them of the virus. |
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| Another strong determinant in women's vulnerability to HIV
in Asia Pacific is the oppressive violence against them, which
range from homes to workplaces. Violence and HIV are mutually
reinforcing, both directly through rape and sexual coercion,
but also indirectly by predisposing women to risky behaviour
later in life. There is also growing evidence that HIV can be
a precursor to violence as women face retribution for disclosing
their HIV status. |
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| In Asia Pacific, the vulnerability of women also arises from
unsafe mobility and trafficking. In several parts of the region,
women are compelled to move within their countries and across
national borders in unsafe conditions and without adequate preparedness.
Such situations in many cases, lead to their being trafficked.
Studies on trafficking and HIV linkages show that one out of
three trafficked survivors are HIV positive. |
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| What is apparent, but unseen, is that unless the interaction
between HIV infection, cultural values and the rights and needs
of women are recognised, the fundamental changes required to
stem the epidemic will be unattainable. Where women are denied
dignity and respect, HIV/AIDS spreads. |
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| HIV and the Human Development Linkages |
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| One of Asia's major challenges in containing the epidemic
is also that a large part of its population live on the margins
of society and their vulnerabilities are not recognised: mobile
workers and their families, rural families clustered in urban
slums, sex workers, men having sex with men, injecting drug
users and women and children living and working under hazardous
or exploitative conditions. |
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| HIV is not random in its spread and impact. Bulk of the epidemic
burden is on the poor, the marginalised (sex workers, injecting
drug users, men having sex with men, migrant labourers and their
families and trafficked persons), the youth and women. This
is because social inequalities facilitate the spread of the
virus and the virus in turn reflects and reinforces these inequalities.
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| The learning from the last two decades show that HIV is not
just a "disease", but a manifestation of poor human
development and deep-rooted socio-economic and cultural factors
that we have failed to address over the years. There are many
more disconcerting factors that call for urgent responses. Key
among them are the intense stigma and discrimination and violation
of rights faced by people living with HIV/AIDS, lack of access
to treatment, inadequate leadership, lack of integrated responses
and shortage of resources. |
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| For instance a study by the Asia Pacific Network for People
Living with HIV/AIDS (APN+) showed that 80 per cent of the respondents
have experienced discriminatory practices. The rights violations
have been from moderate to repressive: from denial of treatment
and eviction from jobs to fatal assaults. On the treatment front,
as the latest UNAIDS report shows, fewer than 6 per cent of
people who require antiretroviral treatment are receiving it.
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| On the resource front, a recent ADB study says that in 2001,
the countries in the region required more than US $ 1.5 billion
to finance a comprehensive response, but had only 200 million.
From 2007, as much as US $ 5.1 billion will be required each
year. The brighter side of the coin, however, is the fact that
it is only 0.2 per cent of the regional gross income. |
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| HIV/AIDS is indeed a daunting challenge, but it also offers
opportunities. (There are success stories such as Thailand,
Cambodia, Uganda and Brazil.) It is not the first epidemic in
human history. Neither will it be the last. What sustains such
epidemics is poor human development. Needless to say, the answer
is good human development practice. |
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| The Millennium Development Goals (MDGs), that have become
a framework for development practice, recognises the impact
of HIV on human development by listing reversal of the epidemic
as a key goal. There is absolute consensus among sociologists,
economists and development practitioners that without achieving
the MDG on HIV, attainment of all the other MDG is in jeopardy.
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| That definitely does not augur well for global humanity and
we are left with only one choice: the choice of multi-sectoral
action that respects the rights of women, marginalised communities
and HIV positive people. |
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| The author is a senior UNDP official
and heads the UNDP Regional HIV and Development Programme in
Asia Pacific. |
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