Cover Image
close this bookAgenda for Action: Background Materials to the 4rth World Conference on Women (UNAIDS, 1995, 9 p.)
View the documentSummary
View the documentIntroduction
View the documentHow HIV/AIDS is spreading among women
View the documentEconomic subordination leads to HIV vulnerability
View the documentFemale biological vulnerability to HIV
View the documentImpact of HIV/AIDS on women
View the documentResponding to reality: agenda for action
View the documentDr Eka Esu Williams, Nigeria
View the documentReducing the vulnerability of women to HIV/AIDS
View the documentReducing the impact of HIV/AIDS on women
View the documentCaring for women with HIV/AIDS
View the documentConclusion
View the documentAnnex

How HIV/AIDS is spreading among women

Sexual subordination leads to HIV vulnerability

1. In many societies, there is a significant power differential between men and women, supported by social and cultural systems that posit the control by males. Males are expected to initiate relationships, and sexual assertiveness in women is often stigmatized or punished. The gender power differential is compounded by age differences. Women typically marry or have sex with older men, who have been sexually active longer and hence are more likely to have become infected themselves. In countries with high HIV infection rates, men justify the selection of young adolescent girls, even female children, on the grounds that they are less likely to be infected with HIV/AIDS.

2. Many countries which promote monogamy and mutual fidelity, and discourage multiple casual partners as a societal norm, have also encouraged these values as a primary AIDS prevention strategy. Some societies, however, expect women to adhere strictly to this norm while tacitly condoning male deviation from it. Women are expected to have one lifetime sex partner while men are expected, or even encouraged, to have more than one partner. As a result, women are more likely to be monogamous than men and to have fewer lifetime partners. Reliance on monogamy or mutual fidelity as a principal solution can be misleading for women, as fidelity protects against HIV/AIDS only if it is completely mutual and life-long. It creates an illusion of safety for individuals who are monogamous but who cannot be certain about their partners. For example, a situation like this develops. If your man comes home at 3 a.m. smelling of a perfume you don’t recognize, that’s the time he’s going to ask for sex because he’s trying to clear his conscience by making you think he hasn’t already had it. But if he goes out drinking with the boys, he comes home and goes straight to sleep peacefully. You have to go along with whatever he asks, even if you’re smelling this strange perfume, because you cant say no.

3. In some cultures, women don’t have the permission to talk about sex with men, or to negotiate safer sex practices. To do so may have serious repercussions, ranging from stigma to fear of violence or abandonment. Despite this, many HIV/AIDS prevention and family planning programmes have expected women to assume responsibility for the prevention of both pregnancy and sexually transmitted diseases (STDs), including HIV infection, in a context in which they have limited control over when, with whom, and how they engage in sexual activity.

4. Male resistance to condom use and women’s inability to negotiate safer sex puts women (as well as men) at greater risk of HIV infection. For men, the rationale for resisting the use of condoms includes concern about reduced sensitivity, ignorance about how to use the condom properly, and fear that using it will permanently interfere with fertility. In addition, within marriage or other long-term relationships, the very suggestion of condom use carries with it an indication of infidelity or other behaviour that could threaten the security of the relationship, making it difficult for both men and women to introduce condoms into an existing relationship.

5. Some countries have statutory or de facto restrictions based on age or gender regarding access to information about sexuality, contraception, disease prevention, condoms and lubricants, and health care. In many communities, schools and other institutions that work with adolescents are wary of providing sex education or otherwise discussing issues related to sexuality, due to social and cultural concerns about protecting young women from sexual experience. As a result, young women and men lack adequate information and skills to protect themselves if they are sexually active. In addition, children and adolescents, in some countries, must have a parents permission to obtain health care services. This is a particular problem for young people who have left home or are homeless.

6. Women are also vulnerable to coerced sex, including rape and other sexual abuse, in and outside of the family, and forced sex work. Any non-consensual penetrative sex can carry an increased risk of transmission of HIV and other STDs, particularly as men who rape are not likely to use condoms. Moreover, even when sex is non-consensual, women are often stigmatized and blamed, causing them to be ostracized from family and support networks. The problems associated with rape and other forms of violence against women are often intensified in war situations, in which occupying or invading armies, systematically rape women as part of a strategy to intimidate the local population.

7. In all countries there are customs related to women’s sexual activity. Some have become deadly in the AIDS era, such as ritual intercourse with a male relative in the event of death of the husband. Traditional practices such as female genital mutilation, ritual scarification, tattooing and blood letting can also, if performed with unsterile equipment, result in infection.