Dr Sanjeev Kenchaigol | December 4, 2017
The United Nations Sustainable Development Goals (UNSDGs) have quite diligently covered issues of human well-being to achieve greater sustainable development in the years to come. Among the 17 goals, the third target is to achieve good health and well-being and signifies how good health is a fundamental and basic need that should be provided to each individual. Several studies on the status of this goal have indicated that preventable infant mortality and the maternal mortalities are the biggest health problems that the world is facing today. Lack of basic and affordable healthcare facilities significantly contributed to the poor health status in the developing world. HIV-AIDS is another endemic problem that has taken its toll on millions of people in Sub-Saharan Africa and South Asia, among other affected regions.
According to the latest report by UNAIDS (2017), there has been a 48% decline in deaths from AIDS related issues from a peak of 1.9 million in 2005 to 1.0 million in 2016 due to global pro-active action against the epidemic. Though studies indicate that more men than women suffer from the disease, AIDS related illness has remained the leading cause of deaths among women of reproductive age (15-49 years) anywhere in the world and the second leading cause of death for young women aged 15-24 years in Africa.
South Africa alone has nearly 3 million people on treatment more than any other country in the world. The recent UNAID data suggests that more than 90% of new HIV infections in Central Asia, Europe, North America, the Middle East and North Africa in 2014 were among the people from key populations (people who are sex workers, who inject drugs, transgender people, prisoners and gay men, among others) and their sexual partners. In the Asia and Pacific region, Latin America and the Caribbean, people from key populations and their partners accounted for nearly two-thirds of new infections. In sub-Saharan Africa, the key populations accounted for more than 20% of the cases.
Reported for its prevalence for the first time in Tamil Nadu in India in 1986, India has witnessed an estimated 86,000 new HIV infections in 2015. A technical report of Indian HIV estimates published in 2015 by the government of India suggests that the northeast states of Manipur, Mizoram and Nagaland and the southern states of Telangana, Karnataka, Tamil Nadu and Maharashtra have an adult HIV prevalence within the age group of 15-49 years that is greater than the national average. Increasing cases of HIV is found in places such as Assam, Chandigarh, Delhi, Jharkhand, Punjab, Tripura and Uttarakhand. The national average for adult HIV prevalence is 0.26%, with an estimated 0.30% men and 0.22% women affected by the disease. It is of utmost importance that the key populations be fully included in the AIDS programme. Data has shown that when such services are available within the environment free of stigma and discrimination, new HIV infections have declined significantly.
Social stigma, harmful gender norms and practices, cultural perceptions, and beliefs will affect HIV prevention and treatment. Particularly women face difficulties due to unequal gendered power relations and stigma. In the countries with high HIV prevalence, access to HIV elimination treatments remains weak, even when they are available. In 2013, 33% percent of pregnant women living with HIV globally did not receive antiretroviral (a WHO recommended medicine for treating HIV infected people) medicines to prevent new HIV infections among children. Many reports on women living with HIV infection strongly suggest that gender related cultural and economic issues can pose major barriers to women’s access and adherence to HIV treatment services. Alerted by such reports the Joint United Nations Program on HIV/AIDS (UNAIDS) undertook qualitative rapid assessment of gender related and cultural barriers to access HIV services and the assessments were done in partnership with women living with HIV at six sites in five high burden countries: the democratic republic of Congo, Ethiopia, Nigeria, India, and Uganda.
The barrier to access HIV services among others were found to be the lack of women’s autonomy over their sexual and reproductive health and was strongly associated with lack of uptake of maternal health services. For instance, a 2006 survey in India indicated that majority of women who did not attend the ante-natal care were prevented from doing so by their husbands and the family. Similarly, stigma among women living with HIV is widespread and severe. Existing studies have shown that women have deterred from accessing the services due to fear of abuse and mistreatment because of the stigma attached with HIV. For instance, according to an assessment study, a woman participant living in Ethiopia says:
For a man, the community says, let it be, “because he is a man”; if it is a woman, they say, “she is a woman, how come (she got the disease)? She must have been caught fooling around.”
In all the sites, as the study indicated, the participants felt that HIV infected woman should not get pregnant believing that the mothers would soon die and the baby would be born with HIV. In another case, in regard to access to services in the context of unequal power relationships, in India, a pregnant woman (with HIV status unknown) thus says:
My in-laws decide about (going to health care facility)… If I step out of home without permission, I will be yelled at. People in the village raise a finger at me, saying “what kind of woman is she who does everything on her own?”
Conversely, approaches that empower women and engage men in antenatal care appear to contribute in women’s utilisation of services to prevent new infections among children and keep mothers alive and healthy. In its 2013 review, the World Health Organisation (WHO) found that working with men and boys to promote gender equitable attitudes and behaviours is a promising approach to address the violence against women in the context of HIV. Support from peers and extended family in this regard helped women to access HIV and antenatal services.
In order to devise a systematic strategy to eliminate unequal gender relations related to HIV stigma and achieve the gross decline in HIV/AIDS, the approaches that include strategies such as: address the stigma related to HIV and increase access to services, address violence against women, adopt culturally appropriate, gender sensitive, rights-based approaches for transformation of traditional gender roles related maternal health and HIV services, address lack of awareness and mistrust of existing services to prevent new HIV infections among children and to mothers alive and healthy would prove a right direction in tandem with what the global agencies such as United Nations along with their partners have visualised and dreamt of in achieving the sustainable goal of Good Health and Well-Being which would rather be impossible without achieving Goal Five: Gender Equality.
Dr Kenchaigol is a programme officer at Public Affairs Centre, a not for profit think-tank.
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