Women, girls, focus of the World AIDS drive 2004

Women, girls, focus of the World AIDS drive 2004

Nafsiah Mboi, Senior Consultant, National AIDS Commission, Jakarta

On March 8, Indonesians celebrated International Women's Day
(IWD) along with people in many countries around the globe. The
theme of IWD this year is "Women, Girls, HIV and AIDS".

If we look at the development of the AIDS epidemic in this
country and the way AIDS has moved across the globe it is clear
that discussion of this issue is timely. Indonesia's current
National AIDS Strategy (2003-2007) states that "Indonesia is
among the Asian countries experiencing an HIV/AIDS epidemic
where prevalence is escalating rapidly and shows no signs of
slowing down."

Thus, the Government of Indonesia, the UN "Country Team",
Indonesian women leaders, and community organizations have
welcomed this opportunity to highlight the multiple impacts of
AIDS on women and their crucial roles in responding to the
epidemic. Further, celebration of IWD 2004 will be used as the
occasion to launch Indonesia's participation in the World AIDS
Campaign 2004 with the same theme.

At the end of 2003 an estimated 40 million people -- men,
women, children -- were living with HIV/ AIDS. Women comprise
about half of all people living with HIV/AIDS today. In the age
group 15 -- 24 they represent an even larger proportion of the
total, an estimated 64 percent of young adults living with AIDS.

In some areas infection rates among adolescents are even more
skewed, infection among girls, running 4 to 6 times higher than
boys of the same age. Infection rates of women/ girls are
climbing at a faster rate than those of men.

In terms of absolute numbers, sexual transmission is the
primary cause of the spread of HIV/ AIDS in Indonesia. However,
recently a rising proportion of HIV infection has been associated
with injecting drug use especially among young men. The
practice of needle sharing among those injecting drugs is
extremely dangerous in the presence of HIV.

Once HIV enters a community of drug users, infection rates
rise steeply and rapidly. This represents an enormous danger to
the community at large as the men and women involved invariably
have unprotected sex with partners often spreading infection to a
wider public.

It should be noted that high infection rates from sexual
causes among women/girls are generally not because of their own
high risk behavior. Data shows that as many as 80 percent or
more of pregnant women who are HIV positive across the developing
world have only one sexual partner. Specifically among young
girls, infection is often acquired from unwanted sex -- sex they
dared not turn down lest they loose affection, status, support or
all three. Incidental studies in Indonesia show similar
patterns.

In many parts of the world, including Indonesia, both men and
women are placed at increased risk of infection by notions of
"femininity" and "masculinity" which dictate how they will
interact sexually. Boys/men are taught that experience with
multiple sex partners is part of growing to full manhood.
Girls/women have traditionally been socialized to defer to male
partners who expect and enforce such compliance.

Sex workers, unless protected by effective regulation, are
particularly vulnerable. Forced by their work to accept multiple
sex partners, they have little chance to protect themselves from
infection or, in fact, from gender-based violence, if a client
does not oblige.

But women's vulnerability to HIV is not exclusively social.
Women and particularly younger adolescents are physiologically
and anatomically particularly vulnerable to infection. A woman
having sex with an infected man is more than twice as likely to
become infected than a man having sex with an infected woman.
Furthermore, information about sex, sexually transmitted
infections including HIV, and ways to protect against them reach
only limited numbers of women/ girls.

But is infection the only way that women are affected by
HIV/AIDS? In every country touched by HIV/AIDS, women, in the
end, carry a double burden. They risk infection but particularly
in countries like Indonesia they also care for the sick, support
the healthy, and comfort the grieving in the home, the community
and often in health care settings. When infected herself, to
her other concerns is added worry about care of her children when
she is gone.

Generally, the situation of women becomes progressively worse
as more time is needed for nursing, more money is needed for
medicine, and less time and energy is left over for economic
activity. In Indonesia and around the globe, the spiral of
deprivation and poverty are accentuated by the social isolation
and discrimination which are often the lot of people known to be
HIV positive. In many cases HIV+ women cannot even get
appropriate care and treatment because they are shunned even in
health care settings.

Such discrimination can have an impact in the next generation.
Women may be deprived of needed treatment, for example, anti-
retrovirals which given to an HIV+ woman can protect her unborn
child from possible HIV infection before or during birth or
through breast milk. Women's advocates point out that such
treatment should be available to women (regardless of their
pregnancy status), as it is to men, for its known positive
effects in most cases delaying development of AIDS and improving
the quality of life.

What can be done? Experience indicates four key issues are
acceptance, empowerment, information and service.

Wide acceptance is needed by the public as well as community
and government leaders that AIDS is a challenge in their own
community, a challenge which can be effectively met but only if
full attention is given to the special needs of women/ girls.
In Indonesia this will require, among other things, significant
new effort to assure collection, analysis, and constructive use
of data disaggregated by age, sex, and location (Urban/Rural).

Empowerment of women is crucial. It has been achieved in many
places by increasing women's access to full and appropriate
information, education, opportunity for economic activity and the
development of effective support groups.

These can increase women's understanding of the risk of HIV,
desire to avoid infection, and skill in doing so. However, this
happens only where there is political will as well as changes in
public policy and public opinion, attitudes and behavior of men/
boys, as well as women/ girls.

Information has a crucial role to play in breaking the chain
of HIV infection. Given the importance of sexual transmission as
a driving force in Indonesia's epidemic, information targeted to
adolescent girls and boys and young adults must be a priority.
Young people need help learning to manage their emerging
sexuality in non risky ways.

They need to learn how to change their own behavior and their
interaction with each other to reduce high risk activity and
increase sexual responsibility among young men, to increase self
respect and assertiveness among girls/ young women. Peter Piot,
Executive Director of UNAIDS pointed out that "In every country
were HIV transmission has been reduced, it has been among young
people that the most spectacular reductions have occurred".
Abstinence has increased as has the practice of safer sex.

Improved services -- general health, reproductive health, HIV
counseling and testing, administration of anti-retrovirals among
others -- are crucial in the fight to control the AIDS epidemic.
Studies show that services need to be more "user friendly" and
more appropriate in content and must reach women/girls regardless
of whether they are married or single, HIV positive or free of
infection if the epidemic is to be controlled. There are many
possible entry points.

Women/girls are directly in the path of HIV/AIDS as it sweeps
through any community. Specific needs of women and girls have
been overlooked in dealing with the epidemic. If the power of
HIV/AIDS is to be broken in Indonesia, we must do better.
Women's concerns must have higher priority. International
Women's Day and the World AIDS Campaign 2004, should be used to
focus attention and mobilize new energy on that task.