Analysis: HIV progress blunted by discrimination and sexual violence
Gender discrimination, sexual violence and poverty are undermining global progress in tackling HIV/Aids, Amnesty International said on World Aids Day. Women are at greater risk of HIV infection and HIV has a particularly devastating impact on women and their families. Unless these gender disparities and their underlying causes are adequately addressed, efforts to reduce the spread of HIV and address its consequences will be woefully incomplete. The picture at the end of 2009 is, in some important respects, a positive one. UNAIDS, the Joint United Nations Programme on Aids, reports that new HIV infections are down by 17 per cent over the past eight years. Sub-Saharan Africa has seen the most progress in reducing new infection rates. More people have access to antiretroviral treatment, and the number of Aids-related deaths has declined by more than 10 per cent over the past five years. However, laws, practices and proposals in many countries undermine these positive developments. Canada and the United States have in recent years prosecuted and secured convictions of dozens of people with HIV under legislation that criminalises HIV transmission. Elsewhere in the world, countries have increasingly adopted or considered such measures. Human Rights Watch reports that in Africa alone, 14 countries have enacted laws that criminalise HIV transmission — in terms that potentially outlaw all sexual behaviour by those who are HIV positive. A measure now being debated in Uganda would require pregnant women and their partners to be tested, even without their consent. Mandatory testing increases the potential for stigma and discrimination. In particular, women who test positive face a greater chance of violence at the hands of their partners. The measure would also criminalise “attempted transmission” of HIV and would provide for other criminal penalties for the failure of an HIV-positive person to “observe instructions on prevention and treatment,” among other provisions. Laws like these are impractical, unnecessary and counterproductive — especially because they create incentives to avoid getting tested, receiving health information and obtaining necessary care. Even where such legislation is not an issue, stigma and discrimination are an everyday reality for those who live with — or are suspected of having — HIV. Gay and bisexual men, people who use drugs, prisoners and sex workers, among others, may face significant hurdles in access to effective HIV prevention programmes. Heterosexual transmission accounts for a larger proportion of new HIV transmission worldwide, and in sub-Saharan Africa the significance of heterosexual transmission has long been well-known. Even so, knowledge has not translated into sound policy responses. Not enough has been done to address the human rights abuses and the role of poverty in driving the epidemic among women. As one example, the rate of HIV infection in South Africa for young women between the ages of 15 and 19 is more than twice that for young men of the same age. The prevalence rate for women in their mid to late 20s is more than 32 per cent. South Africa’s alarming level of sexual violence is one contributing factor in these high rates. Two out of five men surveyed for a study on rape prevalence had been physically violent to an intimate partner, and one in four admitted to at least one rape, the South African Medical Research Council found this year. Poverty is another factor. As Amnesty International found in 2008, lack of reliable and affordable transport often hinders or prevents rural women from reaching health facilities that offer the comprehensive HIV and post-sexual assault services they need. Rural women also struggle to have access to adequate food every day, essential in order to cope with the side effects of antiretroviral medication. Effective HIV prevention is not easy, particularly when policies must tackle complex factors such as poverty and sexual violence to have real impact. Removing discriminatory laws and policies, including legislation that criminalises HIV transmission, is an obvious step for governments to take. They must quickly follow up by seeking to understand and correct the ways that policies and practice contribute to gender disparities, including in access to health services and vulnerability to violence.