The Power Imbalance between Men and Women and its Effects on the
Rampant Spread of HIV/AIDS among Women
by Julie L. Andreeff*
While women are battling for equal rights throughout the international community, the existing power imbalance between men and women renders women particularly vulnerable to contracting HIV. As a result, many women cannot exercise their fundamental human right to control their own sexuality. The HIV/AIDS epidemic continues to spread rapidly throughout the world and is disproportionately affecting women. In 2000, the Joint United Nations Programme on HIV/AIDS reported that 16.4 million women are infected with HIV/AIDS worldwide. According to the Centers for Disease Control and Prevention, in the United States alone the HIV/AIDS cases reported among women increased from seven percent to twenty-three percent between 1985 and 1999.
Although the World Health Organization (WHO) and many governments are implementing educational programs to teach women about protecting their health, traditional cultural practices continue to perpetuate discrimination against women, in turn forcing women into high-risk situations. Unless proactive human rights policies are enacted to empower, educate, and protect women with regard to their sexual autonomy, HIV/AIDS will continue to spread at an alarming rate and will have a devastating impact on all aspects of society.
Vulnerability of Women to Contracting HIV
Abuses of Economic Rights
Economic inequalities between women and men often force women into submissive roles that require them to become economically dependent on men. Some economically dependent women who fear abandonment by their spouses stay in risky relationships in which they lack control over their sexual activity and the ability to protect themselves from the transmission of HIV. Women who are financially dependent on men are more likely to work in the sex industry, which drastically increases their chances of becoming infected with HIV. Additionally, forced prostitution is prevalent in poorer countries, where women often have no alternative but to exchange their bodies for money.
Abuse of Political Rights
Women are also more vulnerable to HIV infection because of their inability to exercise political rights within their respective cultures. Women are often unable to participate equally in the decision-making processes within their communities. In these circumstances, it is unlikely that policies will be implemented to protect women against the spread of HIV and empower them to control their reproductive health. Women's underrepresentation in political processes translates into unequal access to education and health services because male policy makers often do not prioritize women's needs.
While progress has been made in terms of women's economic and political rights, some cultural beliefs shape behavior that contributes to the increase of HIV infection among women. One traditional belief is that "good women" are sexually passive and ignorant about sex. Within this cultural paradigm, men are expected to dominate sexual relationships and make reproductive decisions for both partners. While men are encouraged to experiment with their sexuality with partners outside the confines of the marital relationship, women are expected to remain faithful to their husbands. In particular, the practice of polygamy exposes men to a high risk of contracting HIV, which in turn increases the risk that their female partners will become infected.
Another harmful cultural belief that makes women vulnerable to contracting HIV is the value placed on virginity. In some cultures, people believe that if a man has sex with a virgin woman he will be cleansed of his infections. Young, virgin girls and women are at a higher risk of being raped by men influenced by this common misperception. These girls and women are especially vulnerable to HIV because of the distinct injuries that result from forced sexual activity and the likelihood that their perpetrators have had multiple sexual partners.
Some cultures place a similar value upon fertility. A woman's ability to become pregnant can elevate her status within her community and help sustain economic survival for herself and her family. Women who link their self-esteem with their ability to become pregnant frequently believe that the use of contraceptives diminishes their fertility. This link between fertility and self-esteem places women in jeopardy of contracting HIV because they sacrifice their own reproductive health to bear children for their husbands. In this respect, researchers in Kigali, Rwanda found that when women learned they were HIV-positive, often their concerns focused on their continued ability to have children rather than the effects of the disease on their personal health.
The Role of the International Community in Protecting Women against the Spread of HIV
The November 2000 Expert Group Meeting in Windhoek, Namibia
The UN Commission on the Status of Women (CSW) noted the need to study the relationship between gender and HIV and made it a top priority for 2001. In November 2000, the UN Division for the Advancement of Women, WHO, and the Joint UN Programme on HIV/AIDS held an Expert Group Meeting in Windhoek, Namibia entitled "The HIV/AIDS Pandemic and its Gender Implications." HIV/AIDS experts from around the world, including government officials, UN officials, and representatives of non-governmental organizations, participated in the conference. These experts concluded that the HIV/AIDS pandemic requires a multi-sector approach with short- and long-term relief efforts as well as a focus on changing relations between women and men to eliminate gender inequality and reduce women's risk of infection. In emphasizing the need to eliminate gender inequality, the experts recognized the link between the spread of AIDS and the power imbalance that exists between women and men. The experts recommended long-term plans to control the spread of AIDS, which require that both genders have access to education regarding the prevention and treatment of HIV/AIDS. The experts expressed the need for separate educational programs for men that address men's roles in the prevention and treatment of HIV. Experts also encouraged the implementation of educational programs designed to target school-aged children and teach respect for the social roles of men and women. Finally, the experts recommended the use of positive cultural and religious practices to help prevent HIV/AIDS as well as treat and support HIV-infected women. The participants noted the importance of working with community leaders to help identify and address cultural and religious practices that lead to women's disproportionate vulnerability to contracting HIV.
Once the local and international communities understand the implications of these practices, community leaders can help persuade their communities to eliminate some of the negative effects of some of these practices to reduce women's chances of contracting HIV. The effort to involve local communities is difficult, however, in that it addresses cultural relativism. Cultural relativism is a theory that stresses the need to respect the diversity of cultural practices and norms throughout the world to effectuate positive change. Although some criticize cultural relativism because its proponents encourage international bodies to tolerate abusive cultural practices, sensitivity to cultural differences is necessary for the international community to protect women's human rights. The understanding of a particular culture's practices regarding the role of women is essential for the development of effective solutions to reduce the spread of HIV/AIDS among women. Engaging in informed cross-cultural dialogues with local community leaders will encourage other community members to eliminate the harmful effects of certain cultural practices that increase women's chances of contracting HIV. Local solutions might involve the development of health care standards and the establishment of programs designed to alleviate poverty and encourage urban growth, which would help address the economic and political imbalances between men and women.
The UN Commission on the Status of Women
In the Report of its 44th Session in 2000, the CSW published a resolution entitled "Women, the Girl Child, and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome," in which the CSW recognized the relationship between gender and HIV/AIDS. In its resolution, the CSW recommended that governments take all necessary steps to promote the advancement and empowerment of women, ensure that women can control their sexual health and reproductive rights, eliminate all forms of violence against women, and provide women with equal access to economic resources. Specifically, the CSW encouraged governments to increase investment in the research and development of prevention methods that women may use to eliminate their dependence on men to make their reproductive decisions.
Applicability of the Convention on the Elimination of All Forms of Discrimination against Women
The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) begins by quoting the Universal Declaration of Human Rights, which "proclaims that all human beings are born free and equal in dignity and rights and that everyone is entitled to all the rights and freedoms set forth therein, without distinction of any kind, including distinction based on sex." Article 1 of CEDAW provides a basic definition of discrimination against women that includes "any distinction, exclusion or restriction made on the basis of sex" that denies a person's full enjoyment of her rights. Although this definition appears to offer women protection from a broad array of discriminatory practices, CEDAW does not specifically list cultural practices or abuses considered discriminatory against women or provide specific guidance for states to protect women from specific harmful cultural practices.
To the contrary, Article 12 of CEDAW applies directly to protecting women from HIV infection. Article 12 requires states to "take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning." Although AIDS was not originally mentioned in Article 12, in 1990, the Committee on the Elimination of Discrimination against Women issued a general recommendation entitled "Avoidance of Discrimination against Women in National Strategies for the Prevention and Control of AIDS," in which the Committee asked states to report on what they had done to improve women's health and prevent the spread of HIV/AIDS pursuant to Article 12 of CEDAW.
Related Provisions of the International Covenant on Economic, Social and Cultural Rights and the Effort of the Human Rights Committee
The International Covenant on Economic, Social and Cultural Rights provides protection against human rights abuses that increase an individual's risk of exposure to HIV. Article 10 is applicable because it requires the protection of children from economic and social exploitation, which often puts girls at a higher risk of contracting HIV. Further, Article 12 requires states to recognize the right of everyone to enjoy standards of health, including the responsibility to prevent, treat, and control epidemic diseases.
The Human Rights Committee (HRC) issued a general comment entitled "Equality of Rights between Men and Women," in which the HRC strengthened the state's reporting requirements to "provide information regarding the actual role of women in society." In its comment, the HRC identified behaviors and practices that increase women's vulnerability and therefore limit their ability to enjoy equal human rights. The HRC highlighted the reality that subordination of women "throughout the world is deeply embedded in tradition, history, and culture" and prevents women from exercising their rights under the International Covenant on Civil and Political Rights. The HRC's effort is vital because it recognized the relationship between traditional cultural practices that continue to force women into subordinate positions and deny women their basic human rights.
The international community must take an active role in reversing gender inequalities by empowering women to assert their cultural, political, and economic rights without fear of retaliation, violence, or abandonment. Improving women's access to economic resources is imperative. The HRC and the Committee on Economic and Cultural Rights must urge states to comply with their responsibilities to ensure that women have the right to property, the right to work, the right to equal pay for equal work, and the ability to develop business skills. If women can exercise their cultural, economic, and political rights, they will be more likely to become economically independent and less likely to remain in risky relationships.
Women must obtain equal access to health care. Access to health care services such as family planning programs and HIV testing empowers women to make decisions regarding their own reproductive health. Education regarding the methods of prevention and medical services to treat HIV-infected women must also become a priority.
The international community must coordinate the education of both men and women regarding the dangerous effects of cultural practices that encourage discrimination against women through local communities. In the long run, these practices will be most effectively addressed through community pressure. Until the international community effectively informs and educates the states regarding their roles in the prevention and reduction of the spread of HIV/AIDS, the epidemic will continue to deny women their human right to life, and in turn will continue to threaten cultural, economic, and political stability throughout the world.
* Julie L. Andreeff is a J.D. candidate at the Washington College of Law.
The proper citation for this article in the Human Rights Brief Volume 9, Issue 1, beginning at page 24 is: 9 No. 1 Hum. Rts. Brief 24 (2001).