GUJHS. 2004 April; Vol. 1, No. 3
Christine Bell, NHS ‘05
To create and build a new solidarity in the face of all the standard, historical, expected, routine and powerful status quos which seek to divide us: to contribute to that societal transformation which offers hope against AIDS and for the world: this is a task — no, a destiny! Worthy of our past, our aspirations, our commitment, our dignity and our lives.
– Jonathan Mann, former director of the Center for Health and Human Rights at the Harvard School of Public Health, during his speech delivered at the XI International Conference on AIDS in Vancouver in July 1996. (Mann, 1999)
It is estimated that 40 million people worldwide are infected with the Human Immunodeficiency Virus, most of whom will eventually contract the Acquired Immune Deficiency Syndrome, or AIDS. The global HIV/AIDS epidemic killed more than 3 million people in 2003, and infected an estimated 5 million (UNAIDS, 2003). HIV/AIDS is the fourth biggest killer in the world (after heart disease, stroke and respiratory diseases) and serves as the largest cause of death in Africa (World AIDS Day, 2003). Of AIDS deaths, 85% have occurred in sub-Saharan Africa, a reality that serves as a barrier not only for the region’s stabilization of public health but also to its struggle for economic, political and social development. As the HIV/AIDS epidemic remains on the top of the global health agenda of agencies such as the World Health Organization, Centers for Disease Control and Prevention and the United Nations, current initiatives to address HIV/AIDS in sub-Saharan Africa (e.g. the Global Fund) primarily involve foreign aid to provide expensive medications to HIV-infected people. Despite good intentions, action for HIV/AIDS prevention has been much more effective. Treatment approaches are costly and time consuming, and may not produce the desired results. Upon receiving foreign aid a country’s health minister may unequally distribute the funds, maintaining the divide between the minority socioeconomic elite and majority terribly poor. Affluent people will still be much more likely to receive drugs than the innumerable poor, for which no realistic amount of foreign aid is likely to be sufficient. What global health leaders and national governments must develop is a practical approach to HIV/AIDS prevention, which will enhance the health behaviors and individual well being of the sub-Saharan cultures and communities affected. Perhaps the most important step for HIV/AIDS prevention is the education of girls, which not only will teach them about their health but also will ultimately empower them in their society.
Regarding the relationship of females and HIV/AIDS in Africa, the trend of infection has always been characterized by heterosexual transmission, as opposed to that of European nations and the United States whose cases were initially concentrated in men who have sex with men (MSM’s) and injection drug users. However, worldwide there has been a recent shift towards increasing infection rates in girls. (BBC News, 2002) In sub-Saharan Africa girls and women account for 55% of those infected with HIV/AIDS, usually acquired through sexual intercourse. Contrasting gender roles lead girls and women to be of increased risk of HIV/AIDS infection due to social pressures and lack of economic power.
Vulnerability to infection results from unequal educational opportunities and expectations, resulting in females’ financial dependence on men that can significantly compromise their ability to negotiate protection or leave unsafe relationships. Also contributing to risk of infection are social norms of masculinity that enable men to seek multiple partners and avoid using condoms, which increases the risk of infection.
In addition to unsafe sexual behaviors, there exist traditional cultural and religious activities that have resulted in HIV infection, particularly the practice of female genital mutilation (FGM). This essential rite of passage for girls in many villages has been identified as a mode of HIV transmission due to the lack of sterility of instruments used and has resulted in multiple cases of infection. The procedure is carried out by the villages’ female elders, who traditionally smear white clay all over the participant’s body, and then lead them through a dance. The female, often under 10 years of age, is then beaten and deprived of food; signs of redemption. Finally, the female is taken to a river for dipping and washing en route to being circumcised and exhibited. In addition to possible HIV/AIDS transmission, FGM also can lead to the severe physiological effects severe pain, excessive bleeding and even death.
As emphasized by UNICEF members at the UN Special Session on Children in 2000 (UNICEF, 2003), both governments and communities must take immediate action to inform children, adolescents, parents and religious leaders of the serious health consequences of FGM, which must result in changes of attitudes and traditional beliefs.
“The approximate 100 million women who endured female genital mutilation as young girls are living proof that the world has failed to protect them. This practice is not only a violation of every child’s rights, it is physically harmful and has serious consequences for a girl’s health,” stated Carol Bellamy, Executive Director of UNICEF, during UNICEF’s First International Day of Zero Tolerance of FGM in February 2003. (UNICEF,2003) As recognized by UNICEF and the Inter-African Committee for traditional practices in Addis Ababa, health and social workers as well as teachers and civil society groups must work together to decrease the prevalence of FGM in particular by keeping girls in the education system and informing them of their protective rights from abuse and exploitation as well as opportunities to succeed academically. Due to the lack of exposure to basic health services such as HIV testing, counseling, treatment, and the denial of educational and employment opportunities, women and girls are seldom knowledgeable of their potential risks to HIV/AIDS infection and therefore do not take the necessary precautions for prevention. As a hopeful sign for increased access to education, free primary education was recently guaranteed in Kenya by new President Mwai Kibaki, who was elected in December 2002. Currently an estimated 1.5M children, previously not in school, have come to attend classes, another promising sign for female empowerment. (UN, 2003).
“We will not be content until every child of primary school age is enrolled… By educating the children we are investing in the future of this country. In the long term, educating children is one way to eradicate poverty,” George Saitoti, Kenya’s Minister of Education, explained to media.
In order for females to have access to such educational opportunities and receive economic empowerment, however, significant gender rights issues must be addressed. In tandem with the denial of female education is the denial of women’s legal rights including the right to hold, inherit or dispose of property, to participate in democratic processes, and to make decisions about marriage or about the education of their children. These human right violations exacerbate the difficulties that women experience when faced with high risk HIV/AIDS scenarios, such as when they or their partner become HIV-positive, and may make it difficult for them to exercise their rights to their property, employment, marital status and security. This inequity of gender rights blatantly disregards the United Nation’s Universal Document of Human Rights of 1948, which in articles 3 and 25 state that all persons have ‘the right to life, liberty and security’, as well as the right to ‘a standard of living adequate for the health and well-being of oneself and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances of beyond one’s control.’(UN General Assembly, 1948) Ideally women in Africa and in all countries would be educated and confident enough to recognize these rights and demand equal educational and economic opportunity, but unfortunately are often inhibited by financial instability and the cultural opposition of their societies.
As the cultural and human rights factors of the sub-Saharan HIV/AIDS pandemic are examined, the importance of attention to female empowerment in relation to HIV/AIDS prevention is critical. It is understandable how both global health leaders and African officials have difficulty providing high technological treatments, expensive hospitals and medical equipment. However, regarding important goals on which health and economic development depend such as the provision of free schooling for all youth or equal employment for both sexes, it is in the best interest of the peoples and administrators of the nation to act. Middle Eastern countries experiencing similar gender inequities such as Afghanistan have been greatly benefited with the implementation of such education services, as evident by both participating women and observing government and military officials. Recently, an Afghan women’s rights activist working to implement health and education programs testified to the developmental progress such services have provided for women.
“With these education programs the women discover their rights and have increased awareness. Previously many women didn’t even know how to have a baby, to which we responded by providing midwifery training. After implementing this program, a member of the Taliban approached me about the training, which made me very scared, but informed me that the training was needed and that it had improved the health of his wife,” Farida Azizi, an Afghan women’s rights activist, explained. (Bell, 2003)
Azizi’s description of the positive effects and influential messages of the public health programs for females in Afghanistan strongly confirms the necessity for female education and economical empowerment in HIV/AIDS prevention. With exposure to preventive health behaviors such as using condoms during intercourse and maintaining monogamous relationships, and receiving an equal education that will inform females of their entitlement to their human rights, it is inevitable that sub-Saharan women will reduce high-risk behaviors and therefore reduce rates of HIV/AIDS infection.
An African nation that has experienced similar success as described by Azizi in implementing public health services and education has been Uganda, which succeeded in decreasing capital city Kampala’s level of HIV infection in pregnant women from 31% to 14% as well as decreasing HIV/AIDS in men from 46% to 30% during the 1990’s (WHO, 2003).
This reduction in HIV infection rates has been the result of high-level political commitment of all sectors of society, including religious and traditional leaders, community groups, non-governmental organizations, and other officials led by President Museveni. Programs were implemented for prevention and care, providing services such as same day results for HIV tests, social marketing of condoms and self-treatment kits for STD’s, and sex education programs. These programs particularly benefited teenage girls. After receiving health education and other public information teenage girls reported more condom use by their partners than any other age group, which was reflected in the falling infection rates among 13-19 year old girls in Masaka, in rural Uganda. Uganda, which has suffered tremendous developmental setback and decreasing life expectancies from AIDS like the rest of sub-Saharan Africa, should serve as a model to surrounding nations for the significance of education and health services in the prevention of HIV/AIDS infection, in which thousands of community individuals have been recruited and trained as peer health educators, reaching more than 180,000 people nationwide. (WHO, 2003).
Along with Kenya’s primary education and Uganda’s health services initiatives there have been various other movements to determine strategies for female empowerment and community action for the prevention of HIV/AIDS incidence. In a 1995 International Conference on STD/AIDS in Kampala, a group of young Africans from 11 countries presented key principles that they saw as essential for effective HIV/AIDS prevention, several of which were related to gender and educational issues (UNAIDS, 1998). The protection of females against sexual abuse and exploitation, the education of males about their sexuality and behavior and the establishment of community networks for support of human rights and acceptance by society were each discussed by the youth representatives, which are absolutely necessary in order to satisfy the 2000 adopted resolution of the U.N. Security Council addressing the HIV/AIDS crisis in Africa. In their 4172nd meeting in July of 2000 the Council emphasized the need for coordinated action of all pertaining U.N. organizations in global efforts against the pandemic, and recognized the call of the Secretary General to reduce the HIV/AIDS infection rates in persons 15 to 24 years of age by 25% within the most affected countries (sub-Saharan Africa) before the year 2005 and by 25% globally by 2010 (USIS, 2000).
Following the Council’s meeting, in November of 2000, several preventative strategies were proposed by the Expert Group Meeting on “The HIV/AIDS Pandemic and its Gender Implications”, organized by the United Nations Division for the Advancement of Women, in collaboration with the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Windhoek, Namibia. (WHO, 2000). Strategies discussed included a movement for gender equality, promoting education and technologies for female youth and the economic empowerment of women, specifically equal rights to inheritance and ownership of property, including land.
Ideally the movement will commence with the implementation of Article 26 of the U.N.’s Human Rights Declaration, which states that every one has the right to education, which shall be free in the elementary levels, and be aimed towards the complete development of respect for human rights and basic freedoms (UN General Assembly, 1948). School teachers and administrators must unite with students and parents to confront the need for female education and empowerment in the prevention of HIV/AIDS. In collaboration with the educational movement, tertiary institutions, and especially universities, must also fulfill their ethical and intellectual responsibility to set an example by openly debating the issues and finding creative responses in developing the education based, human rights approach for the prevention of HIV/AIDS infections. They constitute one of the essential components in developing a united and effective response to the HIV/AIDS pandemic, and can serve as role models for the achievement and victories of female education.
In conclusion, HIV/AIDS prevention must be approached from a human and gender rights perspective in which the education of girls and women will be secured. As exemplified by the success of Azizi’s work in Afghanistan and Uganda’s public health programs, females must have access to sexual and reproductive health services, education and employment opportunities in order for African nations to move towards HIV/AIDS prevention. Protective and remedial actions must also be taken to shield women from the impact of dangerous traditional cultural practices and behaviors that may result in HIV/AIDS transmission and deny females their reproductive rights. Providing education for girls and women as a basic human right and as a preventive strategy for HIV/AIDS is a profound obligation of political leaders, policy makers and all others who have benefited from education during their lifetimes. It will greatly enhance the well being and longevity of the millions of communities and people currently struggling for life.