World AIDS Day is celebrated yearly on December 1st, and its focus is to demonstrate support for people living with HIV/ AIDS and remember, with compassion, those who have died as a result of the virus.  HIV/ AIDS has not been completely eliminated, and so the 1st of December presents a chance for governments to appropriately reflect on policies, budgetary allocations, and education to better contribute to efforts towards eliminating this illness, as well as counteracting the existing stigma and discrimination that surrounds it.

 

While significant strides have been made in combating the current spread of the virus through prevention of new infections, girls and women continue to be disproportionately affected by the HIV/AIDS epidemic as a result of structural inequalities embedded in society.

Such inequities stem from unequal power relations, lack of female access to and control of resources and opportunities, a disproportionate balance of decision-making power between genders, and unfair division of labour due to patriarchal expectations.  The metrics around HIV/AIDS reflect this: Young women are twice as likely as their male counterparts to acquire HIV infections, with adolescent girls between the ages of 10-19 accounting for the highest number of new HIV infections.  To successfully combat the virus, it is of paramount importance that we address these inequalities that predispose women and girls to a higher risk of HIV infection.

In Kenya, women are amongst the key populations that are disproportionately affected, placing them amidst some of the highest-risk category alongside men who have penetrative sex with men, people who inject drugs, and sex workers.  The National AIDS Control Council estimates that 30% of new HIV infections in Kenya are among people from these key populations – but given that women comprise such an enormous percentage of the Kenyan population, it is deeply worrisome that they are amongst some of the most at-risk of all people nationally.

Gender-based violence increases the vulnerability of young girls and women to HIV/ AIDS, and in Kenya, more work can be done to curtail this.  Young girls who have experienced sexual abuse are at high risk of infection, and may not realize their status until they go for voluntary counselling and testing in adult age.  Transmission of HIV is easier in young girls during sexual assault if their vaginal walls are torn which, during sexual assault, is vastly more likely than when sex is consensual due to lack of pleasure-based lubrication.  Most girls who have endured sexual assaulted in Kenya do not have anyone appropriate with which to share their stories about the sexual abuse, which limits their likelihood of engaging with Post Exposure Prophylaxis (PEP) treatment, which can curtail transmission of the virus even after exposure to infection if taken within the designated timeframe.

Fear of violence prevents women from negotiating for safe sex and set standards for unequal romantic and sexual relationships.  It is hard for a number of married women to influence the number of sexual partners their husbands might have, or to negotiate for condom use even when they are aware of infidelity.  Leaving an unfaithful union may not be an option for many women who are limited in their autonomy by economic dependence on men, or a fear of being separated from their children.  Such Intimate Partner Violence bars women from protecting themselves from the virus, as they rarely seek voluntary counselling and testing for HIV or ask their partners to do so, and are less likely to disclose their HIV status or seek treatment if infected.

The coupling of poverty with limited or no education also drives women and young girls into transactional sex, in which sex is exchanged for material benefits, such as shelter, food, or other resources.  Women engaging in this practice are at a high risk of infection and are also prone to sexual abuse.  It may be difficult for these women to seek treatment or report abuse for fear of judgment.  Though nobody should be forced into this economy out of desperation, the reality is that this demographic is populated with young girls, many of whom have little or no information on safe sexual intercourse may not demand barrier contraceptives such as condoms (‘protection’), which greatly reduce the risk of HIV/AIDS transmission.  This could also be because they lack the confidence or negotiating power and may fear that the man will leave them for being ‘stubborn’ about asking for protection.  Demanding the use of protection may also reduce the benefits in transactional sex, which places sex workers in a vulnerable position: to assert boundaries for their own safety, or risk the income desperately needed from the sexual transaction to be given to someone who is less strong-willed.

Barriers to women’s access to sexual reproductive healthcare and rights are a setback in the fight against HIV/AIDS.  Some women don’t have control over their bodies due to the low status placed on them, rendering them therefore unable to access reproductive health and rights services.  Unfriendly healthcare practitioners make women and particularly young girls shy away from health centres.  Girls who seek PEP treatment, for instance, may be sent away by a medical professional who, rather than fulfilling their medical obligations, refuses to allow treatment out of judgement of the girl’s perceived promiscuity or for engaging in sexual intercourse out of wedlock – consensual or otherwise.  Other factors like distance to the health centres and long queues also limit female access to sexual and reproductive healthcare, as domestic time constraints may mean that they are noticed at home for failing to fulfil their on household chores, leading to questions.

There is need for gender mainstreaming in policies, programs, and legislation aimed at combating HIV/AIDS.  This should include laws that promote gender equality.  Increased efforts in promoting girl child education, access to sexual reproductive health and rights for women and girls, and economic empowerment for women is vital.  Education should encompass comprehensive sexuality information where girls need to be equipped on bodily integrity, body autonomy, sexual consent, and safe sexual practices.  It is also important to engage men in ending violence against women and protecting women’s rights.

Health practitioners, policy makers, civil society organizations, and governments need to ‘wear gender lenses’ that will enable them to visualize the structural gender inequalities that put women at a disproportionate risk of HIV infection.  This will bring the world closer to end the epidemics of AIDS by the year 2030.

 

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