Download - WORLD AIDS DAY 2001
WORLD AIDS DAY 2001
Male involvement in the fight against AIDS
Marleen Temmerman, RUG
"I care... Do you?"
• is the slogan for the second year of a two-year Campaign
• intended to create a sustained focus on the role of men in the AIDS epidemic and culminates on 1 December, World AIDS day.
The Campaign aims to involve men more fully in the efforts against AIDS
• to bring about a much-needed focus on men in national responses to the epidemic
• to involve leaders both as politicians and in their personal lives in the response to the HIV epidemic.
Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000
South-Africa
35
40
45
50
55
60
65
1950-55 1955-601960-651965-701970-751975-801980-851985-901990-951995-00
Lif
e e
xp
ecta
ncy
at
bir
th,
in y
ears
Botswana
Uganda
Zambia
Zimbabwe
Source: United Nations Population Division, 1998
Nu
mb
er
of
Peo
ple
L
ivin
g w
ith
HIV
/AID
S
(in
mil
lio
ns
)
The World Health Organization (WHO) launches the Special Programme on AIDS
The International Council of AIDS Service Organizations (ICASO) and the Global Network of People Living with HIV/AIDS are founded
The first therapy for AIDS
- azidothymidine (AZT) - is
approved for use in the USA
In 1991-1993, H IV prevalence in young pregnant women in Uganda begins to
decrease, the first major downturn in a
developing country
An HIV outbreak in Eastern Europe
is detected (among injecting
drug users)
Highly Active Antiretroviral Therapy (HAART) is
discussed for the first time
The first efficacy trial of a potentia l HIV vaccine in a developing country starts in Thailand
In Africa, a heterosexual
AIDS epidemic is
revealed
The Human Immuno-deficiency Virus (HIV) is identified as the cause of
AIDS
Acquired Immuno- deficiency Syndrome
(AIDS) is defined for the first time
In the USA, the first HIV antibody
test is approved by the Food and Drug Administration and HIV screening of blood donations
starts
UNAIDS is created
Scientists develop the first treatment regimen to reduce
mother-to-child transmission
Brazil becomes the first developing country to
provide antiretroviral therapy through its
public health system
The UN Security Council discusses HIV/AIDS for
the first time
UN Secretary-General Kofi Annan maps a plan of action,
and calls for the creation of a global fund on AIDS and health
Rock Hudson becomes the first public figure to disclose he has AIDS
At least one case of HIV/AIDS has been
reported from each region of the world
The first cases of unusual immune deficiency are
identified among gay men in the USA
2 0 y ea rs o f H IV /A ID S
June 2001
Factors influencing HIV transmission
• Social inequalities• Power relations• Poverty• Migration• Urbanisation• Social background• Race• Gender
Gender
• Refers to the social shaping of femininities and masculinities, and challenges the idea that relations between the sexes are ordained by biology or nature
• Unequal gender relations are particularly visible in special vulnerability of women to HIV, and in men’s risk taking behaviour
• Gender relations affect not only the development of the AIDS epidemic but the manner in which individuals and societies respond
Gender is not a woman’s issue
• Whereas ‘sex’ is referring to biological differences between males and females, gender refers to social and cultural notions of masculinity and femininity
• A gender order where men dominate women, cannot avoid constituting men as an interest group concerned with defence, and women as an interest group concerned with change (Connell 1995)
• Not having to think about gender is a patriarchal dividend that men gain from their position in the gender order. This is one of the reasons why ‘gender’ is often dismissed as a women’s issue
Sex and reproduction
• A man’s right, a woman’s duty?– Women carry the burden of pregnancy and
childbirth– They are responsible for contraception and
infertility, but men have the decision-power– Difficult diagnosis of STD in women– Women have little economic and sexual power– Violence against women
• Patrilineal societies often have power relations skewed in favour of men and this is also reflected in the realm of sexuality
HIV and women: multiple jeopardy
• Society: blame on women, economic dependent
• Nature: diagnosis and treatment of STD more difficult, sequelae worse, transmission rates higher
• Partner: no sexual power, scapegoat for diseases
• Science: still no female controlled methods
Social context of STD/HIV risk
• Reproductive health decisions remain the ‘male domain’ in many countries
• Women are often recipients of male-based decisions
• Women are more accessible to health education than men as users of health services
• Yet, they have limited options in light of the STD and HIV epidemic
The STD/AIDS epidemic
• Brought into sharp relief the absence of information on men
• Highlighted the patriarchal structures that benefit men who often remain passive and non-participatory in reproductive health that is considered as a woman’s issue
• Resulted in the introduction of STD/HIV into the framework of reproductive health necessitating the incorporation of men as participants, partners and consumers of services
HIV in pregnant women: prevalence in South HIV in pregnant women: prevalence in South Africa, 1990 to 1999Africa, 1990 to 1999
Source: Department of Health, South Africa
0.71.7 2.1
4
7.6
10.4
14.2
17
22.8 22.4
0
5
10
15
20
25
90 91 92 93 94 95 96 97 98 99
HIV
pre
vale
nc
e (%
)
Prevention of Mother to Child Transmission (PMTCT). during late pregnancy. during labor. through breast-feeding
Prevention of
unwanted pregnancies
(Family Planning)
Primary HIV prevention in parents to be
Three Integrated Strategies to Reduce Paediatric AIDS
Perinatal HIV transmission
• Interventions include VCT during pregnancy, antiretroviral drugs and replacement feeding
• This is visible to the partner, difficult to implement without his understanding and consent
• Major concern in VCT in pregnant women is the adverse consequences following disclosure of their status: stigmatisation, violence, isolation
Violence against women
• High levels of ‘background’violence in women in Tanzania (54% in HIV+ and 32% in HIV- women
• Violence was high in HIV + women in Nairobi
• Beating and abuse of women in Mumbai after disclosure
Poor uptake of PMTCT interventions
• UNICEF study: only 30% of women offered VCT were not tested. Out of the women tested 30% did not take adequate doses of drugs
• Low disclosure rates all over Africa (30-50%)
• Key barrier: blame on the one who brings HIV into the family
Responses
• Involvement of partners, family …into reproductive health services
• Greater efforts to reach men
• Addressing the issue of violence
• Couple counselling and testing
• Education of both men and women
• Empowerment of women
Conclusions
• Men have to be more actively involved in HIV/STD prevention work and reproductive health
• The burden of responsibilities should be carried by both men and women
• The complex inequalities of gender and sexuality which facilitate HIV/STD transmission should be challenged by men and women
Conclusions
• ‘If development is not engendered, it is endangered’(Human development report, 1977)
• Increasing interest in men as potential agents of change, and not merely objects of blame. ‘Time is ripe to start seeing men not as some kind of problem, but as part of the solution’ (Peter PIOT, 2000)