“It is not flattering that it takes a ruthless epidemic to awaken the world to the needs and conditions of her women” said Dr. Suniti Solomon, speaking at the Tenth Retroviruses Conference in Boston, USA this week.
Dr. Solomon is the director of the YRG Centre for AIDS Research and Education in Chennai, India which provides care for 5,000 patients. She was the clinician who diagnosed the very first case of HIV in India back in 1986.
Women account for an ever-increasing proportion of new HIV cases in India. Current estimates suggest that around one third of infected adults are women and a high proportion (over 80%) acquired their infection through sexual intercourse. Two decades of prevention have failed to make inroads and women remain not only biologically more vulnerable to HIV, but also because of economic, social, legislative and cultural discrimination.
In India, the social construct of gender, which has evolved over many hundreds of years, places women at increased risk of HIV and other sexually transmitted infections. It is difficult for women to follow prevention recommendations. A woman may have little control over who her male partner sleeps with and condom use, more often than not, is male-controlled. Women in India may feel reluctant to access treatment for sexually transmitted infections for fear of stigma and lack of access to education allow male-propogated myths to flourish.
Women with poor social skills will offer sex for social support and stay in marriages that may place them at risk of violence and HIV infection. Women adjust their behaviour to violence to minimise violence; in doing so their ability to insist on monogamy, negotiate safer sex or refuse sex is limited. Women in apparent monogamous relationships often fail to realise they have been at risk of HIV infection. In one survey quoted by Dr. Solomon, only one third of men had been monogamous in the previous month, yet 83% of housewives did not think they had been at risk of HIV infection.
Working with female sex workers in Chennai has led Dr. Solomon to believe that empowering women to respond individually and collectively will be a potent weapon in the fight against AIDS.
“HIV is becoming epidemic, where unequal gender imbalance curtails women’s independence,” Dr. Solomon believes. Female sex workers with whom Dr. Solomon works are encouraged to carry condoms and negotiate with their clients to wear them. Yet this simple, but effective, life-saving act is enough to get the woman arrested an put into a remand home; referring to the Suppression of Immoral Traffic Act, Dr. Solomon revealed that police officers have a monthly quota of 100 female sex workers to arrest and many of the women she has educated have suffered such a fate.
In order to prevent HIV infection, women need to become agents of change. Yet this is easier said than done. Research into the acceptability of female-controlled prevention methods has shown high rates of acceptability among women. A survey of the acceptability of microbicides to women revealed 95% of sex workers and 72% of housewives would be willing to use one, yet when the men who were their sex partners or husbands were asked, a resounding 60% said they would not allow their wife to apply a vaginal product and just over half 53% said they would allow a sex worker to apply one. “How do you imagine a microbicide being used even after it has been introduced?” Dr. Solomon.
“The world is changing fast; the position of women is also changing", she concluded. "But men continue to dominate women, whether that be through positive patronisation or through violence and mental coercion - to question the way our society is built is a good beginning.”