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HOME: STATE OF WORLD POPULATION 2002: Women and Gender Inequality
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Women and Gender Inequality

Measuring Gender Inequality
Economic Inequity
HIV, Poverty and Gender Inequality

HIV, Poverty and Gender Inequality

Twenty years ago, early in the HIV/AIDS epidemic, women were rarely infected. By 1997, worldwide, 41 per cent of all HIV-positive adults were women. By the end of 2001, the figure was nearly 50 per cent and in sub-Saharan Africa, 58 per cent (29).

Policy makers now acknowledge that women are being infected because they are women. Mozambique's Prime Minister, Dr. Pascoal Mocumbi, reported in 2001 that the overall rate of infection among girls and young women in his country was twice that of boys their age: "Not because the girls are promiscuous, but because nearly three out of five are married by age 18, 40 per cent of them to much older, sexually experienced men, who may expose their wives to HIV/AIDS. Abstinence is not an option for these child brides. Those who try to negotiate condom use commonly face violence or rejection."


Is there gender inequality in the feeding of children? The evidence is mixed. There is bias against females in South Asia (and also some parts of China) but it is diminishing. Demographic and Health Surveys in 40 developing countries do not show significantly better nutritional outcomes for boys, with the exception of Bangladesh and Nepal.See Sources


IPROGRESA (Programa Nacional de Educación, Salud y Alimentación) has educated Mexican women on health and nutrition issues, provided new spaces in which to communicate with other woman, educated girls to improve their position in the future, and increased their self-confidence and self-esteem. The programme began in 1997 as a country-wide effort to fight extreme poverty in Mexico's rural areas.

With a budget of $500 million, PROGRESA provides monetary assistance, nutritional supplements, educational grants, and a basic health package to poor families for at least three consecutive years. One of its innovations is to provide money directly to women, putting additional resources under their control and giving them greater freedom in their own movements.See Sources

Dr. Mocumbi believes that no effective action against the pandemic is possible until leaders in sub-Saharan Africa recognize that the primary means by which AIDS is spread is risky heterosexual sex. This goes beyond a health issue, he said, for "unlike the communicable killer diseases we have encountered most often in the past, HIV/AIDS is transmitted through the most intimate and private human relationships, through sexual violence and commercial sex; it proliferates because of women's poverty and inequality."(30)

SOCIAL AND RISK FACTORS Gender inequality deprives women of the ability to refuse risky practices, leads to coerced sex and sexual violence, keeps women uninformed about prevention, puts them last in line for care and life-saving treatment, and imposes an overwhelming burden on them to care for the sick and dying.

"Women are truly the most vulnerable in this pandemic…. Until there is a much greater degree of gender equality, women will always constitute the greater number of new infections," Stephen Lewis, UN Secretary-General Kofi Annan's Special Envoy for HIV/AIDS, in Africa told a reporter at the end of 2001 (31).

Socially defined gender roles determine differences between women and men in access to productive resources and decisionmaking. There are variations among societies, but whatever the superstructure, according to Lewis, the foundations always incorporate an unequal power balance in gender relations that favours men. Thus, he says, it is still a worldwide reality that millions of women are effectively sexually subjugated and forced into risky sex, without condoms, "without the capacity to say no, without the right to negotiate sexual relationships."

Biology also works against women: women's physiology is more vulnerable to HIV and other sexually transmitted infections. Reproductive tract infections, which predispose to HIV infection, are more easily transmitted and less easy to diagnose in women. Vaginal scrapes and cuts suffered during violent or coerced sex increase the risks.


A number of NGOs in Bangladesh direct credit to women. The Grameen Bank and Bangladesh Rural Advancement Committee (BRAC) have improved women's mobility, economic security, control over income and assets, political and legal awareness, and participation in public protests and political campaigning.

The programmes increase demand for contraception and help women overcome obstacles to their use. Both Grameen Bank and BRAC have family planning awareness programmes, and having a small family is one of the Grameen Bank's Sixteen Decisions that every woman has to memorize. Neither has offered family planning services (though BRAC has recently started providing contraceptives to some members) but this seems to be less important than the effect of economic empowerment on women: where services are available from other providers, empowerment is linked with contraceptive use.

Women feel empowered by credit despite the extra work it entails: they feel more self-fulfilled and valued by other household members and the community. The effect on fertility seems to be in addition to the impact of family planning programmes and other health care interventions.

Microcredit programmes have a more powerful impact if women are the borrowers: female borrowing has a significant effect on seven out of eight indicators: boy's and girl's schooling; women's and men's labour supply; total household expenditure; contraceptive use; fertility; and value of women's assets other than land. By contrast, male borrowing was significant in only three out of eight. Household consumption increases by 18 taka for every 100 lent to a woman and by 11 for every 100 lent to a man.See Sources

IGNORANCE ABOUT SEX IS EXPECTED In many societies, culture dictates that "good" women are ignorant about sex and passive in sexual interactions. This makes it difficult for women to inform themselves about risk reduction, and even more difficult, even if they are informed, for them to negotiate safer sex or the use of condoms (32). A study in Zambia revealed that only 11 per cent of the women interviewed believed that a married woman could ask her husband to use a condom, even if she knew that he had been visiting prostitutes and was possibly infected.

Young women are particularly vulnerable and under-informed. In 17 African countries, surveys indicated that over half of the girls did not know any way of protecting themselves from HIV (33). Yet there is much evidence that teenage girls are sexually active before marriage, indicated by the numbers of teenagers who drop out of school because they are pregnant. The "sugar daddy" syndrome, though more talked about than proved to be widespread, works against young women. HIV infection rates among young African women aged 15-19 in some urban areas are said to be five to six times higher than for young men (34).

The strong norms of virginity and fidelity applied to women (but not to men), as well as the "shame" that prevents open discussion of sexual matters, make it very difficult for women to seek protection or treatment or even information about sexually transmitted diseases, and especially HIV/AIDS.

STIGMA A husband's family and the community at large may blame his widow for his death, and may refuse the usual support to her and her children. The law may allow the woman to inherit her husband's land and property, but local and customary rules often override it in practice. Stigma coupled with fear has even spawned lynch mobs when women are discovered to have the disease, or, as in the case of young South African activist Gugu Dhlamini, courageously reveal their HIV status (35). The outcome has been tragic for many innocent women and their children.

ECONOMIC DEPENDENCY Women's economic dependency increases their vulnerability to HIV. Although women are the primary producers of food across much of Africa, they may not have any rights in the land they work or to the products of their labour. Inheritance may depend on local practice and in effect put them at the mercy of their husband's relatives.

This poverty and economic dependency make it impossible for many women either to negotiate the terms of their relationships or remove themselves if the relationship puts them at risk. It may force them to endure routine domestic violence, which both increases their chance of contracting HIV/AIDS and deters them from seeking testing and treatment. With few opportunities to earn livelihoods independent of men, many women are compelled to use sex to gain resources, increasing the risks to themselves and the men who use them.

DOBLE STANDARD The power imbalance limits women's freedom in other ways. A 1999 Tanzanian study showed that while men sought voluntary counselling and testing without consulting their wives, women felt compelled to consult their husbands (36).

Initial Africa-based surveys are revealing that when anti-retroviral therapies become available, health facilities discriminate in favour of men.

Women are expected to be virtuous and faithful, to take care of their sick partners and children, support their families and comfort the dying. Yet they are denied support themselves or the information or treatment that could save their lives: and when their partner dies, they are held responsible.

Women's tragedy passes down the generations. Mothers often discover that they are HIV-positive only when they visit prenatal clinics. The risk of mother-to-child transmission is high, but women have little support in reducing the risks-anti-retroviral therapy, advice on the alternative dangers of breastfeeding and of breast-milk substitutes, or continuing care or counselling.

Where treatment has been offered, it most frequently is for a brief period, to prevent infant infection, leaving the mother to face the prospect of her own death and worry about the fate of her orphaned children. Young children whose mothers die from any cause are at much higher risk of death themselves; their risks after an AIDS-related death may be higher because of the stigma and the possibility that they may themselves be infected.

Conflict situations, in which rape is used as a weapon of war spread the pandemic, as the virus is spread through sexual violence. In Rwanda today, many women who were raped in the genocide are now dying of AIDS, so for them the genocide continues.

TAKING ACTION, EMPOWERING WOMEN Empowering women is key to challenging the pandemic, preventing its further spread and rolling back the incidence of new infections. It is more urgent than ever to protect and improve women's health, including their reproductive health, and provide the information and services to do so; to decrease the gender gap in education and make education universal; to improve women's access to economic resources, increase their political participation, protect them from violence and enable them to achieve their rights to sexual and reproductive health and self-determination. The goals include real and equal partnership with men. They are ambitious but realistic, and more than ever necessary.

The global community has developed a serious set of blueprints for addressing inequality. Their recommendations are laid out in the Convention on the Elimination of All Forms of Discrimination against Women, the ICPD Programme of Action and the Platform for Action of the Fourth World Conference on Women with their five-year reviews. Many of the recommendations are included in the MDGs. Will countries accelerate their implementation of these recommendations, and will the international community provide additional resources to do so?

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