Women and HIV & AIDS
Women and HIV/AIDS
The impact of HIV/AIDS on women in India is particularly harsh. India’s patriarchal society puts women at a disadvantage economically, culturally and socially, denying them access to adequate treatment and branding them carriers of the disease.
The HIV/AIDS epidemic is inextricably linked to the social and cultural values and economic relationships between men and women and within communities. While social inequalities facilitate its spread in the country, the virus in turn reflects and reinforces these inequalities. In addition, there is an absence of choice at the individual and systemic levels, whether it is the choice to use a condom or even to have sex.
The problem is compounded by the fact that for most Indian women, sexual intercourse is not a question of choice but rather one of survival and duty. A woman’s fertility and relationship to her husband are often the source of her social identity.
As per NACO, an estimated number of 1.6 million women (between the ages of 15-49 years) are living with HIV/AIDS from the end of 2005; hence 1 out of 3 HIV infections are amongst women.
Given the spurt in HIV cases amongst women, experts have shifted from looking at the HIV/AIDS epidemic solely as a health issue to focusing on other factors that increase vulnerability to infection. For women, low economic and social status, abuse and violence, as well as limited legal and social protection increase their vulnerability to HIV/AIDS.
Vulnerability
India’s social structure leaves women at a much greater risk of contracting the virus than men. The reasons being:
Biological
- During intercourse a large section of the female genital mucosal surface is exposed which could lead to microlesions that are believed to be the entry points for the HIV virus. Young women who have not attained physiological maturity are at even greater risk.
- A larger virus is present in sperm than in vaginal secretions
- Coerced sex increases the risk of microlesions
Economically
- India’s patriarchal society puts women in a state of financial or material dependence on men allowing them to control when, with whom and in what circumstance to have sex
- Again most women are forced to sell sex for material needs and survival. While most people are aware of sex workers in cities, in rural India the problem is even more compounded with even housewives forced to turn to this means for survival.
Socially and culturally
- Women discussing or seeking information on sex, let alone making decisions in this regards is taboo
- A women requesting for a condom or refusing sex is often suspected of infidelity
- Unmarried and even unmarried men are known to frequent sex workers which puts them at high risk of contracting the virus which is in turn transmitted to their partners
Contraceptives
India’s male dominated society increasingly puts pressure on women to care of issues such as contraception and birth control on their own. While the pill remains a popular option, it lacks the ability to protect against HIV. Listed below are some of the contraception methods available today:
The Pill
The Pill is the most popular type of birth control which stops ovulation, preventing the ovaries from releasing eggs. It also thickens cervical mucus, making it harder for sperm to enter the uterus. The hormones in the Pill prevent fertilization and is 92-99.7% effective in birth control. However, it does not in any way protect against reproductive tract infections, including HIV/AIDS
The female condom
The female condom is a disposable contraceptive designed for use by women to help prevent HIV, other sexually transmitted diseases (STDs) and unintended pregnancy. Its sole purpose is to reduce the risk of transfer of virus, bacteria and sperm between sexual partners.
The female condom, 40% stronger than the latex used in male condoms, is a soft sheath that is open on one end and closed at the other. It has two soft, flexible rings. The ring inside the closed end is used to insert the device and helps to hold it in place over the cervix. The other ring forms the open end and remains outside the vagina after insertion. In addition to lining the inside of the vagina, the device covers the outside part of the vagina and the base of the penis during intercourse, reducing skin-to-skin contact.
A setback towards the use of female condoms in India is its pricing as well as availability. Like male condoms, the female condom can be used for one intercourse only.
Microbicides
Touted as an effective means of HIV prevention that does not require the cooperation of the male partner, microbicides are compounds that can be applied topically to protect against sexually transmitted infection including HIV. Though still being tested as a gel/ film/sponge/lubricant/suppository, they are amongst the most promising options on the horizon since it can be applied several hours before sexual intercourse. A safe and effective microbicide will put the power of protection from HIV infection in the hands of women and will save millions of lives. Conservative estimates suggest that the introduction of even a partially effective microbicide could result in 2.5 million averted cases of HIV over three years.
Dental Dams
Dental dams are squares made out of latex that dentists use to isolate the tooth on which they are working. AIDS educators have advocated their use for oral sex, either mouth-vagina or mouth-penis. Because they were not originally designed for sex, they tend to be thicker than condoms.
Pregnancy
An important choice that HIV positive women have to make is whether or not to have a child and what (if any) intervention should be used to reduce the risk of transmission from Mother-to-Child.
HIV positive women who are pregnant or considering pregnancy, have a 1 in 4 chance of passing the virus on to the fetus. Although the precise mechanisms are not known, scientists believe that HIV may be transmitted when maternal blood enters the fetal circulation or by mucosal exposure to the virus during labor and delivery. The risk of prenatal transmission is significantly increased if the mother has advanced HIV, large amounts of HIV in her bloodstream or few of the immune system cells – CD4+ T cells – that are the main targets of HIV.
Maternal drug use, severe inflammation of fetal membranes, or a prolonged period between membrane rupture and delivery are also seen as elements that contribute to the possibility of Mother-to-Child infection. A recent study by a US based group found that HIV positive women who gave birth more than four hours after the rupture of the fetal membranes were nearly twice as likely to transmit HIV to their infants, as compared to women who delivered within four hours of membrane rupture. Breast
feeding introduces an additional risk of HIV transmission of approximately 14 percent.
The chances of Mother-to-Child transmission can be reduced to 1 in 12 if the woman takes specific drug therapies to reduce transmission. In some cases, a 200mg pill of nevirapine (an anti-retroviral drug) given to the mother during labor and a spoonful of the syrup to the baby within 72 hours of its birth has proved to be quite effective in reducing the risk of transmission.
Research data also suggests a 50 per cent reduction in transmission where C-section is performed as compared to vaginal delivery in non-breast feeding population. By combining the use of ARV drugs and elective C-section, transmission rates have been brought down to two per cent in non-breast feeding population. Similar results have also been obtained by using ART without the use of C-section.
Due to the success of such treatments, it is recommended that all pregnant women be tested for HIV so they can make early decisions about treatment to prevent transmission. In the US alone, about 6500 HIV positive women get pregnant and give birth annually. However, due to the availability of information and timely treatment, only about 25% of the babies are HIV positive.
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Heroes Project India
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