Gender inequality drives HIV epidemic in sub-Saharan Africa
Recent publications by the National Agency for the Control of AIDS (NACA) have provided evidence-based reasons why women and girls are more vulnerable to Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).
According to one of the reports titled “WOMEN, GIRLS, GENDER EQUALITY AND HIV IN NIGERIA: FACT SHEET 2016,” gender is an inextricable part of the HIV/AIDS equation; and young women are disproportionately vulnerable to infection; elderly women and young girls are also disproportionately affected by the burden of care giving in the epidemic’s wake.
The NACA-produced report noted: “Globally, females make up to 50 per cent of People Living with HIV (PLHIV) while in sub-Saharan Africa, 60 per cent of PLHIV are females. In low and middle- income countries worldwide, HIV is the leading cause of death and diseases in women of reproductive age. Men and boys are affected by gender expectations that may encourage risk-taking behavior, discourage accessing health care services and narrowly define their roles as partners and family members. Rates of HIV testing and treatment tend to be lower among men compared to women. Gender inequality and poor respect for the human rights of women of women and girls are key factors in the HIV/AIDS epidemic: both from the point of view of effectiveness and from the call of social justice.”
The NACA report also observed that violence against women and girls is a key driver of HIV.
Studies have demonstrated strong links between gender-based violence (GBV) and HIV infection with violence as a risk factor for HIV as well as a consequence of being HIV positive. About 35.6 per cent of women across the world have experienced either non-partner sexual violence or physical or sexual violence by an intimate partner or both.
Gender-based violence and gender inequality are increasingly cited as important determinants of women’s HIV risk. In Nigeria, women and girls abducted by the insurgency groups are forced to marry, convert and endure physical and psychological abuse, forced labor, and rape in captivity. More than 500 Nigerian women and girls have been abducted since 2009.
Forced sex increases the risk of HIV transmission among women due to lacerations. Women dreading or experiencing violence, are less likely to negotiate for safe sex, go for HIV testing, share their HIV status and access treatment.
According to the report, Women (45 per cent) who ever experience physical or sexual violence did not seek help from any source or tell anyone about the violence. Current gender roles also compromise men’s health by encouraging them to equate risky sexual behaviors and violence with being manly.
Various studies in Nigeria identified the following as factors that make women and girls more vulnerable to HIV. Most women and girls lack power to control key aspects of their lives including marriage and sexual negotiation in and out of marriage. Most women and girls also lack social and economic power to control the impact of the epidemic in their lives.
About 70 per cent of Nigerian women live below the $1 a day threshold emphasizing the feminization of poverty in Nigeria. Women and girls lack access to education at all levels, economic empowerment largely tied to property rights (10 per cent of women in Nigeria own land). In Nigeria, 60 – 79 per cent of the rural workforce is women but men are five times more likely to own land. Weak political commitment to domesticate and implement international and regional treaties and national laws that aim to address gender inequalities remain a challenge for empowering women across board in Nigeria.
Studies have shown that in Nigeria, masculinity norms impress on men to have more than one sexual partner and it is common for older men to have unprotected sexual relationship with much younger women.
To address these issues, another new publication by NACA recommended gender responsive budgeting to ensure milestone in HIV/AIDS programming.
According to the publication title “GENDER RESPONSIVE BUDGETING:
Milestone in HIV/AIDS Programming,” mainstreaming of gender into all policy-related and programmeming activities and structures ensures that all interventions and programmes are gender-sensitive and gender-responsive, appropriately meeting the unique needs of females and males.
It noted: “This guiding principle is a clear indication of due recognition of the place of gender equality in the national HIV response. There is however, a clear gap between rhetoric and reality. Available data continues to point to the fact that women, girls, men and boys are disproportionately affected. Women and girls vulnerability to HIV is deeply rooted in their biological make up and this is exacerbated by a complex mix of societal norms and value systems which not only affect women and girls but also men and boys.
“ Similarly, gender inequality has been identified as a key driver influencing the vulnerability of women and girls to HIV infection. This is evident in the current HIV prevalence among the general population in Nigeria of which women constitute 58 per cent. The rate among young women between the ages of 15 and 24 years is estimated to be three times higher than among men of the same age.”
Meanwhile, the National Policy on HIV and the National Strategic Framework and Plan over the years elucidate the strong commitment of the national response to promoting gender equality and upholding human rights of all Nigerians.
Within the ambits of the policies and legal frameworks, participation and involvement of women, girls, men, boys and the marginalized groups including key populations is encouraged. The federal nature of the country also allows each State to enact its own laws and develop its own policies.
Gaps however exist both in implementation and provision of some of the laws that mitigate its efficiency. Punitive laws may reverse the gains in the HIV prevention achieved over the years especially among key vulnerable populations. Efforts are however being scaled up to make gender equality and human rights response a reality.