STDs and AIDS
Sexually Transmitted Diseases Are Profoundly Sexist Diseases
STDs cause greater pain and suffering for women than for men because:1. Transmission of sexually transmitted diseases (STDs) from men to women is much easier than from women to men. The risk of acquiring gonorrhea from a single sexual encounter is 25 percent for men and 50 percent for women. 1
2. Consequences for women are severe, long-term and can end in death. They include chronic pelvic pain, infertility, cervical cancer, and ectopic pregnancy.
3. Symptoms are much less likely in women than in men. Half of the women who are infected do not know it because they have no symptoms; other symptoms, such as discharge, are experienced as "normal" by women. Women, therefore, often do not get treatment until infections reach an advanced stage, when severe consequences are inevitable. 2
Society reinforces the sexist nature of STDs and HIV/AIDS
In many cultures, symptoms of STDs are often interpreted as a sign of virility in men, but a disgrace for women. 3No effective, affordable, female-controlled method to prevent STD transmission exists. The female condom is not totally controlled by the woman and is still very expensive. Scientists are researching MICROBICIDES --- compounds that could be a reliable, women-controlled method of STD and HIV/AIDS prevention.
STD clinics are often so stigmatized that few women are willing to use them.
Older men seek out young girls as sexual partners because they regard them as HIV-free.
Among Ethiopian teenagers, for every boy with AIDS there are 3 girls with AIDS. For men and women in their 30's, this ratio is reversed. 4
In Zimbabwe, AIDS cases among 15 to 19 year-olds show that for every case in a young man, there were five cases in younger women. 5
IWHC's colleagues in Asia, Africa and Latin America have faced the complex set of issues that surround HIV/AIDS and STD prevention. Despite cultural and social diversity, health educators world-wide have realized that prevention cannot depend on condom programs alone. In order to stop the spread of AIDS, men and women must be able to address sexuality in a frank and open way. Poverty and lack of education only contribute to the disempowerment that many women experience in their sexual relationships. IWHC supports programs that are at the forefront of AIDS and STD prevention and treatment --- community-initiated programs that attack the roots of the STD and AIDS epidemics.
Prevention Strategies
Through years of work on reproductive health issues, our colleagues have come to recognize the central role that sexuality plays in achieving reproductive health. After all, if women and men are ashamed of their bodies and unable to talk openly about sex, then there is little room for discussion of HIV/AIDS prevention. From the U.S. to Mauritania, many cultures blame or ostracize women who suffer from sexually transmitted diseases. Women's shame about their bodies or fears of harassment can prevent them from seeking medical care, or asking for information about STDs. Until we address the complex issues that keep the lines of communication about sex and reproduction closed, preventing disease and suffering will remain extremely difficult.
Understanding Human SexualityIWHC supports several programs that conduct research on human sexuality. For example, two IWHC-sponsored organizations in Nigeria are undertaking research projects which aim to gain greater insight into women's sexuality. Knowing how women think about sex and their bodies will help these organizations to better serve their communities.
- An IWHC-supported NGO in Cameroun educates the public about HIV/AIDS. In the past year, this NGO has noted a marked increase in the number of cases of HIV/AIDS and related deaths. In 1996 the group completed activities under a grant from IWHC for public education on STDS and AIDS, including training 27 community women as AIDS educators, conducting public education activities, maintaining and improving its counseling and resource center, and holding meetings of the national executive committee. The organization emerged from these meetings with a new executive committee and revitalized provincial branches. While the strategy to train community women has proved effective in enabling the group to educate many more people, women's lack of power within marriage remains a nearly insurmountable obstacle in efforts to enable them to avoid infection.
Men's Roles
Men's contributions are essential to ensuring sexual and reproductive health and rights for all. Yet, in most areas of the world, there is little documentation on how men experience or view sexuality and their own sexual lives. Traditionally, family planning-centered programs have focused their work on women --- hoping to reach entire families and affect community change through their contact with contraceptor "acceptors." Our approach is woman-centered --- we are interested in programs that do more than provide pills or insert Norplant --- and focused on men as well as their sisters, wives, girlfriends, daughters and mothers. The responsibility for healthy sexual lives depends on women and men working together.IWHC grantees have developed innovative, community-based education programs that sensitize men to issues of sexuality, intimacy and gender roles. Men in these groups are challenged to think of women as more than sexual objects, and to think of themselves as more than sexual aggressors. Men who are already caring and just in their everyday lives are encouraged to educate others about the status of women --- to prove that men can be feminists and women's health advocates.
- IWHC supports an NGO that has initiated background research on reproductive health and masculinity in Chile. As a part of this initial background research, they are developing an annotated bibliography on existing research on masculinity and reproductive health in Chile and creating a theoretical framework to ground their future study. This study will contribute to the development of new sexual and reproductive health programs that involve men in true partnerships with women in family planning, HIV/STD prevention and other related matters.
Adolescents
The population of adolescents is expected to be one billion by the year 2000, almost 20% of the world's population. In the developing world, up to 2/3 of all new HIV infections may be occurring among 15-24 year-olds. Overall it is estimated that half of global HIV infections have been in people under the age of 25. Up to 60% of infections in women are believed to occur by the age of 20. Despite these staggering figures, most young men and women do not have access to information and services for contraception, sexually transmitted diseases or HIV/AIDS; they also know little about issues of sexuality and gender relations.Given the health risks that they face, denial of confidential services and information to adolescents is counter-productive and dangerous. Young women and girls bear most of the consequences of inadequate or inaccessible sexuality information and health services; in most societies of the world, they have far less power than men and boys to make choices about their own bodies. The international community has a clear responsibility to young women and girls as well as to young men and boys to provide sexual and reproductive health education services that are user-friendly and confidential.
To address the spread of HIV and STD infection among youths, IWHC funds programs that provide clinical care and health education specifically for adolescents. We also support programs for boys and girls before they become teenagers, to educate them and empower them to make healthy decisions and address gender issues.
- An IWHC colleague organization works with adolescent boys in Nigeria to develop anti-sexist and critical consciousness while educating the participants about Nigerian society, sexuality and reproductive health, violence and social action. Since its inception, the project has quadrupled the number of participants and is continuing to develop and refine its methods and materials. The first program of its kind in Nigeria, it could provide inspiration for others seeking to encourage men to take responsibility for their roles in ensuring reproductive and sexual health, as well as women's equality.
For More On Programs That Work With Adolescents See:
Nigeria and Cameroun
VIOLENCE AS A PUBLIC HEALTH ISSUE
The global health burden of violence against women aged 15 to 45 is comparable to that posed by HIV, TB, sepsis in childbirth, cancers, and cardiovascular problems combined. 6 Rape and domestic violence in both the developed and the developing world are responsible for nearly one out of five healthy days of life lost to women of reproductive age. 7 One-fourth of all suicide attempts by American women --- and half of all attempts by African American women --- are preceded by abuse. In Papua, New Guinea, 67 percent of rural women admit to being beaten. In India, in 1990, police recorded 4,835 "dowry deaths" in which young brides are subjected to abuse and murder by husbands and in-laws if their demands for money and goods are not met by womens' families. 8IWHC supports programs that take action to prevent violence against women. One quarter to one half of women in many countries report having been abused by a present or former partner. When women are threatened by beatings or verbal abuse, their options for protection from disease and unwanted pregnancy diminish. Safe sex requires the participation of both partners. Violence against women is a public health issue that must be negotiated on a global and local scale.
- IWHC supports an organization in Chile that recently held a one-day seminar for women from a low-income neighborhood of Santiago to explore the ways in which violence makes women vulnerable to HIV/AIDS and to work on building skills to improve their capacity to communicate with their partners, negotiate safer sex and defend themselves in violent situations. Poor women in Chile, as in the rest of the world, face an increased risk of HIV infection due to the lack of access to high-quality health care services and health-related information, and overall poorer health indicators associated with poverty. One out of 4 Chilean women has experienced physical violence, compounding their vulnerability in situations that may lead to the transmission of STDs and HIV/AIDS.
- IWHC also supports the leading feminist organization in Cameroun, which educates the public on violence against women, provides services athe their Centres Vie de Femme (Women's Life Centers). This NGO provides important intellectual leadership to the women's community in Cameroun. The Women's Life Centers run support groups and provide counseling, education and legal services to women who have suffered violence --- the only services of this kind available in Cameroun.
REPRODUCTIVE TRACT INFECTIONS:
Millions of women worldwide suffer from reproductive tract infections (RTIs) --- infections of the lower and upper reproductive tracts of girls and women. Most are sexually transmitted diseases. Some are due to overgrowth of organisms normally in the vagina; others result from poorly performed gynecological, childbirth, or abortion services.
NEGLECT AND SILENCERTI's are an invisible epidemic.
330 million new cases of STDs occur worldwide each year. 913 million women worldwide will be infected with HIV by the year 2000. 10
The risk of HIV transmission is 3 to 5 times greater when other STDs are present. 11
RTIs cause chronic ill health, infertility, disability, and death among women, and congenital disabilities such as blindness in newborns. Cervical cancer, frequently related to a sexually transmitted virus, accounts for 3 to 5 percent of all adult female deaths in many areas of the world and is the leading cause of death from cancer in Southern countries. 12
RTIs are the cause of infertility at the following rates:
50% to 80% of cases in many sub-Saharan African communities
30% in Latin America
15% to 40% in Asia. 13IWHC has published extensively on this neglected and dangerous women's health issue; see our publications sections for more information on RTIs. Look for these titles:
CHALLENGING THE CULTURE OF SILENCE
THE CULTURE OF SILENCE
REPRODUCTIVE TRACT INFECTIONS
SAFE ABORTION SAVES LIVES
Access to safe, legal abortion services is essential to save women's lives and health.Unsafe abortion is a global problem with enormous impact on women's health and lives, particularly in poorer, less developed countries where abortion is also the most legally restricted. Mortality due to abortions is unnecessary and could be prevented through training health professionals to provide safe procedures and amending laws and policies that restrict women's access to safe, legal services.
Botched abortions kill an estimated 85,000 women per year, even though abortion, when properly performed, is one of the safest and simplest medical procedures. Compare the following relative risks of female death in the U.S.:
Abortion (under safe conditions and under 9 weeks' gestation) one in 400,000 Live births one in 10,000 14 When safe, early abortion services became available in Jakarta, Indonesia, hospitals shut down their special wards for women suffering from botched abortions. No one came; there were no cases. 15
When abortion was made illegal in Romania, maternal deaths increased sevenfold. 16
Botched abortions use up scarce resources of public health systems desperately needed for other life-saving interventions. In many countries, including those in sub-Saharan Africa and Latin America, studies estimate that botched abortions:
-- fill half of all obstetrical/gynecological ward beds
-- use up half or more of the blood bank resources of local hospitals
-- take up half or more of the operating theater time
-- occupy half or more of the time of surgeons or specialized professionals. 17Thirty-four to 57 % of all admissions to the gynecological ward of a hospital in Tanzania were women suffering from complications of abortion. The cost of care was U.S. $7.50 per day in a country where the health budget provides U.S. $1.00 per person per year. 18
Our work on abortion
The International Women's Health Coalition works with women's health advocates in Latin America and West Africa to help ensure the delivery of safe and legal abortion services. We sponsor public education campaigns, support local activists who put pressure on policy makers, and send colleagues to international meetings. IWHC supports organizations that work to change abortion policies.
- An NGO based in Mexico, has been serving as the coordinator of a regional abortion rights campaign to increase awareness of the need for legal, safe abortion services with the ultimate aim of decriminalizing abortion. This campaign has undertaken the important task of stimulating debate on abortion throughout Latin America. Two representatives benefitted from their attendance at international conferences (one was sent to the Netherlands and the other to India). Both returned to their home countries with new ideas and lessons learned from women working on similar issues worldwide, which have been shared with other campaign members throughout the region.
- Another IWHC colleague NGO in Bolivia disseminates information and raises public awareness on abortion as a public health issue, and helps to organize the Latin American Day for the Decriminalization of Abortion (September 28). In May, 1996 the Bolivian Health Minister declared that he personally advocates legalization of abortion as a way of decreasing needless deaths, which caused a sensation within the country and attracted international attention. This campaign was designed at a critical moment to maintain pressure after debate had been opened by the Minister's declaration. After a month of media blitz, the campaign culminated in a one-day cultural festival of exhibitions, performances and discussions about reproductive rights, which were designed to educate the public and attract the press.
For More On Abortion See:
Country Programs
News
FOR MORE INFORMATION on programs in Asia, Africa and Latin America see:Country Programs
and these IWHC publications:
Learning about Sexuality: A Practical Beginning (1996)
The Sexuality Connection in Reproductive Health (1993)
The Cairo Consensus: The Right Agenda for the Right Time (1995)
Footnotes
1. Dixon-Muellerand Judith Wasserheit, "The Culture of Silence: Reproductive Tract Infections Among Women in the Third World" (New York: International Women's Health Coalition, 1991), p. 11.2. Anne Tinker, et. al., "Women's Health and Nutrition: Making a Difference," World Bank Discussion Paper #256 (June 1994), p. 4.
3. Gita Sen, Adrienne Germain, and Lincoln Chen. eds., Population Policies Reconsidered: Health, Empowerment, and Rights (Boston: Harvard School of Public Health, 1994), p. 42.
4. Debrework Zewdie, "Men, Women, and AIDS," presentation for the XIIIth International Conference on AIDS in Africa and the VIIIth African Conference on Sexually Transmitted Diseases Marrakesh, Morocco (December 1993), p. 3.
5. Ibid.
6. Lori Heise, "Violence Against Women: The Hidden Health Burden," World Bank Discussion Paper #255 (1994), p. 17.
7. World Bank Discussion Paper #255, p. 17.
8. World Bank Discussion Paper #255, p. 19.
9. Gita Sen, Adrienne Germain, and Lincoln Chen. eds., Population Policies Reconsidered: Health, Empowerment, and Rights (Boston: Harvard School of Public Health, 1994), p. 229.
10. WHO, quoted in the New York Times (November 2, 1993).
11. Christopher J. Elias, Ann Leonard, Jessica Thompson, "A Puzzle of Will: Responding to Reproductive Tract Infections in the Context of Family Planning Programs" (New York: Population Council, 1993), p.6.
12. Ruth Dixon-Mueller and Judith Wasserheit, "The Culture of Silence: Reproductive Tract Infections Among Women in the Third World" (New York: International Women's Health Coalition, 1991), p. 6.
13. J. N. Wasserheit, "The Significance and Scope of Reproductive Tract Infections Among Third World Women," in International Journal of Gynecology and Obstetrics, pp. 145-168.
14. Ruth Dixon-Mueller and Adrienne Germain, "Four Essays on Birth Control Needs and Risks" (New York: International Women's Health Coalition 1993) p. 9.
15. E A. Moelock et al., "The Relation Between Menstrual Regulation Service and the Incidence of Septic Abortions in Indonesia" (Jakarta: University of Indonesia, 1988), p. 2.
16. World Bank Discussion Paper #256, p. 65.
17. Kajsa Sundstrom "Abortion--A Reproductive Health Issue" (Stockholm and Washington, D.C.: Swedish)
18. G. S. Mpangile et al., "Factors Associated with Induced Abortion in Public Hospitals in Dar es Salaam Taruania" Dar es Salaam, Taruania, Family Planning Association (1992).
IWHC HOME PREVIOUS INDEX TOP OF PAGE