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Lack of HIV Prevention Services for the Displaced
The power of education in fostering a better and effective response to HIV and AIDS is undeniable.
Education promotes knowledge and with knowledge about HIV and AIDS, individuals, families and communities have the ability to make informed choices about their behavior.
However, governments and international donor organizations often underplay this important intervention, particularly in the emergency phase of the cycle of displacement, says a report recently issued by UNHCR and UNESCO on the importance of education to populations that find themselves victims of displacement due to conflict, disaster or other emergencies.
Education can play a key role in helping refugees and internally displaced persons (IDPs) cope with the negative excesses of their circumstances, such as ignorance, exploitation, violence and the risk of HIV infection.
Many factors combine to put IDPs and refugees at the risk of HIV infection, including loss of livelihoods, lack of access to basic services, poverty, alcohol and drug abuse, and violence. Read the rest of this entry »
The Great Vasectomy Fear
For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.
According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.
“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report. But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”
The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.
The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Read the rest of this entry »
In Jamaica and Globally AIDS Stigma Barrier to Progress
In 2005, Jamaica – a country notorious for homophobia predominantly channeled through musical lyrics – received global attention for the killing of Lenford “Steve” Harvey, a gay man and an AIDS activist.
Harvey’s murder was blamed on stigma and discrimination against gays, and led to a huge outcry within the AIDS community.
The witch hunt against homosexuals in the country is regarded as a factor contributing to the spread of HIV, the virus that causes AIDS.
According UNAIDS, the national HIV infection rate in Jamaica is 1.5 percent among an estimated 2,700,000 people, and AIDS is the leading cause of death among 15- to 44-year-olds. Predominant modes of HIV transmission include multiple sex partners, history of sexually transmitted infections, drug use, and unprotected sex among men who have sex with men.
It is estimated that 33 percent of gay men in Kingston, Jamaica’s capital city, are HIV positive, but many of them opt to stay underground, away from public health services due to fear of stigma and discrimination. Read the rest of this entry »
In Zambia Young People Have Sex to “Prove a Point” or Make Money
Young men and women in Zambia are under pressure to engage in multiple sexual relationships due to prevailing societal attitudes about masculinity and for economic benefits, respectively, according to a study recently published in the African Journal of AIDS Research.
The study states that young men are likely to engage in high-risk sexual behaviour because that is the way men are expected to behave, with the majority believing that their identity is defined by their sexual prowess.
On the other hand, young women have multiple sexual partners as a way to escape poverty, which affects approximately 68 percent of the population.
“Among young women in the study, the practice of multiple sexual partnerships seemed fairly widespread and it typically involved powerful socio-economic ties, making it difficult for individuals to change their own behaviour,” said the study.
Young people’s sexual attitudes and behaviours comes against a backdrop of high rates of HIV and AIDS which have shortened life expectancy in the country.
According to UNAIDS, an estimated 16,5 percent (1,200,000) of people aged 15-49 in Zambia are living with HIV, of which 57 percent are women with the main mode of HIV transmission being heterosexual intercourse.
To make matters worse, UNAIDS reports that in Zambia there is also pressure on women to demonstrate their fertility, so they do not use condoms and a cultural trend for inter-generational relationships also puts girls at risk.
Statistics show that HIV prevalence peaks in men between the ages of 29 and 34; in women it is 15 and 24.Among young people ages 15-24, the estimated number of young women living with HIV in Zambia is more than twice that of young men.
In Zambia, like many countries in sub-Saharan Africa, epidemiological evidence shows that multiple sexual partnerships are contributing considerably to HIV transmission.
In light of this, there is need for increased emphasis on fidelity and partner reduction in the prevention of HIV transmission. However, a combination of cultural and economic factors push young people into potentially risky sexual engagement with multiple partners.
According to the study, although young people were aware of the risk associated with having multiple sexual partnerships, they described several barriers to translating safer-sex knowledge into health-promoting safer-sex behaviours.
“For many young men, having many partners was a way of demonstrating their virility and manliness,” states the study titled “Reasons for multiple sexual partnerships: perspectives of young people in Zambia”.
“It was seen as more acceptable for men than women to have multiple sexual partners.”
The study adds that a traditional culture that associates masculinity with having multiple sexual partners does exist among youth in Zambia.
“When respondents spoke about young men having multiple sexual partnerships in order to “prove a point,” it is evident that in essence the point they were trying to “prove” was that they could live up to the cultural expectations of masculinity in Zambia,” says the report.
Notions of masculinity have long been singled out as a stumbling block to safe sexual practices between men and women.
The study recommends that there is a need to challenge traditional notions of masculinity which puts both men and women at risk of exposure to HIV. Respondents also cited polygamy, which is widely practiced in some parts of Zambia, as a factor which influences multiple sexual relationships for young people socialized in a polygamous environment.
Effective responses to HIV and AIDS in Zambia, like many countries in sub-Saharan Africa, need to continuously figure out how to tackle often-sensitive cultural issues that facilitate HIV transmission.
Among young men, existent concepts of masculinity need to be redefined so that the definition of manhood is not simply confined to sexual prowess or number or sexual encounters.
The study further recommends that young women need to be offered more opportunities to escape poverty because this will reduce the need to resort to multiple partners as a means of survival.
“While the majority of the young people were well aware that having multiple sexual partnerships increased their chance of contracting HIV, it is vital that youth be made aware of the sexual networks that are created as a result of this multiple partnering – and how the chance of becoming infected can depend on one’s position within the networks,” states the study.
Overall, sex education can play a key role in encouraging young people to either delay having sex or practice safer sex.
Young Couples Face Baby Pressures
Zimbabwean culture, like many cultures in sub-Saharan Africa, places a high value on procreation. Child-bearing is regarded as a rite of passage into becoming a normal adult member of society.
As a result, reproductive health choices and practices often play second fiddle to pressures to reproduce that are exerted by traditional and cultural norms. Usually, these pressures are covert so they tend to be ignored in the design of reproductive health programs and interventions.
Reproductive health generally implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
But in Zimbabwe, men and women’s ability to exercise this right is curtailed by the unseen force of tradition and culture.
In many parts of the country, a woman is expected to have been married at roughly age 24, and within two years of marriage is expected to have a child. Young women, in spite of their educational status, are under immense pressure to fulfill this social expectation. On the other hand, a man who goes beyond 30 without getting married or having a child attracts significant social ridicule.
Failure to procreate especially in a marriage, even if it is by choice, is interpreted in negative light and is equated to reproductive health failure. For a man, becoming a father is associated with a sense of achievement, and failure to reproduce severely undermines the sense of masculinity. A woman’s place within a marriage is regarded as secure when she reproduces. If she fails to do so, she can become ostracized within the household and community.
“Failure to reproduce can strain family and other social relationships, particularly when the negative views of extended family members are taken to heart,” says a study conducted in Zimbabwe in 2001 titled Culture, Identity and Reproductive Failure in Zimbabwe.
“Generally speaking, about one year after entry into marriage or a stable sexual partnership, others expect there to be a child, irrespective of the reproductive choices of the partners.”
It is clear that traditional and cultural attitudes play a significant role in how both men and women construct their reproductive capabilities and choices.
As Danielle Toppin notes “given the often covert nature of socialization, certain gendered behaviours are often left untouched, resulting in reproductive health policies that fail to meet the specific needs of women, and of men”.
In Zimbabwe, the family, a primary unit of socialization, is often the root of pressure for men and women to prove that they can reproduce. The desire to conceive in order to gain social acceptance is given preference to adopting tools and methods that promote safe sex.
The social pressure on women to become pregnant and give birth leads them into conditions of vulnerability, where they have to acquiesce to their partner’s sexual demands. It can also lead men to have multiple sexual encounters exposing them to a high risk of contracting HIV.
Put simply, the effectiveness of sexual and reproductive health tools is inhibited by culturally and socially constructed layers that define people’s sexual behaviors.
However, instead of being an impediment, culture can be used as a stepping stone to promote reproductive health rights. To have effective reproductive health programs, therefore, a full understanding of a given society’s values and beliefs is required.
There’s need for an approach that is sensitive to contextual, cultural, traditional and gender practices that impact on reproductive health choices.
The traditional, spiritual and cultural beliefs that shape and define sexual identities and attitudes towards sexual and reproductive health need to be given serious attention in the design of programs and interventions. Traversing the cultural and traditional can be very difficult and requires a lot of sensitivity, investment and patience.
It’s imperative to involve the target communities in the design and implementation of reproductive health policy, planning and practice in order to challenge cultural norms that may put women and men at risk.
Why Tuberculosis Matters to Women’s Health
Tuberculosis (TB) has a major impact on women’s sexual reproductive health and that of their children.
For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth.
The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality.
Unfortunately, there is little to no attention about women’s vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.
In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.
There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women’s health needs at the core.
More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.
In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.
A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fueling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.
According to WHO, although Africa has only 11% of the world’s population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.
Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.
HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.
For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women’s specific needs.
Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.
Even with the availability of TB drugs women’s socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.
For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.
The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.
Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.
An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.
According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.
TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.
A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.
Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.
To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives.
Unsafe Abortion Leads to Maternal Death
In many parts of the world, women who have an unwanted pregnancy often find themselves caught up in an isolated and agonizing situation, left alone to decide whether to have a child that they may not be able to support or have an abortion.
According to the UN, although abortion is commonly practiced throughout most of the world and has been practiced since long before the beginning of recorded history, it is a subject that arouses passion and controversy.
In Zimbabwe, as in many sub-Saharan African countries, abortion, except in cases of rape, incest, fetal impairment, or to preserve a woman’s health, is illegal – and if caught, women face jail terms.
As a result, many women resort to clandestine, unsafe and life-threatening abortion methods. Backyard abortions are so rife in Zimbabwe in spite of the laws that prohibit the practice, putting the life of women, particularly young women, at risk.
UNICEF estimates that 70,000 illegal abortions take place in the country every year. In sub-Saharan Africa, 70% of women who end up in hospital after an unsafe abortion are under 20.
Marie Stopes International reports that the risk of death from unsafe abortion is higher in Africa than any other region: nearly half of global maternal deaths related to abortion occur in the region.
“Unsafe abortion has the highest impact in developing countries whose citizens lack widespread access to high-quality medical care,” the group reports.
Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – governments will have to adopt progressive pro-adoption policies.
In the absence of Prevention of Parent to Child Transmission (PPTCT) methods, there will likely be an increased demand for abortion services. And, thus, there is need to set up abortion clinics and ensure access to safe abortions.
“Women living with HIV seek abortion care for the same myriad reasons as all other women. Additionally, the same factors that make some women vulnerable to HIV also often increase their need for access to safe abortion services,” says Barbara Crane, Ipas executive vice president for technical leadership and advocacy.
Having said that, young women – in particular – left with little choice, face immense pressure to terminate unwanted pregnancies.
Traditional and cultural norms highly stigmatize and discriminate against children born out of wedlock further putting pressure on young women who fall pregnant before marriage to opt for abortion – either conducted by untrained persons or self-inflicted.
Abortions are usually conducted in unregulated and unsanitary conditions and with methods that kill the young women or render them infertile for the rest of their lives.
To put it bluntly, clandestine abortions are a leading cause of maternal mortality in the country. According to a UNICEF report, illegal, self-inflicted abortion methods are thought to include the consumption of detergents, strong tea, alcohol mixes and malaria tablets; other methods include the use of knitting needles, sharpened reeds and hangers.
The termination of the pregnancy is permitted in circumstances where a pregnancy endangers the life of a woman or where there is a serious risk that if the child to be born would suffer from a physical or mental defect of such a nature as to be severely handicapped.
In addition, the termination of pregnancy is permitted if the fetus is conceived as a result of unlawful “intercourse,” defined as rape, incest or intercourse with a mentally handicapped woman.
Given the high rates of maternal mortality attributed to unsafe abortions in the country, there is need for treating abortion as an issue of health and welfare as opposed to one of crime and punishment in order to save women’s lives.
The fact is that even though abortion is criminalized, young women affected by high levels of poverty and the social undesirability of children born out of wedlock, resort to abortion as a way to manage their lives and livelihoods.
According to analysts, abortion laws which are traceable to colonial regimes in sub-Saharan Africa need to be reformed in order to safeguard the rights of women. However, removing women’s criminal liability for abortion is only but one part of the solution.
There is need for widespread educational campaigns about contraceptive methods that are available to women. Access to the methods must be made as easy as possible to women who may face social condemnation for using contraceptives within their communities.
Also, evidence in countries such as Nepal shows that provision of comprehensive care and support and approving clinics where women can have an abortion safely can significantly reduce the number of women that die due to pregnancy-related causes.
All in all, a liberalized law in Zimbabwe can help to avert the high rates of injury and death among women associated with unsafe abortion.
Chief K.Masimba Biriwasha
