Diversity and Community: Addressing HIV/AIDS and Gender Inequality

The following is an excerpt from my short presentation at the International Planned Parenthood parenthood Federation (IPPF) and Family Planning Organization of the Philippines (FPOP) Youth Forum and Stake holder's Conference at AIM, Makati, June 6-8 2007. I spoke on the Report Card on HIV AIDS Prevention for Young Women and Girls as the IPPF Consultant in the Philippines.

In a recent article published by the Reproductive Health Matters Journal in 2005, Tim Frasca of the Mailman School of Public Health asked a most thought provoking question:

"Now that AIDS is affecting more and more women - Is it a crisis because it is affecting more women?"

Indeed, despite the real and serious impact of sex and gender stereotypes, norms and discriminatory practices, as well as violence on HIV AIDS prevalence, there is a necessity to confront how rhetoric and characterization of so-called "innocent victims" of HIV AIDS does little to end the stigma of AIDS. In fact, it reinforces it, discriminated not only against men but also perpetuates the social categories of "bad" and "good" women.

This is a challenge for the IPPF Report Card, which focuses on the situation of girls and young women, at this moment in history.

For while its much needed research focus on the the situation of young women and girls, who in the Philippine context are often "invisible" to the system which denies them sexual and consequently health rights, as a tool, the card's effectiveness lies in the critical involvement of all sexes and genders.

One statement in the study captures the situation of Filipino young women and girls:

"It doesn't follow that, just because service delivery guidelines are supposedly inclusive (generic), that young women and girls necessarily have equal access to services and information. In fact, discrimination on the program level is common simply because government services in health do not recognize "sexual health needs" for girls who aren't supposed to be having sex yet anyway."

As far as local policy is concerned the Philippines has boasted of a law enacted since 1998 which ensures a legal frame of respecting consent, confidentiality and discrimination. Republic Act 8504 or the 1998 HIV AIDS Law also established an AIDS Council, a national policy making body with representaives from NGOs and PLWHA.

Yet like many local laws, those working in HIV AIDS have pointed out how much of a gap exists between actual policy and practice. The AIDS Council's local counterparts are not all active. In some areas, they have yet to be established, over almost nine years after the law's passage.

Likewise, much like a missing integral piece of a puzzle, the lack of a clear policy and program on sexual and reproductive health law has taken its toll on the effectiveness as well as the reach of HIV AIDS services. Among others, the absence of universal access to contraceptives, condoms in particular, the opposition to sex education as part of school curricula and the overall context of conservatism which plagues the programs on family planning have directly affected HIV AIDS information and service provision.

Still, in other respects, policies and law around two particular issues, namely drugs and prostitution, reflect very "Penal" frame. While some NGOs have already been doing work which adopts "harm reduction" strategies, emphasizing rights, we have yet to see this adopted by the State, specifically with regard to prostitution and drug abuse.

Another key informant noted how "Youth focused strategies also often take generic and neutral position, and thus fail to address the underlying causes of vulnerability like gender inequality."

Following the universal laws of general application, such strategies while by themselves not intentionally discriminatory and in fact, aimed to include and not exclude, have limited success if in the end they do not benefit a sector whose particular situation and circumstances, it fails to consider.

Considering that the continuum of available prevention, care and support available in the Philippines is a severely limited one, stake holders also pointed out that it is even more scarce for young women and girls.

Maureen, a PLWH and active organizer and trainer/advocate on HIV AIDS prevention recounted her own story of having been diagnosed positive with HIV as a young woman. She tells how the community and care given to her by the NGOs like PAFPI and Pinoy Plus, helped her pick up the pieces and helped her get to where she is now, happily married with four children and a healthy family.

Indeed, Maureen's story of being able to access the available services and care in her condition is not the usual story for other PLWHA in the Philippines. Cutting edge technology and treatment regimens already standard in other places such as the first world, are yet to be found in Manila.

Even when patients were to seek Voluntary Counseling and Testing, unless they live near Metro Manila and or an NGO which provides these services, they would be unable to access this most basic of services in HIV AIDS.

The bias against young women and girls in service provision also overlaps with marital status. The stake holders note how much like Family Planning services which are harder to come by for the unmarried, even the would be patients would have a difficulty approaching the health centers because of the stigma of non-marital sex for women and girls.

Moreover, married women (who are among those recently noted for recent documented infections) are also worse off because condom-use within marriage is even more rare.

On the other hand, the women in prostitution interviewed for the report card who acknowledged that theirs was a very much sought-after sector as far as HIV AIDs programs were concerned, stressed that as much as they have been informed about the condom's effectiveness in preventing HIV transmission, they could only ask: "When the men refuse, what do we do?"

Notably, even the women in prostitution claimed that while they are able to use condoms with clients who cooperate, they don't use them with their husbands or their boyfriends.

Of course on top of all these, ARVs in the case of treatment, are expensive and limited in supply. [Here I would have wanted to discuss the issue of how patent extensions and the smear campaigns against generics is actually also a big factor in depriving PLWHA, to the ARVs which could ease their suffering and even help them lead longer, healthier lives but I think this merits a whole separate article]

Few trained professionals (of those who opt to stay in the country) are practicing medicine in this area.

On the whole, there are enough standards in place to address the weak rights and gender frames in local policy and programs around HIV AIDS. Again, the Philippines has virtually ratifies every existing International Human Rights Convention as well as actively participated in the adoption of various consensus documents which tackle HIV AIDS, including the June 2006 Declaration which focuses on women and girls.

Perhaps more than any other issue, HIV AIDS has challenged us to go the farthest in confronting our views about sex, gender and women's rights advocacy. While it is true that rape and abuse can also be the site of transmission of the HIV AIDS virus, consensual sex also the mode it is most often transmitted.

No other issue has perhaps forced us to think outside the usual practices and strategies which while giving women and girls due space and power to assert their rights, if we stop there, will fall short of truly addressing their lived realities of living with and among men.

The agenda to transform relationships of power comes into greater focus whenever we speak about male participation, which ought to also include cooperation and partnership.

Indeed, the links between HIV/AIDS prevalence and core inequalities across sex/gender/class/race have most effectively demonstrated to us the overlaps that have long affected rights exercise, and have made the realization of human rights impossible all these years.

More than any other issue, HIV AIDS has focused our attention on respect for difference, (esp. across sexes and genders) and diversity, while at the same time, realizing the value of community.

Additional reading:
Health professionals need to tailor AIDS research to ethnic communities and gender barriers to participation in HIV vaccine trials attributed to gender, ethnicity and economic status

The underrepresentation of women, various ethnic groups and those with low-incomes limits the effectiveness of HIV/AIDS clinical trials and can have a serious impact on the eventual success of vaccines, says Professor Peter Newman of the Faculty of Social Work and the Centre for Applied Social Research at University of Toronto.