Factors affecting HIV infection - Gender


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Factors affecting HIV infection - Gender

  1. 1. Munyaradzi Mataire Bindura University of Science Education
  2. 2. DEFINITION  • Gender refers to sexual identity or the condition of being male or female or being masculine or feminine. • Gender inequity and inequality are critical in the spread of HIV. This explores the need to involve men in problem solving rather than seeing them as part of the problem. The inequalities between men and women aggravate the situation for women with HIV and AIDS.
  3. 3. gender  • In many cultures, ideals of manhood include strength, courage and dominance and critically accept men as having an uncontrollable sex drive that let them off the hook of responsibility. • Alcohol is a major contributing factor reducing the sense of responsibility further. • Little blame or stigma is attributed to men when men says he had sex when he was drunk. On the other hand if it is a woman she is labeled by both men and women as a whore.
  4. 4. Men & HIV & AIDS  • Gender norms related to masculinity can encourage men to have more sexual partners and older men to have sexual relations with much younger women. In some settings, this contributes to higher infection rates among young women (15-24 years) compared to young men. Norms related to masculinity, i.e. homophobia, stigmatizes men having sex with men, and makes them and their partners vulnerable to HIV.
  5. 5. Women & HIV & AIDS  • According to the latest (2008) WHO and UNAIDS global estimates, women comprise 50% of people living with HIV. In sub-Saharan Africa, women constitute 60% of people living with HIV. In other regions, men having sex with men (MSM), injecting drug users (IDU), sex workers and their clients are among those most-atrisk for HIV, but the proportion of women living with HIV has been increasing in the last 10 years.
  6. 6. Women & HIV & AIDS   This includes married or regular partners of clients of commercial sex, IDU and MSM, as well as female sex workers and injecting drug users.
  7. 7. Women & HIV & AIDS  • Gender inequalities are a key driver of the epidemic in several ways: • Aiming for two Millennium Development Goals (MDGs) • HIV/AIDS programmes that promote and invest in gender equality contribute to both MDG 6 on combating HIV/AIDS, TB and malaria and to MDG 3 on promoting gender equality and women's empowerment.
  8. 8. contd   Norms related to femininity can prevent women – especially young women – from accessing HIV information and services. Only 38% of young women have accurate, comprehensive knowledge of HIV/AIDS according to the 2008 UNAIDS global figures.
  9. 9. contd   HIV/AIDS programmes can address harmful gender norms and stereotypes including by working with men and boys to change norms related to fatherhood, sexual responsibility, decision-making and violence, and by providing comprehensive, ageappropriate HIV/AIDS education for young people that addresses gender norms.
  10. 10. Violence against women   Violence against women (physical, sexual and emotional), which is experienced by 10 to 60% of women (ages 15-49 years) worldwide, increases their vulnerability to HIV. Forced sex can contribute to HIV transmission due to tears and lacerations resulting from the use of force.
  11. 11. Violence against women   Women who fear or experience violence lack the power to ask their partners to use condoms or refuse unprotected sex. Fear of violence can prevent women from learning and/or sharing their HIV status and accessing treatment.
  12. 12. Violence against women   Programmes can address violence against women by offering safer sex negotiation and life skills training, helping women who fear or experience violence to safely disclose their HIV status, providing comprehensive medico-legal services to victims of sexual violence, and working with countries to develop, strengthen and enforce laws that eliminate violence against women.
  13. 13. Gender-related barriers in access to services   Gender-related barriers in access to services prevent women and men from accessing HIV prevention, treatment and care. Women may face barriers due to their lack of access to and control over resources, child-care responsibilities, restricted mobility and limited decision-making power.
  14. 14. contd   Socialization of men may mean that they will not seek HIV services due to a fear of stigma and discrimination, losing their jobs and of being perceived as "weak" or "unmanly".  Programmes can improve access to services for women and men by removing financial barriers in access to services, bringing services closer to the community, and addressing HIV-related stigma and discrimination, including in health care settings.
  15. 15. Women as Caregivers   Women assume the major share of care-giving in the family, including for those living with and affected by HIV. This is often unpaid and is based on the assumption that women "naturally" fill this role.  Programmes can support women in their care-giving roles by offering community-based care and support, including by increasing men's involvement.  Marriage also increases the of having HIV.
  16. 16. Lack of education and economic security   Lack of education and economic security affects millions of women and girls, whose literacy levels are generally lower than men and boys'. Many women, especially those living with HIV, lose their homes, inheritance, possessions, livelihoods and even their children when their partners die. This forces many women to adopt survival strategies (e.g. prostitution) that increase their chances of contracting and spreading HIV.
  17. 17. Education & Economics   Educating girls makes them more equipped to make safer sexual decisions.  Programmes can promote economic opportunities for women (e.g. through microfinance and microcredit, vocational and skills training and other income generation activities), protect and promote their inheritance rights, and expand efforts to keep girls in school.
  18. 18. Anatomy of women   Young girls have an underdeveloped reproductive system which is so delicate and prone to bruises hence increased chances of HIV infection.  The anatomy of women i.e. the inner vaginal membrane have fornices which harbour the virus hence increases the chances of HIV infection.
  19. 19. Anatomy of women   Menstruation also increases the chances of infection . During menstruation there is shading of blood from inflamed endometrium which increases chance of HIV if there is unprotected sex with an infected partner during this period.
  20. 20. Programmes   Many national HIV/AIDS programmes fail to address underlying gender inequalities. In 2008, only 52% of countries who reported to the UN General Assembly included specific, budgeted support for women-focused HIV/AIDS programmes.
  21. 21. Programmes   HIV/AIDS programmes should :  collect and use sex and age disaggregated data to monitor and evaluate impact of programmes on different populations.  build capacity of key stakeholders to address gender inequalities.
  22. 22. Programmes   facilitate meaningful participation of women's groups, women living with HIV and young people  allocate resources for programme elements that address gender inequalities.
  23. 23. A. Manwere
  24. 24.  Culture and Religion Culture and religion have an influence on sexual  and societal level. behaviour at both individual  Many men and women publicly endorse the strict moral norms of their religion and culture but privately behave quite differently  One approach of HIV prevention is to encourage people to follow more closely the precepts of their religion and culture
  25. 25. Culture & religion   HIV prevention can be achieved by the following precepts of religion; usually promotes strict sexual guidelines e.g. Christianity only accepts sex within a monogamous marriage. While Islam accepts polygamy, but again only accepts sex within marriage.
  26. 26. Culture & religion  • In Africa some traditions tend to support polygamy and taboos against sex outside marriage, which differs widely for males and females, and in specific situations e.g. rites held at puberty in some countries involve sexual intercourse. • In Swaziland it is a prestige for a men to have multiple female partners e.g. king, which would promote high-risk behaviour.
  27. 27. Harmful cultural Practices  1. The practice of levirate (inheritance of a wife by the deceased husband’s brother), despite the cause of death e.g. AIDS. 2. Initiation rites in parts of Malawi, involve adolescent girls being secluded for training to be a wife, the training includes sex with an anonymous man selected from the community.
  28. 28. contd   The practice of dipo (initiation ceremony into womanhood in Krobo culture in Ghana involves initiating sexual activity. Adolescents were usually targeted but now younger girls are now involved often prepubescent.
  29. 29. contd  i. ii. Polygamy-were use of condoms is not practiced, if the partner is infected, the other are at high risk of infection during the window phase. The practice of dry sex-common in South East, West and central Africa. Vaginal secretions are seen as dirty and indicate that the woman’s sexually aroused which may not be socially acceptable.
  30. 30. culture  iii. The view that the boy friend must use force in a first sexual encounter with new girlfriend, so that she can prove to be respectable. This leads to the risk of tearing and increases chances of infection. iv. Expectation in parts of Zimbabwe that the woman uses the same cloth to clean herself and the man after sex, even if a condom was used. v. Sex is male pleasure and sex in marriage is for procreation rather than for enjoyment, men needs a variety of different partners outside marriage.
  31. 31. Myths & Misconceptions about  sex  First sexual contact (act) with a new partner cannot cause pregnancy or infection.  The view that wives cannot contact STI from unfaithful husbands because STIs do not affect “nice” women.  Fears that condoms actually spread HIV, or that they can become stuck in the vagina.
  32. 32. Culture & Religion   Culture, tradition, beliefs and values are dynamic and are changing over overtime and can be influenced in positive ways. Changing does not mean abolishing a particular practice or custom but only changing the damaging or harmful elements while retaining the overall custom, it’s symbolism and its meaning.
  33. 33. Culture & Religion  • Religious prohibitions against sex education and condom use. • Some powerful religious and faith groups still oppose sex education despite the evidence in favour of it. Hence the reason why faith groups need to decide whether they are more concerned with or to try to prevent sex that they consider immorale.g. Catholics. Some churches support condom use e.g. the Anglican.
  34. 34. Culture & Religion  • Although in other studies, Catholics, developed a concept e.g. Tanzania, Fleet of Hope Three Boats namely Fidelity, Chastity and Condoms. Therefore a person chooses which boat to move in, but condemning those who chose the condom boat. • The Fleet of Hope is being utilized as a tool for behaviour change communication in many countries.
  35. 35.  Culture and religion Culture, tradition and beliefs are dynamic and they can  be influenced in positive ways  There is need for sensitive approaches that promote discussion and involvement to transform some of the practices.  We don’t need to abolish the tradition but merely change the damaging elements while retaining the overall custom, its symbolism and its meaning
  36. 36. A. MANWERE
  37. 37. Definition & Introduction  • The period of development between puberty and maturity. • Development: Process of growth and differentiation. • About half of the population in developing countries is aged between 15 and under, and this is the age group that is beginning to be sexually active. Hence the reason why access to quality sexual and reproductive health services information is important.
  38. 38. Introduction  • The cultural and religious leaders need to actively support the youths. • Peer pressure force the youths to engage in sexual activities. • Biological, social and economic pressures may encourage young people to have sex while tradition, a sense of morality , and religious and family pressure are likely to discourage girls from engaging in sex but not necessarily boys.
  39. 39. Pressures  • Pressures that force young people into sex are: • Alcohol and other drug consumption that reduces the will power, judgement and inhibitions. • Curiosity and hormonal changes (natural). • Pressures from the friends e.g. be a real men. • Pressure on girls from boys who refuse to believe that NO means “NO”.
  40. 40. Pressures  • Coercion of girls into sex for exchange of gifts, money, marriage or other benefits. This is usually by sugar daddies, who maybe teachers, relatives, friends of the family , members of the church/community. • Urge to rebel against parental rules to establish an independent identity. • Media images showing casual sex in glamorous, wealth contexts.
  41. 41. Pressures  • Poverty and pressure on girls to engage in sex to pay for school fees, food or other needs. • Fear of seeking sexual release through masturbation. • Lack of knowledge about non-penetrative sex options. • Trafficking in women and girls whereby they are abducted or promised employment and then sold into prostitution, less in Sub-Saharan Africa than in Africa.
  42. 42. Approach A by Verkuhl (1998)  • Approaches of helping young to stay safe. a) Information and Empowerment Equip young people with adequate knowledge on (technical sex education), moral standards(peer pressure) and materials(pill, condom, STI clinics), to make sex enjoyable without exposing them to too much risk. (teach teenagers how to swim or how to use a boat, while telling them about crocodiles and bilhazia in the water).
  43. 43. Approach B  b) Repression and Control • Create taboos about sexual relationships outside formal marriage and enforce the taboos using culture and religion. • The method leads to little information and even misinformation.( refusing to teach teenagers how to swim and use the boat while warning them about dangers in the water).
  44. 44. Approaches  • Approach A-Leads to few teenage pregnancies, abortions, STIs and HIV rates are low e.g. in the Netherlands. • Approach B-commonly used in the Muslim culture i.e. control route, where there is female genital mutilation (FGM). Removal of the external genitals e.g. clitoris and sewing up the vagina and leaving a hole for menstruation.
  45. 45. contd   It causes excruciating pain, psychological trauma, risk of infection from wounds.  Agony repeated when husband has to break open the scar tissue to have sex and again during child birth. The later leads to increased maternal mortality rate.  FGM is common in Northern and East Africa and parts of West Africa.
  46. 46. Empowering Approaches  • Providing information to enable them to make their own decisions. • Assisting youths to gain access to education and training. • Supporting young people to help themselves and peer education. • Helping young people to reduce gender inequality all areas but particularly around sexual relationships.
  47. 47. Empowering Approaches  • Ensuring youths have access to youth friendly sexual and reproductive health services e.g. VCT and use of condoms. • Helping youths to find gainful employment. • Adolescent sexual health reproduction actually starts early e.g.in Zimbabwe it starts in primary school. • Key strategies to empower children and young people are sex education and life skills development before they become sexually active.
  48. 48. Empowering Approaches   The aim is to maintain safe behaviour into future, delaying the start of sexual activity.  UNESCO (1998) and UNAIDS, 1997 states that sex education combined with life skills development including a focus on HIV/AIDS /STIs and reproductive health tends to delay onset of sexual activity and make young people’s existing sexual behaviour safer.
  49. 49. A MANWERE
  50. 50. Introduction   Communication remains the only vaccine against the spread of HIV because there is no cure for AIDS.  Fight against AIDS remains in the use of communication to teach people about the disease and encourage them to change behaviour.
  51. 51. Introduction contd   The use of communication techniques and technologies can positively influence individuals, populations and organizations in the fight against AIDS.  Health communication remains the only “vaccine” against the spread of HIV.
  52. 52. Behaviour Change   Strategies to provide condoms and promote their use are compatible with promoting abstinence.  Using condoms is the smallest behaviour change to make risky sexual behaviour safe.  Any barrier method to prevent infection still carries a risk e.g. if condom breaks there are chances of infection.
  53. 53. Condom use  • Consistent condom use reduces the risk of HIV (& other STIs) transmission . • Efficiency rate is 99.99%, one in 100,000 can be expected to break or let viral particles pass. • Although as a personal strategy against HIV infection, condom use is not a perfect solution, it requires people to be highly motivated, always having them available and of good quality .
  54. 54. Condom use   There are two types of condoms , male and female.  Both are available on the market, but the female condom cost more than the male.  Female condoms appear to be highly effective at preventing infection and pregnancy, being made of stronger material than the male condoms and unlikely to tear.
  55. 55. Condom use   Careful information and behaviour change campaigns combined with marketing of condoms in an attractive way can increase condom acceptability.  Condoms need to be associated in public mind with positive images appropriate to the target group whether love, sensuality, fun, sexiness, performance, excitement, safety, trust, care or responsibility.
  56. 56. Barriers to condom use        Availability and accessibility. The Pricing. Culture and Religion. Myths and Misconceptions about condoms. Incompatibility with the need to have children. Trust and Fidelity in stable relationships.
  57. 57. Ways of reducing HIV & AIDS infection   Fewer sexual partners, Monogamy  The more the sexual partners, the greater the chance that one or more have HIV. If no body in the population has many partners, HIV spreads much more slowly than in the populations where many men have multiple partners.  “sticking to one faithful partner” or “zero grazing" as it is called in Uganda if it applies to both partners equally is a useful message.
  58. 58. contd   Non-penetrative sex and abstinence -:Culture  In some cultures sexual practices involves the men rubbing his penis between the tightly closed thighs of his partner until he reaches ejaculation.  Traditional healers, health staff and educators should encourage this traditional practice where appropriate.
  59. 59. contd   Masturbation does not involve any penetration and is essentially safe.  It can be between two people or undertaken alone for sexual release.  Avoiding any penetrative sexual activity is another option: Realistically if abstinence is advocated then masturbation should be encouraged to make abstinence easier to maintain over time. Nonpenetrative sex is a safe option for HIV discordant couples.