International Women’s Day: an interview with Purnima Mane
08 March 2007
Purnima is a renowned social scientist and an expert in gender issues in international health, especially in AIDS. Purnima worked for over 12 years as an Associate Professor at the Tata Institute of Social Sciences, Mumbai, India before she joined the Global Programme on AIDS at the World Health Organization in Geneva in 1994. At UNAIDS, she pioneered work on gender and AIDS and managed the Executive Office until 1999. After working for the Population Council in New York in 1999 and the Global Fund to fight AIDS, Tuberculosis and Malaria, Purnima returned to UNAIDS in 2004 as Director of Policy, Evidence and Partnerships. She has co-authored and edited four books including one of the first books on social and cultural aspects of AIDS in India and is a founder-editor of the journal, Culture, Health and Sexuality. On International Women’s Day, Purnima reminds us how women are more vulnerable to HIV and how violence against women increases their vulnerability.
Dear Purnima, today is International Women’s day. Can you tell us how and why women are particularly affected by the AIDS epidemic?
Women represent almost half of people living with HIV. According to the latest data available, 17.7 million adult women are now living with HIV. This is more than ever before and the trends suggest that this number is on the rise. Everyday, 7000 women become infected with HIV. The expression “feminization of the epidemic” does not nearly catch the enormity of the situation…Nearly 25 years into the epidemic, gender inequality remains one of the major drivers of HIV. Yet current AIDS responses do not, on the whole, tackle the social, cultural and economic factors that make women more vulnerable to HIV, and that unduly burden them with the epidemic’s consequences. Women and girls have less access to education and HIV information, tend not to enjoy equality in marriage and sexual relations, and remain the primary caretakers of family and community members suffering from AIDS-related illnesses. When infected with HIV, women are more likely to be deprived of treatment and more likely to face discrimination . To be more effective, AIDS responses must address the factors that continue to put women at risk.
What would be in your opinion, the top priority intervention to reduce women’s risk to HIV?
'No one solution is obviously enough but if I had to choose one, I'd say education is critical. Sending all girls to school and making sure that they complete high school must become a collective top priority. With each additional year of education, girls acquire vital life skills and higher income-earning potential. Girls who complete secondary education know more about HIV – both how to prevent infection and what to do if they think they are infected. They tend to have fewer sexual partners over a lifetime and are more likely to use condoms. And by providing women with more economic options and independence, education gives them vital knowledge, skills, and opportunities. This means they can make informed choices about delaying marriage and childbearing, having healthier babies and avoiding risky behaviour – as well as knowing more about their rights.
The theme of this year’s International Women’s Day is Ending Impunity for Violence Against Women can you tell us more about the issue?
Violence against women continues to be a common, yet widely ignored phenomenon that robs women worldwide of their health, well-being and lives. In many places, violence against women and HIV risk are intertwined.
The most prevalent forms of violence against women are perpetrated by their intimate partners. A staggering 40–60% of women surveyed in Bangladesh, Ethiopia, Peru, Samoa, Thailand and United Republic of Tanzania said they had been physically and/or sexually abused by their partners. Laws for protecting women from such abuse are either lacking, too weak or too poorly enforced to make much of a difference. Social norms in many countries condone domestic violence as a private, even normal matter—leaving millions of women without hope of legal recourse. But there is nothing natural or inevitable about violence against women. Attitudes can and must be changed.
How does violence against women increase risk of HIV infection?
Violence against women is often associated with a heightened risk of HIV infection. Studies in South Africa and Tanzania show that women who have been subjected to violence are up to three times more likely to be HIV-infected than women who have not experienced violence.
Violence—even the fear of violence—also prevents many women and girls from learning or disclosing their HIV status, or accessing essential AIDS services. In Cambodia, the fear of domestic violence appears to be one of the reasons why unexpectedly low numbers of women have been using HIV counselling and testing services at some antenatal clinics. At a clinic in Zambia, some 60% of women eligible for free antiretroviral treatment opted out of treatment, partly because they feared violence and abandonment if they were to disclose their HIV status to their partners. Fear of violence also prevents women from demanding protection or negotiating safer sex.
What is happening to help reduce violence against women?
Promising initiatives are under way to help reduce violence against women. Some, like Stepping Stones, now active in almost 30 countries, and Men as Partners in South Africa, use community-based workshops to challenge gender stereotypes and reshape power relations. Others, such as the Gender Violence Recovery Center in Kenya and the Cambodian Women’s Crisis Center, provide shelters, medical services and counselling, including HIV services or referrals, to women who have experienced domestic violence and sexual abuse. Such efforts must be expanded, supported and incorporated into national AIDS strategies. Governments the world over have committed to eliminate violence against women. It’s time to do more.
What are immediate measures that would help reduce violence against women and reduce their risk to HIV?
Governments must enact and enforce laws that prevent violence against women. In parallel, they must also develop strategies and approaches to ensure that those who uphold the law—civil servants, police, judiciary, healthcare workers, social services etc.—implement it in fact, and to support the victims of violence. We must also develop and fund community-based programmes to help change social norms that condone violence against women and perpetuate its acceptability. This includes educating women, men, boys and community leaders about the rights of women, and the need to change menacing norms of masculinity.
We must also work to expand women’s access to support services and economic resources so that they can escape and recover from abusive and life threatening relationships.
It’s important that national AIDS plans integrate strategies to reduce violence against women, and link violence prevention efforts with mainstream HIV prevention and treatment services.