Empowering oppressed women to battle HIV/AIDS

When I arrived in Dhaka, the bustling capital of Bangladesh, one of my first destinations was a red-light area. I sat down with women working in the sex trade. They can be among our most important partners in the fight against HIV and AIDS.

One was the breadwinner in her family. She carries condoms, but cannot always persuade her clients to use them. On the street, she faces constant beatings, rape and extortion. The police are often the worst perpetrators.

What does this woman have in common with a young girl in Burundi, a farmer in Malawi, and a faithful wife in Uganda? The Burundian girl was gang-raped by three men, the Malawian farmer had to sell her body to feed her children, and the Ugandan woman has an unfaithful husband who is HIV-positive.

They have in common a high vulnerability to HIV — simply because they are women and because they are powerless, or feel powerless, to protect themselves. Another thing these women have in common? We are failing them.

Women lack power for many underlying reasons. For example, social norms place the disgrace of rape on women, the stigma of being a sex worker denies women their basic human rights, and economies are so frail and assets so easily lost that many women are forced into "survival sex."

Too many HIV-prevention efforts assume that, if people have the information and tools, they will make safe choices. Too few recognize that millions of women and girls do not have the ability to make those choices, especially when it comes to sex.

These issues may seem daunting, but we can make a difference.

First, prevention is not as simple as the so-called "ABC" model (abstinence, being faithful and condoms). All too often, women are not able to refuse sex, or they remain faithful but their partners are not, or they cannot persuade their partners to use condoms. So, in practice, the ABC model is not adequately responsive to the reality of women's lives.

ABC is necessary, but not sufficient. Governments, foundations and individual donors must strike deeper at the heart of the problem. The U.S. government has shown great leadership by increasing funding of HIV-prevention programs in recent years. Now, it must strengthen its response by rethinking the requirement that one-third of HIV-prevention funds go to abstinence-until-marriage programs.

Second, the international community must do more to address the multidimensional nature of HIV/AIDS. Poverty, gender inequity and stigma have as much to do with HIV/AIDS as treatment, testing and condoms. We must broaden the field of battle and diversify the weapons in our arsenal.

Narrowly focused interventions — such as testing only — are insufficient to stop the spread. Sometimes, women test positive for HIV and don't want to have children, but they have no access to contraception. If they become pregnant, their children risk contracting HIV at birth. Beyond testing, vulnerable populations need to be empowered.

In Bangladesh, for example, sex workers have made progress against the spread of HIV by learning to negotiate safe sex with clients and to develop skills that can provide alternative sources of income. Sex workers' organizations are now promoting HIV-prevention messages, marketing condoms and running health clinics. In areas in sub-Saharan Africa, where hunger is chronic, savings-and-loan groups are enabling families to avoid the slide into desperation and risky behavior.

Third, all donors must commit to fight HIV and AIDS in the long term. Empowering women to have more control of their lives and relationships cannot happen overnight. It cannot be packaged into a one-year project. Rather, it involves a lengthy process of working with communities, especially men and traditional leaders. To succeed, it requires mutual trust and respect.

Unfortunately, many donors have one-year funding cycles, require quick impact, and do not invest the time and effort in broader social change. Without social change, particularly with respect to the position of women, HIV and AIDS interventions have no anchor and hard-fought victories may be frittered away.

We are learning more every day in the battle against this devastating pandemic. One key lesson has been that, unless the unique vulnerabilities of women and girls are addressed, the most technically sound HIV-prevention efforts can falter. That is a risk we cannot afford.

This lesson comes at a cruel price. Three out of every four Africans newly infected by HIV are female. One in four South African girls will contract HIV by age 22. In Kenya, HIV prevalence among young women and girls is almost six times that of young men and boys.

Empowering women is not extraneous to the fight against HIV and AIDS — it is central to it. The sooner we rally our actions around that reality, the better our chances of winning this battle.

Dr. Helene Gayle is president and CEO of CARE USA, www.care.org, and is the former senior adviser in HIV/AIDS for the Bill & Melinda Gates Foundation.