Gender inequality fuels spread of HIV in women

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Experts say sexism and stigma are still obstacles to containing the deadly virus


A woman and her children living with HIV in northern Vietnam. Women and girls should be able to protect themselves from HIV transmission via unprotected sex and Vietnam needs to consider this when revising the national HIV response strategy and devising new plans for HIV prevention services, the United Nations has said

N.T.T (*) decided to get married in September, a month after he tested positive for HIV.

His fiancée, who was then quite healthy, knew nothing about his infection.

"I was worried that I would transmit the disease to her. [But] my parents urged me to get married. I was under great pressure. I could not nix their wish without giving them any reason," said T., who contracted the deadly virus from sex workers.

"I could not think of any solution so I got married and tried to prevent her from contracting the disease."

Vietnamese society, still largely dominated by Confucianism, underlies the must for men to get married and have kids to carry on the family lineage.

But the lingering HIV-related discrimination has discouraged men like T. from coming clean with their wives or partners about their HIV status Students with the disease are shunned by classmates and HIV patients have been cast out of families and ostracized by villages.

Similar stigma has already sealed the fate of another woman, T.N.T.

Her husband V.M.H, an HIV-infected drug user, had tried to hush up his disease when they were together.

"When we were in Malaysia, we had sex but we did not use any protective measure. Using condoms would make her suspect about my HIV status... We used the pill named New choice [instead]," H. said.

"I married her because I was sure I had infected her."

Hoang Tu Anh, director of Hanoi's Center for Creative Initiatives in Health and Population, confirmed all these accounts. All of the HIV patients interviewed in this story were from Hanoi or the neighboring port city of Hai Phong, she said.

"Due to the prevalence of gender inequity here, many couples are in unequal relationships and poorly informed [of the HIV status of their partners]," said Anh, who has researched the topic extensively and conducted many in-depth interviews with HIV-affected people.

The disparity has left women very vulnerable to high risk of HIV transmission through their sexual partners, Anh told Thanh Nien Weekly.

The United Nations (UN) has recently stepped up efforts to create awareness of the problem. Its latest findings indicated that most Vietnamese women acquire HIV from their husband or boyfriends, who have contracted HIV through drug use or unprotected sex with prostitutes or male partners.

Vietnam's official statistics also suggest an increase in intimate partner transmission. The HIV infection rates among pregnant women have risen from 0.002 percent in 1994 to 0.34 percent in 2007, the Ministry of Health reported.

"˜I have to give up'

The roots of the gender norms underlying intimate partner transmission in Vietnam lay in traditional, largely Confucian beliefs that women be subservient to men, the UN said in a statement.

Long-held social norms stigmatize sex and discussion of it and sometimes manifest themselves in gender-based violence, which puts women at greater risk of HIV, the statement added.

"When I mentioned an HIV test he cursed me. When I asked him about HIV, he got angry and made a racket in the house. I don't want to have a conflict in the family," said N.T.P, whose husband had visited sex workers.

Being in a subservient position in their families, coupled with the deep-seated belief that condom use is associated with sex work and promiscuity, also aggravates the woes of vulnerable women.

"Many times, when I ask him to use condoms, he saw red. So I have to give up. About two out of ten times [having sex], I have to follow him [not to use the condoms]," said T.T.K, the wife of an intravenous drug addict.

Anh of the Hanoi's Center for Creative Initiatives in Health and Population said many Vietnamese people associate condoms with prostitution, not a tool to prevent sexually transmitted disease.

"People are very often shy of buying condoms at drugstores. They just pop in and get the condoms without bothering to consider which one is of good quality," Anh said.

Latest studies indicated that just around 9 percent of Vietnamese couples use condoms for birth control. The predominance of other contraceptive methods such as intra uterus device and the birth control pill makes the negotiation of condom use and safer sex also harder, Anh said.

"I told him that if he had sex with many people he would have bad consequences such as H., our next door neighbor, who died of AIDS, or a girl in another alley who was addicted to drugs like her husband and just died. I asked if he was scared," said T.N.A, the wife of a man who engages in sex with male partners.

"He did not say anything but slapped my face. I told him many things and only got slapped. My mouth was swollen. He just slapped me the night before last night."

More compassionate policy

The UN statement pointed out that Vietnamese HIV laws and policies still fail to adequately challenge power relations between men and women, particularly in sexual relationships.

Anh also said it would be a tough task to enforce the regulations that ban the deliberate transmission of HIV in the context of husband-and-wife relations.

"Women and girls should be able to protect themselves from HIV transmission via unprotected sex and we need to take this into account when revising the national HIV response strategy and devising new plans for HIV prevention services," said UNAIDS Vietnam Country Director Eamonn Murphy.

*The names of all the HIV patients in this story have been changed and shortened for privacy reasons. This is common practice in Vietnam, where the stigma against HIV patients is a long-standing problem.

UNPROTECTED

Intravenous drug use accounts for 44 percent of all HIV infection in Vietnam. Many have sex with sex workers, but few use condoms with their intimate partners.

Despite the lack of national data, small scale studies indicate that one-third of men aged 18-55 have visited sex workers and only a minority used condoms.

A significant share of men who have sex with men in Vietnam also have sex with women, but less than 40 percent use condoms with regular partners.

Male migrant workers also have a higher tendency to engage in risky behavior. Most are married, but do not use condoms with their wives.

(Source: The United Nations)

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