Too many women in too many different countries speak the same language- silence

As according to recent NCASC estimates, the prevalence of HIV in adult population in Nepal has gone down from 0.48 in 2007 to 0.39 in Feminization of HIV in Nepal Medha Sharma 30th November 2010 Too many women in too many different countries speak the same language- silence As according to recent NCASC estimates, the prevalence of HIV in adult population in Nepal has gone down from 0.48 in 2007 to 0.39 in 2010. But then, the proportionate share of women has been increasing. Currently, one female in every three male is affected with HIV in Nepal (sex ratio 1:2.9), and 2.9 percent are female sex workers against 5.2 male sex workers and 3.7 MSM (IBBS), but then the total number of women infected is increasing in Nepal. The number of women living with HIV increased by 1.6 million between 2001 and 2007, globally. In 2007, an estimated 2,900 new HIV infections occurred each day among women (ages 15+) (UNAIDS, 2007). Globally, there are 5.4 million young people living with HIV, and nearly 60% are female.

What is interesting is that though the proportionate share is higher for male in Nepal, I am talking about feminization of HIV and what is alarming is that most of the transmission to women is sexual i.e. mostly from their husband or through sexual violence.

Initially, Nepal’s HIV epidemic was driven by sex workers and drug users. But now, the epidemic is shifting to housewives and clients of sex workers. The prevalence of women (15+) is 17,000 and proportion of young women (15-24) is 0.3 in 2007. (2) UNFPA reports that ‘young women (ages 15 to 24) are up to six times more likely to be infected than young men their age. Correct knowledge among ever married women is 69 versus 87 percent in male in 2006. (MoHP, 2007)

Let me highlight on the data from recent Integrated Biological and Behavioral Survey 2010 round 2 data that HIV prevalence among the wives of migrant labors is 0.8, against 0.3 in general women population. Most of the transmission to women in Nepal is sexual. But, in female curbed society like ours, sex is not choice for women, and sex out of marriage is out of norm. It is a sad reality is that many women, who are infected or are at greater risk of becoming infected, do not actually engage in high-risk behavior, and moreover the behavior that puts them at risk is not under their control. Labour migrants bring Nepal a huge remittance, but what about the virus that comes along with? Early marriage is common and a significant proportion of population is illiterate. In average, a Nepali man migrates to India at the age of 19, so vibrant age to get trapped by brothels. Back here, wives are very less likely to get into extra marital affairs, as it is out of norm in the Nepali society.

Quoting a FCHV of Palungmainadi VDC of Palpa, it is not that women do not suspect that their husband might have been infected and that they too may get infected when they come back home. But, on the first night back home, since they are together after such a long time, women retard talking about condoms. FCHVs go to a home immediately the next day after knowing that house has got back its male member. They always tell women to use protection and request her husband to get tested the next day. But, after her husband is back, the wife tries to defend that her husband did not involve in multiple sex. How can she agree for testing when that would mean suspecting her husband and a shame to the society?

Now let me talk about women’s access to protection. Female condom is expensive, less accessible and rare. Male condoms are available free in government centers, available extensively, accessible; but women do not have control over it. Even female sex workers must use male condoms, but since sex work involves money and condom use is rather a bargain, control of condom use is totally upon the client, not the worker.

Physiologically too, HIV is feminized. Women are two to eight times more likely than men to contract HIV during vaginal intercourse. Women in general experience different symptoms of HIV than men. While both genders experience the early, non-specific manifestations of the disease including low-grade fever, lethargy, night sweats and weight loss, women are more likely to encounter a more severe weight loss which can result in wasting syndrome. Some studies have shown HIV-infected women to be more susceptible to the herpes simplex virus. With respect to the transition to AIDS (Acquired Immunodeficiency Syndrome) too, there are sex differences. Scientists have shown that HIV-infected women will die at higher CD4 cell counts than men, and since CD4 counts determine when to begin antiretroviral treatment, therapy may be delayed for HIV-infected women.

When the husband is severely ill of AIDS, the responsibility of his treatment and after his death, running household in adverse economic condition becomes a double trouble to women. Women are also most likely to lose property and assets on becoming widowed. For those women who are living with AIDS and are poor, access to ART itself is a problem. Even where support services may be available, women are victims of stigmatization and usually have less access to HIV/AIDS care and treatment than men.

Feminization does not advocate against male interventions. In fact, men can be important partners. Because they are the transmitters, their awareness can be a very effective prevention strategy for women. Best practices around the world have shown that regular testing of women at brothels is the best intervention for both men and women. In case of Nepal, programs that protect the innocent wives of migrant workers are the immediate need.