Women’s rights are high on the international agenda as the world moves towards a more egalitarian model, finally creating and respecting gender equality and the empowerment of women.
As regards AIDS, what is the situation involving women in particular and the population in general, in the Russian Federation, CIS countries and in the international community?
PRAVDA.Ru presents its exclusive interview*.
1. PRAVDA.Ru What is the situation in the Russian Federation regarding the AIDS epidemic?
Nargis Azizova: According to UNAIDS the number of new HIV cases in Russia increased every year: if in 2008 there were 54,000 new cases, in 2009 that number could reach 60 thousand. Although the peak of the epidemic in the world performed in our region – Eastern Europe and Central Asia – the epidemic continues to grow while the number of new cases is increasing annually.
This is typical for Russia. If in 2007 there were about 45 thousand new cases, in 2008 there were around 54 thousand, but this year, according to the Federal AIDS Center, there are expected about 60,000 new cases”, – said Marina Semenchenko, Team Leader of UNAIDS at a press Conference of the International AIDS Day, celebrated December 1. She noted that the main route of HIV transmission in Russia remains injecting drug use. Approximately 80% of all HIV-infected Russians are infected through injection by drug addicts.
Russia is also seeing a growing number of cases through heterosexual relations. For example, in 2006, HIV infections were responsible for 32.300 people; in 2007 – 34.400 in 2008 – 35.100. In this case, drug addicts and their wives are not the only group at high risk. Commercial sex workers, men who have sex with men, and prisoners are more likely to contract HIV than other groups.
In Russia, millions of migrants come from other countries (the Commonwealth of Independent States, for instance). And if earlier it was believed that they brought to us HIV infection and tuberculosis, now studies show that those who arrive are healthy, young men. They are detached from families, receive the money and, unfortunately, often acquire HIV infection in Russia, which they then pass to their wives and girlfriends .
Advisor on HIV / AIDS in Eastern Europe and CIS Shombi Sharp also believes that the epidemic can be stopped by using preventive measures among drug addicts.
2. PRAVDA.Ru: Figures, in concrete terms, for Russia and the CIS?
Nargis Azizova: The number of registered cases of HIV infection (first diagnosis) increased almost 10 times over the years 1991-2000 in Russia – from 579 people (0.39 per 100 thousand persons) to 56,471 (39.1), after which, having passed a certain point of saturation in high- risk groups was reduced – to 30,212 people (21,2) in 2004, then resumed growth – up to 52,185 people (36,7) in 2007. In Ukraine, Kazakhstan, Moldova, Tajikistan and other CIS countries, the epidemic continues to grow.
According to the number of registered HIV cases diagnosed for the first time, in 2008 the incidence per 100 thousand resident population ranged from 5.0 in Azerbaijan to 31.9 in Russia. In Ukraine, where the disease is not less common, the incidence reached, according to data for 2007, 38,5 first diagnosis of HIV infection in 100 thousand people.
As regards CIS, ah ead of them all – Belarus, with 22% growth in AIDS. The number of new HIV infections in 2009 in Ukraine has increased by 5%, in Russia – by 8%; in Georgia – 10%; (figures from Regional Director of UNAIDS for Europe and Central Asia, Denis Broun). He noted that in absolute terms the number of new HIV infections in 2009 totaled 19,840, against 18,963 in 2008.
Most cases of the disease as previously recorded was among injecting drug users, but the situation is compounded by the fact that this category of people have wives, partners and friends. This, he says, leads to an increase in sexually transmitted infections.
3. PRAVDA.Ru: Putting this in a worldwide context?
Nargis Azizova: In the world in 2008, 430,000 children were born with HIV. As a result, the total number of children living with HIV younger than 15 years was in 2008 2,1 million people. According to UNAIDS, the young people in the world are accounting for about 40% of all new HIV infections.
A third of all people living with HIV have TB, which is one of the main causes of their deaths. At the same time, TB is curable and preventable. According to UNAIDS in 2010 services in connection with HIV treatment will require 25 billion dollars.
4. PRAVDA.Ru: And specifically, what is the situation among women?
Nargis Azizova: About 25 million people on Earth have died from AIDS since the appearance of the disease. According to UN experts, 60 million are HIV-infected. Necessary drugs are available for less than half of the 9.5 million carriers in need of antiviral therapy. HIV has become the main cause of death and illness among women of childbearing age worldwide (UNAIDS). Up to 70% of women worldwide are forced to have sexual intercourse without protection measures. According to UNAIDS this violence against women is intolerable. In sub-Saharan Africa, women constitute 60% of people living with HIV. And in southern Africa, the threat of HIV infection for young women is three times higher than for young men of the same age.
Only 40% of those infected know that they are carriers of the virus. According to UNAIDS, in 2007 women accounted for 35% of new infections in the Asia-Pacific region, while in 1990 there were 18%. The main factors in the spread of HIV infection among women in this region is unprotected sexual intercourse and the transmission of infection from husbands who take drugs, sleeping with men or who go to prostitutes. Women who are abused, are more at risk. Adding more f uel to the fire, add cultural constraints against women, including the freedom of movement, as well as the humiliating position in society. According to UNAIDS from 32 to 40% of women pass HIV testing because of their sick husbands, and 75% did not have the means to health services.
In 2009 in the Asia-Pacific, 1.6 million women were living with HIV. Another 50 million are at risk because of men. According to the Independent Commission on AIDS in Asia and the Pacific, in 2008, about two-thirds of men – injecting drug users – have been married or had regular partners of the opposite sex. About 40% of new HIV cases in Eastern Europe and Central Asia reported in 2006 were among women.
5. PRAVDA.Ru: What more needs to be done, for example in your native country Tajikistan?
Nargis Azizova: As the analysis of current practice of HIV programming in Tajikistan shows that reflection of the gender dimension within the HIV/AIDS problem is, however, relatively inadequate in the current projects; firstly, because in traditional society women are generally in the background and their lives mostly take place inside the home. Women are perceived by society as having only a reproductive or sexual function, which is associated with the private sphere of life and is rarely made the subject of public attention. Accordingly, development at action level focuses primarily on these functions, such as in the projects to prevent HIV transmission from mother to child, where the emphasis is on women’s reproductive function, or in the projects to provide services for sex workers, which emphasize the female sexual function (e.g. the project for the development of youth-friendly health services).
That is why, in spite of the undoubted importance of a practical approach which targets issues shaped by the notions of femininity and the female social roles traditional in Tajik society, it is also important to focus attention on a number of other, more general issues relating to the integration of a gender perspective in HIV/AIDS prevention.
6. PRAVDA.Ru: And priorities for a worldwide combat against this scourge?
Priority 1. Full and concerted gender mainstreaming in legal and regulatory frameworks set up for preventing the spread of HIV infection and addressing the vulnerability of major risk groups to HIV infection.
Priority 2. Mobilization of the capacity of civil society, spiritual and religious leaders and the mass media for publicizing safe behavior practices and challenging social attitudes to overcome the most dangerous gender stereotypes in terms of HIV infection.
In case of Tajikistan today most people have not had personal experience relating to HIV-positive people and they know about HIV/AIDS only from the mass media. By providing accurate information about HIV/AIDS, the media can have a positive influence on both the development of safe behavior practices among men and women and public perceptions of PLWHA (People Living With HIV/AIDS), as well as helping to break down the gender stereotypes that pose a threat in terms of HIV infection. In countries like Tajikistan, where religious values are strong among the population, the views on HIV/AIDS of spiritual and religious leaders respected in the community could become a valuable tool for overcoming the worst prejudices associated with HIV, such as the widespread belief that HIV is a punishment for immoral living and the baseless inclination to blame women for HIV infection, as well as the phobias, stigma and discrimination directed at PLWHA.
At the design stage of an awareness raising campaign it is essential from the gender perspective to have guidance from people who have authority not only in the eyes of the male audience, but whose views are also respected by women.
Priority 3. Inclusion in the zone of increased attention of not only the most vulnerable groups of the population, but also their sexual partners
At present, the most vulnerable groups (IDUs, SWs, prisoners) are the subject of increased attention from both government agencies developing and coordinating national policies to prevent the spread of HIV/AIDS and the many HIV service organizations; h owever, studies show that not only the representatives of those groups themselves are in the high-risk zone, but their sexual partners, who are mostly women, are too. This is particularly the case for the IDU group, most of whom are men and who often practise unsafe drug use and unprotected sex.
It is necessary, therefore, not only to strengthen the capacity of HIV service organizations whose activities directly target the women and men in the risk groups, but also to develop interventions targeted at the women (and men) who are sexual partners of people from the most vulnerable groups. In addition, an essential aspect of the focus of HIV service organizations should be on the working with pairs of sexual partners, if at least one of them is from any of the risk groups and is participating in a prevention or harm reduction program. This aspect is of particular importance for the group of IDUs, as female IDUs are often completely “invisible” to the social services and HIV service organizations, due to the fact that it is their male partners who mainly have contact with outside organizations. In this context, close interaction and coordination with projects aimed at addiction treatment and harm reduction is required in order to more actively incorporate female IDUs and female sex partners of IDUs into the orbit of the agencies’ activities.
Priority 4. Use of special education technologies to address particularly large groups who face increased risk of HIV infection
In order for information to have a significant positive impact, the ‘typical situations’ should be designed with the participation of family psychologists, and several standard options for solving the problems could be presented to the audience to highlighting the range of possible decisions and allow for the identification of behavior patterns suitable for each individual. In addressing the issues surrounding the risks of HIV infection, the models might be based, for example, on a situation where a wife refuses unprotected sex, but her husband insists on it, or perhaps, where a wife wants to be sure that sure that her husband did not contract any sexually transmitted diseases during migration , but he refuses to be tested for HIV, STIs, etc.
Obviously, such a program for a mass audience (and migrant workers are precisely this type of audience) should have medium-and long-term contingency plans, since review and change of stereotypical attitudes and behavioral practices among the target audience are precisely what would be expected in the case of the programme being successful.
Priority 5. Promoting the value of a healthy lifestyle as a life-goal
Studies conducted in many countries show that the promoting the value of health and a healthy lifestyle is a complex undertaking and it cannot be artificially introduced into the consciousness and behavior practices of people simply through running various information programs and training sessions . Health, as a life value is only one integrated element of a complex, often conflicting network of values and the ability to pursue a ‘healthy lifestyle’ is dependent on many factors, not least people’s standard of living. T he responsibility of preventing the spread of HIV/AIDS cannot be left entirely to the state and international organizations and NGOs. To be truly effective, policies need to be based, among other things, on encouraging people to care about their own health and understand their own responsibility for its protection and on developing awareness of the relationship between healthy living, longevity and quality of life.
In this regard, it would be prudent to conduct comprehensive studies on healthy lifestyle related issues, based on which standard motivational modules to maintain a healthy lifestyle can be formulated, based on the values that are important for different groups; for example, the value of maintaining health and status as a breadwinner for men, the value of visual attractiveness and reproductive health for women, the value of longevity for seniors, etc. The experience of many countries confirms that efforts to promote a healthy lifestyle can become truly effective only when those efforts develop and enrich the values that people already hold dear; o therwise, the promotion of healthy lifestyles and the value of health most often remains an empty declaration . Developing such motivational models promoting safe behavior in terms of HIV infection risk would align the basic motivation of maintaining a healthy lifestyle, on the one hand and informed safe behavior, on the other. Given the above considerations on differing values influencing motivation, it would be preferable to develop such motivational models separately for men and women.
Priority 6. The use of methodologically appropriate research approaches and improvement of the sentinel surveillance system
It should be emphasized that virtually the entire range of issues related to HIV, including issues of sexuality, contraceptive behavior, the presence of irregular or commercial sex partners and drug use is classified as sensitive; that is, the kind of issues which evoke in those polled emotional stress and fear and push them to give socially acceptable answers. For Tajikistan, where public discussion of sexuality issues strictly taboo, not only in the society, but also even in the family, bearing this in mind is of paramount importance.
There is a similar situation concerning issues related to drug use. Discussion of the issue is not as strictly taboo as issues of sexuality, but there is strong social stigmatization of drug users, which also significantly reduces the sincerity of answers to direct questions. For example, according to estimates in Russia made by N.M. Folomeeva and her colleagues in surveys that examine the prevalence of drug use, up to 60% of respondents gave deliberately false information to their interviewers.
There is a gender perspective to this theme that is clearly evident in Tajikistan: women are not only more closed to contact with interviewers but, as has been illustrated by sociological research, are also subject to strict social taboos forbidding the discussion of topics regarded as “indecent”, for example, issues of sexual relations or even contraception.
7. PRAVDA.Ru: What is the message that UNIFEM would like to communicate regarding women’s rights and AIDS?
Nargis Azizova: Within its report presented at the AIDS Conference, UNIFEM articulated actionable recommendations as a roadmap for governments, donors, civil society and others involved in the AIDS response to ensure women’s participation. They include:
– needs to recognize affected women, such as HIV-positive women, home-based caregivers, and young women, as key stakeholders in the AIDS response and reserve formal places for their full participation and leadership in decision-making bodies, such as on the Country Coordinating Mechanisms of the Global Fund to Fight AIDS, Tuberculosis and Malaria. To enable women to contribute to the policy consultations in this filed, there should be commitments to strengthen their capacity and promote a new cadre of women-leaders at local and national levels ;
– monitoring of the full and active participation of people living with HIV, vulnerable groups, most affected communities in the HIV and AIDS response, with special attention to women living with and affected by HIV;
– ensuring that national policy on HIV/AIDS prioritize women’s needs identified by them through participatory and inclusive policy formulation processes. Immediate needs such as improved access to prevention, voluntary counseling and testing, treatment and social support services have to be addressed efficiently;
– improving gender responsiveness of the formal decision making bodies and funding mechanisms;
– providing support for CSOs for consultation and collaboration, and investing in organizations and initiatives led by HIV-positive women, especially community-based ones;
– placing education and awareness raising on women’s human rights as a priority for development interventions;
– Documenting and dissemination of best practices and innovative approaches to strengthen leadership of women, in particular HIV-positive women, in HIV/AIDS response.
*Exclusive interview between PRAVDA.Ru and UNIFEM Gender and Governance Advisor for Tajikistan Nargis Azizova regarding the AIDS epidemic worldwide and in the ex-CIS countries, including Russia. PRAVDA.Ru interview conducted by Timothy Bancroft-Hinchey.