What does it take to get to zero? While reflecting on the theme of this past World Aids Day (Getting to zero, Zero new infections, Zero discrimination, Zero deaths), I asked myself this question. The truth is that it takes a combined effort across multiple sectors, using multiple strategies and targeting multiple audiences.
However, one issue that cuts across all sectors is that of gender inequity and its role in shaping sexual relations and in determining life choices. HealthBridge believes that unequal gender relations are a root cause of the HIV/AIDS epidemic, and addressing these inequities is absolutely essential for reversing it. It is no coincidence that in countries and regions with high HIV/AIDS prevalence (such as Sub-Saharan Africa), women tend to have a lower position in society.
Underlying gender inequality is the unspoken reality that, in many parts of the world, women and girls are undervalued by society and even their own families. The undervaluing of girls is evident even before they are born with son-preference and sex-selective abortions.
But exactly what are the linkages between how women and girls are valued and their risk for HIV/AIDS?
A significant factor is the ability to make choices. As a result of their lower position in society, girls and women often lack power to make choices and are forced into life situations that hinder their development and put them at risk. For example:
The choice to go to school: In many developing countries, girls are less likely than boys to go to school and stay in school. Families with limited resources often choose to educate their sons. Early marriage or pregnancy leads to school drop-out. Educated girls, however, are more aware of HIV-prevention methods, better able to negotiate the use of condoms, and are more likely to be economically secure.
The choice on when to marry and who to marry: Poverty and the cultural desire to prevent pre-marital sexual relations lead families to marry off their daughters at a very young age. Girls that are married before the age of 18 are less likely to be educated and are typically much younger than their husbands. This age difference creates a power imbalance which, along with patriarchal norms, makes it more difficult for girls to negotiate safe sex and other health decisions. Growing evidence from Sub-Saharan Africa shows that girls married before age 18 are more at risk for HIV.
The choice to have safe sex: Women's lack of power relative to men gives them less bargaining power in negotiating the use of condoms to protect themselves. This is true amongst both married and unmarried women.
The choice to leave a violent and abusive partner: Cultural norms and economic dependence prevent women from leaving abusive relationships. Fear of violence prevents women from asking their partner to use condoms, from getting tested for HIV and seeking treatment. Research has confirmed a strong linkage between abuse against women and women's chances of contracting HIV.
The choice of safe employment: Poverty and lack of alternative options lead women to use survival strategies, including prostitution and exchange of sex for resources. One example is the sex-for-fish practice in Kenya, in which women fish vendors have sex with fisherman to obtain the best catch of the day.
To improve women's position in society and give them more control over their life choices, the perceived value of women and girls must change. How can this be done? There are multiple paths: Advocating for policies which protect the rights of women and girls. Using social media to promote positive images and examples of equitable gender relations. Developing educational curricula which teach children and youth that men and women should be equally valued and have equal opportunities.
HealthBridge challenged the undervaluation of women by calculating and increasing awareness of the social and economic value of women's unpaid domestic work. The fact that this work does not produce a tangible income is often used to justify husband authority and preferential treatment of sons. It is also a reason that women's health is viewed as less important by government and even their own families. Increasing awareness of the economic and social value of women's unpaid domestic work is one way to increase their perceived value to society.
To Get to Zero in the HIV/AIDS epidemic, we need more innovative approaches that challenge and improve the position of women and girls in society, give them control over their lives and open doors to a more promising future.
Lisa MacDonald is the project manager of Gender, Reproductive Health and HIV/AIDS for the HealthBridge Foundation of Canada.
Only one quarter of the 1.1 million <a href="http://www.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-CareFactSheet-508.pdf">people with HIV</a> have their <a href="http://www.huffingtonpost.com/2012/07/27/hiv-under-control-1-in-4_n_1711260.html">condition under control</a>, where "under control" means the virus has been suppressed, according to a report released this summer by the Centers for Disease Control and Prevention. "Only if we get <a href="http://www.philly.com/philly/health/HealthDay667108_20120727_Only_1_in_4_Americans_With_HIV_Has_Virus_Under_Control__CDC.html">everyone under regular care</a> for HIV/AIDS can we recognize the full benefits of treatment and prevention," Irene Hall, an epidemiologist at the CDC and one of the authors of the report, told HealthDay. <em><strong>CORRECTION</strong>: The first sentence has been reworded to more accurately reflect the number of people with HIV.</em>
Two men with HIV and cancer no longer have <a href="http://www.huffingtonpost.com/2012/07/26/hiv-free-men-bone-marrow-transplants_n_1707505.html">detectable blood levels of the virus</a> after receiving bone marrow transplants for their cancers, news outlets reported this year. Doctors were unable to <a href="http://www.huffingtonpost.com/2012/07/26/hiv-free-men-bone-marrow-transplants_n_1707505.html">find any traces of HIV</a> in the men's cells after they received the bone marrow transplants while also being treated with antiretrovirals. The finding "suggests that under the <a href="http://abcnews.go.com/blogs/health/2012/07/26/two-more-patients-hiv-free-after-bone-marrow-transplants/">cover of anti-retroviral therapy</a>, the cells that repopulated the patient's immune system appear to be protected from becoming re-infected with HIV," Dr. Timothy Henrich, of Brigham and Women's Hospital, told ABC News. However, the Boston Globe pointed out that it's still too soon to say that these men have been<a href="http://www.huffingtonpost.com/2012/07/26/hiv-free-men-bone-marrow-transplants_n_1707505.html"> full-on <em>cured</em></a> of HIV, since they are still on the anti-retrovirals. There's no firm word on whether they will go off of the medication.
New <a href="http://www.huffingtonpost.ca/2012/11/27/free-hiv-drugs-decrease-infection-bc_n_2200393.html">HIV infection rates</a> can be dramatically lowered by making antiretroviral drugs free, a study from Canadian researchers found. The Canadian Press reported on the study, conducted by B.C. Centre for Excellence in HIV-AIDS researchers, which showed that British Columbia -- a province that offers <a href="http://www.huffingtonpost.ca/2012/11/27/free-hiv-drugs-decrease-infection-bc_n_2200393.html">free access to antiretroviral therapy</a> -- had the lowest rate of new HIV infections over a more-than-10-year period, compared with Ontairio and Quebec.
More than half of HIV-infected young people are <a href="http://www.huffingtonpost.com/2012/11/27/hiv-youths-infected-aids-young-people_n_2198629.html">unaware that they have the virus</a>, according to a Centers for Disease Control and Prevention report. "Given everything we know about HIV and how to prevent it in 30 years of fighting the disease, it's just unacceptable that young people are <a href="http://www.huffingtonpost.com/2012/11/27/hiv-youths-infected-aids-young-people_n_2198629.html">becoming infected at such high rates</a>," Reuters reported CDC Director Dr. Thomas Frieden saying. The report also showed that for young people, 72 percent of the new HIV infections were in men who have sex with men, while almost 50 percent were in young, African-American males, Reuters reported. These figures are based on 2010 data.
The number of people <a href="http://www.huffingtonpost.com/2012/07/18/hiv-aids-numbers-statistics-worldwide_n_1682936.html">living with HIV</a> has increased by 18 percent from 2001 to 2011, according to a report released this year from the United Nations Programme on AIDS. An estimated 34.2 million people around the world are living with HIV. The report also showed that <a href="http://www.huffingtonpost.com/2012/07/18/hiv-aids-numbers-statistics-worldwide_n_1682936.html">deaths from AIDS </a>have <em>dropped</em>, from 2.3 million in 2005-2006 to 1.7 million in 2011, Reuters reported.
According to the same United Nations report, costs for the cheapest UN-recommended <a href="http://www.huffingtonpost.com/2012/07/18/hiv-aids-numbers-statistics-worldwide_n_1682936.html">antiretroviral therapy drugs</a> have also decreased over the past 10 years, Reuters reported. A year's worth of the drugs used to cost $10,000 in 2000 for one person; now, it costs $100 a year.
The Food and Drug Administration this year officially approved the <a href="http://www.huffingtonpost.com/2012/08/09/truvada-heterosexuals-aids-hiv-prevention-pill_n_1760542.html">drug Truvada</a> -- which has been used since 2004 as a treatment for HIV -- to be sold as a preventive measure for people who don't have the infection, but are at high risk for it. The FDA said that the pill should be considered for <a href="http://www.huffingtonpost.com/2012/08/09/truvada-heterosexuals-aids-hiv-prevention-pill_n_1760542.html">preventive use</a> not only by gay or bisexual men who are at high risk for HIV, but also heterosexual men and women who may also face HIV risks, the Associated Press reported. <a href="http://www.huffingtonpost.com/2012/08/09/truvada-heterosexuals-aids-hiv-prevention-pill_n_1760542.html">Heterosexual men and women</a> make up more than one-fourth of new cases of HIV, and "that's not a portion of the epidemic we want to ignore," the CDC's Dr. Dawn Smith, who was the lead author of the new recommendations, told the Associated Press. The FDA also approved a new drug this year, <a href="http://www.huffingtonpost.com/2012/08/27/stribild-hiv-treatment-fda_n_1834734.html">Stribild</a>, to treat HIV, Reuters reported.
In findings published this year in the journal <em>PLoS Pathogens</em>, scientists from the University of California, Los Angeles found that it's possible to <a href="http://www.huffingtonpost.com/2012/04/16/stem-cell-aids-hiv-study-ucla_n_1428660.html">genetically engineer stem cells</a> to attack living HIV-infected cells in mice. While the study was only for "proof-of-principle," it "lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body," study researcher Dr. Scott G. Kitchen, an assistant professor of medicine at UCLA, said in a statement.
People should be screened for HIV even if they're not at high risk of contracting the infection, according to draft recommendations released just last month by the U.S. Preventive Services Task Force. The recommendations would mean that everyone between the ages of 15 and 65 should be <a href="http://www.huffingtonpost.com/2012/11/19/routine-hiv-screening-us-preventive-services-task-force-uspstf_n_2161090.html">screened for HIV</a>, even if they're not at high risk for it, Reuters reported. "The prior recommendations were for screening high-risk adults and adolescents," Dr. Douglas Owens, a member of the USPSTF task force and a Stanford University medical professor, told Reuters. "The current recommendation is for <a href="http://www.huffingtonpost.com/2012/11/19/routine-hiv-screening-us-preventive-services-task-force-uspstf_n_2161090.html">screening everyone</a>, regardless of their risk."
<em>All</em> HIV patients should be <a href="http://healthland.time.com/2012/07/23/new-advice-calls-for-putting-all-hiv-patients-on-drug-treatment/">treated immediately with antiretrovirals</a>, according to new guidelines issued this year from a panel of the International Antiviral Society-USA, as reported by <em>TIME</em>. The recommendations are counter to previous guidelines, which said that antiretrovirals should only be used if the CD4 count -- a measure of immune cells in a person's body -- becomes less than 350 cells for every mm3 of blood.
During the AIDS 2012 conference, Christina Rodriguez talks about growing up with HIV.