By Fahmida Iqbal Khan, Community Mobilization & Networking Advisor
UNAIDS Country Office for Pakistan and Afghanistan
The global literature and research shows that relationship between Violence against Women (VAW) and HIV risk is incontestable, multifaceted, and involves numerous corridors. Violence against women places women and girls at increased risk of HIV both through direct risk of infection and through creating an environment in which women are unable to protect themselves from HIV, rather increasing burden of stigma further deteriorate their lives. And if someone looks deeper into the matter of disclosure, male partners’ unwillingness to disclose if they are HIV positive, and/or unwillingness to accept their HIV positive status specifically in case of migrant workers, put spouses at risk.
The violence (physical, emotional and neglect) against women stemmed from their partners’ inability to accept their own HIV positive status which actually put women more at risk and also increasing the risk of mother to child transmission because status is unknown. Look at the data presented by Pakistan Demographic health Survey of 2012 where proportion of ever-married or partnered women aged 15-49 who experienced physical or sexual violence from a male intimate partner in the past 12 months is 27.3% to 29.2%. The recent number of increase in rape cases in country is really mind trembling because as per WHO research providing HIV post-exposure prophylaxis (PEP) for rape survivors is, without question, an important human rights issue, from a population perspective. But are we really following these treatment protocols for rape victims is a question? The primary burden of HIV risk from VAW and gender inequality arises through longer-acting indirect risk pathways. The first of these involves chronically abusive relationships where women are repeatedly exposed to the same perpetrator.
The HIV response in Pakistan is firmly located within the rights framework but needs to be looked from social, human rights and gender equality perspective rather than just a health issue. HIV issues need to be mainstreamed into women empowerment and rights based framework issues. There exists an inextricable link between human rights, gender and HIV/AIDS. Available global evidence establishes beyond doubt that safer sexual practices for HIV prevention can be adopted by individuals and communities on a sustained basis, only when the gender relations between sexual partners and between them and their social environment are equitable and based on mutual respect. Available literature also suggests that individuals’ and communities’ demand for HIV related prevention and care services, is directly impacted by the stigma surrounding HIV, which for the large part stems from the social constructs of morality applied differently to those who display dominant and accepted behaviors of masculinity and those who display dominant and accepted behaviors of femininity. Social patriarchal culture needs to be studied in detail to address these inequalities.
More researches are required to explore patterns of VAW and HIV from urban, rural, tribal and non-tribal, elite and non-elite settings etc. Gender inequality is thus not only associated with the spread of HIV but also with its consequences. Men and women are vulnerable in different ways – leading to differential rates of susceptibility to infection, access to information and access to available services for prevention and management of illnesses specifically to women and girls and transgender. The relationship between gender and HIV is extremely complex and constantly evolving, and is further complicated by interaction with other equity variables such as education, poverty, peaceful and non-violent societies, capable institutions, income, ethnicity or race, or sexual orientation. A woman living in a context of severe gender inequality may face the added burden of racial discrimination, or she may faces certain aspects of gender discrimination due to low income or social class specially in cases where they are wives or family members of people who inject drugs or are migrant workers.It is critical that the response is based on a nuanced understanding of how and why the gender roles and relations fuel the uneven spread and impact of the HIV infections. There is a growing realization that gender inequalities facilitate the spread of HIV and intensify the burden of HIV transmission to a large extent.
The need of a time is to come up with a National Plan of Action on HIV, Gender and Human Rights. Since Pakistan is signatory to CEDAW and also got the status of GSP Plus which bounds Pakistan to report on 27 UN conventions, out of which 07 are related to human rights, which also addresses some key response to be sustained by state pertaining to HIV and health. Need of time is to improve women’s access to health-care facilities and medical assistance by trained personnel, especially in rural, tribal and remote areas and ensure adequate allocation of human and financial resources to the health, human rights, planning and development sector in all provinces. Key government departments and Ministry of Health needs to collaborate with Social Welfare Departments and Women Development Departments through National and Provincial AIDS Control programme.
There is a dire need to involve people living with HIV and AIDS in programming, planning, advocacy and policy making together with women networks and women organization to advocate having HIV positioning in post 2015 development agenda. Ending Violence against women and girls Alliance (EVAWG) at national and provincial level along with Association of People Living with HIV and AIDS (APLHIV) can really play pivotal role in further strengthening the role of HIV and affected women and girls. HIV is a concentrated epidemic in Pakistan prevailing among key affected populations and high risk groups but this is a right time for early investments by Government of Pakistan to allocate more domestic resources and mainstream HIV in other sectors to stop becoming it generalized epidemic, otherwise it will be too late to achieve Three Zeroes in next coming years.