There is a lot of information on HIV now. What is there to be afraid of, asks Geeta Rao.
STIGMATISED: Women experience the consequences more severely.
Geeta Rao Gupta, global authority on Women and AIDS and President of the Washington-based International Centre for Research on Women (ICRW), was in Delhi recently. Challenging stigma associated with HIV and integrating HIV programmes with other devel
opment programmes are critical for an effective response, she says in an interview.
Women and AIDS has been a major area of research for ICRW in recent years. What has your research shown?
The HIV epidemic affects men and women differently. While policies look at men’s realities, they are not looking at women’s realities to the extent they should. Women are dependent and, therefore, more vulnerable whether it is negotiating condom use or having sex for money.
It is important that economic empowerment programmes go together with HIV treatment and care programmes.
The same goes for programmes around women’s education and anti-violence. We know there is a direct co-relation between education, violence against women and their vulnerability to HIV. The point is, you cannot just say: use a condom, practise abstinence to prevent HIV infection.
To what extent is this integration of HIV prevention with other development programmes happening?
For at least a decade we have known women’s risk and the need to integrate HIV prevention and care with other development programmes. Today, this is happening to some extent in the smaller communities in different parts of the world, although much more needs to be done at the level of national policy. But, I am optimistic.
There needs to be a wider recognition of this integration. Since research shows that women’s vulnerability to HIV is not a bio-medical domain but a social one, perhaps this integration requires community-based programmes. For example, sex workers in Tamil Nadu and West Bengal lead their own programmes.
The HIV prevention programme at Sonagachi in Kolkata has become a global model; India has led the way to move forward. The Sonagachi model has been applied in the Dominican Republic and in other parts of India. The principles are the same though, of course, the programme is not identical because that is the whole point — that communities develop and run their own programme of empowerment and HIV prevention. ICRW is working with sex workers’ programmes in Andhra Pradesh on the Andhra Pradaesh-Karnataka border where we are applying the principles of community processes for HIV prevention.
Women in sex work tell horrendous tales of violence. Where do we start to give them some safety net?
You start by helping women get organised where they see themselves not as isolated but as part of a larger whole; you give them tools for decision making, make services for HIV prevention such as treatment of sexually transmitted diseases and testing for HIV available to them. You protect them from violence from pimps and police. You offer alternate livelihood to those who want to move out of sex work.
What makes stigma around HIV such a widespread global phenomenon?
Stigma and discrimination is a major problem in response to HIV. Ignorance and lack of awareness are the most important factors fuelling stigma. Our research shows that it is important to provide clear and full information to ensure people are not afraid of being infected through casual contact. They need to know how HIV is transmitted, how the virus dies very quickly when exposed to air. People are less likely to stigmatise when they know they need not be afraid of HIV transmission through casual contact. The other aspect influencing stigma is the perception that HIV positive people have somehow stepped out of the ‘moral’ boundaries. That has dramatically changed — it is not true — we know that anyone can get infected.
What will help reduce stigma?
The legislation against HIV discrimination will, I am sure, go a long way in reducing stigma and violence. ICRW has developed a stigma and violence reduction toolkit ‘Understanding and Challenging HIV Stigma’. It has been used in Vietnam, Tanzania, Ethiopia; we have just introduced it in India. If there is fear of violence and social ostracism, people will not come forward for testing. The more you stigmatise, the more infected people go underground and that is likely to fuel spread of HIV. Therefore, rolling out treatment will help. Presently, HIV is associated with blame, shame, morality. If you have diabetes you are not ashamed of it, why should you be ashamed of HIV?
Does stigma impact men and women differently?
Both men and women experience stigma; women experience its consequences more severely because they are economically and socially dependent. In some cases the stigma of HIV is adding to the layers of stigma people are already facing: as sex workers, injecting drug users, men who have sex with men.
Does being an Indian give you an edge in your role as President of ICRW?
I grew up in India so to that extent I understand the Indian context, a developing country context that much more. That is very valuable in the nature of my job. But I didn’t experience stigma or poverty. I can only empathise with that.
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