Most agencies agree that HIV programmes will not reach their potential until gender-oppressive “social norms” are overturned. Kay Parris reports

UNAIDS chief Peter Piot is far from the only expert to believe that, “Without putting women at the heart of the response to AIDS, I don’t think we will be able to control this epidemic.”

In regions where the disease is entrenched, more women are now infected than men, and in countries where epidemics are just beginning, new infections among women outnumber those among men.

Unequal gender relationships force millions of women, already biologically much more vulnerable to infection than men, to submit to demands for unprotected sex, and to be kept in ignorance of the casual encounters of their partners.

At the same time, women at work – particularly poorer women in insecure jobs, who depend on their income for the survival of their families – will often succumb to sexual coercion or assault from colleagues in superior positions, due to a fear of retribution or of being sacked.

MAINSTREAMING GENDER IN WORKPLACE HIV PROGRAMMES By Romano Ojiambo-Ochieng In order to be effective, workplace HIV/AIDS programmes must take into account the reality of the sexual behaviour of men and women. Therefore: • All workplace HIV/AIDS programmes should, in addition to being sensitive to race and sexual orientation, be gender-sensitive. They should explicitly target both women and men, possibly by addressing women or men in separate programmes. • Information on HIV/AIDS for women needs to alert them about and explain to them their higher risk of infection and in particular the special vulnerability of young women to HIV infection. • Education should help both women and men to understand and act upon the unequal power relations between them both in employment and personal situations; and sexual harassment and violence should be specifically addressed. • Programmes should help women to understand their rights, both within the workplace and outside it, and empower them to protect themselves. • Education for men should include awareness raising, risk assessment and strategies to promote men’s responsibilities regarding HIV/AIDS prevention. Women must be particularly involved in the planning and implementation of workplace HIV/AIDS policies and programmes.

Studies show sexual violence – which often entails injury to women and therefore allows HIV open access to the bloodstream – is extremely common in many societies and parts of societies. One study states that in South Africa 30 per cent of women’s first experience of intercourse is forced and that 71 per cent of women experience sex against their will at some point during their lives.

In another study, this time of Hispanic women living in the US, one fifth of the sample reported sexual assault by their partners in the past three months. There are many other studies.

Need for a voice

Patterns of controlling and abusive behaviour are particularly prevalent in countries where HIV is most established, but they are also common in many pockets of society all over the world.

There is no suggestion that male transport workers are more disposed towards these behaviours, and the attitudes that trigger them, than their peers in other industries, and clearly in many countries they are far from common.

However the evidence overall of risk-taking behaviour by transport workers, and their relatively higher HIV prevalence rate compared to general populations, is overwhelming. So too is the evidence for the links between gender inequality, risk-taking sexual behaviour and HIV prevalence.

We know that transport workers in mobile jobs experience many hardships, including protracted separation from their partners and inadequate facilities for proper rest – which contribute to them becoming involved in unsafe sex encounters.

Many HIV action programmes in the transport industry have therefore focused upon improving working conditions, and providing education and information to encourage these workers to make their sexual encounters safe, by using condoms. These vitally important programmes have had major and crucial successes.

However, it is clear that messages about prevention and behaviour change are much more effective in groups where women have a voice, or in programmes that make gender discussions a central focus. Transport unions are using their women activists to great effect in training and advocacy roles. The benefits of working with sex workers who ply ports and truck stops are already well accepted, and the importance of community outreach work that brings in the voices of wives and partners is now understood.

Why is this? Partly it seems, because women are particularly receptive to safe sex messages, and if they have enough power within a relationship to act on such messages, they will.

Key to safe sex

Condoms are least used in long-term relationships and marriages – which explains why married women in many countries, who are infected by their husbands after extra-marital encounters, are more likely to be HIV positive than unmarried women of the same age. In Cambodia for example, recent figures suggest that 42 per cent of new HIV transmissions are occurring from men to their wives.

Unions can help vulnerable members to understand and face up to the risks they have exposed themselves to – and then help them to consider the risks they might pose to their partners, whether casual or permanent. Through learning better communication within their relationships, members may seek fewer partners, or at least become more honest about the need to use condoms.

A man who practises violent sex poses a much greater HIV risk to his partner than she does to him, and needs to be targeted by something more than a traditional safe sex message about protecting himself.

Similarly a sexually experienced man who has sex with a woman much younger than himself may be taking little or no risk with his inexperienced partner, while exposing her to enormous risk, since her immature genital membranes are highly susceptible to transmission.

This is a widespread problem in some parts of the world, where young women are commonly offered up for marriage to older, perhaps financially solvent men by their families, in exchange for gifts, money or status. As a result of this pattern the average age of death from AIDS in some countries is much lower for women than for men.

Challenges like these cannot be addressed by basic safe sex messages alone. They ask fundamental questions of social behaviours that are accepted as norms, and may be intrinsically linked with poverty and lack of education. Unions working in the HIV/AIDS arena will not be able to overturn these realities on their own. But they have to be aware of them, and to foster awareness among their members if a new trend towards equality is ever to take hold and make HIV prevention a widespread reality.

The challenge of change

While cultures are complex and entrenched, there is no reason to submit to the idea that change can never happen. Cultural norms that may oppress women in South Africa are at odds with national laws promoting the equality of women, and many groups and individuals are working to close the gap between the two.

Catherine Albertyn, head of gender research at the University of Witwatersrand, wrote recently: “Alternative norms and values do exist, women do oppose and resist, and one of the most important starting points is to bring these conversations into the public domain.”

The Zimbabwe Amalgamated Railway Workers’ Union was one of three national unions to benefit from an education programme for couples run by the Zimbabwe Confederation of Trade Unions, which began in 1995 and had ran successfully for 10 years until economic and political pressures in the country forced it to close.

Places were oversubscribed for the course, which entailed workers and their spouses attending a series of seminars in workplaces and union offices, and talking openly about HIV and their relationships.

Clementine Dehwe, health and safety officer for ZCTU at the time (now the Global Unions’ HIV/AIDS campaign coordinator), who orchestrated the programme said: “When we talk of condoms, we are really talking of the issue of communication.
How, for example, can the women say to the men, ‘Can we use condoms?’, or how can you encourage your partner to go for voluntary counselling and testing? Our delegates understood they would have to go beyond the normal programme boundaries if they didn’t want to see more of their members dying from AIDS.”

The programme trainers believe their work has had an enduring impact on the lives of couples who participated. Of course the approach taken in Zimbabwe, will not be applicable to every region or country, when cultural differences will dictate for example, how direct or indirect the discussion should be, and whether gender groups should be mixed or separated.

Women in transport

Women transport workers in many parts of the world go home to  the role of subservient and unprotected wife. In addition, transport trade unions have to face up to the fact that women workers, particularly those working far from home and their support structures, and those working in lower status, insecure jobs, are being put at risk by unwelcome advances, and in some cases assaults, by a minority of their male colleagues.

Women also risk loss of work and income because of the much greater responsibility they carry in most societies for caring for family members who contract the virus. If they become infected, they will suffer more acutely from social stigma than their male counterparts, making them more likely to be driven out of or lose their job.

These realities should put the gender dimension of HIV/AIDS squarely at the centre of trade union concerns. As ITF women’s officer Sarah Finke comments: “Transport unions must address power relations between men and women in the workplace and at home, in an urgent and practical way – not just as a longterm objective. This means taking sexism seriously, in all its forms, and confronting it now.”

UNAIDS’ 2006 report concludes: “Laws and policies that protect women and girls against sexual violence, disinheritance and gender discrimination of all kinds, including harmful traditional practices and sexual violence in and outside of marriage, must be enacted, publicised and enforced.”

If trade unions want to tackle HIV on behalf of their members, both men and women, they must contribute to improving the status of women overall, by tackling gender inequality at work, in the bedroom, and in national laws.

Peter Piot remains optimistic in the face of a challenge that can seem overwhelming. In a recent interview with Newsweek magazine he said he could perceive all around him the beginnings of attitude change.  

“I see it everywhere I go. Men and women are feeling less helpless and ashamed. Whole communities are standing up to take their destinies in hand.”