Welcome to this week’s Charity Spotlight Interview. This week we are talking with International HIV/AIDs Alliance, an alliance of organisations dedicated to ending AIDS through community action. If you have further suggestions for charities you would like to be featured, do get in touch with us at email@example.com
1. Please describe the work that the International HIV/AIDS Alliance does, and the issues that you work on
The Alliance is at the frontline of the HIV response working with community-based organisations in over 40 countries globally with a focus on Africa, Asia, Eastern Europe, Latin America and the Caribbean. Our work largely focuses on working with people most affected by and living with HIV, including people who use drugs, sex workers, gay men and men who have sex with men and transgender people.
HIV prevalence varies across the world, but we are seeing worrying trends in countries and regions where we work, where HIV infections are on the rise, in contrast to a global decline over the past 10 years according to a UNAIDS report in 2018. In Eastern Europe and Central Asia, people who use drugs in Ukraine have an HIV prevalence of 21.9% compared to 0.9% for people aged between 15-49 . In Uganda criminalisation of same sex behaviour is a contributory factor for high HIV prevalence amongst men who have sex with men at 13.2% compared to 1.37% for the general population. Despite lower overall HIV prevalence compared to other regions, the Middle East and North Africa (MENA) region made up 12% of global new infections in 2017.
Through an innovative range of advocacy and service delivery programmes last year we reached over 1.6 million adults, adolescents and children with HIV treatment, care and support services. We also played a role in holding governments in 36 countries to account on enabling equal access to services for some of the most marginalised people and, increasing domestic financing of the national HIV response or upholding human rights.
Our work with adolescents and young people is also central to our work, particularly supporting young women to be empowered leaders to tackle new HIV infections and realise their right to health.
2. How does gender affect an individual’s likelihood of becoming affected with HIV/Aids in the developing world?
Gender inequality and harmful gender norms play an important role in affecting people’s vulnerability to HIV. We see this, for example, in the disproportionate number of young women acquiring HIV, especially in the areas with the highest prevalence, in Southern and Eastern Africa. Across this region, young women aged 15-24 are 50% more likely to have HIV than their male counterparts; however, in some locations this difference can be up to eight times higher. Among the reasons for this are high prevalence of gender-based violence. In high prevalence settings, intimate partner violence increases the likelihood of acquiring HIV by 50%. Many young women report that their first sexual encounters are forced or coercive. Girls typically become sexually active earlier than boys, and are more likely to have sex with older men. This has two worrying implications for young women – first, HIV prevalence among older men is higher than among younger men, and second, the age difference creates an additional power imbalance – on top of gender norms — whereby teenage girls and young women are less likely to have control over their sexual encounters.
The Alliance has recently implemented LEARN MENA, a project in the Middle East and North Africa (MENA) among women living with and most affected by HIV. Nearly all (92%) of the 250 women who participated in the project – who included women living with HIV, sex workers, migrant women, and lesbian, bisexual and transwomen — had experienced some form of gender-based violence. Most had experienced multiple forms of violence in different places – from their spouse or other sexual partners (74%) , from family and neighbours (58%), in the community (71%), in health services (41%), and by the police (33%). These forms of violence often start in childhood or adolescence, including with child marriage and female genital mutilation, and continue across the life course.
Violence or fear of violence against women can also stop people accessing the services they need – either to prevent HIV (and other sexual and reproductive health issues, such as unwanted pregnancy), or to access treatment. Over half (54%) of the women from the LEARNMENA project said that either experience or fear of violence had an effect on their ability to protect themselves from or manage their HIV.
3.To what extent does gender influence the way in which individuals’ lives are affected by a diagnosis of HIV/AIDs in the countries you work in?
An HIV diagnosis can also be a trigger for gender-based violence. In general, women are more likely to access health services than men are – in particular during pregnancy. This means that more women test for HIV, and often the burden of sharing a positive diagnosis with a spouse or partner rests on their shoulders, and they face being blamed for bringing HIV into the family. This can be a trigger for violence, abandonment, or abuse, and fear of these things happening can also stop women from disclosing to their partner(s). For sex workers, disclosure of an HIV status can mean they lose clients, or are not allowed to work as sex workers any more.
Two other ‘gendered’ aspects of HIV both have to do with the economic value given to care provision inside the home and in the wider community Typically, women both give care and use care services more than men do. So, at home or in the community most caregivers are women, and throughout the HIV epidemics women have shouldered a huge burden of care for family and community members living with HIV. This is nearly always voluntary/unpaid work and can be a huge drain on women’s personal resources – financial, physical and emotional. It also uses up the time they could have used for paid work, leisure or learning.
In addition, as users of health services – particularly sexual and reproductive health services – women living with HIV have often experienced stigma, discrimination and even violence from health providers. This can include being denied services or abused, told they can’t or shouldn’t have children, being coerced into terminating pregnancies, and in some cases being sterilised so that they can’t have (more) children. One woman in the LEARN MENA project described how “As soon as I came back to the doctor’s office [after a positive HIV diagnosis], he started shouting at me, insulting me. He harassed me over the phone for a month, sending me messages of blackmail and insults.” Another woman shared how she experienced stigma and discrimination when delivering her baby. “They took a picture of me and they posted my picture saying that I am HIV positive … They asked the other mothers not to use the same toilet I use. I went through hell after giving birth …”These findings urgently call for health providers to be sensitised and to provide non-discriminatory, high quality services to women in all their diversity, free from stigma, coercion or violence.
4. Beyond medical treatment, what wider societal changes and programmes can help to reduce the impact of HIV/AIDS on people’s lives? Both regarding prevention and supporting those living with HIV/AIDS
Restrictive laws and policies can also have adverse effects on the people most affected by HIV, such as sex workers, men who have sex with men, and transgender women. These groups can be extremely marginalised, both socially and economically. Criminalisation of sex work and same sex relationships, and non-recognition of non-conforming gender identities means that these groups often lack legal protections, making them vulnerable to violence – including sexual violence – and exploitation. And if these abuses occur, it is difficult to report them or seek redress. In fact, extortion, violence and sexual abuse by the police are common among these groups too.
Another key focus area is life beyond treatment for HIV. We need programmes that respond to people’s holistic health needs and overall quality of life. An area of the HIV response that has been quite neglected until now and which has gained significant global attention and action is mental health, particularly amongst adolescents and young people. In the Alliance’s work we focus on three aspects for this group which are really entwined: supporting access to and adherence on HIV treatment; empowering young people to have healthy sex lives and realise their fertility desires – whether they decide to have children or not; and providing psycho-social support to adolescents and young people with HIV so that they can fulfil their potential in all areas of life.
Find out more at http://www.aidsalliance.org/.
Featured Image: Ntsiki, a community adolescent treatment supporter (CATS), helps young people to improve their quality of life through peer support.
©Sydelle Willow Smith
This blog post was a collaboration between Serena Bailey, Director of Engagement for CORBIS and Luisa Orza, Technical Lead: Gender at the Alliance. If you are a student at the University of Sussex, Brighton and Sussex Medical School or Institute of Development Studies and would be interested in getting involved with our work, get in touch with us at firstname.lastname@example.org