HIV as a Human Rights Issue: Intersection of Gender, Race, and Violence

10 Nov


 

I Care about HIV/AIDS because...

I Care about HIV/AIDS because…

Why should people care about HIV if they are not personally affected by the disease, or if they do not know of anyone who is personally affected? I’ll tell you why: HIV is a human rights issue. 
One of the things that I love about my job is that when I’m discussing HIV prevention, I’m never just restricting my conversations to talking about HIV. I talk about STD concerns, general sexual and reproductive health, issues of consent for sexual activity, and finally issues related to power dynamics within relationships.
Here is one thing many people don’t realize, at least not consciously: condom use is all about negotiation. Okay, logically, to prevent the sexual transmission of HIV (and other STD’s), one should engage in all sexual or intimate encounters using condoms. That makes sense.
What if no condom is available at the moment? Or how about if your partner doesn’t want to use condoms? Okay, let’s focus for a second on the latter: Your partner is pressuring you into not using condoms.

There’s that classic line:

“You’re on birth control, and I don’t have anything (read: Sexually Transmitted Disease)….and neither do you. Why do we need to use condoms?”

If your partner doesn’t want to use condoms when you do, then logic tells us to just kick him/her to the curb. But unfortunately, logic cannot always be applied to instances of sex or intimacy. Beyond the emotional attachment which may cause someone to abandon his or her preferences “out of love” for their significant other, there are a few other matters to consider: What if you are in a long-term relationship and your partner is upset or offended by your request to continue using condoms? What if he/she threatens to leave you if you go against his/her wishes. Or…..

What if your partner threatens to (or does) hit you for resisting his/her demands? Ultimately: HIV transmission is not as simple as someone forgetting to wear a condom or not having any condoms available. It’s not even JUST an issue of a lack of education around HIV or sexual health. It comes down to negotiation. It’s and issues of power dynamics: who has the power (or IS empowered) to demand that condoms are (or are NOT) used.

The Three-Way Shift

In the early 1980s, when HIV was first observed in the United States, it was considered a “gay disease” because it was primarily observed among young, Caucasian, homosexual men in the Los Angeles area. Almost thirty years later in 2013, there has been a three-way shift in the race, gender, and sexual orientation of the demographic group with the highest incidence rate of HIV: from Caucasian, homosexual, men in the 1980’s to African American, heterosexual women in present day.

That’s a pretty remarkable shift to consider. In just thirty years, a virus has completely changed its course to disproportionately affect an entirely different demographic. This was what initially drew me toward researching HIV and its relationship to women.

Reasons cited by scholars for this shift in HIV to targeting women, particularly African Americans, include the power dynamic between men and women engaging in heterosexual intimate/sexual relationships, particularly in relationships in which:

  1. Gender-based violence (GBV)/Intimate Partner Violence (IPV), including domestic violence, rape, and sexual assault, are involved
  2. Women are financially unstable/”economically vulnerable”
  3. Men in heterosexual relationships bear attitudes of dominance or patriarchy

Because condom use is a direct product of negotiation, the individual with more power has the greater efficacy to control whether or not condoms are used in a relationship. Below I discuss the three situations listed above and describe their relationship to power dynamics within heterosexual relationships, condom use negotiation, human rights issues, and HIV transmission.

Gender-Based Violence (GBV)/Intimate Partner Violence (IPV) in Heterosexual Relationships

Julia Kim (2008) describes the most visible “manifestation of the unequal power balance between men and women is violence against women”, specifically, violence against an intimate partner. If violence or sexual assault is an impending threat for a woman while she is in a relationship, she may not feel empowered to demand condom use from her partner out of fear of physical or sexual abuse. GBV and IPV constrain of individual agency and consequently lead to issues with women’s health. Women are physically at risk of being hurt from being hit or sexually abused by their partner. Additionally, they are left scared and in a disempowered state, in which they are unable to defend their human rights and protect themselves from STI’s and HIV.

Currently, the intersection of gender-based violence, intimate partner violence and HIV prevention among women is an initiative that is being undertaken by the White House (see link below).

Financial Disempowerment/Economic Vulnerability of Women Engaging in Heterosexual Relationships

Demonstrated lack of financial security among  women characterizes another social factor that contributes to female disempowerment, and subsequent transmission of HIV. Oftentimes, women who are struggling financially may turn to men for financial support.  In many of these situations, financial dependence upon men, the “sole bread-winners” of the household, places women in vulnerable positions. Women who are poor, many of whom are minorities, may rely on their partners for housing, food, or other forms of financial support. As a result they may be pressured to submit to the sexual needs of their partner. Women are more likely to engage in risky sexual behaviors, such as unprotected sex, because they believe they owe their partners in exchange for money, food, and resources. These type of sexual transactions in exchange for money or other material goods, including housing, clothing, food, or even drugs predispose women to HIV and other STD’s.

Patriarchy/Structural Violence

A woman who engages in sexual relationships with a man who bears attitudes of superiority toward women may be pressured to submit to the needs of her partner, including forgoing condom use if her partner demands it . If a man asserts his dominance, as the male “head of the household”, a woman may have limited control over protecting her body during intimacy, leaving her in a position of little control. Women may unwillingly submit to the pressures of her partner out of fear that her partner will leave her or engage in affairs outside of their relationship. The “subordinate status of women”, particularly of minority women, directly influences the health-threatening decisions made by women in relationships and characterizes a violation of women’s rights (Farmer 2003).

Dr. Paul Farmer (2003) cites structural violence,  the historically adopted behaviors or attitudes, e.g. sexism, racism, or classism, “that conspire to constrain individual agency”, as a key contributor to health disparities. Sexism, racism, and classism deprive certain groups of their basic human rights, creating “inegalitarian social structures”. Sexist or patriarchal styles of thought establish a hierarchy and division of power between the sexes, in which men are afforded the power to make final decisions. As a result, women are denied their right to assert control over their bodies and their health.

References

Farmer, Paul. (2003). Pathologies of power: health, human rights, and the new war on the poor. Berkeley: University of California Press.

Farmer, Paul. (1996) Women, poverty, and AIDS : Sex, drugs, and structural violence In Simmons J. (Ed.), Monroe, Me. : Common Courage Press

Kim, Julia, Pronyk, Paul, Barnett, Tony, & Watts, Charles. (2008). Exploring the Role of Economic Empowerment in HIV prevention. AIDS Journal (2008) Volume 22. Lippincott Williams & Willkins.

As always, please feel free to email me. I limited much of my discussion for ease of reading, but I’m always open to questions/further discussion and reading.

–Rachel Safeek

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