AIDS and Girls
If a poster child were chosen to represent the 12th World AIDS Conference this week in Geneva, it might be one with an unexpected face: a girl, trusting, but very vulnerable. In other words, it could be your teenage daughter or mine.
Researchers estimate that 14,000 people were infected with HIV daily in 1997. Forty percent were women. More than 50 percent were between the ages of 15 and 24.
While, there's much to celebrate in Geneva, the celebrations should be tempered by a heightened awareness that the single greatest barrier to controlling the AIDS epidemic is social and economic inequality.
Conferees need to examine what inequality makes girls appear increasingly vulnerable to HIV infection. Looking at the epidemic through gender-sensitive lenses will help them see that women in many cultures are less able to protect themselves from HIV than men because women have less access to five critical resources: information and education, economic assets, skills, technologies and services, and social support. In short, women, especially young women, often don't have the knowledge, the money, the technologies, or the power to protect themselves. This is borne out in research findings from 25 studies conducted in 14 countries through the Women and AIDS Research Program of the International Center for Research on Women.
These studies show that women, particularly young women, have very little leverage in heterosexual relationships to negotiate protection.
The data also revealed that many women around the globe know little about sex, reproductive anatomy, or physiology. Their access to such information is severely limited by social norms and notions of what "good girls" should be warned about. Their economic vulnerability limits their ability to negotiate safer sex with partners or to leave "risky" relationships. And women, particularly young adolescents - due to cultural factors - have little control over sexual interactions and, fearing physical violence or abandonment, are loath to raise difficult issues.
We used to think that if we focused on individual behavior and persuaded individuals to play safe, that would be enough. We now know that's not sufficient to effectively combat the AIDS epidemic. We need to address the inequalities in the social and economic contexts of individual lives. We must not only address who does what with whom - but we must try to understand and change the why.
To protect girls, addressing the why involves implementing programs to increase their autonomy and power through education - including sex education; through training trusted adults to be sources of information and counsel; through finding a technology that women can control and use, such as microbicides; through putting economic resources in the hands of women; and through involving boys and men in reexamining the high cost of a reckless, macho, and often violent image of masculinity.
We in Geneva have a choice. We can either be overwhelmed by the realization that the people at the center of the pandemic - the young and female - are also the population at greatest risk because they are doubly disadvantaged by their gender and their youth. Or we can be encouraged that this same population offers an opportunity for education and intervention before behaviors and lifestyles are set in place.
As one young woman who was trained to be an AIDS-prevention peer educator in Brazil said to a researcher:
"I learned about AIDS, about sexuality, gender, and what I liked most was learning about the rights of women, that women have rights to say no.... Now I have all this information.
"I am stronger."
* Geeta Rao Gupta is president of the International Center for Research on Women (ICRW), based in Washington, and the social science co-chair of the 12th World AIDS Conference in Geneva.