December Issue 2005

As Pakistan observes World AIDS Day on December 1, not many Pakistanis are aware of the fact that the incidence of AIDS and HIV-positive cases is assuming alarming proportions within the country.

Incidentally, there exists a huge misconception that AIDS is a disease which predominantly strikes men. The truth can’t be further than that: today nearly half of all adults living with HIV and AIDS globally are women, and according to Dr. Nafis Sadik, special envoy of the UN Secretary General on HIV and AIDS in Asia, girls and young women comprise nearly two-thirds of those who have tested HIV-positive. The major reason for this unfortunate development is the fact that cultural norms of patriarchal societies (both urban and rural) do not allow women to ‘resist’ the sexual advances of AIDS-afflicted husbands. Consequently, the woman and the child she is carrying both end up with the disease.

Pakistan holds the status of low prevalence but high risk country, where women are more susceptible to the virus.”Discounting biological factors, increased levels of poverty, low literacy levels, economic dependence and a lack of essential health services (especially reproductive), have added to women’s vulnerability to HIV and AIDS in South Asia,” says Asma Bokhari, the manager of the National AIDS Control Program, Ministry of Health, Islamabad.

“When patients who have AIDS or are HIV-positive are admitted, the hospital staff refuses to treat them. Health service providers are not trained to deal with them, to the extent that a board marked HIV-positive is placed on the wall behind their bed. That is discrimination,” says Nighat Kamdar of AWARD, a Peshawar-based NGO working on women’s awareness and counselling on HIV and AIDS,” making no effort to hide her fury. Working in this field, Nighat herself is widely criticised and receives her share of sarcastic remarks. “People question my commitment and some have even labelled me HIV-positive.”

“We started working on HIV and AIDS-awareness in 1996 and there were no patients at that time. We had not come into contact with an HIV-positive person as yet, and were as apprehensive as the common person. Then we began getting to know people living with HIV and AIDS and the issues that confront them. We started counselling and offered whatever support we could provide, especially to women and children. Today, we have established a referral system and a counselling centre at the Khyber Teaching Hospital. In the event of death of an AIDS patient, we offer to perform the last rituals if the family is not willing to touch the victim’s body. People living with HIV and AIDS, register themselves with AWARD and come to Peshawar on a monthly basis for check-ups.”

Contrary to common perception, marriage does not offer any protection to these women. On the contrary, many infected women have had sexual relations only with their husbands. Therefore in some communities, simply being married counts as high-risk behaviour.

“Sometimes when women come to us, their husbands are in the last stages — and even then the wives do not know the whole truth. In many cases, the husbands have not disclosed anything at all, and it seems like every body but the wife knows of it.” Sitting in her office, Nighat is in a counselling session with Lalima, a 15-year-old Afghani girl who has tested HIV-positive. Lalima, along with her husband, Abdul Rehman, and his first wife, have all tested HIV-positive.

“Empowering women to control their sexual and reproductive lives, and providing access to culturally appropriate means to do so (including availability and increased usage of condoms to prevent STIs and unintended pregnancies), and getting the men involved as well, can contribute significantly in quelling the rising HIV and AIDS pandemic,” says Dr. Nabila Zaka, project officer at Women’s Health, UNICEF, Pakistan.

Dr. Zaka strongly believes in addressing gender relations and power dynamics between men and women and, considers their impact on sexual relations and decision-making critical for HIV prevention in Pakistan.

For Marina Mahathir, president of the Malaysian AIDS Council, an umbrella body of 39 NGOs working on HIV andAIDS, the plight of young women living with HIV, is of particular concern — they still seem “invisible to the general population” and that makes it very difficult to cater to their needs. She attributes this ‘invisibility’ to a number of factors including “sheer ignorance of the masses in patriarchal societies.”

The low status accorded to women in Asia contributes to their vulnerability to AIDS and HIV, by limiting access to the means and resources they need to protect themselves, such as knowledge, awareness, health care services and, most importantly, decision-making power. Dr. Nafis Sadik says that, “the first step to reduce the suffering of married women lies in empowering women through health care, education and the power of the purse.”

As the looming danger of AIDS slowly comes into sight, one needs to take action — wake up to the gravity of the situation, and adopt stringent measures to arrest the spread of this crippling disease.