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Numerous negative social factors have arisen in Zambia and other parts of the developing world especially which are a fallout' of the epidemic, the most vexing of which is the problem of the destitute orphan whose parents have been claimed by AIDS. The inescapable conclusion is that the world has to find from somewhere,anywhere, and release extra energies to attempt to contain the devastating spread of AIDS.
One of the tactics used in the awareness campaigns is targetting people by groups in terms of commonalities. We have reproduced here a UN/AIDS release on Women and AIDS, a very informative discussion of factors predisposing women to HIV/AIDS. This, and some select abstracts of journal articles, bring out the dangers, for instance, of social traditions in Africa that take away from the woman the power over her own body which in this era can spell the difference between life and death, making the woman a sitting target.
Novel herpes viruses have been described recently. These include human herpes viruses 6, 7 and 8 (HHV-6, -7, -8). HHV-6 has at least two strain groups, variants A and B. The B strains are predominant in the West and can account for over 97% of infections in infants. In contrast, the A strains are rare and the few well-characterized isolates have been from adult African AIDS patients. It is not clear whether the HHV-6 variant A strains are AIDS-related and/or whether they can also be acquired as childhood infections and may reactivate later during adulthood. What contribution geographical variation plays has yet to be assessed. HHV-8 has been associated with AIDS-related epidemic Kaposi's sarcoma (KS), but has also been identified in endemic KS. In regions of Africa where KS is endemic, the onset of AIDS has led to increased prevalence of KS. In this report, we examine in Zambia, an AIDS epidemic and KS endemic region, infection with these novel herpes viruses during infancy. In blood samples from human immunodeficiency virus-negative infants with first febrile episode, both semi-quantitative PCR and sequence analyses were used to identify HHV-8 in 8% and HHV-6 in 30%, with 44% of these variant A; in childhood endemic KS biopsies HHV-8 was detected in 100% and HHV-6 in none. The high viral-DNA loads in the infant blood samples were consistent with viraemia. This is the first demonstration that HHV-6 variant A and HHV-8 may be acquired as common childhood infections.
Kasolo FC. Mpabalwani E. Gompels UA. Infection with AIDS-related herpes viruses in human immunodeficiency virus-negative infants and endemicchildhood Kaposi's sarcoma in Africa.
Journal of General Virology. 78 ( Pt 4):847-55, 1997 Apr.
HIV & Kaposi's Sarcoma in children
Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (KS) is well documented in adults. However, very little information is available about KS in the pediatric age group. A retrospectively study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia, to define the incidence and clinical profile of KS in Zambian children over the last 13 years and to determine the influence, if any, of the current human immunodeficiency virus (HIV) epidemic on the pattern of pediatric KS. All the histopathological records from 1980 to 1992 were reviewed and all cases of KS along with the total number of malignancies, both in children and adults, were analysed. Along with this, 17 of 23 case files of pediatric KS patients treated at the UTH since 1984 were retrieved and clinical details recorded. Of a total of 915 cases of KS, 85 (9.25%) were in children < 14 years of age. The age ranged from 7 months to 14 years, with an average of 5.62 years; the male/female ratio was 1.76:1. A significant increase in the incidence of pediatric KS has been recorded since 1987 (p < 0.001). This coincides with the advent of the HIV epidemic in the country. The disease was aggressive and fulminant in pediatric patients. More than 80% HIV seropositivity was detected. Children with blood transfusion-related HIV infection had cutaneous or lymphocutaneous disease, indicating that the mode of acquisition of HIV infection may influence the clinical appearance of KS. Thus, HIV-associated KS in children is becoming a common entity in Zambia. An urgent prospective epidemiologic study is needed to address this problem in HIV-affected regions.
Athale UH. Patil PS. Chintu C. Elem B. Influence of HIV epidemic on the incidence of Kaposi's sarcoma in Zambian children.
Journal of Acquired Immune Deficiency Syndromes & Human Retro Virology. 8(1):96-100, 1995 Jan 1.
Childhood cancers in Zambia
Human immunodeficiency virus (HIV) related cancers in children are not as common and as well described as in adults. An HIV epidemic has been prevalent in Zambia since 1983-1984. To study the effect of the epidemic on the epidemiology of cancers in children a retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia. All the histopathological records from 1980 to 1992 were reviewed and all cases of cancers in children less than 14 years of age were analysed. In order to define the effect of the HIV epidemic, the epidemiological features of various childhood cancers occurring before (during the years 1980-1982) and after (during the years 1990-1992) the onset of the HIV epidemic were compared. A significant increase in the occurrence of total childhood cancers was found. This is mostly due to a highly significant increase in the incidence of paediatric Kaposi's sarcoma (p = 0.000016), which is causally related to HIV infection, and a significant increase in the incidence of retinoblastoma (p = 0.02), which has an unknown relation to HIV infection. Though not yet statistically significant, there has also been a gradual and sustained increase in the incidence of non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and rhabdomyosarcoma. There has been a significant reduction in the incidence of Burkitt's lymphoma. A prospective in depth epidemiological study of HIV related childhood cancers in Africa is urgently needed.
Chintu C. Athale UH. Patil PS. Childhood cancers in Zambia before and after the HIV epidemic.
Archives of Disease in Childhood. 73(2):100-4; discussion 104-5, 1995 Aug.
Adult malignancies in Zambia
This study analysed histopathological and haematology records of 7836neoplasms seen during the period 1980-1989 at the University Teaching Hospital, Lusaka, Zambia. The crude incidence rate of each malignancy per 100,000 adults per year was calculated and the patterns of malignancies were compared for the periods 1980-1983 and 1984-1989, the later coinciding with the advent of the human immunodeficiency virus (HIV) epidemic. The six most common tumours were carcinoma of the cervix (19.6%), Kaposi's sarcoma (7%), bladder carcinoma (6.3%), hepatoma (5.8%), lymphoma (4.6%) and carcinoma of the breast (4.4%). Significant increases in the crude incidence rates of Kaposi's sarcoma (KS) and carcinoma of the breast were observed during the last 6 years of the study period (P = 0.001). Nodal KS showed the most significant rise from a crude incidence rate of 0.25 per 100,000 adults per year in the 1980-1983 period to 1.11 during the 1984-1989 period. In contrast to findings from Europe and the USA, no significant increase in non-Hodgkin's lymphoma was detected in Zambia following the HIV epidemic.
Patil P. Elem B. Zumla A. Pattern of adult malignancies in Zambia (1980-1989) in light of the human immunodeficiency virus type 1epidemic.
Journal of Tropical Medicine & Hygiene. 98(4):281-4, 1995 Aug.
Surgical pathology & HIV infection
HIV (human immunodeficiency virus) infection is prevalent in many areas of sub-Saharan Africa. Seropositivity rates reach 10-15% in urban adults, 21% in critically ill adults and 30% in surgical inpatients aged 21-40 years. AIDS (acquired immune deficiency syndrome) is a multi system disease which presents to the surgeon with a wide range of pathologies including Kaposi's sarcoma, lymphadenopathy and sepsis. The more common sites for sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (necrotizing fascitis) and bone and joints. To prevent iatrogenic HIV infection more use should be made of autologous blood. Occupational exposure to HIV infection can be minimized by double-gloving, protecting the eyes when operating and ensuring that theatre gowns are waterproof. The risk of HIV infection from a needle stick injury is 0.4%. Although contact with blood during a surgical procedure is common, the risk is lower than for a hollow needle stick injury.
Watters DA. Surgery, surgical pathology and HIV infection: lessons learned in Zambia.
Papua New Guinea Medical Journal. 37(1):29-39, 1994 Mar.
STD care in Zambia
Clinical diagnosis of STDs is unreliable and therefore constitutes a poor basis for choice of treatment. A syndromic approach has been suggested to increase effectiveness of treatment in resource poor settings. Algorithms for the treatment of STD syndromes were evaluated. A total of 436 patients were followed; cure rates were defined and estimated for genital ulcer disease (GUD), urethral and vaginal discharge. Cure rates for the discharge syndromes were high, 97-98%, for both sexes. The cure rate for GUD was 83% for female and 69% for male patients. A higher prevalence of syphilis in the female study population probably contributed to this. It is likely that a large proportion of the treatment failures were due to decreased susceptibility of Haemophilus ducreyi to trimethoprim-sulpha. The determination of cure rates met with a number of methodological problems. This makes it difficult to evaluate the algorithms as part of routine activities, as suggested earlier by WHO.
Hanson S. Sunkutu RM. Kamanga J. Hojer B. Sandstrom E. STD care in Zambia: an evaluation of the guidelines for case management through a syndromic approach.
International Journal of STD & AIDS. 7(5):324-32, 1996 Aug-Sep.
Behaviour, knowledge & reactions concerning STDs
Available data show that STDs and their consequences are a major health problem in Zambia. This study focuses on factors which could have implications for partner notification, as a tool for prevention. Fifty women and fifty men with STD were interviewed at two outpatient clinics in Lusaka, where partner notification is not functioning optimally. A majority of the sexual partners during the last three months were known by the patients who also stated a willingness to bring more partners than they were asked to do. Women had symptoms for a longer period than men before they came for treatment. They were less aware of symptoms connected with STD and a majority of them did not know that they were receiving treatment for STD. The communication between the health care provider and the patients about disease, treatment and partner notification needs to be improved especially for women.
Faxelid E. Ndulo J. Ahlberg BM. Krantz I. Behaviour, knowledge and reactions concerning sexually transmitted diseases: implications for partner notification in Lusaka.
East African Medical Journal. 71(2):118-21, 1994 Feb.
Where is the epidemic going?
Routine surveillance of HIV (human immunodeficiency virus) infection and AIDS has been established over the past decade in many countries around the world. HIV estimates derived from empirical data are essential to the assessment of the HIV situation in different parts of the world and trends are used in tracking the development of regional epidemics, thereby keeping intervention activities focused on realities. As of the end of 1995, and following an extensive country-by-country review of HIV/AIDS data, a cumulative total of 6 million AIDS cases were estimated to have occurred in adults and children worldwide and currently 20.1 million adults are estimated to be alive and infected with HIV or have AIDS. Of the total prevalent HIV infections, the majority remain concentrated in eastern, central and southern Africa, but the epidemic is evolving with spread of infection from urban to rural areas, as well as to West and South Africa, India and South-east Asia, and to a lesser extent--with proportional shifts to heterosexual infections--in North America, western Europe and Latin America. While the longer-term dimensions of the HIV epidemic at global level cannot be forecast with confidence, WHO currently projects a cumulative total of close to 40 million HIV infections in men women and children by the year 2000. By that time, the male:female ratio of new infections will be close to 1:1. Recent trends indicate that HIV prevalence levels may be stabilizing or even decreasing among pregnant women in southern Zaire and parts of Uganda, among military recruits aged 21 in Thailand, and in some populations of northern Europe and the USA. While these changes may take place as part of the intrinsic dynamic of the epidemic, there is some evidence that declines in HIV prevalence are related to declines in HIV incidence which are, at least partly, due to prevention efforts. The challenge of surveillance and evaluation methods is now to identify the ingredients of success which may reveal a glimmer of hope.
Mertens TE. Low-Beer D. HIV and AIDS: where is the epidemic going?.
Bulletin of the World Health Organization. 74(2):121-9, 1996.
AIDS & ethno cultural communities
This paper presents the results of Phase II of the Ethno cultural Communities Facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated with HIV/AIDS in six ethno cultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arabic-speaking communities in Montreal. Results demonstrated that there are common elements across these ethno cultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethno cultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices.
Singer SM. Willms DG. Adrien A. Baxter J. Brabazon C. Leaune V. Godin G. Maticka-Tyndale E. Cappon P. Many voices--sociocultural results of the ethno cultural communities facing AIDS study in Canada.
Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 87 Suppl 1:S26-32, S28-35, 1996 May-Jun.
Public health implications
The human immunodeficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS) epidemic has led to greatly increased international collaboration for medical research, mainly epidemiologic in nature, in Africa. Greater understanding of HIV/AIDS has resulted, and considerable training and technology transfer have occurred. However, analytic and descriptive research in countries heavily affected by AIDS has been slow to turn to assessment of interventions, and practical benefits to those countries' public health and policies have lagged behind scientific knowledge. This article considers the public health implications of selected HIV/AIDS research in sub-Saharan Africa and discusses opportunities for interventions and more applied research. Topics covered include HIV testing and its role, surveillance, control of sexually transmitted diseases, the vulnerability of youth and women, tuberculosis, HIV/AIDS care, and the inadequacy of resources currently committed to HIV/AIDS prevention and control in resource-poor countries. Research on HIV/AIDS in Africa has yielded crucial information but now should prioritize interventions and their evaluation. Specific goals that might limit the effects of the HIV/AIDS epidemic in resource-poor countries are achievable given vision, commitment, and resources.
De Cock KM. Ekpini E. Gnaore E. Kadio A. Gayle HD. The public health implications of AIDS research in Africa.
JAMA. 272(6):481-6, 1994 Aug 10.
Impact of HIV/AIDS on children
The increasing numbers of children born to HIV-infected women poses formidable problems for maternal and child health programs throughout the world. Between 20% and 40% of these children will be infected with HIV and most are expected to die by the age of 5 years as a result. The vast majority of the uninfected children will be orphaned before age 15 years as their mothers and fathers die of AIDS. By the late 1990s, several hundred thousand children will be born annually to HIV-infected women in developing countries, with the majority in sub-Saharan Africa and Asia compared with a few thousand in North America. [References: 33]
Chin J. The growing impact of the HIV/AIDS pandemic on children born to HIV-infected women. [Review] [33 refs]
Clinics in Perinatology. 21(1):1-14, 1994 Mar.
AIDS action research with women
AIDS has assumed epidemic proportions in Central Africa. Knowledge of culturally constructed gender relations and sexual meanings is crucial to developing prevention strategies and reducing the impact of AIDS. CONNAISSIDA, a transdisciplinary medical anthropology research project, developed culturally appropriate community-based empowerment workshops. These used cognitive, emotional and social stimulants to provoke critical reflection and action. Collaborative relationships developed in workshops were used to study sexual relations in many contexts. Significant changes in knowledge and action were observed. Nevertheless, economic necessity and inequality limited the ability of many women to avoid sexual risk. Economic crisis, structural adjustment and debt reimbursement policies have exacerbated poverty, particularly among women. Linking macro level political economy to micro level sociocultural analysis shows how strategies adopted for survival contribute to sexual risk. Therefore broader socioeconomic changes that reduce poverty and gender subordination are necessary to control the HIV/AIDS epidemic. Findings from Zaire are widely applicable in the region. [References: 92]
Schoepf BG. AIDS action-research with women in Kinshasa, Zaire. [Review] [92 refs]
Social Science & Medicine. 37(11):1401-13, 1993 Dec.
African women's control over their sexuality in an era of AIDS
Very limited knowledge is available about African women's control overtheir sexual relations with husbands or other stable partners in situations where there is a high risk of STDs and HIV/AIDS. Such control must be seen as encompassing women's control over their sexuality and reproduction as well as the broader areas over which they can make decisions. The paper examines other research findings in sub-Saharan Africa, and then reports a study carried out by survey and anthropological methodologies among the Yoruba people in Ado-Ekiti, a town in southwestern Nigeria. Because the AIDS epidemic is still at an early stage in Nigeria and because of the relation of STD infection to HIV-transmission, as well as the probability that the behaviour developed for limiting STD transmission will subsequently be employed to limit HIV transmission, the study focused on STDs. Yoruba women have a considerable ability to refuse sexual relations for a limited time, and they are placed at greater risk of STD infection by their ignorance of whether their partner is infected than by a lack of ability to control the situation when STDs have been identified. This ability may be more limited in the case of AIDS because of its longer duration.
Orubuloye IO. Caldwell JC. Caldwell P. African women's control over their sexuality in an era of AIDS. A study of the Yoruba of Nigeria.
Social Science & Medicine. 37(7):859-72, 1993 Oct.
Rights & powers Vs control & exclusion
The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.
Seidel G. The competing discourses of HIV/AIDS in sub-Saharan Africa: discourses of rights and empowerment vs discourses of control and exclusion. [Review]
Social Science & Medicine. 36(3):175-94, 1993 Feb.
In industrialized countries, practically all infections used to occur in men. No longer. While women comprised around 12% of the AIDS cases reported in France in 1985, ten years later this figure rose to around 20%. In Spain, women's share of reported AIDS cases more than doubled over the same ten-year period from around 7% to 19%.
Brazilian women have experienced an even more spectacular increase in risk. While only one woman was infected for every 99 men in 1984, a decade later women accounted for a quarter of all those with HIV.
Asian women face an enormous challenge from their region's runaway HIV epidemic. Typically, one-third or more of prostitutes in cities in Cambodia, India and Thailand are infected. Even among women who are not occupationally exposed, the risk is growing. Nationwide in Thailand, in 1991, fewer than 1% of pregnant women attending antenatal clinics were found to be infected. By 1995, the figure was more than 2%.
In Africa south of the Sahara, there are already 6 women with HIV for every 5 men. Close to four-fifths of all infected women are African. In the younger age brackets (15-24 years), the HIV risk for African girls in seven more disproportionate. In countries where youngsters account for 60%of all new infections, young women outnumber their male peers by a ratio of 2 to 1.
Currently, close to half of the 7500 adults worldwide who become infected daily are women. And over 9 out of 10 infected women live in a developing country. More than four-fifths of all infected women get the virus from a male sex partner (heterosexual transmission). The remainder become infected from a blood transfusion or from injecting drugs with a contaminated needle.
Studies in Africa and elsewhere have shown that many married women have been infected by their one partner or their husband. Simply being married is a major risk factor for women who have little control over abstinence or condom use at home or their husband's sexual activity outside.
Women with a sexually transmitted disease (STD) like gonorrhoea are often unaware of it because the infection is "silent". Conclusive proof now exists that STDs facilitate the spread of HIV. An untreated STD in either partner increases the risk of HIV transmission during unprotected sex* 3- to 4-fold. The STD epidemic, with 333 million new cases a year, thus fuels the AIDS epidemic.
AIDS prevention campaigns often fail women by assuming that they are at low risk, or by urging prevention methods that women have little or no power to apply, such as condom use, abstinence and mutual fidelity. (*Unprotected sex means intercourse without a condom).
Women continue to make strides towards equality with men. Wherever they are educated, able to generate income, and enjoy equal protection under the law, they are in a position to have some control over their economic, social and personal life. But for millions of women, these goals are still remote. These are the women who are the most vulnerable to infection with HIV, the virus that results in AIDS.
Biological vulnerability:
Research shows that the risk of becoming
infected with HIV during unprotected vaginal intercourse is as
much as 2-4 times higher for women than men. Women are also
more vulnerable to other sexually transmitted diseases. As
compared with men, women have a bigger surface area of
mucosa exposed during intercourse to their partner's sexual
secretions. (In women, the genital mucosa is the thin lining of the
vagina and cervix.) And semen infected with HIV typically contains
a higher concentration of virus than a woman's sexual secretions.
This makes male-to-female transmission more efficient than
female-to-male.
Younger women are at even greater biological risk. Their physiologically immature cervix and scant vaginal secretions put up less of a barrier to HIV. There is evidence that women again become more vulnerable after the menopause. Tearing and bleeding during intercourse, whether from "rough sex", rape or prior genital mutilation (female "circumcision"), multiplies the risk of HIV infection. Throughout the world, women run a similar risk from unprotected anal intercourse. Sometimes preferred because it preserves virginity and avoids the risk of pregnancy, this form of sex often tears the delicate tissues and affords easy entry to the virus. A final important biological factor is an untreated STD in either partner, which multiplies the risk of HIV transmission by 300-400%. Between half and four-fifths of STD cases in women go unrecognized because the sores or other signs are absent or hard to see and because women, if they are monogamous, do not suspect they are at risk.
Social and economic vulnerability:
Social and economic vulnerability : Biologically vulnerable does
not mean unprotectable. Experience from the past decade
proves that both men and women can be helped to avoid HIV.
Around the world, infection rates have been lowered by screening
blood for transfusion, by frank information about how HIV can
spread, by clear prevention messages urging abstinence, fidelity
or safer sex, by condom promotion, by needle exchange
programmes for drug users, and by encouraging and enabling
people to get prompt care for STDs.
However, for millions of women, many of these services are inaccessible and many of the messages irrelevant or inapplicable. Because of their socioeconomic circumstances, women's autonomy is crippled. Lacking economic resources of their own, and fearful of abandonment or violence on the part of their male partners, they have little or no control over how and when they have sex and hence over their risk of becoming infected with HIV. This is the meaning of vulnerability.
Millions of young girls are brought up with little understanding of their reproductive system or the mechanics of HIV/STD transmission and prevention. Even when human sexuality is taught at school, girls are at a disadvantage because, especially in developing countries, they are taken out of school earlier than boys. At the same time, girls are taught to leave the initiative and decision-making in sex to males, whose needs and demands are expected to dominate. Male predominance often comes with a tolerance for predatory, violent sexuality. It also carries a double standard whereby women are blamed or thrown out for infidelity, real or suspected, while men are tacitly expected or allowed to have multiple sex partners.
Failure to respect the human rights of girls and women in terms of equal access to schooling, training and employment opportunities reinforces their economic dependence on men. The reliance may be on a "sugar daddy", a husband or stable partner, a few steady male partners who have fathered the children, or, for women in prostitution, a succession of clients. Indeed, for girls and women in many cultures, sex is the "currency" in which they are expected to pay for life's opportunities, from a passing grade in school to a trading license or permission to cross a border.
A woman in a stable relationship who is economically dependent on her partner cannot afford to jeopardize his support even when she suspects he has HIV. If she refuses him sex or asks him to use condoms, she is breaking the conspiracy of silence that surrounds his extramarital activity or, even worse, intimating or admitting that she was unfaithful. And while some men agree to use condoms, many react with anger, violence or abandonment.
A further dilemma is that condoms are incompatible with pregnancy. Couples wanting children need to know their HIV status and, if both are uninfected, agree to remain faithful or refrain from unsafe extramarital sex. Obstacles are unwillingness to discuss these issues openly and a lack of voluntary HIV testing and counselling services.
STDs, which augment a woman's biological vulnerability to HIV, often go untreated even when symptomatic. Women are brought up to accept ill health and especially "women's troubles" as their lot in life, and in general have poor access to appropriate health services. Because sexually transmitted infections carry a heavy social stigma (less so for men), women tend to avoid STD clinics for fear of being recognized. And the health workers to whom women do have access, in primary health or maternal and child health clinics, are often unsympathetic, judgmental, and unprepared to diagnose and treat STDs.
Prostitution constitutes another setting in which women have little power to protect themselves from HIV. Girls forced or sold into sex work, even before puberty, are generally unaware of the AIDS risk and unable to run away or take protective action. The sexual exploitation of girls is one of the most pernicious forms of child abuse. Not all prostitution is forced. While for some women it is a choice, many turn to occasional or steady sex work as an alternative to dire poverty, exchanging sex for the basic necessities of life for themselves and their children. Often, these are women whose lives have been disrupted by war, or divorcees or widows who because of inequitable laws and customs have lost their property as well as their husband's earning power. While many sex workers risk violence or loss of income if they request condom use, in some places prostitutes have banded together to demand condoms from all clients, or work in brothels where the government has instituted a "condoms-only" rule. Ironically, these women may enjoy more protection than housewives who have no "social permission" to request or negotiate safer sex. A vulnerable woman is one who is lacking in power or control over her risk of HIV infection. The remedy is empowerment.
Combat ignorance:
Improve the access of girls to formal
schooling. Ensure they have information about their own bodies,
education about AIDS and the other STDs, and the skills to say no
to unwanted or unsafe sex. UNAIDS is testing and comparing
different approaches to skills-building and determining the best
practices in this area.
Provide women-friendly services Ensure that girls and women have access to appropriate health care and HIV/STD prevention services at places and times that are convenient for them. Expand voluntary HIV testing and counselling services. Make condoms and STD care available where women can go without embarrassment. UNAIDS is helping to ensure that women's family planning options help rather than undermine their ability to avoid HIV.
Develop female-controlled prevention methods: The male condom, currently the only barrier method available for HIV prevention, urgently needs to be complemented by methods that women themselves can use, if necessary without the know-ledge or cooperation of their male partner. UNAIDS is facilitating the development of and access to several such methods, including the female condom and vaginal microbicides virus-killing creams or foams that women can insert vaginally before intercourse. A microbicide that does not kill sperm and prevent conception would be helpful to millions of couples worldwide.
Build safer norms Support women's groups and community organizations in questioning behavioural traditions which have become deadly with the advent of AIDS, including tolerance of child abuse, rape and sexual coercion. Educate boys and men to respect girls and women, to engage in responsible sexual behaviour, and to share the responsibility for protecting themselves, their partners and their children from HIV and the conventional STDs. UNAIDS speaks out for safer, egalitarian norms and supports concrete efforts to build these in and out of school.
Reinforce women's economic independence. Multiply and strengthen existing training opportunities for women, credit programmes, saving schemes and women's cooperatives, and link them with AIDS prevention activities. For example, UNAIDS is supporting efforts to enable Zambian women fish traders to form a cooperative that will give them interest-free loans. With these, they will no longer have to exchange sex with the fishermen or truck drivers who control their access to fish and to transport.
Reduce vulnerability through policy change UNAIDS' message is that policies from community to national level must be reshaped if women's vulnerability to HIV is to be reduced. Among other things, this means protecting their human rights and fundamental freedoms and improving their economic independence and legal status. This cannot be achieved without a greater political voice for women.
UNAIDS Best Practice materials:
The Joint United Nations Programme on HIV/AIDS (UNAIDS) is
preparing materials on subjects of relevance to HIV infection and
AIDS, the causes and consequences of the epidemic, and best
practices in AIDS prevention, care and support. A Best Practice
Collection on any one subject typically includes a short publication
for journalists and community leaders (Point of View); a technical
summary of the issues, challenges and solutions (Technical
Update); case studies from around the world (Best Practice Case
Studies); a set of presentation graphics; and a listing of key
materials (reports, articles, books, audiovisuals, etc.) on the
subject.
Improvements in Quality and Availability of Postabortion Care:
Governments in the CRHCS member countries already are
expending a considerable amount of resources to treat
women for complications of unsafe abortion. The following
policy and programme implications describe how resources
could be used more efficiently to deliver better services.
Key areas to target are health policies and procedures,
training and material resource provision. The vast majority
of possible reform measures listed do not require additional
funds. They do, however, require that policy makers
recognise unsafe abortion and treatment of abortion
complications as priority health problems.
Policies and Procedures:
Training:
Improvements in the Legal/Administrative Environment:
Major improvements in the delivery of postabortion car can
be made under existing laws in the region. Restrictive
abortion laws, however, remain a major limiting factor in
the reform process. The following are areas where
modifications in existing laws, policies and programmes
could be beneficial:
Recommendations for Priority Research:
This monograph is a testimony to the wealth of information
that exists on the epidemiology of unsafe abortion in the
region, practically as this problem interests with country
health care systems. Consequently, further similar research
(e.g., hospital logbook reviews to document that the
problem exists) should not be considered a priority. On the
other hand, gaps in important information do exist, as
evidence by the problem (e.g, cost, male perspective,
postabortion FP acceptance and continuation) Based on the
findings of the literature review, recommendations for
priority research include:
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Last updated December 31, 1997