All in a day's work

Women have earned many titles over the years. From matriarchs to leaders, of both households and companies. In most cases, women are thought to be beings of soft fragrant femininity, but they can wield iron fists when the occasion arises. Many are blessed with sharp wit and intellect, creating waves within male-dominated industries. Others are natural caregivers, caring for the sick, elderly and abandoned. It is said a mother’s job is never done, but the same can be said of any woman. Ending a tough day at the office only to get home and cook, see to the kids and dote on their better half, is all in a day’s work. In 2008 it was estimated that out of the 31.3 million adults worldwide living with HIV/Aids, around half were women. The Aids pandemic has a unique impact on women, which has been exacerbated by their role within society and their biological vulnerability to HIV infection. In many cases, caregivers for persons living with HIV/Aids are women. This care-giving is usually in addition to many other tasks that women perform within the household, such as cooking, cleaning and caring for children and the elderly. Caring for parents, children or husbands can increase one’s workload and women often struggle to bring in an income while providing this care; therefore many families affected by Aids suffer from increasing poverty. With so many people infected and affected by HIV/Aids on a daily basis, the roles of women become strained and even further challenging. “This epidemic unfortunately remains an epidemic of women,” says Michel Sidibé, executive director of the Joint United Nations Programme on HIV/AIDS. As August is Women’s Month, we shed light on the challenges faced by women – not only in Africa but globally. Millennium Development Goals HIV/Aids is not restricted to any given geographical location, race, age or gender. Global leaders have acknowledged this fact and HIV/Aids has become a top priority. The United Nations Millennium Development Goals (MDGs) are aimed at creating a healthier planet by the year 2015. With only five years to go, global leaders are racing against the clock. Child mortality, maternal health, malaria and HIV/Aids are among the main concerns of the UN. A summit to be held in New York in September will reveal and evaluate the progress that has been made to date. In South Africa, Minister of Health Aaron Motsoaledi has continuously stressed the level of difficulty that women and children have to endure with the rising deterioration of health in many poverty-stricken areas. “HIV and Aids, TB and malaria do affect women and children more than any sector and are wreaking havoc on the lives of our mothers and children. We are actually refocusing all our departmental programmes to be centred around the Maternal, Child and Women’s Health Unit,” he said. The minister further emphasised that the health of mothers and children directly affects the future and development of the nation. The reality of the matter is that women are more likely than men to become infected with HIV through unprotected intercourse. In many countries, women are unable to negotiate condom use and are more likely to be subjected to non-consensual sex. In certain societies, women have few rights within sexual relationships and the family. Often, men make the majority of decisions, such as whom they will marry and whether they will have more than one sexual partner. This power imbalance makes it more difficult for women to protect themselves from becoming infected with HIV. For example, a woman may not be able to insist on the use of a condom if her husband is the one who makes the decisions. Even though many South African hospitals have had bad publicity due to the high rates of maternal and infant mortality, Motsoaledi says that an estimated 46% of these deaths are due to HIV/Aids. The number of stillbirths and deaths in infants under the age of one has exceeded the 20 000 mark, a major cause of concern. “The number who die before they reach five years has reached 75 000 and [in] 43% of these deaths, the contributing factor is HIV and Aids; and we believe we should not only try to decrease the issue of mother-to-child transmission, but we should try to eradicate it altogether. This should be achievable in the next five years,” says the Health minister. More than half of new HIV infections in Africa occur in women and girls, and more needs to be done to alleviate the burden of the epidemic. This includes promoting and protecting women’s human rights, increasing education and awareness among women, and encouraging the development of new preventative technologies such as post-exposure prophylaxis and microbicides. New hope South Africa has made major strides in its pursuit to prevent HIV infection, the most recent being the development of a microbicidal vaginal gel that can reduce sexually transmitted HIV infection by as much as 54%. A two-and-a-half-year study of 889 women by the Durban-based Centre for the AIDS Programme of Research in South Africa (Caprisa) found that a vaginal gel containing the antiretroviral drug tenofovir was 39% effective in reducing a woman’s HIV risk when used for about three-quarters of sex acts. It was 54% effective when used more consistently, and also halved the incidence of genital herpes infections. “Tenofovir gel could fill an important HIV prevention gap by empowering women who are unable to successfully negotiate mutual faithfulness or condom use with their male partners,” said Quarraisha Abdool Karim, one of the lead investigators of the study and associate director of Caprisa. “This new technology has the potential to alter the course of the HIV epidemic, especially in southern Africa where young women bear the brunt of this devastating disease,” she added. Funded by the South African and United States governments, the Caprisa trial involved 889 HIV-negative, sexually active South African women who were considered to be at high risk of HIV infection. Half of the women were given vaginal applicators containing a 1% concentration of tenofovir gel, while the other half were given a placebo gel. The women were asked to insert a dose of the gel 12 hours before sexual intercourse and a second dose within 12 hours after intercourse. Over the course of the study, 98 women became HIV positive – 38 in the tenofovir gel group compared to 60 in the placebo gel group. On average, adherence to the gel was over 70%, but among women who used the tenofovir gel for more than 80% of sex acts, the gel provided greater protection from HIV. “We believe that the most responsible plan of action now is to quickly and efficiently articulate the sequence of steps necessary for confirmation and follow-up of these results, while also aggressively planning for potential rollout of a licensable product,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, in a statement. “As exciting as this result is – and as important as it is to follow it up without delay – the reality is that this product will not be available for widespread introduction tomorrow,” he added. “It is critical to manage expectations while maintaining urgency.” Educate Evidently, education is one of the most effective tools in preventing HIV infections. An estimate from the Global Campaign for Education suggests that if every child received a complete primary education, around 700 000 new HIV infections in young adults could be prevented every year. Education is particularly important for protecting girls against HIV infection. Gone are the days when discussing sex was taboo. Armed with knowledge, many will be able to make more intelligent decisions. Schools can teach vital HIV prevention methods such as condom use, having fewer sexual partners, abstinence, and the importance of greater communication about HIV prevention between couples. Furthermore, girls who frequently attend school are more likely to make their own decisions about their sexual lives, are more independent, and are more likely to earn a higher income in the future. Executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Professor Michel Kazatchkine, reiterated the pleas by the late child activist Nkosi Johnson and Constitutional Court Judge Edwin Cameron as well as former president Nelson Mandela at the 13th International AIDS Conference, when asked for a better response to HIV/Aids. South Africa has partnered with eight countries in the southern African region to form E8, or Elimination 8. The eight countries have vowed that, at least by 2020, they should have eliminated malaria from the Southern African Development Community. Aids has affected millions of women worldwide. Elizabeth Glaser, Gugu Dlamini and Rebekka Armstrong are a few of the many ladies who have become publicly known for their personal stories in the fight against HIV/Aids. Elizabeth Glaser In 1981, Glaser became infected with HIV through a blood transfusion while giving birth to her daughter, Ariel. At a time when little was known about the virus, Glaser unknowingly passed it on to Ariel through breast-feeding, and later to her son Jake during pregnancy. When Elizabeth and her husband – actor and director Paul Michael Glaser – tried to get treatment for Ariel, they found out that the only drugs available were for adults. Ariel died as a result of Aids in 1988. Glaser decided to help other children with HIV and, with two friends, established the Pediatric Aids Foundation. The Foundation has helped to raise money for basic Aids research and has been dedicated in supporting prevention and treatment programmes. In 1994 Elizabeth passed away from Aids-related illnesses and the foundation was renamed the Elizabeth Glaser Pediatric Aids Foundation. Today, it continues its influential work around the world. Gugu Dlamini Born in 1962, Dlamini lived in a town in eastern KwaZulu-Natal. She was a volunteer field worker for the National Association of People Living with HIV and Aids. On World Aids Day in 1998, Dlamini revealed on radio and television that she was HIV positive. It was a brave attempt to help reduce the stigma and discrimination with which HIV-positive people are faced. A few weeks later, Dlamini’s neighbours beat her to death. They had accused her of “shaming” their community by revealing her HIV status. The attack highlighted the extent of the stigmatisation and rejection of HIV-positive people, and caused outrage across the world. Rebekka Armstrong Armstrong grew up in a town three hours north of Los Angeles in the United States. At the age of 18, she moved to LA and got a job modelling swimwear and lingerie. In 1986 she was Playboy’s Miss September. At 22, after suffering from extreme tiredness, Armstrong underwent a routine health check, which included an HIV test. Much to her surprise, it came back positive. Armstrong is still not 100% certain how she became infected, but suspects it was a result of unprotected sex at the age of 16 or a blood transfusion. She was able to keep her HIV status secret for five years. After a suicide attempt, she went to a seminar for HIV-positive women, which changed her life. In 1994, she announced in an American lesbian and gay magazine that she was living with HIV. Since then, Armstrong has dedicated herself to increasing Aids awareness. She has toured throughout America, educating about HIV prevention and safer sex, and the reality of living with HIV/Aids. Fikiswa Majikela