Asia Women's Next Obstacle: AIDS

by Vishakha N. Desai

Originally published in Newsday, December 1, 2004

The new epicenter of the global AIDS pandemic is Asia, and its new faces are Asia's young girls and women. This was highlighted by a recent United Nations report on HIV/AIDS and the theme of World AIDS Day 2004, which is today, "Women, Girls, HIV and AIDS."

But while the feminization of AIDS in Asia is crucial for the world to recognize, it has long been understood in Asia by activists on the ground, families, health care practitioners and family planning organizations who witness it first hand. They know that the ravages of HIV are only one more terrible impediment among many others to valuing the basic rights and contributions of women in many Asian societies. In the words of an old Indian folksong, "The lives of women without children are like oxen milked out, like a plant leaf discarded after the meal." Yet in Asia today, having a husband is itself a risk factor for HIV.

Here are some of the grim facts: In East Asia, the number of women infected by the disease is up 56 percent over the past two years. Women are more vulnerable than men to HIV infection. In China, selling of blood by poor farmers for plasma collection has led to widespread infection among them, their wives and children. Young girls from Burma, Cambodia and Nepal caught in the growing sex trade are inevitably exposed to infection.

The burden of HIV/AIDS on women is a vicious cycle: They are the primary caretakers for infected family members who get progressively sicker, leaving them little time to earn income. If they become infected themselves, they typically defer their own treatment until the disease reaches an advanced stage. As adults become unable to care for themselves or their families, girls are often the first to be pulled from school to help or forced into prostitution to bring in money.

Current preventive strategies offer few real options for women to take charge of their sexual health. The now famous ABC campaign (Abstain, Be faithful, use a Condom) cannot help women who do not control their own sexual lives. Abstinence is often not an option, faithfulness is no guarantee their partners won't infect them, and stigma discourages women from discussing prevention options or enforcing condom usage with their husbands.

This fight must be fought on many fronts, but it must begin with broader engagement of women; concurrently, public education on all aspects of the disease needs to be stepped up.

Already Asian popular culture has begun to reflect this, and popular arts can reach at-risk women and girls effectively, especially in regions of low literacy. A recent Bollywood film in India, "Phir Milenge (See You Again)," a positive human story with famous movie stars, tries to shatter the myths relating to HIV, similar to the Tom Hanks movie "Philadelphia" more than a decade ago.

In Vietnam, the Hanoi Reproductive Health Theater Troupe uses drama and comedy to address HIV/AIDS. In bustling urban centers such as Beijing and devastated rural provinces like Henan, people living with AIDS use visual arts for therapy and for raising public awareness. Among minority communities in China, a rich repertoire of song and music is emerging, which takes up taboo subjects such as drug use and sex work.

Such examples show how the epidemic needs to be attacked culturally, breaking silence, telling the truth, recasting old roles. For many Asian girls and women, stereotypes, stigma and discrimination, underlying poverty, and low economic and social status form a tragic nexus with HIV infection. The epidemic cannot be stemmed until the culture speaks about and to them, until it values them as worthy of protection and care in their own right, until their voices are heard, and their interests are at the heart of health policy debates.

This is a tall order, perhaps, but failure is not an option. India and China, the world's most populous nations, are in ascendancy. The world increasingly looks to the Asia-Pacific region as a rising economic and political power.

But that future depends in no small measure on Asia confronting its feminized AIDS epidemic and quickly building a new culture, which revalues its girls and women, before scores of millions are infected. Fail, and regional and perhaps global stability are at risk.

Vishakha N. Desai is president of the Asia Society.