HIV, Women and Sex Work

The prevalence of HIV/AIDS in Pakistan is still low compared to rates in Sub-Saharan Africa and other countries throughout the world.  But there is also a great deal of denial from government officials and the public about this disease so the numbers may be higher than we think.  For example, in 2002 the official estimate of HIV/AIDS in Pakistan was about 2000 whereas World Health Organization rates were between 80,000 and 100,000 across the country.  The key to preventing Pakistan from becoming like South Africa is to put in the effort and resources at this critical juncture to educate and therefore prevent the further spread of infection.  Pakistan must utilize proven prevention and education methods in order to save lives even if these make us culturally uncomfortable.

Underlying causes

HIV/AIDS is a complicated issue with many underlying causes.  It’s not as simple as being promiscuous, being a drug user, or being gay.  In the majority of the world poverty is directly correlated with your chances of contracting and dying from the disease. Poverty here refers to two things: insufficient income to satisfy basic food and essential non-food needs; and human poverty, fundamental stumbling blocks such as illiteracy, malnutrition, poor maternal health and illness from preventable diseases. Both of the above contribute to a context that makes one more susceptible to transmitting HIV.  Living in extreme poverty can lead people to engage in risky behaviour such as joining the sex industry, undertaking long distance labour migration and entering into substance use.  While in some contexts, high risk behaviours and poverty are not so clearly correlated, research suggests that countries with the highest income inequalities are the hardest hit.

Disempowerment: feminization of HIV/AIDS

Unfortunately HIV/AIDS disproportionately affects women.  In most societies women are given less importance in regards to receiving healthcare and education. They are also more likely to be victims of sexual violence. Regrettably also women are also more likely to contract HIV based on their biological makeup: the female genital tract has a greater exposed surface area than the male genital tract; therefore, women are biologically at greater risk of infection.  The male-to-female transmission rate is about twice that of the female-to-male rate. Currently more women are becoming infected than men. Globally, nearly 50% of people living with HIV are female.  In 1992, 42% of those infected were female.

The main method of prevention that is being used and encouraged by those with money is the ABC method.  Abstinence, Be faithful, and use Condoms.  However, the ABC method is not relevant for females. Abstinence is moot in the face of coercion and rape, etc., faithfulness will not prevent transmission if the woman’s partner is not faithful, and condoms require the consent of the man.

High-risk group

There are many high-risk groups that are more susceptible to HIV.  Migrant workers that travel away from there families for work, injecting drug users, men that have sex with men, and sex workers.  Sex workers are adult women and men, children, young people, and transgendered people that exchange money or goods for sexual services, including intercourse, either regularly or occasionally.  In several regions, significantly higher rates of sexually transmitted infections and HIV infection are found among sex workers and their clients than in other groups.  It generally spreads among sex workers and their clients before it spreads to the general population to their spouses, families, extended sexual networks and then the population at large.  Sex work can be either voluntary or involuntary.  While some people work in the industry out of choice, it is more typically the only means to escape poverty, or is forced upon individuals as part of human trafficking.  Sex workers frequently have little control over their working conditions and their capacity to negotiate condom use.

It is estimated that there are tens of millions of sex workers worldwide.  Their clients number in the hundreds of millions.  However, little is known about sex work in pre-dominantly Muslim countries.  The few statistics we have are worrying.  In Tamanrasset, Algeria, sex workers have an HIV prevalence rate of 10%.  In Karachi, Pakistan, more than one quarter of sex workers had never heard of AIDS.  Three quarters do not know that condoms prevent HIV, and only 2% use condoms with all their clients.  In Jakarta, Indonesia, one in five drug injectors buys sex, which doubles the chances of contracting HIV.  In the Eastern Mediterranean, only 0.5% of sex workers are protected by any sort of HIV protection program.

In November 2007, Islamic Relief Worldwide held a unique international consortium in Johannesburg, South Africa.  We invited scholars, practitioners, and people living with HIV/AIDS with the purpose of informing scholars of what HIV really is, the practicalities of how it is transmitted, how poverty plays a role, how women’s rights play a role, and the difficulties in living with it.  The consultations were a success, with representatives from over 50 countries participating in ground-breaking initiatives and steps decided on to help the Muslim world face this problem. Consultation discussions included talks on the stigma and discrimination; rights and obligations; gender dimensions; awareness and prevention; protection, treatment, care and support; and particularly vulnerable groups.

Although Islamic and cultural guidelines do not allow for the behaviours that can lead to contracting the disease, we do not live in a world that is that simple.  There are many factors such as poverty that we need to realize do affect situations and contexts.  And as you can see women bear the brunt of many of life’s disproportionate challenges and therefore are more likely to contract and suffer from HIV and other diseases.  We as a community need to acknowledge these facts and do our part to bring awareness, education, and much-needed funds to face this challenge head-on before Pakistan becomes another South Africa.

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