Two factors in the Asia Pacific region look more overwhelming than
ever before: the rapidly rising rate of HIV infection and the
increasing feminisation of the epidemic.

With 8.2 million people infected, Asia Pacific has more people
living with HIV/AIDS than any other region in the world except Sub
Saharan Africa. More than half a million people died due to AIDS-
related illnesses in 2004 and twice as many people were newly
infected during the same period - a disturbing epidemic momentum,
particularly in view of the fact that until the late 1980s no
country in the region had a major HIV epidemic.

What causes graver concern is the uneven rise of infection among
women. About one third of people living with HIV/AIDS in the region
now are women compared to about 20 per cent a decade ago. In fact,
the number of women living with HIV grew by 13 per cent between 2001
and 2003.

Women and HIV: the multiple jeopardy

Surveillance systems tell us how the epidemic is spreading. But what
they often fail to tell us is that the spread of HIV is closely
linked to relationships and power dynamics between individuals and
within communities that are grossly unfavourable to women. The low
economic and social status of women; the endemic abuse and violence
against them; lack of recourse measures, and limited legal and
social protection increase their vulnerability to HIV. For many
women in the region, sexual intercourse is not a question of choice,
but rather a question of survival and duty. A woman's fertility and
her relationship to her husband is often the source of her social
identity. As the UN Secretary General, Mr. Kofi Annan says, social
inequalities put them at risk - unjust, unconscionable and
untenable.

Dominant social constructs in the region dictate that a married
woman has little or no power to negotiate the nature of her sexual
relationship with her husband. We also know that increased income
alone does not lead to empowerment and autonomy of women in the
absence of legal, ethical and social environment that will allow
them to gain better control of their lives.

More than half the new infections in the world are among people of
15-24 years of age. Among them, women face the highest risk. In
addition, younger girls are increasingly being forced into sexual
relations and prostitution in an attempt by men to avoid infection
and also from a mistaken belief that intercourse with a virgin can
cure them of the virus.

Another strong determinant in women's vulnerability to HIV in Asia
Pacific is the oppressive violence against them, which range from
homes to workplaces. Violence and HIV are mutually reinforcing, both
directly through rape and sexual coercion, but also indirectly by
predisposing women to risky behaviour later in life. There is also
growing evidence that HIV can be a precursor to violence as women
face retribution for disclosing their HIV status.

In Asia Pacific, the vulnerability of women also arises from unsafe
mobility and trafficking. In several parts of the region, women are
compelled to move within their countries and across national borders
in unsafe conditions and without adequate preparedness. Such
situations in many cases, lead to their being trafficked. Studies on
trafficking and HIV linkages show that one out of three trafficked
survivors are HIV positive.

What is apparent, but unseen, is that unless the interaction between
HIV infection, cultural values and the rights and needs of women are
recognised, the fundamental changes required to stem the epidemic
will be unattainable. Where women are denied dignity and respect,
HIV/AIDS spreads.

HIV and the Human Development Linkages

One of Asia's major challenges in containing the epidemic is also
that a large part of its population live on the margins of society
and their vulnerabilities are not recognised: mobile workers and
their families, rural families clustered in urban slums, sex
workers, men having sex with men, injecting drug users and women and
children living and working under hazardous or exploitative
conditions.

HIV is not random in its spread and impact. Bulk of the epidemic
burden is on the poor, the marginalised (sex workers, injecting drug
users, men having sex with men, migrant labourers and their families
and trafficked persons), the youth and women. This is because social
inequalities facilitate the spread of the virus and the virus in
turn reflects and reinforces these inequalities.

The learning from the last two decades show that HIV is not just
a "disease", but a manifestation of poor human development and deep-
rooted socio-economic and cultural factors that we have failed to
address over the years. There are many more disconcerting factors
that call for urgent responses. Key among them are the intense
stigma and discrimination and violation of rights faced by people
living with HIV/AIDS, lack of access to treatment, inadequate
leadership, lack of integrated responses and shortage of resources.

For instance a study by the Asia Pacific Network for People Living
with HIV/AIDS (APN+) showed that 80 per cent of the respondents have
experienced discriminatory practices. The rights violations have
been from moderate to repressive: from denial of treatment and
eviction from jobs to fatal assaults. On the treatment front, as the
latest UNAIDS report shows, fewer than 6 per cent of people who
require antiretroviral treatment are receiving it.

On the resource front, a recent ADB study says that in 2001, the
countries in the region required more than US $ 1.5 billion to
finance a comprehensive response, but had only 200 million. From
2007, as much as US $ 5.1 billion will be required each year. The
brighter side of the coin, however, is the fact that it is only 0.2
per cent of the regional gross income.

HIV/AIDS is indeed a daunting challenge, but it also offers
opportunities. (There are success stories such as Thailand,
Cambodia, Uganda and Brazil.) It is not the first epidemic in human
history. Neither will it be the last. What sustains such epidemics
is poor human development. Needless to say, the answer is good human
development practice.

The Millennium Development Goals (MDGs), that have become a
framework for development practice, recognises the impact of HIV on
human development by listing reversal of the epidemic as a key goal.
There is absolute consensus among sociologists, economists and
development practitioners that without achieving the MDG on HIV,
attainment of all the other MDG is in jeopardy.

That definitely does not augur well for global humanity and we are
left with only one choice: the choice of multi-sectoral action that
respects the rights of women, marginalised communities and HIV
positive people.


By Sonam Yangchen Rana

The author is a senior UNDP official and heads the UNDP Regional HIV
and Development Programme in Asia Pacific.

To access the column online please click on the link
http://www.youandaids.org/Guest Column/SYR/index.asp