Vulnerabilities and opportunities after the Arab spring revolutions5 It is important to have a theoretical framework to
inform our vision of priorities during a time of upheaval. Changing unjust laws is insufficient. Change needs to occur at a deeper, more fundamental level.
Gender is socially constructed so we need to engage with religion and culture to achieve enduring progress.
Laws operate in the exterior, objective world but to achieve change we also need to affect the subjective domains of collective cultural norms and individual values. Norms, values and traditions perpetuate gender power differentials.
For example, homosexuality per se is not criminalized in Egypt but homosexual men are targeted by police statutory laws in determining gender relations. Gender is a power relationship and the way the relationship is
defined is created by society. Advocates need to not only challenge laws, but also the underlying traditions that perpetuate power relationships if we are going to achieve a paradigm shift to protective and empowering laws. Manifestations of patriarchal systems include female genital mutilation (FGM), polygamy and concepts of honor divorce. Women who experience FGM are 300 times more at risk of HIV transmission.
According to social change theorist Otto Scharmer, social problems can be understood by identifying three layers of complexity: dynamic, social and generative. Dynamic complexity involves policies. Social complexity involves values, beliefs and norms. Generative complexity involves understanding disruptive patterns of change, such as we now see in the MENA region. To respond to these levels of complexity we need to approach social change with an open mind (noticing difference), an open heart (empathic listening), and an open will to connect to an emerging new future.
In the context of women’s rights, equality means much more than 50% of decision makers being women. 50% representation is not helpful if representatives do not have a shared understanding of gender and power. Scattered interventions are not enough. We need fundamental changes to complex social norms and structural factors that contribute to gender violence and inequality. This requires change agents who can provide
5 Dr Khadija Moalla, Regional HIV/AIDS Practice Leader, Programme Coordinator for Arab States, UNDP.
“A significant challenge in the
transformational leadership and challenge rigid dogmatic beliefs. With the assistance of evidence and science, women can act as leaders to change the way religion is interpreted.
We have seen examples of this in working with women from Sudan. At first, some women advocated FGM as their tradition, but after deeper examination of the issue they changed their opinion. Instead of learning from the past, the focus was on learning from emerging new futures. This allows a process of ‘presencing’ to occur, which is a process of self-realization.
Revolutions are times of instability and opportunity. It is possible that gender inequalities will be reduced and a new humanity will manifest, but it is also possible that patriarchy may become stronger and fundamentalism may gain more power.
We need a ‘full spectrum response’ addressing immediate and underlying causes, laws, systems, and leadership. Advocacy needs to target religious leaders as the guardians of religious values, and to influence the media. Political change requires challenging reactionary political, religious and media discourse.
Discussion
There are limits to that which can be achieved by raising awareness among religious leaders, which is sometimes not very productive. Religion is informed and defined by religious intellectuals, not just religious leaders.
We need a better evidence base on actions of the judiciary and the police. We cannot realistically achieve legal aid for all people living with HIV and most-at-risk populations.
Research into police and judicial practices can provide a sound basis for our work to achieve systemic change.
The separation of religion and state and the importance of a secular state to enjoyment of human rights are key themes. Tunisia has been a secular country since 1956. Tunisia legalized abortion in 1956, 20 years before France. Sex work is also legal in Tunisia.
In Southern Africa, culture and religion are associated with polygamy and violent opposition to homosexuality. Leaders have been persuaded through training to change their perspectives. Church leaders are now preaching against homophobia in some communities in South Africa.
When advocates work with leaders, it is important to not just provide information, but to change their worldview. In the MENA region, HARPAS has worked with leaders to transform their views by bringing the best of them together. Magistrates and police take power from what they think is the true meaning of religion, so we need to encourage a paradigm shift.
The current emphasis on ‘test and treat’ as the priority approach to both HIV prevention and treatment is troubling. During the UN General Assembly Special Session on HIV/AIDS in June 2011, the Vatican argued that it was unnecessary to talk about sexual and reproductive health because we just need to provide treatment. A narrow focus on testing and treatment ignores the need to address gender inequality and gender-based violence as underlying causes of HIV vulnerability.
Gender does not refer only to men and women, but also to transgender people.
Rights of women and girls: Latin America6
Advocacy on sexual and reproductive health rights in Latin America is difficult because of religious taboos and stigma. Women represent 34% of the total population of people with HIV in Latin America. Heterosexual sex is the main route of infection among women. Young women (15 to 24 years) are most affected. There are increasing cases of HIV among indigenous women.
HIV policies omit the needs of some marginalized populations (e.g. lesbian and bisexual women, and mobile populations). There are no specialized sexual or reproductive health care services for female prisoners.
In addition to biological factors that increase women’s risk of acquiring HIV, gender inequality defines a context of poverty, discrimination, lack of power and violence that makes women more vulnerable. Premature sexual activity is often involuntary, uninformed and unprotected. Sexual violence exposes women and girls to risk, including coerced sex, sexual harassment or rape. Women postpone their own health care due to being assigned the role of caregivers.
Women living with HIV are often victims of sexual assault and domestic violence. Fear of violence limits the ability of women to negotiate safer sexual behavior. Forced sex directly increases the risk of HIV in women. Childhood abuse increases the sexual risks during adolescence and adulthood. Women living with HIV who disclose their diagnosis to their partners are at greater risk of violence.
Despite the existence of protective laws, violence against women persists; the application of the law is inconsistent. Many countries do not criminalize marital rape.
Laws that establish sexual and reproductive health rights for women are controversial and slow developing. Policy makers do not recognize the link between reproductive health rights and HIV. Women living with HIV lack access to reproductive health services, suffer discrimination and violation of confidentiality, and receive little or no information about their sexual and reproductive health rights.
Women living with HIV are often subjected to sterilization and forced abortion.
Legislation and public policies are failing to address the growing feminization of the epidemic and violence against women. There is a lack of protocols for rape cases involving post-exposure prophylaxis for HIV and other STIs and emergency hormonal contraception. There is a lack of public investment in female condoms.
Stigma, discrimination and denial of the sexual life of women who are living with HIV contributes to the violation of the right to decide the number and spacing of children and undermines the health of women. There is a failure to provide counseling on family planning as part of HIV care. Assisted child-birth and adoption as options for women living with HIV are absent in national HIV policies and programs.
6 Ms. Yolanda Guirola, the Norma Virginia Guirola de Herrera Institute of Women’s Studies, El Salvador.
Advocacy on women’s rights is poorly coordinated and there is a lack of consensus on common agendas in the context of HIV. We see a division in the women's movement in relation to advocacy for policies to promote the sexual and reproductive health rights of women. Advocacy needs to address the increased involvement of the church in the definition of public policies related to sexual and reproductive rights of women and comprehensive sex education.
There is a lack of funding for advocacy work on issues of women's rights. Women and HIV need to be more prominent on the agenda of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund).
Actions to reduce women’s vulnerability include:
1. Develop specific prevention campaigns for women to recognize gender inequalities and make visible the vulnerability of women to HIV;
2. Identify gender-based violence as a routine part of prenatal care and post-test counseling for women living with HIV;
3. Provide STI and HIV prevention services to victims of sexual violence;
4. Ensure the integration of HIV services with sexual and reproductive health services;
5. Provide more information about HIV, especially among women whose partners have risky sexual behaviors;
6. Expand HIV testing and counseling services for women of childbearing age;
7. Support programs that prevent sexual and gender-based violence;
8. Provide comprehensive sex education in educational institutions;
9. Ensure adolescents can access guidance and information on sexual and reproductive health services;
10. Ensure empowerment of women and girls is included in HIV policy frameworks.
Rights of women and girls: Southern Africa7
The issues in Southern Africa are similar to those described in Latin America. There is very little work being done on sexual and reproductive health rights.
Property and inheritance rights are a major gender equality issue. There are numerous laws that overtly discriminate against women and girls. For example, in Lesotho only the first-born legitimate son has the right to inherit. Although there are constitutional rights to gender equality, discriminatory laws remain on the statute books. Governments have no political drive to rectify these laws and case-by-case legal challenges are very piecemeal.
Forced sterilization and HIV testing of pregnant women without their consent in public and private hospitals represent widespread violations of women’s rights.
In Botswana, an NGO working in the HIV field stipulated a condition of employment that employees not become pregnant. This indicates the extent to which sex discrimination is entrenched.
As in Latin America, in some countries marital rape is not criminalized.
7 Ms Priti Patel, Southern Africa Litigation Centre.
No country in the region is focusing on the relationship between HIV and cervical cancer, which is preventable and treatable. There is a higher mortality rate for cervical cancer among women living with HIV.
There are no government policies to assist women living with HIV and women in general to access HIV services.
Public health models focus on individuals and their sexual partners. Post-test counseling focuses on ‘how to protect yourself and your partner’ – there is no conversation about how to have children and where you can go for support about reproductive health issues. There is a failure to recognize the social pressure placed on women to have children in African communities. There is little attention given to the right of women to reproductive choices.
Women do not know where to turn for support.
When the International Community of Women Living with HIV/AIDS (ICW) held a meeting with young women living with HIV in Namibia to discuss their rights, some women said that they had been sterilized but they did not understand that to be a violation of their rights.
They had not known that they had been sterilized when it occurred, it was disclosed later when they went back to hospital for a check-up. When told, the women were not surprised they had been sterilized, as they did not understand they had a right to fulfill their reproductive choices even if they were HIV positive. When during the course of the meeting with ICW the women became aware that their rights had been violated by forced sterilization, other rights violations were disclosed.
Lawyers have not yet pushed far enough on constitutional rights to test issues such as women’s right to abortion. Women’s rights groups are poorly coordinated, so duplication of advocacy efforts is an issue. There is very little priority placed on women’s rights and reproductive health issues because there is very little funding for programs addressing these issues.
Sex work is criminalized within the Southern African region. Sex workers are arrested for offences such as loitering and vagrancy. Police can hold sex workers for up to 48 hours and extort money from them. Strategically, the Southern Africa Litigation Centre wants to work with other groups that are targeted by loitering laws. This will allow advocacy to focus on the broader unifying issue of the rights of citizens to protection from police abuses.
Litigation strategy needs to recognize how most-at-risk populations are perceived. A case challenging the compulsory testing of female sex workers has been carefully framed to focus on testing without consent, rather than the fact that the women who were tested are sex workers.
A priority is to better understand the prevalent violations of women’s rights, which requires research and local dialogue to uncover abuses and inform an advocacy strategy. We need to be vigilant to ensure sexual and reproductive health rights are not lost while so much emphasis is given to ARVs. Ensuring women living with HIV obtain access to prevention and treatment services for cervical cancer is an urgent priority.
Discussion: rights of women and girls
Stigma is the underlying cause of discriminatory laws and practices. We should target media and religious leaders to tackle the beliefs that generate stigma and justify discriminatory customary laws e.g. in relation to early marriage and FGM.
For women to call for their rights they must know what their rights are, which requires creating spaces where women can present their own agendas relating to employment rights, family rights, inheritance and housing. In El Salvador, human rights organizations have proposed multidisciplinary laws addressing women’s rights in education, labor, prisons, migration and mobile populations. In El Salvador a clinic offers a holistic package of services including psychological, medical and legal assistance to women living with and affected by HIV.
In the MENA region knowledge production is recognized as important, which means supporting progressive thinkers, including women scholars, who are pioneering religious thinkers. For example, an intellectual moderate was able to challenge FGM.
Religious factors affect policy in all regions. The anti-prostitution pledge introduced by the USA Leadership Law on HIV/AIDS had religious origins. Religious groups also oppose harm reduction laws.
In Central America, customary laws of indigenous communities sometimes go against the interests of women, e.g. women have very limited inheritance rights in traditional communities in Mexico.
Property and inheritance issues are primarily resolved under customary law provisions in Africa. Although we can mount constitutional arguments, we also need to do a lot of work on the ground to change community beliefs and tap into deeper conversations.
In Lebanon, law reform is not realistic in the short term, so we have to focus on the judiciary. It may lead to positive results if research focuses on creating change based on a body of evidence that supports a reinterpretation of the law. We need a multi-disciplinary approach. Insisting on the importance of religious leaders is risky and could lead to negative results if ideology is the point of reference rather than evidence.
In the MENA region, sex workers are difficult to reach because they are highly stigmatized and they have little sense of community. In Egypt, it is more difficult to reach female drug users than male drug users.
HIV can be a useful entry point in arguing for women’s rights e.g. in the MENA region we were able to persuade parliamentarians that unequal age of eligibility to marry contributes to HIV vulnerability. This resulted in a change in the law to equalize the age of eligibility to marry. It is a common experience of Egyptian women to marry at a young age such as 13.
They may hence acquire HIV from their spouse while still very young.
How can we use human rights norms to address customary law and the obstacles of tradition? In Zimbabwe, although the Constitution states that divorce settlements are governed by customary law, the courts have been prepared to intervene based on the concept of overarching rule of tacit universal partnership.
Litigation provides us with tools by which we can bring about social change. Litigation and law reform for sex workers’ rights in Louisiana is based on a social movement. Advocacy groups were able to persuade the churches to support law reform by emphasizing the impact of prosecutions on women’s lives.
Women lack ownership in the concepts of human rights defined by international treaties and national constitutions. If ownership in these concepts is promoted at the community level then women will fight for their rights. The dual system that operates in many countries of customary law and statutory human rights law is unhelpful. Courts are not going to change laws unless there are popular education campaigns on HIV, gender equality and human rights, efforts to train advocates and support for more women to participate in the legal profession. In Zimbabwe, a quota system was established so that more women were admitted into law school. Women’s legal organizations in East and Southern Africa have led to an increased profile of women in the profession including judicial appointments.
In Latin America there has been a movement to introduce sexual and reproductive health law and to consider issues such as same-sex marriage and abortion in universities.
The mainstream women’s movement has been reluctant to engage in the rights of women living with HIV. ICW has documented violations of positive women’s rights and examined legal frameworks and services across a number of countries. The strategy has been to bring women together to build regional momentum to address these issues.
In the USA there has been a campaign for resource allocation arguing if 30% of the epidemic burden is borne by women then 30% of resources should go to women.
Key issues that can be highlighted and addressed through networks include assisted reproduction, forced sterilization and violence against women. In Brazil, we need to form alliances with the mainstream women’s movement, e.g., in support of the historic Maria da Pena Law on violence against women. Sterilization is the only sexual and reproductive health service being provided to HIV-positive women in Peru.
Women are sometimes provided financial incentives to participate in clinical trials that are ethically questionable.
Women are sometimes provided financial incentives to participate in clinical trials that are ethically questionable.