Worldwide, increasing numbers of adolescent girls and women, who are biologically more susceptible to HIV than males, are becoming infected with HIV and they are becoming infected at younger ages than men. Many are reporting having had only one lifetime sexual partner or only having sex with their current partner. Thus, despite the tendency in many countries to label women as “vectors” of HIV and to blame them for its spread, women around the world are increasingly being infected by their husbands or regular partners who themselves are engaging in unsafe behaviours, such as unprotected casual sex with multiple partners, with commercial sex workers or with other men, and who engage in unsafe drug-injecting practices.
Prevention strategies that promote male condom use, mutual fidelity and non-penetrative sex may be irrelevant to many women at risk for HIV infection. Women may fear the consequences of insisting on condom use, such as physical or sexual abuse, loss of income or a place to live, disruption of the relationship, and loss of esteem and respect. Many women are denied the right to refuse sex, or they live in a social, economic and cultural context which undermines their ability to negotiate safe sex and which sanctions male but not female infidelity.
Although there has been a greater focus on the vulnerability of women to HIV/AIDS and its underlying causes in recent years, little information has been gathered on approaches that specifically aim to address the special needs of women. In response to this gap in knowledge, GPA convened a meeting to draw from experiences in the HIV/STD field, as well as from other, well-established, fields such as family planning, maternal and child health and income-generation. The overall objective of this meeting was to document and promote interventions that directly or indirectly increase women’s ability to protect themselves from HIV.
The meeting was organized around four themes (see Agenda, Appendix 1):
• Effective approaches to HIV/AIDS prevention in women: promoting safer sexual behaviour
For each theme, reports of three or four interventions were presented and discussed. Overall and theme conclusions were drawn. The interventions had been selected to represent efforts among different communities. Many of the described activities could easily belong under more than one theme, but were placed to emphasize certain principles. Some had a strong research component for comparing different approaches, or assessing the effectiveness of a particular intervention, while others focused on achieving high coverage. Similarly, some interventions aim to promote safe sexual behaviours among individuals who are not yet at risk or to encourage behaviour change among those who are, while others attempt to influence the environment in which high-risk behaviours take place.
The meeting was attended by 13 participants who described the projects with which they were involved and by other participants from governmental and nongovernmental organizations (see List of participants, Appendix 2). Dr Sheila Tlou served as Chairwoman and Dr David Wilson as overall rapporteur. One additional rapporteur was selected for each theme area.
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