The smiling face of R. Meenakshi, the 27-year-old woman who is HIV positive but who has decided to go public about it, tells a story of astonishing courage. But behind it is another tale, one that is sometimes overlooked. This is the story of the inextricable link between violence, skewed gender relations and the spread of HIV/AIDS.

Many people, including this writer, have argued in the past that HIV/AIDS is not the most important disease in India. People are afflicted by innumerable other diseases like malaria and TB — "diseases of the past" as Prime Minister Manmohan Singh recently called them. They die because timely medical intervention is not available. Most of those who cannot survive these ailments are the poor living in rural areas where the public health infrastructure is scandalously inefficient even where it exists. As a result, thousands of children die from an affliction as ordinary as diarrhoea, women die while giving birth and an increasing number of people, especially the very young and the old, die from respiratory diseases that are aggravated by the increasing levels of pollution in our cities. All these deaths are avoidable. Yet they fail to excite sustained attention or outrage. On the other hand, HIV/AIDS has received funds and attention out all proportion to the numbers afflicted by it in India. As a result, there has been much scepticism and questions raised about the thrust of the campaigns to curb the spread of this disease.

However, recent statistics about the growing number of women afflicted by HIV/AIDS around the world, and in India, are forcing even the sceptics to pause. They throw light on a different dimension of this disease — the link between inequitable gender relations and the spread of HIV. This sets it apart from other communicable diseases.

Gender and HIV

Of the 39 million cases of HIV/AIDS worldwide, 23 million are in sub-Saharan Africa. Of these 57 per cent are women. It is this "feminisation" of the epidemic that is raising concerns everywhere. In India, of the estimated five million cases of HIV/AIDS, around 20 lakhs are women. Many of them are wives of men who are HIV positive but who did not bother to take any precautions. As a result, not only are their wives infected but also children born after the man had become infected.

In the majority of cases, the woman would not have even known about the possibility of contracting the diseases through sexual relations with her husband. Even if she knew, and was aware of the precautions that ought to be taken, she would not have been in a position to insist. Thus, her subordinate position as a woman and as a wife have ensured that she is infected with a virus that is equivalent to a slow and painful death. Add to this the reality of women's health status where they are socialised to hide their ailments and not get them treated in time. In the case of HIV this can prove fatal as timely intervention can prolong life and stem the spread of the virus. Again, most women would not even know of this possibility. And finally the stigma attached to contracting HIV/AIDS is guaranteed to keep women out of the range of any treatment that could make a difference.

If a woman who has been infected by her husband passes on the virus to her child, she is stigmatised and blamed. And if the infant happens to be a boy, then the woman is considered even more of a villain.
A recent United Nations report by the Special Rapporteur on Violence Against Women, quotes a man in Zambia blatantly explaining how, even if he had given the virus to his wife because of unprotected sex, he would find a way to blame the wife. He said, "I might transmit the disease to my wife then tell my wife to go for an AIDS check-up. If she is found positive, I blame it on her and tell the whole community that she has infected me." Replace Zambian with any other nationality and you get a picture of what is happening in many of our countries.

Here in India there is an added twist to the problem. If a woman, who has been infected by her husband, passes on the virus to her child, she is stigmatised and blamed. And if the infant happens to be a boy, then the woman is considered even more of a villain. The responsibility of the man in all this is completely overlooked.

The new face of AIDS

Another aspect that needs to be documented more thoroughly is the fallout of HIV/AIDS as seen in the increasing violence against women, and particularly girls. In many societies, there is a belief that if the infected male has sex with a virgin, he will be cured. Every day we read reports of girls as young as three years old being raped by men. There may be a connection and even if it is difficult to establish, it ought to be investigated. The Special Rapporteur mentions an alarming trend when she reports, "Young women are fast becoming the new face of the HIV/AIDS epidemic. Worldwide, adolescents and young women are more than three times more likely to be living with HIV/AIDS than young men."

Equitable gender relations and ensuring that women's rights are respected within marriage and outside it are essential ingredients of a just society. The spread of HIV/AIDS, and its "feminisation", suggests that they are also imperative for a healthy society.