India: 90 percent of female HIV infections occur within marriage

[Guest guest]

A Worldwide Gender Gap

By Kati Marton, Newsweek

May 10 issue - Women suffer countless disadvantages compared with

men. Even after decades of progress, we make up two thirds of the

world's 880 million illiterate adults, and up to 70 percent of its

poorest citizens. But health remains the cruelest of all

inequalities. Women receive inadequate medical care in many

societies, and they don't suffer the consequences alone. Healthy

women are the foundation of healthy families, which foster healthy,

prosperous societies. Experience shows that even small investments in

women's health can pay large social dividends. Unfortunately, few of

those who could make those investments are doing it.

The gender gap in health is especially dramatic in the HIV/AIDS

epidemic. In sub-Saharan Africa, 60 percent of people with AIDS are

women. " It is a shocking fact, " U.N. Secretary-General Kofi n

said recently, " and one of which I, as an African man, feel ashamed. "

Polygamy, sexual coercion and violence against women all contribute

to this distressing fact. Girls are frequently pressured into sex

with older men in exchange for food, clothing or school tuition.

Abstinence and monogamy make for fine rhetoric, but they are

inadequate defenses for women who are married off young and deprived

of education and social status. In Zambia only 11 percent of women in

a recent survey thought a woman had the right to ask her husband to

use a condom—even though women are twice as likely as men to contract

HIV from a single sex act. In India, where 90 percent of female

infections occur within marriage, women who stand up to their

husbands risk violence—and those who get infected by their husbands

are often shunned by their families. Lacking other skills, they may

survive by selling sex—which, of course, spreads the disease further.

Any real solution to the AIDS pandemic will have to empower women

through education and a guarantee of human and reproductive rights.

AIDS is not the only threat women face. Consider the current state of

reproductive health. An estimated 350 million couples want safe and

effective contraception but are unable to get it. The result:

approximately 80 million unintended pregnancies each year, some 19

million of which are terminated under unsafe conditions. Those unsafe

abortions cause 13 percent of the 529,000 deaths that women suffer

annually during pregnancy and childbirth. Wealthy nations could

prevent this tragedy for a fraction of what they spend on the

military. Yet the neglect continues. Since 2002 the United States has

withheld its annual $34 million contribution to the United Nations

Population Fund, the world's largest provider of family-planning

services.

When women lack reproductive-health services, they also miss

opportunities to prevent and treat such killers as malaria and

tuberculosis. Young children and pregnant women account for most of

the world's 1 million annual malaria deaths, 90 percent of which

occur in Africa. And as HIV destroys their immune systems, women

become ever more vulnerable to tuberculosis. TB now causes half of

the AIDS-related deaths in Africa. This highly contagious disease can

be cured with a $10 regimen of antibiotics, yet U.S. support for

international treatment efforts is declining.

Disease isn't the only risk. Every year some 2 million girls and

young women worldwide are subjected to genital mutilation, a barbaric

practice that can cause infertility and long-term ill health. And far

more experience rape, battering and sexual coercion. Almost half of

all girls from 10 to 25 say their first sexual encounter was forced,

and the United Nations estimates that one in three girls will fall

victim to violence in her lifetime.

Last year, during a trip to India, I met with a group of adolescent

girls in the slums of New Delhi. Some were as young as 12. Most of

their friends were already married—their futures foreordained and

severely circumscribed. But the girls I met still had their hopes and

dreams. The question is whether they will be able to protect

themselves in a world where the balance still tilts heavily against

them. The answer will be decided not only in the slums of South Asia

but in the capitals of the wealthiest nations. Leadership must come

from the top—starting with Washington—or this injustice will never

end.

Marton, author of " Hidden Power: Presidential Marriages That Shaped

Our Recent History " (Anchor Books), is chair of the International

Women's Health Coalition. © 2004 Newsweek, Inc.

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