Peace Review 16:1, March (2004), 79–83

Globalization, Women and the HIV/AIDS Epidemic Geeta Rao Gupta

Globalization is to the world what marriage used to be for most women—inevitable and transformative, for better or for worse. And like marriage, because of the societal construction of gender, globalization affects women differently than men. In the developing world, women’s vulnerability to HIV/AIDS illustrates the consequences of globalization and why we need a more ethical and rights-based approach to the epidemic if we are to contain its spread and mitigate its impact on women and girls.

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ntire forests have been demolished to accommodate the voluminous writings on globalization. Here, suffice it to say that globalization is a rapid accelerating process of change that is transforming the ways individuals, social groups and political states interact with one another. It is a process that cannot be stopped; instead, we must learn how to harness its strengths and limit its risks. It is characterized by the free flow of ideas, knowledge, people and capital across national boundaries, accompanied by rapid innovation in technology. As many have noted, globalization has forced us to redefine the role of the nation state, threatened local cultural identities, and shrunk the world into a global village. It has also forced us, like never before, to confront the rapid spread of infectious diseases, particularly HIV/AIDS, across national boundaries. Today half of all those infected with HIV are women, and young women between the ages of 15 and 24 bear the brunt of the epidemic. The infection is growing at the fastest rate among this age group, and the numbers are overwhelming. In Sub-Saharan Africa, where 58 percent of those infected are women, the epidemic has left 13.4 million orphans. An estimated 6 to 10 percent of young women are living with HIV/AIDS, compared to 3 to 6 percent of young men. National HIV prevalence rates are staggeringly high, particularly in Southern Africa: 38 percent in Botswana and 33 percent in Zimbabwe and Swaziland. And the worst news—the news that gives me a sinking feeling in the pit of my stomach—is that prevalence rates have not yet peaked in Africa and are rising steadily higher in other epicenters of the epidemic such as the Caribbean, India, Russia and Eastern Europe. Women and girls bear a disproportionate share of the burden of this disease because they are vulnerable in many ways. Young girls are physically vulnerable. The infection is passed more efficiently from an infected man to a woman than from a woman to a man. Women face difficulties for a wide range of sociocul-

ISSN 1040-2659 print; ISSN 1469-9982 online/04/010079-05  2004 Taylor & Francis Ltd DOI: 10.1080/1040265042000210201

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tural and economic reasons in assessing information and services to protect them from infection or to help them care for themselves once infected. Many married, monogamous women find themselves infected with HIV even when they themselves have not engaged in risky behavior. And, as governments watch and wax eloquently about the wonders of home-based care, women assume the extraordinary burden of caring for the sick, infected and dying at great cost to themselves. We now know, through research conducted over the past decade, that the inequitable way that societies construct the roles and responsibilities of women and men—what women can or cannot do as compared with men—greatly affects the way that women can protect themselves from infection, cope with illness once infected or care for those who are infected. In short, we know that gender inequality plays a key role in increasing women’s vulnerability and is the root from which this epidemic grows. I focus here on just two aspects of that inequality: access to economic resources and assets, and gender norms of sexuality. In each case, it’s important to describe the role that that factor plays in increasing women’s vulnerability to the epidemic and the ways that globalization has influenced that effect, for better or for worse. Through many years of research on women’s roles in development, we know that policies based on gender norms greatly restrict women’s access to productive resources—such as land, income, education and credit. This economic power imbalance produces a vulnerability and dependency that make it more likely that a woman will sell or exchange sex for money, goods or favors. It makes it less likely that she will be able to negotiate safer sex with her partners, less likely that she will leave a relationship she perceives to be risky, less likely that she will be able to cope once infected and, finally, less likely that she will be able to care for loved ones who are infected without great cost to herself and her family members.

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o doubt globalization—with its characteristic liberalizing of trade and finance to promote the free flow of goods and capital—has greatly increased women’s access to income and employment. No country has successfully liberalized its exports without recourse to women workers. For example, in 1978 Bangladesh had only four garment factories. In 1995 it had 2,400 such factories employing 1.2 million workers, 90 percent of whom were women under the age of 25. Despite these employment gains, the vast majority of women still work in low-paying, seasonal and insecure jobs in the informal and semi-formal sectors of the labor market. The feminization of employment has been accompanied by a transformation of the conditions of paid work, such that more jobs are casual, irregular, flexible and precarious—characteristics traditionally more typical of “women’s work” than “men’s work.” Many multinational corporations have failed to meet the standards for basic ethical and humane conditions of work because, as competition increases, incentives to exploit workers also increase. Until recently there were very few mechanisms to hold such organizations accountable, although this is rapidly changing due to pressures from civil society groups. In addition, traditional industries where women tend to predominate are often those most negatively affected by the import of cheaper goods and services. In India, for example, employment losses from trade liberalization were concentrated in the traditional

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textile industry, a large employer of women. The effects on women workers in this sector include reduced income, increased unpaid work, and a shift to informal and insecure economic activities. The evidence suggests that, despite liberalization, the gender wage gap has persisted and in some countries apparently widened. Vertical occupational segregation has also persisted, with women remaining for the most part concentrated at the bottom of the job hierarchy, even though horizontal segregation (the distribution of women and men across occupations) has fallen. The impact of this dynamic on the AIDS epidemic is complex but strong. The precariousness of women’s employment and the income insecurity they continue to face in this era of globalization greatly decrease a woman’s leverage, for example in negotiating the use of condoms with male partners or in discussing her partner’s fidelity. It also makes it more likely she will seek to augment her income by selling sex in unsafe ways, which pays as much as five times more than most menial, daily-wage jobs, thus greatly increasing her risk of infection. For a young woman who gains access to the new employment opportunities created by trade liberalization, the increased income and, more importantly, the self-confidence and sense of accomplishment that it buys create conditions that could increase her ability to negotiate the terms of a sexual interaction. It also delays the age of marriage, which some describe as the biggest risk factor for HIV for women because the possibility of negotiating the use of protection is so much more difficult within marriage than it is in casual sexual relationship. But this all presumes that the extra income and exposure to a wider world increase a women’s access to health information and services. Without that, it is likely that the increased employment opportunities will have little or no effect in reducing women’s vulnerability. In fact, the evidence suggests that when young women move away from their rural homes to seek employment in factories in urban centers, the loss of the social support afforded by the family and community becomes yet another factor enhancing their vulnerability to infection. The possibility of sexual exploitation in places of work and the risk of seeking solace from hard labor through multiple sexual partnerships are also realities that underscore the need for women workers to have access to information and services for HIV/AIDS and reproductive health.

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ike access to economic resources and assets, gender norms of sexuality also affect women’s vulnerability to HIV/AIDS and are in turn affected by globalization. The unequal power balance favoring men in the economic sphere translates into an unequal power balance in heterosexual interactions, in which male pleasure supersedes female pleasure and men often have greater control over when, how, where and with whom sex takes place. In many societies and communities, societal norms often dictate that “good” women must be ignorant about sex and passive in sexual interactions, making it difficult for them to be proactive in negotiating safer sex options. Conversely, men are put at risk by prevailing norms of masculinity that expect them to be all knowing about sex. Such norms prevent young men in particular from seeking information, and coerce them into experimenting with sex in unsafe ways to prove their manhood. Research has also shown that in parts of the developing world a strong norm of

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virginity for unmarried girls can paradoxically increase young women’s risk of infection, because they hesitate to ask for information about sex for fear of being thought to be sexually active. Virginity norms also put young girls at risk of rape and sexual coercion in high-prevalence countries because of the erroneous belief that sex with a virgin can cleanse a man of infection and because of the erotic imagery that surrounds the innocence and passivity associated with virginity. Processes of globalization greatly exacerbate these differences in male and female sexuality. One of the most dramatic characteristics of globalization in the developing world is rapid and unpredictable social change at all levels, accompanied by an onslaught of images and messages from the Western media. Globalization has brought Britney Spears, The Bold and the Beautiful and Ally McBeal to the developing world, carrying with them strong but often confusing messages about gender and sexuality. Not surprisingly, worldwide globalization has stimulated a push backwards to fundamental ideals and primary cultures—to reach for stability and hold on to what is sacred. It is no coincidence that diverse forms of religious and political fundamentalism accompany globalization. These ideologies use control of women’s mobility and women’s and young people’s sexuality as primary tools. Whether within the U.S., in international arenas such as the UN or in developing countries, diverse forms of fundamentalism and violence have been unleashed in response to rapid change. For example, last year the Indian health minister announced a ban on mentioning condoms in AIDS public service advertisements on television, even though rates of HIV are skyrocketing and everyone recognizes the urgent need for open information about HIV/AIDS prevention. Also, a Swaziland minister asked that the age of marriage for girls be decreased to protect young girls from HIV infection, even though the benefits of late marriage for women, their children and the national economy have been repeatedly documented. In another African country a head of state admonished young girls for dressing provocatively, identifying this as the reason men engage in unsafe sex. But the most stunning examples are from the United States. At the 2002 UN General Assembly Special Session on Children, the U.S. delegation joined Iran, Libya, Pakistan and the Holy See to argue that sexual abstinence was the only way to prevent HIV/AIDS today. At an Asia Pacific regional UN conference in Bangkok that same year, the U.S. asked that all discussion of reproductive rights and reproductive services be deleted from a document on public health on the grounds that it implied support for abortion. American delegates insisted that the term “consistent condom use” be deleted from a list of measures to prevent HIV/AIDS. Fortunately for the world of public health, several Asian and Pacific countries overruled the U.S., and the deletions were rejected. Such actions seriously infringe on the rights of individuals to health and security, and have life and death consequences for many people around the world. Prioritizing political agendas and ideological opinions that grow out of the misguided morality of a few over scientific evidence and public health imperatives is not just wrong: it is fatal. It can cost tens of millions of lives.

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he only way to contain the global HIV/AIDS epidemic is to find ways to harness the best from globalization. Women and men should be able to equally realize the fruits of globalization. Its inevitable costs must be minimized

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for all. In the context of the HIV/AIDS epidemic, gender inequality in access to economic resources, or in levels of sexual autonomy, is now fatal. The extent to which globalization, or our responses to it, exacerbates that inequality only increases the danger. Gender inequality and the negative impacts of globalization for women and girls can be reduced in several ways. First, we must ensure women’s access to economic assets such as land and property. Second, we should confront the existing epidemic of violence against women though a high-level campaign, led perhaps by the UN Secretary-General, to push for zero tolerance of such violence. Third, we must ensure that adolescents get full and complete information on sex and HIV prevention. And, finally, we should provide the resources and support that caregivers need in order to tend to the sick and dying. These are among the many ways we can integrate the ethical and humanitarian principles outlined by Mary Robinson into HIV/AIDS policies and programs. But for any of these strategies to work, we need mechanisms of accountability. And to effectively hold governments and international agencies accountable, we need increased data on women’s lives both at the country level and internationally. Then we can begin to harness the best of globalization for all. RECOMMENDED READINGS

Kerr, Joanna & Caroline Sweetman (eds.). 2003. Women Reinventing Globalization. Oxford: Oxfam. Mehra, Rekha & Sarah Gammage. 1999. “Trends, Countertrends, and Gaps in Women’s Employment.” World Development 27(3): 533–550. Msimang, Sisonke. 2003. “HIV/AIDS, Globalization, and the International Women’s Movement.” in Joanna Kerr & Caroline Sweetman (eds.), Women Reinventing Globalization. Oxford: Oxfam. Rao Gupta, Geeta. 2000. “Gender, Sexuality, and HIV/AIDS: The What, the Why, and the How.” Plenary Address at the XIIth International AIDS Conference, Durban. Washington: ICRW. Rao Gupta, Geeta, Ellen Weiss & Daniel Whelan. 1996. “Gender and the Global HIV/AIDS Pandemic.” in Jennifer Turpin & Lois Ann Lorentzen (eds.), The Gendered New World Order: Militarism, Development, and the Environment. New York: Routledge. Sassen, Saskia. 1998. Globalization and Its Discontents. New York: New Press. Stiglitz, Joseph. 2002. Globalization and Its Discontents. New York: W. W. Norton. UNAIDS. 2003. AIDS Epidemic Update. Geneva: UNAIDS.

Geeta Rao Gupta is president of the International Center for Research on Women, a Washingtonbased organization that undertakes policy-oriented research, technical assistance, and advocacy focused on women’s economic roles, health and nutrition, the environment and natural resources, adolescent sexual health and women’s rights. She holds a Ph.D. in social psychology and is an international expert on HIV/AIDS issues. Correspondence: 1717 Massachusetts Avenue, NW, Suite 302, Washington, DC 20036, U.S.A. [email protected]