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Year : 2008  |  Volume : 21  |  Issue : 3  |  Page : 277

HIV and AIDS Vulnerability of Women in Asia and Africa

Book and Electronic Media Review Editor, Education for Health, USA

Date of Web Publication25-Jan-2013

Correspondence Address:
J A Gravdal
1775 Dempster St., Park Ridge, IL 60068
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Source of Support: None, Conflict of Interest: None

How to cite this article:
Gravdal J A. HIV and AIDS Vulnerability of Women in Asia and Africa. Educ Health 2008;21:277

How to cite this URL:
Gravdal J A. HIV and AIDS Vulnerability of Women in Asia and Africa. Educ Health [serial online] 2008 [cited 2022 Jan 23];21:277. Available from:

HIV and AIDS Vulnerability of Women in Asia and Africa

Edited by Kiran Prasad and U.V. Somayajulu

Empowering women worldwide series 1

The Women Press New Delhi (2008)

403 pp., ISBN 81-89110-18-7

In November 2006, my son traveled by train for 27 hours from Delhi to Bihar with a local Indian activist to speak about HIV treatment (which was not available) and human rights in Darbhanga, a city 5 hours from the capital of Bihar. He noted only one woman among the more than fifty villagers in attendance at the session. That woman had been invited to perform traditional songs during the opening ceremony. Newspapers publicized the event to everyone, but some attendees remarked it was considered inappropriate for women to attend the session.

This is the concern addressed in each chapter of HIV and AIDS, Vulnerability of Women in Asia and Africa. In this first text in the "Empowering Women Worldwide series" the editors collect studies and policy discussions from local investigators/advocates about the impact of HIV on women in sub-Saharan Africa, India, Pakistan, Bangladesh, China, and Indonesia. Although methodology changes, deaths, behavior changes and time challenge some of the statistics and trends cited in these chapters, the authors make a significant contribution to understanding how HIV affects the daily lives of women. They detail how the confluence of gender inequality, poverty, legal discrimination, violence, and lack of education fuel the epidemic in developing countries. The writers do not address the effects of scale-up of antiretroviral therapy, as this has been a more recent development. But they illustrate how the promotion of gender equality and women's human rights will be necessary to stem the tide of the epidemic.

Six of the eleven chapters focus on India, addressing variance in AIDS awareness and knowledge and the use of effective behaviors to prevent HIV transmission. Women in rural Bihar had one of the lowest literacy rates, least exposure to media related to HIV, least awareness of HIV, lowest age of sexual debut and low use of condoms with non regular sex partners, making them more vulnerable to HIV than others. Most sex workers in India are young, don't have accurate knowledge of HIV transmission (though they did know that condoms would reduce transmission), and don't use condoms with their lovers even if they do with their customers. Sexually active women college students in India lack HIV risk perception and do not insist on their partners using condoms.

The UNAIDS July 2008 global report reflects government and UN epidemiologic sources and downwardly revises India's HIV prevalence to 0.36, with 2.5 (2.0-3.1) million people living with HIV, in sharp contrast to the estimated 5 million infected persons reported previously through 2005 and cited in HIV and AIDS. This does not in any way diminish the policy suggestions to improve reproductive health and reduce transmission of HIV for women in India. These recommendations broaden the health agenda to address social determinants of health and are applicable to other developing countries: improve socioeconomic condition of rural and urban women, increase literacy programs for girls, advise families to delay marriage of their daughters, provide economic programs for and reduce discrimination of women sex workers along with providing condom availability and education.

Other important gender issues are emphasized in chapters on other countries. Bangladesh, a Muslim country with an HIV prevalence of less than 0.1%, must address injection drug users, migration patterns, sex trafficking in women and children, and cultural norms discriminating against women, especially widows with HIV. Though prostitution is legal in Bangladesh, most women in the sex industry are trying to overcome severe poverty and are less likely to change behaviors as they try to survive economically. China has high HIV prevalence rates among injection drug users (40% of whom are women), who make up almost half of those infected with HIV, and therefore must employ other strategies to address the epidemic. Indonesia, with economic instability and weak health care infrastructure, finds women with HIV in triple jeopardy related to their inability to inherit property, poor education, and general cultural and gender denigration.

Readers will find the information on sub-Saharan Africa more familiar yet still devastating, reinforcing again the significance of violence, poverty, cultural and gender norms, and governmental denial in producing such a devastating toll. The destruction of families, through death and reduced household incomes, and of the productive workforce of doctors, nurses, teachers, and farmers have produced an unimaginable toll in mortality, life expectancy (reduced by 20 years), increasing number of orphans, and worsened poverty. In contrast, lower HIV prevalence in youth age 15-24 in recent years in South Africa is very encouraging.

Students of global health and women's studies will find much to ponder in this depiction of gender related structural violence. However, the editors could have done a better job in reducing repetitive global statistics in many chapters. Considering HIV is such a dynamic epidemic, these statistics will be quickly outdated. Also, some of the chapters could have been tighter and then perhaps more effective in promoting the multidisciplinary approach, findings and policy implications. It would have been helpful to hear more about the implications of struggles of women sex workers who are asserting their rights for economic and legal protection.

The most hopeful thread weaved through the chapters is that in country after country women and advocates have emerged to work for the needed policy changes and address gender inequity, poverty, violence and education. We need more texts that reflect these voices in order to help and lead our struggle for better global health.

Reviewed by:

Mardge Cohen

Medical Director, Women's Equity in Access to Care and Treatment

Founder & former Director of Cook County Women and Children's HIV Program

Department of Medicine Stroger (formerly Cook County) Hospital

Professor of Medicine, Rush Medical College, Chicago, USA


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