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Addressing Gender Inequalities & Microbicides

Addressing Gender Inequalities Key As Microbicides Research Proceeds


By Bobby Ramakant

CHIANG MAI (THAILAND) - During a monthly NGO forum on Microbicides organized by Health and Development Networks (HDN) and Northern NGO Coalition on AIDS (NNCA, Thailand) , NGO representatives concluded that unless gender inequalities are addressed, even when microbicides eventually become available, they might only be another HIV prevention option and not a magic bullet in averting considerable number of new HIV infections.

Global HIV data- tragically- confirms what women's health, rights, and social justice advocates have said for more than a decade - social, economic, and sexual vulnerability of women, particularly young women and girls, harms their health and increases their risk of HIV and other sexually transmitted infections (STIs). Existing prevention strategies have largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use- none of which are easily controlled by women.

Microbicides are compounds that can be topically applied inside the vagina or rectum to protect against sexually transmitted infections, including HIV. Microbicides are still being researched, and will require significant political will, public investment and popular demand. Microbicides are not yet available, but are at different stages of research in a number of countries. Some microbicides candidates are in human clinical trial stage as well.

Though microbicides are a desirable HIV prevention method for women, power imbalances between men and women will continue to make it difficult for women to negotiate for safer sex, said the participants.

"Ultimately, history tells us that vaginas never belong to women as they have never had genuine power to decide on sexual matters and about their own bodies," said Ms. Kanjana Thalaengkit, a representation of the Thai Women's HIV/AIDS Task Force (TWAT).

In Thailand, as in many parts of the world, socio-cultural and economic factors weigh heavily on women's ability to negotiate for safer sex. The persistence of patriarchal norms has resulted in women's lack of autonomy and increased risk to HIV/AIDS infection, reports United Nation's Population Fund (UNFPA) Women have been socialized into passivity and taking a non-initiating role, acquiescing only to male demands.

Current prevention methods such as condoms tip the power balance heavily in favour of men when it comes to negotiating for safer sex. Consequently, there has been a growing need in recent years to develop tools that women can control to protect themselves from diseases.

Because microbicides can be used without a male partner's knowledge or consent, women who are not able to negotiate condom use with their male partners, will be able to protect themselves from STIs including HIV, and unwanted pregnancy. The real empowerment will be when culture of silence on matters related to sex is broken, and men and women can ably negotiate the use of HIV prevention options with dignity and understanding.

"Unless the fundamental inequalities between men and women are addressed, microbicides will not be enough to protect women from HIV-infection", said Khun Kanjana.

"Take for example, the female condom. Many women dislike using it not to mention it is expensive and not easily accessible. We have learned lessons from female condoms - they have been produced but women are not able to use them because of the limited power to negotiate and to assert their sexuality," said Khun Kanjana.

Microbicide trials

Phase III clinical trial of cellulose sulfate - a potential microbicide being tested for HIV prevention in women - was recently simultaneously halted in Benin, India, Nigeria , South Africa , and Uganda due to increased HIV risk of the women involved in the trials.

Although there have been microbicide trials in Thailand, the results have never been made public.

In discussing microbicide trials, participants called for greater recognition of ethics and human dignity in the trials. Community Advisory Board (CAB) – is responsible for providing meaningful and broad community input into the microbicides research. CAB is responsible to ensure that microbicides scientific priorities reflect the pressing needs of the affected communities. CAB also help integrate community into the research process and promote greater understanding of the research among trial participants and the community at large. The participants at the NGO Forum urged CABs together with scientists and researchers to play a more significant role in the protection of ethics and human rights of volunteers in clinical trials .

"The emphasis of microbicide trials should be placed on the management of power relationships between women and men. Microbicides will become meaningless should women still have no power to decide on their own sexual matters" said Khun Kanjana.

Khun Udom Likhitwonnawut of the CAB in Thailand, made the following three points about clinical research within communities:

First, the trials need to respect the human dignity of the volunteers, and the process of informed consent must be applied to the volunteers.

Second, emphasis must be placed on harm reduction and if any problems are detected in the trials, mitigation measures must be initiated, including canceling the trials.

Third, the recruitment of volunteers must be fair and neutral and there should be no bias toward recruiting marginalized groups, youth or prisoners.

Overall, participants concluded that, the inequality between men and women coupled with a lack of sensitivity towards women's reproductive health requirements remains a major hindrance towards the effectiveness of new HIV prevention methods targeted at women.

There is always hope that not only gender inequity might change for the better, and women and men will recognize, appreciate and respect the rights of each other, but that women will have more meaningful roles to play in decision making, and will be empowered enough to access, afford, use and negotiate the use of HIV prevention options with their partners. This struggle shall indeed be a long one.

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Bobby Ramakant works for the Health & Development Networks (HDN), www.TheCorrespondent.org, email: info @ hdnet.org

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