Power and Gender Impacts on HIV

Global problems are thorny and complex, yet somehow we expect to be able to come up with easy solutions to them. The global HIV/AIDS pandemic is a perfect example. HIV/AIDS touches all manner of nerves and taboos: how our cultures deal with sex and sexuality, how power is distributed between men and women, how much our societies value health and education over other kinds of spending, and how willing we are to recognize young people’s human rights, in theory and in practice.

Global problems are thorny and complex, yet somehow we expect to be able to come up with easy solutions to them. The global HIV/AIDS pandemic is a perfect example. HIV/AIDS touches all manner of nerves and taboos: how our cultures deal with sex and sexuality, how power is distributed between men and women, how much our societies value health and education over other kinds of spending, and how willing we are to recognize young people’s human rights, in theory and in practice.

Instead of turning toward these questions with a cooperative and energetic spirit, their very enormity often drives us in search of shortcuts to success.

  • It’s not the government’s job to legislate sex—people should just get married and stay faithful to their partners, simple as that!
  • It’s not our job to deal with gender, do you think we’ve got a thousand years? We’re busy enough dealing with HIV/AIDS, we’ll work on gender when we’re done!
  • Young people are having sex? Well for crying out loud, tell them to stop!

Such simplistic responses to complex problems not only slow our progress, but also take us backwards. Engaging with the thorny realities around power, gender, and sex that make the HIV/AIDS pandemic so hard to tackle requires a level of honesty and cooperation we haven’t yet been able to muster as a global community. But the pandemic also offers us a golden opportunity to begin some incredibly difficult conversations—and this is a process from which men and women alike stand to benefit.

Around the world, in rich and poor countries, gender norms are preventing everyone from developing healthy and satisfying sexual lives. In order to prove their masculinity, boys are often encouraged to resist condom use; discouraged from seeking healthcare, asking questions, and sharing fears about sex; and pressured to accumulate as many sexual partners as possible. If girls ask for information, demonstrate knowledge about sex, or admit to a desire for sexual pleasure, they risk being labeled promiscuous. If they insist on condom use, they open themselves to accusations of infidelity, at times provoking violent reactions from their husbands or partners. Pervasive homophobia and heterosexism prevent all people from navigating the development of their sexual identities with support, safety, and self-esteem.

How can we talk about HIV/AIDS without talking about these issues? And in particular, how can we formulate policies without recognizing that all around the world, women’s life decisions—who they have sex with and when, if and when and who they marry, how many children they have, whether they can get an education, whether they can go to the doctor, whether they can get divorced, whether they can own property—are often made not by themselves but by their fathers, brothers, husbands, in-laws, or even sons?

An honest look at these realities exposes strategies like the Bush administration’s ABC approach to prevention (abstain from sex, be faithful to your partner, and if you must have sex, use condoms) as laughably simplistic. Instead of moral directives, we need full, accurate, uncensored health information and life skills education, backed up by quality, affordable, accessible, and confidential sexual and reproductive health services for women, men, and adolescents. But that’s not all we need, because information and services alone won’t do it. We need to start a frank conversation—within societies and cultures and between countries and regions—about who is vulnerable to HIV/AIDS and why, and how we can build cooperative spaces for men and women to come together and address these challenges with candor, creativity, and openness to change. Men should be seen as allies, rather than obstacles, in tackling these challenges, since the goal is not to punish men, but rather to support everyone in their efforts to build strong, healthy, just, satisfying, equitable relationships with themselves and with each other, sexual and otherwise, as the foundation of strong, healthy, just, satisfying, equitable societies.

This week at the UN, as governments of the world come together for a landmark meeting on HIV/AIDS, I hope they will find the courage to start these conversations, and to support others in doing so. Only then can we begin to make progress on HIV/AIDS.