CARE: Preventing HIV Takes Social, Economic and
Cultural Change
Women must be empowered if we are to stem the spread of HIV and AIDS

Madhu Deshmukh, HIV/AIDS unit director, at the CARE booth. (2008 Rick Perera/CARE)

"Women's search for a safe place in the social and cultural spheres often takes priority over their search for physical protection from HIV and other sexually transmitted infections," said Dr. Helene Gayle, CARE president and CEO. "To prevent HIV, we have to promote social, economic, policy and cultural changes so that women and girls have greater control over their own lives and bodies. These are the same changes that are fundamental to fighting poverty."

Women and girls with limited economic alternatives may be forced
to trade sex for food or to stay in relationships where they have unprotected sex out of fear of abandonment.

A participant in a CARE focus group discussion on HIV in Lesotho said, "We earn very little money here; this is what makes us easy prey and exposed to HIV infection. For example, if a man tells you he will drive on Mpilo Boulevard (an expression used to describe unprotected sex), just because you are at the mercy of this person, you agree to have unsafe sex in expectation that he will not withhold his money or other favors."

The low social and economic status of women is part of the problem in preventing HIV, says Madhu Deshmukh, director of CARE's HIV/AIDS unit. "Empowering women is part of the solution. Insights from our preliminary research show that empowered women are better equipped to prevent and manage HIV risk in most situations."

Because of women's low social status, the risk of violence from a partner or a client is also an important factor. In India, a 2006 survey found that 42 percent of sex workers had been beaten, threatened or raped in the past 6 months. The constant threat of violence is a barrier that keeps sex workers from insisting that clients use condoms.

Although there is a lot of emphasis on female controlled prevention methods, such as microbicides, these biomedical tools are still years away. In the meantime, new HIV infections are outpacing treatment.

"We have no choice but to focus on preventing HIV," said Deshmukh. "We have a responsibility to do it in the most effective way possible, by using a comprehensive development approach that looks at the underlying causes, including poverty.

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