Abstract: The H IV/AIDS-infected people are still the most marginalised section of society. It is necessary to society’s awareness about the connection between the feminisation of global poverty and the socio- economic and religious dimension of AIDS. Women are increasingly bearing the burden of the epidemic, especially the poor women, by and large. who must wrestle with this grave danger, and impoverished parents are forced to sell their daughters into commercial sex work. It is imperative to end the silence of stigma, denial and fear about AIDS and embrace in a practical way those who have become victims of our apathy and ignorance. As feminists, what we share in common is the quest for greater solidarity, love and justice for the most marginalised people of our communities. Then we see lives that are exploited in the name of the market economy, we must cooperate to make changes and seek alternatives for those who suffer from economic exploitation and oppression.
Keywords: HIV/AIDS, powerlessness, prostitution, violence, drugs, World Trade Organisation (WTO), marginalisation, global economy, global poverty
I deliberately bring the issue of AIDS to our gathering as an invitation for all of us to contemplate the suffering of some of the most marginalise women and children of our work d—HIV/AIDS-infected people, especially our Asian sisters. In addition, I also want to raise our awareness about the connection between the feminisation of global poverty and the socio-economic and religious dimension of this disease.
The Fight against AIDS in Asia
United Nations Secretary -General Kofi Annan opened the 15th International AIDS Conference on July 11, 2004, in Thailand’s capital of Bangkok with a warning that the epidemic is now spreading alarmingly in Asia where 60 percent of the world’s population resides. Presently, 7.4 million, people in Asia have the disease with 50,000 people dying each year in the region. Moreover, AIDS will force 5.6 million more people into poverty each year in Cambodia, India, Thailand and Vietnam. India, with an estimated 5.1 million cases at the present time, is now second only to South Africa in the size of its AIDS population. As for China, UNAI DS has projected that there will be 10 million cases in this country by 2010.
The U.N. leader also noted that women are increasingly bearing the burden of the epidemic, which has claimed 20 million lives in two decades. Annan blamed ‘society’s inequalities’ for putting women at greater risk of, contracting A IDS. He cited poverty, violence and coercion by older men as well as men having ‘concurrent sexual relationships that entrap young women in a giant network of infection.’
Unfortunately, Asian leaders have not fully focused on the looming catastrophe. They need to talk more openly about AIDS and invest in prevention and treatment. A vast majority of Asians have never heard about AIDS prevention and have no access to condoms, HIV testing or counselling.
The world put US$4.7 billion into fighting AIDS last year, a large increase, but nothing compared to what is needed, which is US$ l2 billion for 2005 alone. Japan is giving the Global Fund to Fight AIDS, Tuberculosis and Malaria only US$ 100 million this year, and the other Asian contributors— China, Thailand, South Korea and Singapore—are together giving a pathetic (US$ 3.7 million. Nor are Asian countries spending enough at home. These countries must spend far more to prevent an explosion in the number of AIDS cases.
Nevertheless, Thailand has been held up as a model for dealing with the epidemic in Asia. A nation known for its thriving commercial sex industry, Thailand suffered a frightening eruption of HIV infection among prostitutes and their clients in the early 1990s. An aggressive condom promotion campaign in red-light districts dramatically reduced the infection rate, but it did not prevent HIV from spreading to the general population. Unfortunately, the Thai government has cut the budget for prevention by nearly two-thirds, and infection rates and risky behaviour are now rising.
Meanwhile, in India , prostitutes, homosexuals and drug users represented the first generation of HIV infections in the country, but today most cases are among young people and housewives whose husbands bring it home. India has a huge trucking industry, and several million truckers who frequent roadside brothels have been instrumental in spreading the disease. Moreover, ignorance about the disease arid discrimination remains widespread India. Women contract the virus from their husbands who frequent prostitutes; and when the husband dies, their wives are generally thrown out of the family. Human Rights Watch has also reported widespread abuse and arrests of HIV- positive people and AIDS-awareness campaign workers by the police in India. China, however, has its own unique means of transmitting HIV/AIDS— blood donations —for tens of two thousands of villagers were infected by an sanitary blood-buying industry in the 1990s in Henan Province alone in central China, making it the country’s hardest hit province. In some villages, nearly every family has a member with the virus. After years of denial, Beijing s become increasingly open about its AIDS epidemic and has promised to provide free testing and counselling for those who seek it and free anti-retroviral treatment for the poor. However, authorities still control information about the disease and harass independent activists.
As governments across Asia grapple with a rising tide of HIV/AIDS, health workers are meeting resistance to messages about sexuality and infection. Indonesia, a conservative Muslim organisation forced TV stations to cancel U.S.-funded ads that promoted condom use by men who visit sex workers, Catholic bishops in the Philippines oppose condoms and other family planning methods.
What dismays some observers is the fear that Asia may be repeating the takes of Africa where churches and mosques initially greeted A IDS with fief, hostility and silence that has only belatedly given way to compassion.
The common conception is that HIV/AIDS comes from illegitimate sex and homosexuality, which are considered major sins, and condoms are thought to be a way of promoting these illegitimate acts. Many religious leaders make the mistaken claim that the virus cannot be spread among their believers because of their purity.
Moreover, there are fears that lives are at risk in some the world’s poorest countries because of American objections to a ‘safe sex’ approach to combating AIDS. Under the influence of the Christian Right, U.S. President George W. Bush has adopted the so-called ABC approach to A IDS prevention— A for abstinence, B for being faithful and C for condoms. Condoms, however, are to be promoted only for use by ‘high-risk groups,’ such as prostitutes and drug abusers, with sexual abstinence the objective for all unmarried young
In addition, Washington also faced a storm of criticism at the AIDS conference in Bangkok over its funding policy, especially a US$ 15 billion, five-year emergency plan for AIDS relief, mainly directed toward Vietnam and 14 countries in Africa and the Caribbean. Activists complain that the countries were chosen because they shared the U.S. philosophy of stressing abstinence as a tool for preventing HIV rather than condoms. They say the United States should instead give much of that money to the Global Fund, which reaches out to 128 countries. Most experts at the conference were also highly critical of the U.S. plan, in part because it calls for purchasing only brand name drugs. Such drugs can cost patients more than US$5,000 per year, compared with as little as US$ 150 per year for the copies manufactured abroad.
Women and AIDS
Throughout the world, the majority of women with HIV infection are poor and are denied access to resources and services. In her thoughtful examination of the gendering of American AIDS discourse, Paula Treichler asks, ‘Why were women so unprepared? And why do they continue to take it so quietly?’ She responds to her questions with an insightful critique:
‘As evidence of AIDS in women mounted, speculations linked the disease to prostitutes, intravenous drug users and women in the Third World. It was not that these three groups were synonymous but rather that their differences of race, class or national origin made speculation about transmission possible—unlike middle-class American feminists, for example. American feminists also by this point had considerable access to
public forums from which to protest ways in which they were represented while these other groups of women were, for all practical purposes, silenced categorically so far as public or biomedical discourse was concerned. (Farmer, 1996, 27)
Poor women, however, have not been silent in public. Rather, they have been unheard. This selective deafness on the part of those who enjoy positions of privilege is because the dominant myths and mystifications of treating AIDS, like treating poverty, view HIV/AIDS as merely a personal matter rather than recognising it as an issue of justice. It is therefore important to make connections between the construction of AIDS victimhood and constructions of the poor, who also suffer the triple curse of objectification, institutionalised powerlessness and blame for their condition.
In recent years, extensive evidence sugges.s that poverty is the most harmful and least studied risk factor for AIDS. Through myriad mechanisms, it creates an environment of risk. In addition, poverty and gender inequality are inextricably intertwined. Poverty plays a large role in structuring dependent relations hips with a male partner, whether that relationship be marriage or another type of union.
In many settings, HIV risks are enhanced, not so much by poverty in and of itself, but by inequality. Increasingly, what people with AIDS share are of personal or psychological attributes. They do not share culture or language or a certain racial identity. They do not share sexual preference or an absolute come bracket. What they share rather is a social position—the bottom rung the ladder in inegalitarian societies. It is poor women, by and large, who net wrestle with this grave danger, and impoverished parents are forced to sell their daughters into commercial sex work. The cumulative effects of lives poverty and sexual exploitation force many women into circumstances where sex becomes a survival strategy.
Thus, if the hypothesis that inequality is an important co-factor in this pandemic is correct, then stopping AIDS will require a more ambitious agenda, that calls for the fundamental transformation of our world. What is at stake in these tasks is well expressed by anthropologist and activist Brooke Schoepf: ‘Unless the underlying struggles of millions to survive in the midst poverty, powerlessness and hopelessness are addressed, and the meanings of AIDS understood in the content of gender relations, HIV will continue to spread.
The Global Economy and the Feminisation of Poverty
The border less societies that the global economy promotes continue to exploit women by selling them as ‘wives,’ forcing them into prostitution or engaging them in other kinds of exploitative work, such as working in sweatshops and as domestic labour. Take, for example, the social situation and people’s livelihood in China that have gone through drastic changes since the mainland began its series of economic reforms and open-door policy in the late 1970 s. The Chinese government has focused its polices on developing the coastal cities and special economic zones. Foreign capital has rushed into these areas, and tourism has been encouraged. At the same time, because of the uneven economic development between urban and rural areas, thousands of peasants have been pushed to southern coastal cities, like Guangzhou, Shenzhen and Zhuhai, and eventually to Hong Kong.
It has been reported that among migrant workers in the coastal cities almost 80 percent are women. Because of difficulties in finding a job, harsh working conditions and other problems, some migrant women workers choose to join the sex industry in order to earn more money and hence provide more economic support for their families in their hometowns.
‘Their numbers are increasing rapidly, says social worker Elaine Lam, ‘and I can use the use the word horrible to describe the situations we have seen. Any policeman or robber can exploit and suppress them. The situation is very serious. We hope to tell them of their rights to help stop the problem.’
Ah Hung, 28, was born Guangdong village and later farmed chickens and pigs. Today the mother of 9- and 10-year-old sons works as a prostitute in Temple Street in Hong Kong. She told a reporter of the South China Morning Post: ‘My first customer helped me take off my clothes. Afterwards, I cried and felt dirty. I asked, “Why do I have to do this?” I comforted myself by saying, ‘It’s for my children. If I don’t do this, they will have no food and no future.’
Women displaced from farms and collapsed domestic industries because of trade liberalisation have been forced to week survival by migrating to foreign lands where they often suffer abuse and harsh treatment at the hands of their recruiters and/or employers. Many become victims of sex trafficking.
Owing to the corruption of many Third World governments, women are forced to use the services of untrustworthy organisations and intermediaries. This places migrating women in extremely vulnerable situations, subject to abuse by procurers, employment agencies, marriage agencies and other kinds of intermediaries. Thus, migrant women who are trafficked do not have access to legal resources in order to bring their traffickers to justice. On the contrary, most state policies regarding ‘aliens’ effectively turn these women into criminals instead of victims and expose them to a variety of health ri.sks, including HIV/ AIDS. For example, sex workers in Hon g Kong used to be able to have a free health check-up and receive treatment from social hygiene clinics operated by the Health Department. However, beginning in April this year, non-Hong Kong ID cardholders are now charged HK$700 (US$90) for each visit. This new policy is having an ad verse affect on migrant sex workers as the fee is beyond their means.
Above all, the people most vulnerable to HIV infection are those on the social and economic margins of society who are denied access to their most basic human rights. As Peter Piot, the executive director of UNAIDS said on International Women’s Day in 2003:
‘There is no question that we understand women’s vulnerabilities to HIV— vulnerabilities based on biological factors, culture and on their social and economic status. We know that women face domestic violence, at times exacerbated by conflict or insecurity; that girls are the first to be pulled from alcohol and put to work when AIDS strikes at home; that women lack the power and economic independence to negotiate sexual safety.’
Another issue related to the global market economy and the marginalisation of the poor concerns drug patents. Much of the progress in the treatment of HIV/AIDS has occurred because some countries, notably Brazil. Thailand and India, have begun manufacturing copies of drugs developed by large pharmaceutical companies. The World Trade Organisation (WTO) sanctioned this process last year, affirming that countries could declare drug patents invalid in times of health crises.
Critics, however, charge that the United States is trying to elude the requirements of the WTO accord, which it signed, by negotiating free trade agreements with individual countries that would extend drug patents while promoting trade.
French President Jacques Chirac said at the Bangkok A IDS conference that forcing countries ‘to drop these measures in the framework of bilateral trade negotiations would be tantamount to blackmail. We should implement the [WTO] generic drug agreement to consolidate price reductions. What is e point of starting treatment without any guarantee of having quality and affordable drugs in the long term?’
A U S. official, who refused to identify himself, called the French allegations ‘nonsense,’ saying a proposed agreement with Thailand would permit it to continue manufacturing copies of drugs. ‘There really is no issue,’ he said.
Thai Prime Minister Thaksin Shinawatra has promised that drug patent would not be included in the U.S. agreement, but critics fear he will cave in to pressure from Washington,
‘The negotiations are carried out behind closed doors,’ said Jiraporn Limpananont of Chulalongkom University in Bangkok. ‘We are still very much concerned.’
Such debates and discussions reveal a harsh reality that whoever has the power and resources sets the rules. In the name of protecting trade and the free market, sacrificing human lives has apparently become unavoidable. for an examination of the drug industry over the past two decades reveals that the pharmaceutical industry has moved far away from its original high purpose of discovering arid producing useful new drugs. Now primarily a marketing machine to sell drugs, this industry uses its wealth and power to co-opt every institution that m’s ht minimise its profits, including governments, the WTO, academic medical centres and the medical profession itself.
A Religious Commitment to be in Solidarity with Women to Overcome HIV/AIDS
Women who are empowered are women who can protect themselves. Peter Piot warns that ‘equity in all fields—health, education, the environment and the economy—is essential if women are to act to protect themselves when it comes to HIV/AIDS.’
One image to describe the context of the global econ omy and the threat of HIV/AIDS to the wor ld’s women and marginalised people is a global war, a war of the strong against the vulnerable, all those judged by society to be ‘ immoral’ or ‘the majority poor.’
In analysing the epidemic of HIV/AIDS, one cannot just focus on sex as a personal moral issue or AIDS as a medical problem. Rather, unequal power structures and the social constructions of gender, sexuality, class and race that create systems that exploit the vulnerable, especially the poor, the youth, people of colour and socially outcast women, must be re-examined.
One must, first of all, recognise that people exist not just as physical bodies but they live in a social world and that, therefore, AIDS must not be viewed just as a virus. Rather, HIV/AIDS is a complex, multifaceted social issue. It touches deeply internalised gender stereotypes, the power structures of societies and religious beliefs.
Secondly, AIDS is often perceived by Christians and others in the First World as a sign of moral weakness, of promiscuity and illegal behaviour. To recognise poverty as a dynamic force, a reorientation is necessary to understand that the majority of the poor are forced to reprioritise their lives based on survival, often at the expense of their well-being. Many poor women, consequently, are faced with a choice between exploitation and survival, which hardly can be called a choice at all.
As feminists, we must open our eyes to see that modern poverty is not a natural social phenomenon: it is the product of political decisions. It is part of the inter locking system of ongoing global politics and the global economy, The most damaging tact is that poverty destabilises lives, crushes self-esteem and creates an apartheid between those who have economic power and those who do not.
At an interfaith AIDS conference held in November 2003 in Bangkok, the 147 participants of tour religions—Buddhism, Islam, Christianity and Hinduism—corporately admitted that HIV is a critical test for their faith and commitment to building a sustainable community and the fullness of life of err people since HIV is rooted not merely in the health and physical spheres but also involves lifestyles, social perspectives and attitudes and individual behavioural practices. They also agreed that HIV/AID S is not a form of punishment for the sufferer but an opportunity for them to serve the sufferer. In this way, the religious communities have been challenged by their faith and divine teaching against stigmatisation and discrimination.
The root causes of the HIV/AIDS crisis include gender inequality, systemic injustice and the unequal distribution of wealth. Thus, as people of faith, their approaches must be sensitive to the effects they will have for women men, children and adults, rich and poor. They also affirm that all humans equal. Therefore, we should treat each other with mutual care and respect regardless of one’s social status, faith, gender or lifestyle.
In facing the challenge of the threat of HIV/AIDS, if we continue to s the sinfulness of individuals and perceive sex as simply a personal moral choice, we will become perpetrators of the status quo and blame the victims— poor and women—for their problems.
Secondly, it is vitally important that we are called to return to the core value of all religions, that is, in the beginning is the relation and we bear responsibility to care and love our neighbours as ourselves. The conditions that exclude some from the household of God distort the life of all who are already in the household. Even those who seem successful according to present household rules are dehumanised by structures of a household that exclude the ‘losers’ in society.
We must end the silence of stigma, denial and fear about HIV/AIDS and embrace in a practical way those who have become victims of our apathy and ignorance. One practical response for the Church to take is to push our governments to make its fight against AIDS a higher priority, to honour their commitments to provide cheaper AIDS drugs to those who cannot afford them and to increase their financial support for AIDS-related health care in developing countries.
As feminists, what we share in common is the quest for greater solidarity, love and justice for the most marginalised people of our communities. We share the value that the economy is organised to serve life. When we sec lives that are exploited in the name of the market economy, we must cooperate to make changes and seek alternatives for those who suffer from economic exploitation and oppression.
Lastly, the quest for justice and peace must promote hope not optimism. Optimism is the belief that humankind will inevitably progress to a more just, peaceful world. It is a passive virtue. Hope is the faith that, together, we can create more justice and peace in the world. Hope is an active virtue. Hope requires action from responsible citizens to create new relationships, societies and citizens. Hope is preventive democracy. Hope is the path to kinship and understanding of the stranger, empathy with ‘the other’ and the courage to extend a hand across boundaries of estrangement or hostility. Hope is love in action.
Farmer, Paul, Connors , Margaret and Simmons. Janie (1996) eds., Women, Poverty and AIDS: Sex, Drugs and Structural Violence Monroe, Maine: Common Courage Press.
Rose Wu is based in Hongkong and works in the Hon Kong Christian Institute, Hongkong.
ROSE WU. Has a doctorate in Theology from Episcopal Divinity School in Boston. At present she is teaching at the Chinese University of Hong Kong. She has authored a book, The Story of Hongkong’s Sexual Minority. She has been an active participant in the women’s movement and other social and political movements in Hong Kong since the 1980s.