HIV VULNERABILITY IN RELATIONSHIP AMONG WOMEN

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CHAPTER 2 LITERATURE REVIEW

INTRODUCTION

This chapter presented literature review of the previously existing sources in the field of study. A literature review is a manuscript written by someone to reflect on the significant points of recent understanding as well as theoretical and procedural contributions to a study subject matter (Burns & Grove 2011:107). The main goals of literature review for this study was to place the study within the body of literature and to provide the context for this study. Thus the researcher assumed the literature review as a staple for the current study to fasten the current study with the pre-existing knowledge in the study field.
The researcher consulted different literature sources to arrive at appropriate literature for the study. Consulted literature sources include electronic sources, published and printed materials from different libraries, different data basis and different internet search engines. During literature searching period, the researcher used key words such as gender, HIV, AIDS, reproductive health, sexuality, reproductive age group, reproductive health services and women to find relevant existing knowledge in the field.
Finally, the researcher read all literature sources collected and tried to sort them based on their appropriateness to the current study. After appropriate literature sorted, then the researcher started the process of write up on this chapter as evidence was presented under different sub section of the chapter.

HIV AND AIDS VULNERABILITY IN GENDER

Globally, many women compared to men are dying of HIV and AIDS (United Nations 2013:33). However, there are important differences between women and men in the underlying mechanisms of HIV infection and social and economic consequences of HIV and AIDS (Higgins, Hoffman & Dwokin 2010:435) As these stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power (United Nations 2013:33).

Biological risk factors

Womens’ biological make-up predisposes them to HIV infection (Ramjee & Daniels (2013:1). This is mainly due to the larger mucosal surface which makes it easier for viruses to develop and grow. Women between the ages 15-24 are more at risk because of the immature cervix which increases the trauma and hence exposure to microbes and viruses leading to an increase in sexually transmitted diseases (Gender dynamics 2010:6). Since sexually transmitted diseases are a sequel for HIV and AIDS this then explains why more women than men are at risk of acquiring the HIV (Baratedi, Thupayagale-Tshweneagae & Ganga-Limando 2014:5).

Socially constructed gender differences

Differences in power relations between men and women, which is attributed to culture, economic dependence and women’ vulnerability has been identified as major players in the spread of HIV and AIDS among women and young girls (Dwokin 2005:615; Global Coalition on Women and AIDS 2008:3). In an unpublished study by Seloilwe (2015:8-it is alluded that most of the women at risk are the married ones because it has been ingrained on them that a man should not use a condom in a marital bed and this has not escaped even the learned women who are assumed to understand their rights first as individuals and second as partners in marriage.

Gender variations on rate of infections

UNAIDS 2013:56-68) reported the prevalence of HIV and AIDS in sub-Saharan Africa where the majority of those affected are women. The report further states that 61% of those affected by HIV are women aged between 15-to-49 years and that a large proportion of those are found in Southern Africa, particularly in Botswana, Lesotho, Swaziland and South Africa (UNAIDS 2013:56-68).
According to WHO (2014), a total of 35 million people were living with HIV in 2013 and 16 million of those were women. All this estimates demonstrate the gender risk of HIV infection. In Ethiopia, sex workers who are women mostly and university and high school students were reported to be at risk of contracting HIV (UNAIDS 2014:3). It is therefore clear from the reports that strategies aimed at empowering women should be put in place.
The United Nations assertion is that by empowering women to be able to protect themselves and make informed decisions about their health and children can reduce the HIV and AIDS spread (UNAIDS 2013:7). Improved availability of birth control methods and technologies for reproductive age women with fully informed consent and freedom to choice on the type of family planning methods to be used by each client would avoid unplanned pregnancies and consequently reduce the infection rate among them.
Ethiopia has made substantial gains in increasing access to HIV prevention and treatment services among pregnant women living with HIV and children between 2009 and 2012. On other hand in the country, only 38.0% of eligible pregnant women living with HIV are receiving antiretroviral therapy for their own health (UNAIDS 2013:20).

GENDER AND SEXUAL VIOLENCE

A UNAIDS report based on research conducted in seven countries (Cambodia, Cameroon, Chile, Costa Rica, Papua New Guinea, the Philippines and Zimbabwe) found that notions of masculinity encourage young men to view sex as a form of conquest. The same report said that since ignorance is construed as a sign of weakness, men are often reluctant to seek out correct information on HIV and AIDS prevention (World Health Organization (WHO) 2003:2).
Feminist theories of patriarchy have identified men’s presence and dominance of political institutions as a major obstacle to women’s equality. The expert group agreed that the emphasis on men should be seen as a paradigm shift that allows political actors to focus on gender equality training for men in representative and participative arenas. The socio-economic position of women in societies negatively affects their participation since normally, women earn less than men and the sexual division of labour in society also imposes burdens on women. Most societies fail to organise in a manner that enables both men and women with families to share these responsibilities, particularly considering that child-rearing responsibilities tend to fall disproportionately on women (UNDAW 2005:14).
Violence is not only a risk factor for HIV infection but also becoming increasingly clear result of the epidemic. In Kenya, 19% of HIV positive women experienced violence from partners. Women are more vulnerable to interpersonal violence than men (WHO 2000:11).
Violence against women is widespread and rising numbers of women at risk from AIDS as a result of high risk sexual behaviour on the part of their partners. In a number of countries, harmful practices control women’s sexuality and led to great suffering (United Nations’ Programme of Action 1994:38).
The Fourth World Conference on Women drew attention to the persisting inequality between men and women in decision making. It undermines the concept of democracy, which, by its nature, assumes that the right to vote and to be elected should be equally applied to all citizens. The absence of women from political decision-making has a negative impact on the entire process of democratisation. Without the perspective of women at all levels of decision-making, the goals of equality, development and peace cannot be achieved. The outcome of 2005 World Summit also reaffirmed commitment to the equal participation of women and men in decision-making (UNDA 2005:7).
Given the global commitments to the prevention of HIV spread, there are significant sex and age differences in the decision making processes. This point is supported by study done in USA on factor affecting gender decision making as statistical analyses revealed significant differences due to gender and age in participants’ perception of the factors (Lizárraga, Baquedano & Cardelle-Elawar 2007:387).
Violence in the form of coerced sex or rape may also result in the acquisition of HIV, especially as coerced sex may lead to the tearing of sensitive tissues and increase the risk of contracting the HIV virus. According to WHO report, adolescents’ first sexual intercourse was forced particularly for women. Women may be more affected by stigma and discrimination than men because of social norms concerning acceptable sexual behaviour and more economical vulnerability (WHO 2003:3).
Study done in Tanzania reported that the influence of gender, wealth, ethnicity and education presents substantial challenges. The findings have revealed that fairness principles in health care decision making processes are greatly undermined in the study district. This notion posed a very real threat in health care decision making as they may systematically undermine the views and experiences of particular segments of the population (Shayo, Norheim, Mboera, Byskov, Maluka & Kamuzora 2012).
Overall, there is a need to mobilise entire communities to change the social, cultural and economic conditions that support unsafe sexual behaviours. Women still have to ask their male partner for permission to test for HIV or to access health services; permission to protect themselves. Unless accompanied by broader structural interventions in both the political and occupational realm, people’s ability to make changes in behaviour will continue to be severely constrained by prevailing social conditions (Chersich & Rees 2008:8).

GENDER AND SOCIO-ECONOMIC EXISTENCE

During the past several decades, the formulation, implementation, monitoring and evaluation of population policies, programmes and activities have been benefited from the findings of social and economic researches. These researches highlighted how population change results from and impacts on complex interactions of social, economic and environmental factors. It was believed that social and economic researches are clearly needed to enable programs to take into account the views of their intended beneficiaries especially women, the young and other less empowered groups to respond their specific needs (United Nations’ Programme of Action 1994:72).
A gender gap was said to be a difference in any aspect of the socio-economic status of women and men. On other account, gender discrimination is different treatment given to one gender by comparison with other gender. Further gender oppression is male monopoly of decision-making process by maintaining male privilege and preserving male leisure. Deliberately underlying systemic discrimination against women is the maintenance of patriarchal power for the purpose of retaining male privilege (UNESCO 2001:14).
Whether it is in the public or private sphere, women continue to be denied opportunities to participate in decision making processes that have been affecting their lives. The suppression of women’s voices in many areas has been contributing to the persistence of gender inequality and limits to human development. On other hand, it is widely recognized that increasing women’s bargaining power within the household could improve children’s nutrition, survival rates and literacy. According to United Nations Report, of all the decisions could be made at the household level, the majority of women were free to decide when to visit friends, families, relatives and how to manage their own health. But the situation is worse for women when it comes to money-related decisions as money related matters are disproportionately concentrated on the hands of men (United Nations 2013:23).
Study done in Nepal on women’s role and choices of skilled birth attendants indicated that several socio-economic, cultural and religious factors played a significant role in the use of this service. The same study also revealed that availability of transportation means, distance to the health facility, poor infrastructure, lack of adequate services, availability and accessibility of the those services, cost and convenience of services, staffs’ shortages and their attitude, gender inequality, status of women in society, women’s involvement in decision making processes and women’s autonomy were significantly affecting factors on use of skilled birth attendants (Baral, Lyons, Skinner & Van Teijlingen 2010:1). This study concluded that different socio cultural, religious, financial and demographic factors have a significant role in uptakes of the service (Baral et al 2010:5).
According to study done in Madhya Pradesh State of India on factors affecting the use of maternal health services indicated that very strong positive influence of higher household socio-economic status on the use of maternal health services. The same study brought into picture as religion casts considerable influences on the use of ANC and safe delivery services, though religion posed no noteworthy influence of these factors during use of post-natal care (Jat, Nawi & Sebastian 2011:9).
African Millennium Development Goals Progress Report in 2012 brought into attention that HIV and AIDS is worsening health, economic and social issue in sub-Saharan Africa. The same report showed that in 2010, Africa was the only continent where HIV prevalence was higher among young women than young men. According to the report HIV prevalence among young females aged 15 to 24 years was 3.3% whereas the HIV prevalence among young males of same age group was 1.4% in that year. Thus the report summed up that the trends in age/sex differentiated HIV prevalence rates for people aged 15-24, since the situation for young women has worsened considerably in most African countries (AUC, UNECA, AfDB & UNDP 2012:82).
UNAIDS/UNFPA/UNIFEM (2004:8) puts poverty as factor which could push some women into risky behaviour. This is because women without other options, they may choice sex work to fulfil their personal needs and feed their families. This could be evidenced as in Southern Africa, many older men seek out young women and adolescent girls for sexual favours while providing them with school fees, food and highly sought after consumer goods (UNAIDS/UNFPA/UNIFEM 2004:8). In addition to women’s economic hardship which could lead to risky sexual practices, in countries that are hard-hit by the epidemic, particularly in sub-Saharan Africa, women are responsible to provide necessary support and care for HIV and AIDS patients at household level (UNAIDS/UNFPA/UNIFEM 2004:8).
According to Smith (2002:9), development programmes have focused on women of reproductive age as the prime target for community projects due to this age is at peak people’s economic productivity age. However, HIV and AIDS is leading to demographic changes and changes in the traditional roles and responsibilities of different age groups. The HIV and AIDS epidemic has been fuelled by gender inequality, unequal power relationship, sexual coercion and violence for women of all age groups, seeing that this could result in an array of negative effects on female sexual, physical and mental health (Smith 2002:1). The same study also showed that women and girls of various ages are vulnerable to the infection. Further the study pointed out that women are in the need of support for the survivors to overcome the economic and social effects of the epidemic (Smith 2002:9).

CHAPTER 1  ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM
1.3 RESEARCH PROBLEM.
1.4 RESEARCH PURPOSE
1.5 RESEARCH OBJECTIVES.
1.6 SIGNIFICANCE OF THE STUDY
1.7 DEFINITIONS OF TERMS
1.8 THEORETICAL FOUNDATIONS OF THE STUDY
1.10 SCOPE OF THE STUDy
1.11 STRUCTURE OF THE THESIS
1.12 CONCLUSION
CHAPTER 2 .LITERATURE REVIEW.
2.1 INTRODUCTION
2.2 HIV AND AIDS VULNERABILITY IN GENDER
2.3 GENDER AND SEXUAL VIOLENCE
2.4 GENDER AND SOCIO-ECONOMIC EXISTENCE
2.5 GENDER AND PARTNERSHIP CIRCUMSTANCES.
2.6 REPRODUCTIVE HEALTH AND ATTITUDE ON ITS SERVICES AMONGn WOMEN
2.7 HIV VULNERABILITY IN RELATIONSHIP AMONG WOMEN.
2.8 COUPLES’ SEXUAL NEGOTIATION
2.9 HIV INFECTION’S RISK PERCEPTION AMONG WOMEN
2.10 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHOD.
3.1 INTRODUCTION
3.2 RESEARCH DESIGN
3.3 RESEARCH METHOD
3.4 DATA MANAGEMENT.
3.5 EXTERNAL VALIDITY OF THE STUDY
3.6 ETHICAL CONSIDERATIONS
3.7 CONCLUSION.
CHAPTER 4 PRESENTATION AND DISCUSSION OF THE RESULTS.
4.1 INTRODUCTION .
4.2 PHASE 1: RESPONDENTS’ VULNERABILITY TO THE SPREAD OF HIV AND
AIDS
4.3 CONCLUSION
CHAPTER 5 GUIDELINE FOR GENDER SENSITIVE HIV AND AIDS PREVENTION STRATEGIES 
5.1 INTRODUCTION
5.2 GUIDELINES DEVELOPMENT PROCEDURE.
5.3 GUIDELINES FORMULATION ON GENDER SENSITIVE HIV PREVENTION
5.7 CONCLUSION
CHAPTER 6 CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS
6.1 INTRODUCTION .
6.2 PURPOSE AND OBJECTIVES OF THE STUDY..
6.4 THE STUDY WITH RESPECT TO THE THEORY .
6.5 CONCLUSION FOR EACH PHASE OF THE STUDY
6.6 RECOMMENDATIONS.
6.7 LIMITATIONS OF THE STUDY
6.8 CONCLUSION
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