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Gender Inequality and HIV in South Africa: Learning From Dr. Wendee Wechsberg of RTI's Global Gender Center

May 23, 2016

My blog entry this month is a little different from my usual writings. I had the opportunity to interview one of the world's leading researchers in gender inequality who specializes in HIV and AIDS. On April 12, 2016, RTI International, a renowned research institute focused on improving the human condition by turning knowledge into solutions, hosted a two-day global gender conference featuring world-renowned researchers, policy-makers, gender experts and survivors sharing their research and developing a plan of action to implement their proven solutions.

HIV rates for women have increased exponentially over the past twenty years. Women now represent half of HIV-positive people globally. Social justice issues, such as intimate partner violence and stigma, can increase the likelihood of HIV transmission. This pandemic requires proven strategies to stop the spread of the virus, treat drug abuse, protect and empower victims of violence, and bring the global community together to commit and implement evidence-based solutions to end gender inequality and reduce transmission of HIV/AIDS in order to save women's lives. The RTI conference, led by Dr. Wendee Wechsberg of RTI's Global Gender Center, focused on "Ending Gender Inequalities While Addressing the Nexus of HIV, Drug Abuse and Violence With Evidence Based Action."

Several main points emerged from the conference, which focused on increasing economic opportunities for women within those communities hardest hit by HIV. Participants acknowledged that the poorest women are often the most at risk for infection and that HIV-positive females often face increased stigma and have an exponentially harder time finding and keeping gainful employment. Dr. Wechsberg's presentation on the nexus of HIV, drug abuse and gender-based violence was developed through her own personal story of dealing with substance abuse and her experiences collecting information, analyzing research and working directly with infected populations of women, primarily in Cape Town and Pretoria, South Africa.

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Through my conversations with Dr. Wechsberg, I became impressed by her research and intervention efforts in Cape Town. While serving at-risk women since the early 2000s, she has developed a system for teaching the women to help themselves and thereby help their families.

As females, we all share a common bond as caregivers. This is not unique to South Africans. I see this in every HIV chat room or message board I frequent. Women more often than not are caring for others -- men, children, elders and extended family -- often at the cost of their own health, both physical and mental. The intervention with Dr. Wechsberg begins at the clinic level. While the rest of the modern world may be having success in getting women into and maintaining them in treatment and bringing down their viral loads, thereby reducing their ability to transmit the virus and increasing their likelihood of living longer, healthier lives, in Africa it is a major struggle to achieve the same success.

According to Dr. Wechsberg, issues that affect adherence to antiretroviral medication in South Africa include the fact that clinics are often very far away from the villages where these women live, making transportation difficult and at times even unsafe. Her studies and interventions have shown that South African women deal with both alcohol and drug abuse, which is a fact I did not know and I'm not certain that most of my readers would know. We never hear stories like that in the mainstream media. We hear stories of heterosexual transmission, but we rarely hear about the ancillary issues that complicate those transmissions. Dr. Wechsberg found that when women feel healthy, they have a natural resistance to want NOT to take their antiretroviral medication. The side effects can make them feel sick and unable to care for others, so many will choose simply not to take the medicine. She also noted that structural barriers exist and long lines must be waited in just to get drugs in the first place. Those who are brave enough and committed enough to travel to the clinic for care are often shunned, ostracized and stigmatized in their own villages and communities.

Based on Dr. Wechsberg's work with the Women's Health Co-op (a program designed to address the intersection of alcohol, drug use and violence in order to reduce HIV) the issue of drug and alcohol abuse is very real and becoming more and more prevalent in South Africa. In the Western Cape, fetal alcohol syndrome is a growing concern for children. Alcohol abuse can be directly linked to generations of farming with alcohol as payment. However, Dr. Wechsberg has found that things have progressed to more dangerous addictive substances such as marijuana, and marijuana laced with heroin and methamphetamine. Her findings indicate the drugs allow men to feel an increased sense of power over the women, and the women to feel an increased sense of complacency. Men refuse to use condoms for protection and to stop the spread of disease. Drugs such as methamphetamine are supplied to enhance the effects of group-organized gang rapes. Some men will even have sex with babies and young children, often believing a myth that that it will cure them of the dreaded HIV disease. When looking for a current epicenter of HIV and gender-based violence, one need look no further than South Africa in 2016.

The conference itself was an opportunity for researchers, policy makers, future researchers, gender interventionists, LGBT activists, advocates for incarcerated populations, and students to come together to share resources and ideas. The goal is to take these shared interventions, ideas and resources and scale them up to reach the larger population: to bring all the right people to the table, do the research, bring in the interventions, train the caregivers to stay and be helpful, and use applied research in order to make an impact. That is truly the goal moving forward.

At the conference, there were populations that have been underrepresented in both research and in person, including primarily refugee women. This was an action conference with goals set for immediate networking, collaborating and forging instant new connections.

Throughout my interview, Dr. Wechsberg's passion, knowledge and excitement were palpable. She could sense that real change was in the air and I could sense that she could be one of the ones to bring about that change for the better. The proceedings from the conference were pushed out via note takers to policymakers on the spot. Details and ideas for a follow-up conference are in the works. Plenaries and testimonials by the women involved and affected were streamed live and can still be accessed.

As a woman living with -- not dying -- from this disease, I want to reach out to help my global sisters in need. I want to help move them through the years of education and treatment and advancement that we have been afforded so that they may catch up and their death tolls may cease and their families may survive for generations to come. When hearing the very sad and harrowing issues of violence, poverty and drug abuse, I can only pray that the right interventions can get into their communities in time to spare many, many more lives and save the hearts and souls of both the men and women living through such troubling times.

I hope that through international strategies of prevention, education and applied research we can lessen the burden of antiretroviral treatment for African populations and others around the world. Since we still do not have a functional cure ready for the masses, we must continue to do more. AIDS is not over. No one should die in vain. No more lives need to be lost due to violence, stigma, inequality, poverty, lack of education or lack of access to care and treatment.

As women, we must do better. As women, we must help our men to love us better, stronger, more deeply and more purposefully. Lives depend upon it.

I, for one, am glad that Dr. Wechsberg has taken up this nexus as her cross to bear, as she seems to have the knowledge, personality, interest and energy to affect mass change. She appears to be the real deal and just what the doctor ordered.

Until next time ...

Lynda

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Lynda Arnold

Lynda Arnold

Lynda Arnold, RN, BSN, MBA, was one of the first health care workers to go public after her occupational infection with HIV by an accidental needlestick in 1992. She successfully launched a nationwide campaign for safer needles in hospitals and medical facilities which resulted in the passage of federal legislation mandating the use of such devices in facilities nationwide to protect all health care workers from accidents such as hers. For many years she was a sought-after speaker on living with HIV/AIDS as well as health care worker safety issues, and she traveled the globe educating others. She garnered many awards, national distinctions, authored two children's books, and was the subject of an award-winning documentary. After the birth of her youngest son, Lynda chose to step away from the public eye and focus on raising her young family without the spotlight. As a blogger for TheBody.com, this marks her reentry into the public eye -- 20 years after her infection. She can be reached for further engagements, commentary and questions through her email.


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