526686 research-article2014
APHXXX10.1177/1010539514526686Asia-Pacific Journal of Public HealthLow and Wong
Editorial
Sexual and Reproductive Health and Rights, HIV/AIDS, and Public Health
Asia-Pacific Journal of Public Health 2014, Vol. 26(2) 116–117 © 2014 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539514526686 aph.sagepub.com
Wah-Yun Low, PhD1, and Yut-Lin Wong, DrPH, MPH1
Since the 1994 International Conference on Population and Development, sexual and reproductive health and rights have received increased attention. Improving sexual and reproductive health is essential in meeting health goals of nations, including the United Nations Millennium Development Goals (MDGs). There has also been a strong emphasis on integrating sexual and reproductive health and HIV information and services. Policy makers, program managers, advocates, and people living with HIV now emphasize sexual and reproductive health– and HIV–related programs and planning. In 2007, a Global Consultation on Sexual and Reproductive Health and Rights of People Living with HIV in Amsterdam focused on research, policy analysis, advocacy, and education, with a better understanding of sexual and reproductive rights of people living with HIV and also creating a supportive health system. Men having sex with men, intravenous drug users, sex workers and their clients are among the most at-risk for contracting HIV. Gender norms related to masculinity, for example homophobia, the subsequent stigmatization and discrimination, compound barriers to health care for people living with HIV who have diverse sexual orientations. Globally, there is a rapid feminization of the HIV and AIDS epidemic due to both sex/biology and unequal gender relations.1 Women, relatively, are at greater risk of acquiring HIV after unprotected sex with infected partners than men because of greater efficiency of male-to-female transmission. Women’s primary risk factor for HIV infection is their inability to control when and whether to be sexually active. Often, gender inequalities underlie such forced and unsafe sex, which has been responsible for a large extent of the HIV epidemic. Female sex workers suffer from a high HIV burden and are one of the core populations for HIV transmission. An estimated 15% of HIV prevalence in the general female adult population is attributable to (unsafe) female sex work.2 Sex workers are highly vulnerable to HIV infection as they often experience forced and unprotected sex. In addition, stigma, discrimination, and poverty further exacerbate sex workers’ vulnerability to HIV. Such activities occur mainly because of the lack of education and economic security. Thus, programs emphasizing male responsibility toward safer sex and condom usage and empowering women with negotiation and life skills training are urgently needed. Easy and affordable access to sexual and reproductive health information and services and access to HIV prevention, treatment, and care is warranted. HIV planning and program need to address the underlying gender inequalities3 and further promote gender equality.
1University
of Malaya, Kuala Lumpur, Malaysia
Corresponding Author: Wah-Yun Low, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Email: [email protected]
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on June 9, 2015
117
Low and Wong
Violence against women (VAW) is a significant public health issue and has consequences on women’s physical, mental and sexual and reproductive health. Evidence-based studies have shown that VAW increases women’s vulnerability to HIV. HIV can also be a risk factor for violence, since disclosure can put some women at risk of violence by their partners, family or community members. Overall, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or nonpartner sexual violence. One third of all women who have been in a relationship have experienced VAW.4 Women who have been physically or sexually abused by their partners report higher rates of health problems; they are 16% more likely to have low-birth-weight babies, twice as likely to have an abortion and depression.4 Social and cultural norms related to gender inequalities need to be addressed. Urgent action is needed in providing necessary services for women experiencing violence, and integrating such actions into HIV services. Harmful gender norms, stereotypes, gender inequality as well as violence against women need to be factored into HIV and AIDS programs. There has been much debate on the issue of integrating sexual and reproductive health and rights and HIV in our region and the debate is still going on. Public health issues related to sexual and reproductive health and rights and HIV/AIDS demand a multisectoral effort from all stakeholders plus the population at large in order for us to address this issue and to be able to fully achieve the United Nations MDGs5 and health goals. References 1. Krieger N. Genders, sexes, and health: what are the connections—and why does it matter? Int J Epidemiol. 2003;32:652-657. 2. Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV due to female sex work: regional and global estimates. PLOS One. 2013:8(5):e63476. 3. World Health Organization. Violence Against Sex Workers and HIV Prevention. Information Bulletin Series. Geneva, Switzerland: World Health Organization; 2005. 4. World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council. Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-partner Sexual Violence. Geneva, Switzerland: World Health Organization; 2013. 5. Sadik N. Sexual and reproductive health and rights: the next 20 years. Keynote address. ICPD beyond 2014: International Conference on Human Rights, 7-10 July 2013, Netherlands. Reprod Health Matters. 2013;21(42):13-17.
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on June 9, 2015
APHXXX10.1177/1010539514526686Asia-Pacific Journal of Public HealthLow and Wong
Editorial
Sexual and Reproductive Health and Rights, HIV/AIDS, and Public Health
Asia-Pacific Journal of Public Health 2014, Vol. 26(2) 116–117 © 2014 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539514526686 aph.sagepub.com
Wah-Yun Low, PhD1, and Yut-Lin Wong, DrPH, MPH1
Since the 1994 International Conference on Population and Development, sexual and reproductive health and rights have received increased attention. Improving sexual and reproductive health is essential in meeting health goals of nations, including the United Nations Millennium Development Goals (MDGs). There has also been a strong emphasis on integrating sexual and reproductive health and HIV information and services. Policy makers, program managers, advocates, and people living with HIV now emphasize sexual and reproductive health– and HIV–related programs and planning. In 2007, a Global Consultation on Sexual and Reproductive Health and Rights of People Living with HIV in Amsterdam focused on research, policy analysis, advocacy, and education, with a better understanding of sexual and reproductive rights of people living with HIV and also creating a supportive health system. Men having sex with men, intravenous drug users, sex workers and their clients are among the most at-risk for contracting HIV. Gender norms related to masculinity, for example homophobia, the subsequent stigmatization and discrimination, compound barriers to health care for people living with HIV who have diverse sexual orientations. Globally, there is a rapid feminization of the HIV and AIDS epidemic due to both sex/biology and unequal gender relations.1 Women, relatively, are at greater risk of acquiring HIV after unprotected sex with infected partners than men because of greater efficiency of male-to-female transmission. Women’s primary risk factor for HIV infection is their inability to control when and whether to be sexually active. Often, gender inequalities underlie such forced and unsafe sex, which has been responsible for a large extent of the HIV epidemic. Female sex workers suffer from a high HIV burden and are one of the core populations for HIV transmission. An estimated 15% of HIV prevalence in the general female adult population is attributable to (unsafe) female sex work.2 Sex workers are highly vulnerable to HIV infection as they often experience forced and unprotected sex. In addition, stigma, discrimination, and poverty further exacerbate sex workers’ vulnerability to HIV. Such activities occur mainly because of the lack of education and economic security. Thus, programs emphasizing male responsibility toward safer sex and condom usage and empowering women with negotiation and life skills training are urgently needed. Easy and affordable access to sexual and reproductive health information and services and access to HIV prevention, treatment, and care is warranted. HIV planning and program need to address the underlying gender inequalities3 and further promote gender equality.
1University
of Malaya, Kuala Lumpur, Malaysia
Corresponding Author: Wah-Yun Low, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Email: [email protected]
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on June 9, 2015
117
Low and Wong
Violence against women (VAW) is a significant public health issue and has consequences on women’s physical, mental and sexual and reproductive health. Evidence-based studies have shown that VAW increases women’s vulnerability to HIV. HIV can also be a risk factor for violence, since disclosure can put some women at risk of violence by their partners, family or community members. Overall, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or nonpartner sexual violence. One third of all women who have been in a relationship have experienced VAW.4 Women who have been physically or sexually abused by their partners report higher rates of health problems; they are 16% more likely to have low-birth-weight babies, twice as likely to have an abortion and depression.4 Social and cultural norms related to gender inequalities need to be addressed. Urgent action is needed in providing necessary services for women experiencing violence, and integrating such actions into HIV services. Harmful gender norms, stereotypes, gender inequality as well as violence against women need to be factored into HIV and AIDS programs. There has been much debate on the issue of integrating sexual and reproductive health and rights and HIV in our region and the debate is still going on. Public health issues related to sexual and reproductive health and rights and HIV/AIDS demand a multisectoral effort from all stakeholders plus the population at large in order for us to address this issue and to be able to fully achieve the United Nations MDGs5 and health goals. References 1. Krieger N. Genders, sexes, and health: what are the connections—and why does it matter? Int J Epidemiol. 2003;32:652-657. 2. Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV due to female sex work: regional and global estimates. PLOS One. 2013:8(5):e63476. 3. World Health Organization. Violence Against Sex Workers and HIV Prevention. Information Bulletin Series. Geneva, Switzerland: World Health Organization; 2005. 4. World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council. Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-partner Sexual Violence. Geneva, Switzerland: World Health Organization; 2013. 5. Sadik N. Sexual and reproductive health and rights: the next 20 years. Keynote address. ICPD beyond 2014: International Conference on Human Rights, 7-10 July 2013, Netherlands. Reprod Health Matters. 2013;21(42):13-17.
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on June 9, 2015
