Wednesday, February 18, 2009

I Am Woman, Hear Me Roar

Ok, so I don’t know if I’d go so far as to say I’m a feminist. Though "I Am Woman, Hear Me Roar" was definitely something my dad would tell me after a big soccer win and maybe that had something to do with my female confidence. It is true, however, that I am almost constantly aware of gender roles and the effects of gender inequality. Living in Latin America, where Machismo and Marianismo are so rooted in everyday life, it’s almost impossible to not encounter gender discrimination.

To try to give some kind of simple definition, Machismo is really a cultural phenomenon that claims that men are the strong bread winners, possessing strength in virility and exercising control over their women counterparts, among other cultural beliefs. Marianismo is the belief in the purity of the woman, that she is the weaker, submissive counterpart, and must fulfill her roles as mother and caretaker. Well, it’s easy to see where these gender roles could get carried out the extreme, and it’s usually as a result of these extreme gender-based behaviors that comes women’s vulnerability to unintended pregnancy, violence, and STI transmission.

Since these cultural norms really just fascinate me (and totally affect me living in Latin America), I decided to give the main presentation/discussion talk at the last support group meeting at our clinic in Siguatepeque. It was challenging to prepare for, but felt FANTASTIC doing research and really getting back into the academic realm I miss so much sometimes. Well, I first opened up with some ice breaker activities related to gender that everyone really enjoyed, and then got into the discussion about what is gender and what is sex? If you don’t know, don’t worry…no one else did at the session. Sex is the biological characteristics we use to define “women” from “men”…the characteristics that are permanent, biologically unique (like menstruation, vagina, penis, beard, etc). Gender on the other hand is the cultural and social characteristics we use to define “masculinity” from “femininity”…they are characteristics that are changeable, that are based on social beliefs, values, traditions, and roles and responsibilities of cultures that are always undergoing change (like activities such as cooking/cleaning, nursing, gossiping, or putting on makeup are representative of femininity because they are culturally associated with the female roles and responsibilities, whereas construction, strength, or presidential leaders are associated more with masculinity because we culturally link these roles with the male).

I then asked, “why do you think it is important to talk about gender and sex in terms of HIV/AIDS?” uhhhh, I hear d in the background. Well, in Honduras, and the majority of Latin America, Caribbean, and Sub-Saharan Africa, the most common form of transmission is unprotected heterosexual sex—so that means sex between males and females. So how can we NOT talk about men and women and our differences and similarities when it comes to a topic that is based on relationships between men and women?

So then I into the chart-making stage of the presentation, first starting with “sex” (remember: biological characteristics!) and how that affects HIV treatment and prevention of women and of men. At the root of the discussion, were the questions: How does being a women, biologically speaking, affect HIV treatment of that woman? HIV prevention for that woman? what about men, biologically, affect their form of HIV treatment or HIV prevention? While we talked about a variety of subjects, some key points that came up were that during HIV treatment, women often have lower viral loads at the beginning of their infection which can affect treatment initiation. In terms of HIV infection, women are more vulnerable because biologically the vagina has more tissues and is much more sensitive to tears which would increase susceptibility of infection. Furthermore, they have to be conscious of prevention of mother-to-child prevention through prophylaxis, breastfeeding methods, and proper disposal of sanitary napkins when they return to menstruation. Women are often detected first at pre-natal testing services, which can be good for knowing their status and getting treated, however, being diagnosed first in the relationship often “appears” as if they are the ones that passed it to the men which brings blame to her, though the males may have actually contracted it first and passed it on to the female partner. Ok, not on the male “biological” side, HIV treatment is really no different for men than for women, but in terms of HIV prevention, because they are biologically men, they have the opportunity to be circumcised which has been found to decrease the risk of HIV infection in half…!

Now the tough term: gender (remember: social and cultural characteristics). How does gender affect HIV treatment and prevention? Well, if women are culturally seen as the caretakers then they may not be able to make a doctor’s appointment because she is taking care of the kids, or perhaps she is more likely to miss the exact time she takes her pills because she was occupied with kids who aren’t always on a schedule. However, on the other side, men are culturally seen as the bread winners, so there is more pressure for them to find a job and support their families during an economically tough time…so perhaps this brings more emotional and psychological burden to males which could bring down their CD4 levels. We have seen, however, more cases of women having to play both roles of mother and father, as the all-too-common situation of males leaving wives and children for other women continues to occur, and that means that women are taking on the burden of both social and economic care of their children. Unmarried women are culturally expected to be virgins, which means they could be less likely to seek gynecological care or testing for HIV or STIs if they do become sexually active before marriage. Condoms as a form of prevention are socially seen as the responsibility of the male, so if the male doesn’t bring one or refuses to wear one, that leaves the woman without an option for self-prevention.

An interesting, yet delicate topic that arose during this gender discussion was that of violence. It was difficult, but wonderful to discuss how women and men experience violence differently. Fortunately, I had done some research on this area beforehand with the government-funded Proyecto Deborah. According to them, in Honduras, women experience about 90% of reported cases of violence and the majority of cases are physical or economic violence. Men, however, are victims mostly of verbal violence which has psychological consequences that are often not addressed and treated. Which totally makes sense. Men are victims of verbal violence over and over, and at some point, they break, and they break violently because they are the “macho” strong physical counterpart. Perhaps they are repeating violence experienced in the home when they were children, and it continues on culturally and can have consequences emotionally, physically, and perhaps very acutely in the pressures of sexual relationships and the risk of HIV/STI transmission and/or unintended pregnancy.

In the end, my presentation wasn’t a presentation. Sure, I brought out some statistics, some issues that maybe wouldn’t have been looked at, but ultimately it was a discussion that often times doesn’t happen. There were a few awkward silences at times and it was those moments that I thought I wasn’t doing well, I criticized myself, as any typical perfectionist. But afterward I asked some participants why they didn’t respond, why they didn’t speak up. One man told me, you did a fantastic job don’t worry about that…I just didn’t respond because I was thinking about what you said a lot, really thinking about it, and I didn’t think I had an answer.

That’s exactly what I had hoped for. There really isn’t an “answer,” but rather an understanding of both men and women, and their experiences, and how we can support them in a way that better comprehends and respects each.