In order, I read the Silverman review, then the Jewkes et al. article examining the effects of intimate partner violence and relationship power inequity on the risk of HIV infection in young South African women, and finally the Higgins et al. article critiquing the “vulnerability paradigm.” My reactions subsequently progressed in an interesting fashion where the cliché may ring true in that I saved the best for last.
Upon glancing at Jay Silverman’s Lancet commentary, my first reaction (outside of sheer delight that it ran for only one page) was, “Why, in the bottom/left-hand picture that accompanies this piece, is the nurse not wearing gloves whilst collecting blood for an HIV test in Soweto, South Africa?” Actual reading of the commentary left me wondering why more emphasis had not been placed on what steps could be taken directly with women if the statistics reveal that “the fastest growing sector of those infected with HIV across both Asian and African epidemics is women.” Silverman purports that, “The global HIV community must move to make targeting…male behaviors a central focus of prevention efforts…[and] consider how violence and abusive behaviour by men creates women’s vulnerability to HIV infection.” I neither deny that violence against women impacts the spread of HIV nor object to goals that work toward this fact’s reversal, but if one is to put forth (as Silverman does) women as a “vulnerable” population, the solution of implementing compensatory initiatives with men alone seems like an insufficient pathway to prevention. Men and women are obviously interdependent populations in the context of heterosexuality, and solely considering measures in men seems counterproductive to an end goal of HIV risk/acquisition reduction. The Jewkes et al. article provided a somewhat more balanced representation of potential interventions with statements such as, “There are promising interventions that seek to empower women and change ideals of masculinity.” I suppose what ultimately irked me was the irony of a proposed mechanism to address inequity being marginally inequitable itself.
I give credit to Higgins et al. for intelligently and eloquently expounding what criticisms my brain could only begin to fathom regarding this false stance that men infect women in a uni-directional transaction–that they are purveyors but not preventers of HIV infection. Initially painting women as “vulnerable” in the HIV pandemic yielded several benefits including, but not limited to, the actual recognition that women were susceptible to acquiring the virus and that heterosexual transmission warranted attention. As I read, I mentally likened the vulnerability model’s introduction to the commencement of HAART and proper case management; it initially revolutionized the field but eventually navigated to a point where it could no longer suffice. Something else had to replace or synergize with it to produce better, more equitable results. I especially appreciate the authors’ opinion that, “In moving forward, we should retain an understanding of gendered power dynamics but continue to develop a replacement model of biology, social structure, and gender relations that addresses how structural factors and social vulnerability lead to gendered expressions of HIV vulnerability for both men and women—but for different reasons and via different mechanisms.”