From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Friday 24 July - part 4
Note: non-commercial reproduction.
Archive-Number: 5787
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 26 Jul 92 17:17:04 GMT

(article continued from part 3)
 
The financial dependence of women on men is especially 
entrenched in the developing world. According to Professor 
Maxine Ankrah of Makerere Univerity in Kampala, Uganda, "In 
Africa, the worsening market situation depresses opportunities for 
women's advancement in competition with men over scarce jobs. 
"Thus, the use of sex to generate income places increasing numbers 
of young women at risk of HIV infection and transmission."
Sexual abuse
It would be a mistake, however, to see this as a problem unique to 
developing countries; while the mechanisms may be less overt, 
power and gender are also linked in developed countries.
In a study of 60 HIV-infected adolescents in New York City, Dr 
Donna Futterman, of Montefiore Medical Center, found that 52% of 
females report sexual abuse and over 65% of females engage in 
what she calls "survival sex": sex for money, drugs, food, shelter."
Dr Sunanda Ray, from Zimbabwe, says: "Physical abuse of women is 
universal. Where men feel powerless, they take it out by bashing 
their wives: in Europe, Asia, Africa, America. Violence comes 
through as a result of frustration."
Vulnerable
Women are vulnerable even during consensual sex. Condoms 
require the cooperation of the male partner - something which may 
be difficult at the best of times - and simply an unrealistic demand 
for many women to make. 
According to Berer: "In both developed and developing countries, 
women who suggest their men use condoms have been beaten, 
threatened with violence, ignored and walked out on."
Men may have most of the power in most of the world, but in all 
countries women are refusing to be victims. 
The seropositive women of GIS-SIDA in Mexico have spent a year 
documenting the discrimination they face. Araceli Marquez of GIS-
SIDA says: "The most important result is the recovery of our self-
esteem as women living with HIV or AIDS."
FIDA, an association of women lawyers in Uganda, has developed 
legal protection for women who refuse unsafe sex with their 
husbands. Such women now have the right to remain in their 
homes and maintain economic independence.
Indirect
Large numbers of women throughout the world are organising 
themselves. The ways in which they address the AIDS crisis may 
seem indirect when compared to projects by gay men. But men 
who have sex with men grow up with a     man's understanding and    
expectation of his sexual power. Empowering men to negotiate 
safer sex with each other is teaching a skill. For women, the 
foundation for learning this skill is rarely in place.

*********************************************************
The female condom leads the way to new ideas
by Robin Gorna

I first read about "female condoms" in the Star Market Check-Out 
line. If they're so popular in American supermarket magazines, why 
are they so new to international AIDS conferences?
This year's session on Intravaginal STD/HIV Prevention-Technology 
Controllable by Women must be an international scientific first. 
While hardly the snappiest title, the issue of female control in sex 
demands the spotlight male condoms have always attracted. 
While many applaud the efforts to develop products for use by 
women, some worry that methods controlled by women let men 
"off the hook". Malcolm Potts, president of International Family 
Health says: "We live in a real world with an enormous amount of 
poverty and exploitation, so we need to give people anything that 
reduces the risk of this disease." 
The female condom is another name for the vaginal pouch. This 
mammalian-sounding device gets mixed notices. There is clearly a 
lot of curiosity about it. Within two weeks, 25,000 had disappeared 
from the shelves of pharmacies in Switzerland. 
Of the women who have tried the female condom, a good 
percentage liked it. They reported that men liked it even more. 
Those consumers who object raise both technical and aesthetic 
problems. 
Foreplay
One consumer, Candy, says: "I didn't like it. You have to think very 
clearly, like with a diaphragm, and fit it beforehand. For men it's 
more like 'the real thing' and less restraining, but it interferes with 
foreplay significantly." 
Aural and oral constraints loomed large: Candy found that the sound 
of trapped air during intercourse was anything but erotic. Oral sex 
was out of the question as the clitoris was hidden by the outer ring 
(which fits over the labia, and is supposed to hold the device in 
place). However, some women have found that the outer ring 
stimulates their clitoris more.
Some women inserted the pouch in anticipation of penetrative sex, 
but found they were not very comfortable to wear.
Fitting them during sex was intrusive and time-consuming. But 
both Patrick Friel of the Global Programme on AIDS at WHO, Cheryl 
Overs, coordinator of the Network of Sex Work Related HIV/AIDS 
projects, are enthusiastic about the possibilities: "If you don't use it 
as they tell you to, it's great - and it doesn't fart." Their theory and 
practice is to remove the inner ring (which holds it around the 
cervix when inserted first into the vagina) and use it as a male 
condom. Friel says this method should also be studied for anal sex. 
Negotiation 
The pouch may not be suitable for use with multiple partners 
because of the risk of cross-infection from one client to the next. 
And it is expensive. But even if the problem of cost can be 
overcome, this "woman-controlled device" still fails to avoid the 
problem of dealing with men. Negotiation remains important to 
make sure the penis is inserted into the pouch, rather than 
between the latex and the vaginal wall.
However, as Dr Anke Erhardt, director of the HIV project at 
Columbia University in New York, emphasises, no one is putting the 
pouch forward as the complete answer: "Even if the 'female 
condom' is only liked by 20%, it's important that we get methods 
that women can use and we can always improve it."
Creativity
The debate is moving beyond a simple acceptance that the 
traditional male condom is the solution to AIDS. As the approaches 
to using the female condom suggest, creativity is essential: new 
research and products must address the complaints men have 
already voiced about condoms, developing new shapes and sizes, as 
well as treating condoms as sex toys, not merely protection 
devices. And, of course, there must be more and various ways for 
women to have control over the means to protect themselves from 
infection.
The message from consumers is clear: a diversity of products is 
essential. But there remains a major impediment, as Erhardt says: 
"There's an incredible paucity of research in this area. ...women 
know what we're talking about. But the men don't see the urgent 
need, so the money goes to persuading women to persuade their 
partners to use condoms."
*********************************************************
Worldwide activism against AIDS wears many faces.  In the US, 
activists both sit on a planning committee for government clinical 
trials and carry on "small, dramatic guerilla-based actions" to get a 
drug manufacturer to drop prices. In Brazil, activists teach street 
children as young as eight years old about safe sex and survival. A 
Norwegian activist organises the first AIDS support group in 
Rwanda and advocates frank talk about sex in Northern countries.  
And an American brings activist pressure to bear on basic research 
in AIDS. By Phyllida Brown.
. . . .
Anthony Fauci:
Impact on trials design

Few scientists have been made familiar with activism as forcibly as 
Anthony Fauci, head of the US government's AIDS research effort at 
the National Institute of Allergy and Infectious Diseases (NIAID) in 
Bethesda, Maryland. And if others are still asking whether the 
needs of activism and research can ever be balanced, he has no 
doubt that they can. "We've really come a long way," he says. 
Looking back at a decade of AIDS, the biggest changes brought by 
activists are clearly in the area of clinical trials, says Fauci. Views 
that were once heard only across barricades are now heard 
officially. "Informed activists are now key participants in deciding 
not only the design, but also the kinds of clinical trials that should 
be done," he says.
Activists are represented on the executive committee of NIAID's 
AIDS Clinical Trials Group. Other institutions, such as the Food and 
Drug Administration, have also responded with initiatives such as 
the accelerated approvals process for drugs.
Both activists and scientists acknowledge that they have moved 
from what may have seemed extreme original positions. "There is a 
window of flexibility where you can make trials more user-friendly, 
without necessarily comprising their scientific integrity," says 
Fauci. He now sees the focus of activism moving away from the 
design of trials to other areas, such as greater awareness of 
minority needs in clinical research. Thanks to the initial work of 
gay men in making researchers sensitive to their patients' social 
needs, there is now more attention for the ethnic minorities and 
inner-city poor who are increasingly affected by HIV and AIDS in 
the US. For example, says Fauci, researchers are now more likely to 
provide transport, child care and food to single mothers with low 
incomes, to enable them to participate in research. NIAID provides 
extra funding to AIDS Clinical Trials units to assist them in 
recruiting women and minorities. The result is a better and more 
representative study. "
. . . .
Ana Filgueiras:
Children in a harsh school

A T-shirt worn by some of the street children in Rio illustrates one 
of their favourite ideas for safer sex. It shows a group of boys having 
a masturbation competition to see who can come first. The T-shirt, 
conceived by the children, then professionally designed and 
distributed to them free, is just one of the tools developed by Ana 
Filgueiras and her group to help empower street children in Rio 
against AIDS. Founded in 1987, the Brazilian Centre for the 
Defence of the Rights of Children and Adolescents has pioneered a 
different sort of activism. 
The centre's twelve staff work on a budget of just US$20,000 a 
year, none of it from the Brazilian government. There are some          
7 million abandoned children and adolescents in Brazil, most of 
them in Rio. Filgueiras, a former journalist and educationalist who 
has lived in Portugal and the US, sees AIDS activism as an integral 
part of the overall struggle against poverty. In order to survive, 
children and teenagers on the streets learn to be sexually active as 
young as eight. Male and female prostitution is widespread, but 
children also have sex with each other for comfort, says Filgueiras. 
No one knows how many are already infected with HIV.
The centre's staff do outreach work on the streets, distributing 
condoms, talking with the children and playing board games that 
teach them how to avoid risky sex. They also visit clinics with 
children. As a result of the centre's campaigns, some of the city's 
medical services for adults have been persuaded to treat the 
children and adapt advice and treatment to their needs. For 
example, says Filgueiras, "It is no good a doctor telling a child with 
an infection [such as scabies] to go home and boil the sheets on his 
bed when he lives on the streets without even a mattress." 
But such work can help only a few people. So the centre also 
lobbies government and puts pressure on the public health system 
to provide dedicated clinics, prenatal care and free condoms to 
street youth. "And we try to press for more flexible legislation so 
that kids can exercise their legal rights." 
. . . .
Calle Almedal:
Action in the South

Calle Almedal, a former nurse now based with the Norwegian Red 
Cross, is angry. In the North, commitment and funding for AIDS are 
slipping at a time when they are needed more than ever. "Those 
who grant the money don't understand that as long as Africa and 
Asia have this problem, we all have the problem." 
Almedal has seen AIDS activism in many forms. As a gay man he 
became involved in the campaigns in New York in the early 1980s. 
He has also worked with intravenous drug users and now, with the 
Norwegian Red Cross, is helping to form and support a group of 
people with AIDS in Rwanda. The group, called Miroir HIV, began 
only last January in Kigali, the capital. The concept of an interest 
group is "totally new" here, says Almedal. At the first meeting, 
there were 10 people. At the second, 30 came and at the third, 60. 
"Grassroots activism in the South is definitely coming," he says.
With such an unusually broad experience of activism, what does 
Almedal think is its most important task? "To get people to talk 
about sex. We've got to stop talking about condoms, about viruses, 
about everything except sex." The struggle against HIV will go 
nowhere, he believes, unless people feel in control of their 
sexuality. After a decade of AIDS, where does Almedal think 
activism is going? He feels that seasoned activists should 
sometimes step down and let others come in. Also, he fears, there 
is a danger that a few may become too close to the official 
structures that they have sought to challenge. He says activism will 
always need people on the street, people to build bridges and, 
crucially too, the "allies inside" the system. "There are many people 
who don't identify themselves as activists, but who feed back 
extremely important information. We need all three groups."
. . . .

(article continues in part 5)
-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids