HIV in Cuba:
Prevention of Mother-to-Child Transmission
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Vertical Transmission in Cuba

Gender, Vulnerability and their Relation to HIV/AIDS

The following is a chapter excerpted from Manual para Promotoras de Salud (Manual for Health Promoters), published by Cuba’s National Center for Prevention of STIs and HIV/AIDS. It is used in the Center’s training course for HIV/AIDS prevention workers as part of the Women’s AIDS Prevention Project, launched in 2000.

Gender, Vulnerability and their Relation to HIV/AIDS

To understand our role as women in confronting this pandemic, the difference between gender and sex must be established.

Gender is a social science category enabling us to see that discrimination against women is the result of social constructions, not biology.  Rather, society emits value judgments that assign particular roles and relationships to women and men.

Historically, these relationships have been presented so that whatever is masculine is considered to be superior and  whatever is feminine, subordinate. Traditionally, this is how discrimination against women has been structured.

This position of inferiority is presented as natural, restricting women’s main role to the rearing and education of children and caring for the home, family and the elderly.

Even in our own society, where a strategy to facilitate women’s full integration into economic, political, cultural and social life on the basis of equal rights and opportunities has been in place for 45 years, many of these concepts still survive and are manifested to some degree. Because the weight of tradition is so strong, sometimes these ideas are disguised and not entirely clear. And women’s traditional roles coexist with new attitudes.

Thus, the concept of gender is integral in helping us to understand that men and women have been educated in different ways to play certain roles in society and that different value judgments are applied to judging women and men in similar situations. As we carry out our work, then, this enables us to better understand specific situations in which women find themselves, and better prepares us to design plans of action that will help bring about change.

In short, gender refers to the socio-historical and cultural conditioning that assigns men and women certain roles they are expected to play.

This conditioning implies learning certain behavioral norms that inform people what is obligatory, prohibited and permitted; norms that are of course, different for men and women.  Economic inequalities, ethnicity, inclusion of women in the labor market, age and formal education are factors to be considered when pursuing a gender analysis: women are diverse and varied, not a single category.

Sex is defined as the group of characteristics describing the genital organs and their function that differentiate individuals of the same species. In humans, this refers to men and women, who exhibit these characteristics through various biological definitions of sex.  Thus, the chromosome pair defining female is XX, while XY defines male; estrogen is the female sex hormone and testosterone the male sex hormone.

Gonadal sex in woman is represented by the ovaries and in men, by the testicles. Lastly, genital sex in women is represented by the vagina and in men, by the penis. In addition, psychological sex - considering sexual orientation and sexual identity - is key to a person’s integral development.

It is safe to say then that biological sex determines certain roles in the reproduction of the human species. But there is also social sex - gender - that relies on these biological differences to structure inequalities, which are then presented as natural.

In biological terms, motherhood includes pregnancy, delivery and breastfeeding. However, bathing, caring for and teaching a baby are not natural activities, but rather activities socially assigned to women. Men’s arms are biologically the same as women’s for cradling, changing diapers and playing with a newborn.

Thus, it is important that biological differences not be used as a pretext for discrimination or establishing subordinate relationships.

It is essential to consider the particular vulnerability of women to HIV/AIDS infection, taking into consideration not only their biological condition, but also their social condition and relationships, particularly with reference to men.

Women’s Vulnerability to HIV/AIDS

Women are particularly vulnerable to sexually transmitted infections due to biological and social factors.

Biological Factors:

-    Semen contains more HIV than vaginal fluids.

Because HIV requires live cells for transmission, and since semen has a higher cell content than vaginal fluids, it is more infectious.

-    Semen remains in the vaginal and rectal tracts for longer than vaginal fluids on the penis.
Thus, in unprotected heterosexual relations, women are exposed to HIV for a longer period.

-    In adolescent and post-menopausal women, the vaginal mucous is more permeable to HIV.

This is because the vaginal mucous of adolescents has not acquired sufficient maturity and thickness to act as an effective barrier, while in postmenopausal women it once again becomes thinner and weaker.

-    Tearing and hemorrhaging during sexual relations.

The risks of HIV infection are multiplied for women for various reasons: traumatic coitus, rape, menstruation or microscopic fissures. Women everywhere run the same risks with unprotected anal sex, which is sometimes preferred since it preserves virginity and avoids pregnancy.

-    Women are asymptomatic for many STIs.

Between one half and four fifths of STIs in women go unnoticed since there are no lesions or other signs; these are also hard to see due to the internal configuration of their genital system.

Social Factors

-    Machismo reduces women’s knowledge of and control over their bodies and their sexual and economic life.

Machista conceptions still present in our society assign women the responsibility for family planning and use of contraceptives.  In sexual life, they also confer on men an active role, relegating women to a passive one.

-    Lack of communication between partners about sexuality.

There is a culture of limited communication about sexuality between partners.  In addition, some women simply assume their husbands are faithful, while others do not know their husband’s sexual habits or feel inhibited raising the subject.

-    Male resistance to condom use.

This happens more frequently in men’s stable sexual relationships (to control the sexuality and faithfulness of his partner), since condom use is associated with casual or occasional sex. Another factor is the machista idea that “manhood” is associated with risk taking, if one is to be “a real man.”  On the other hand, sometimes women refuse to use condoms, associating them with casual sex or prostitution.

-    Subordination of women.

Some women, although they may be aware of their vulnerability, are not sufficiently empowered in their interpersonal relationship to negotiate with their partner. They are afraid of losing the relationship, losing economic support, or of provoking violence.

-    Sexist education.

Girls and boys are educated differently, assigning them stereotypical roles that will shape the way they manifest their sexuality throughout their lives, and influencing their interpersonal and couple relationships as well as their social and professional development.

-    Teen pregnancy.

Teen pregnancy increases the risk of contracting HIV, since there is more biological and social vulnerability associated with it (dropping out of school, single motherhood and economic dependence, among other factors).

-    Another aspect of vulnerability is violence.

Violence against women is a serious global problem which has been kept hidden for many, many years. Women victims of violence are found among all races the world over, both in developed and developing countries, in lay and religious societies, in well-to-do and in poor communities alike.

Family and domestic violence in Cuba - particularly violence against women - is manifested in different ways, not only in physical abuse, which is the most widely known expression, but also in psychological abuse. Frequently a couple’s problems and crises are solved by violence on both sides, with shouting and occasionally, mutual blows.

Challenging and changing stereotypes and prejudices is a complex process as Cuban women are well aware.  But we also know such change is possible if there is sufficient political will to promote women’s participation and development on both the social and personal levels and to redefine the meaning of masculinity and femininity. This process, which has shown advances, backsliding and contradictions, is taking place in the midst of the contradiction between old and new ways of thinking. This is why we still find instances of individual and social discrimination in our own society.

This is the reason for the Federation of Cuban Women’s particular work, in close collaboration with governmental agencies and non-governmental organizations, as well as other social actors. One result is a pamphlet like this one used as a guide for HIV/AIDS prevention work, providing knowledge about the specific conditions of women in Cuba as we face the international pandemic.

This is particularly important since up to now, international literature concerning women and AIDS has been inclined to focus on prostitution, reducing discussion to HIV testing for “sex workers” and considering their clients  “victims.”

A broader approach to prevention is based on working with men or women in their social contexts, taking into account that they have been educated differently, and pursue and assume sexuality in a different manner. In the case of women, it is oftentimes necessary to start from prejudices that subordinate them and increase their vulnerability to HIV/AIDS.

Learning about sexuality in general and HIV/AIDS in particular, places women in a better position to protect themselves, to help other women and the community, and to establish safe and responsible sexual relations.

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