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HEALTH-CUBA: Empowering Women to Insist on Safe Sex


HAVANA, Aug 3 (IPS) - Only a revolution similar to the one women led 40 years ago in search of gender equality could curb the spread of AIDS in Cuba and uproot the widespread resistance to the use of condoms, say local AIDS prevention workers.

The process in which women began to achieve equal opportunities in education and work after Fidel Castro came to power in 1959, and to forge a space for themselves in this socialist Caribbean island nation, was seen as "a revolution within a revolution."

Something similar is needed now, but with respect to sexuality, Mar�a Julia Fern�ndez, 48, who has lived with the AIDS-causing human immunodeficiency virus (HIV) for 15 years, told IPS.

"Women have to learn to say `no'," said Fern�ndez, who has dedicated most of her time for more than a decade to AIDS prevention and helping people living with HIV.

Thanks to their strong social standing and broad access to education, Cuban women have the power to make their own decisions, if they would just decide to do so, she said. However, they remain slaves to tradition, and do not demand the use of condoms, for fear of offending their partners, she lamented.

In Cuba, women make up 43 percent of the workforce, hold nearly 67 percent of all technical jobs, and comprise 51 percent of the total number of scientific researchers and more than 60 percent of university students.

Cuban women are in an advantageous position with respect to their counterparts in other developing countries, because not only is female illiteracy a thing of the past, but the "feminisation" of the universities has been talked about here for years.

Although the severe economic crisis suffered by Cuba throughout the 1990s tipped part of the population into poverty, access to education and health care remains free of charge and working conditions for men and women are still equal.

But despite these hard-preserved social gains, studies show that only around five percent of people in Cuba use condoms for safe sex. In a survey published by the National Office on Statistics last year, a majority of female respondents who admitted to engaging in casual sex in the previous 12 months said their partners did not use condoms.

The study found that the women knew about AIDS and how to prevent it, but nevertheless felt sure that they would not contract HIV. The main reasons given for not using condoms were that the women trusted their partners, or that they or their partners did not like using condoms, or had never used one.

To the question of how they "protected" themselves, many women mentioned other contraceptive methods like the pill or the IUD, indicating that their concept of "protection" was limited to the need to prevent an unwanted pregnancy.

Women are still a minority of HIV-carriers in this country of 11 million, but the public health system has registered a disturbing rise in the number of infected women in recent years.

The increase in the number of women who have turned to prostitution has also opened a door to AIDS and other sexually transmitted diseases.

Studies show that prostitutes also fear offending their clients by demanding the use of condoms, while their customers, usually foreign tourists, have an excessively rosy view of Cuba's health statistics, and feel that they are in a place where it's safe not to use condoms.

According to official statistics, 3,485 cases of HIV had been reported in Cuba by late May, 1,254 of whom had developed full- blown AIDS and 887 of whom had died, 54 of them due to unrelated causes.

The reports indicate that 2,701 of the patients were men and 784 women. Homosexuals remain the highest risk group, accounting for 82.7 percent of all male HIV-carriers and 64.2 percent of all people infected with the disease.

Fern�ndez told IPS that many women were infected by their husbands, who had extramarital relationships with other men. She said Cuban women were too used to simply waiting for their partners, and accepting whatever they were told. "The challenge is not to refuse to have sex, but to learn to live with the virus, to say 'stop', and to use condoms," she underlined.

With that message, Fern�ndez is participating in a project carried out by the Ministry of Public Health's Centre for Prevention of Sexually Transmitted Diseases and AIDS, in conjunction with the Federation of Cuban Women (FMC).

The FMC, the only legally recognised women's organisation in Cuba, opened up its nationwide chain of Centres for Orientation for Women and the Family to the project, for the training of community educators who carry out consciousness-raising and prevention work among women.

Joel Iglesias, an HIV-carrier and health promoter, said "a man carrying HIV is likely to infect more people throughout his life than a female carrier.

"Sex between men jeopardises men as well as women. Studies carried out in various parts of the world indicate that up to one- sixth of the male population engages in same-sex relations, which are generally kept secret," said Iglesias.

Women are also more vulnerable than men due to biological and physical reasons.

During heterosexual intercourse, a large surface area of vaginal mucous membranes is exposed to semen, which contains a higher concentration of the AIDS virus than do vaginal secretions. In addition, semen stays in the vagina much longer than vaginal secretions remain on the penis.

The risk is even higher among girls and teenagers, because the immaturity of their genitals reduces the ability of the mucous membranes to act as a barrier against pathogens.

Statistics from the joint United Nations Programme on HIV/AIDS reveal that nearly 52 percent of the people who died of AIDS last year were women. The UN agency also reported that more than nine million people have died of AIDS throughout the world since data on the disease first began to be collected.

Women make up 47 percent - or nearly 17 million people - of all HIV-carriers worldwide, compared to 25 percent in Latin America and 35 percent in the Caribbean.

"We are trying to get women to stop being passive. We want them to be able to take care of their health, to empower themselves, to demand that their partners use condoms," said Fern�ndez.

The woman known as La Paloma (The Dove) among her fellow AIDS prevention workers speaks from experience. She was a virgin at the time of marriage, and remained faithful to her husband - even after he died of AIDS.

She was the fifth woman diagnosed with HIV in Cuba, and the first to join a prevention group. "AIDS changed my life," she says, contrasting the fearful woman full of prejudices that she once was with the person who does not now hesitate to tell a full entire auditorium that she is HIV-positive.


Copyright © 2001 -Inter Press Service, Publisher. All rights reserved to Inter Press Service. Reproduced with permission.Reproduction of this article (other than one copy for personal reference) must be cleared through the Inter Press Service, IPS-ONLINE, World Desk via Panisperna 207 00184 Rome, Italy. Email IPS visit Inter Press Service.

Information in this article was accurate in August 3, 2001. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.