By Dr. Christine Sow, President & Executive Director, Global Health Council
When HIV/AIDS was first identified in the early 1980s, it was labeled as a “gay” disease, and thus immediately linked to one aspect of sexuality. As the world learned more about it, we learned that it was not limited to men who have sex with men, but rather was sexually transmitted and could affect women as well. And it did. As a consequence of sexual transmission, women have borne the most significant burden of the HIV pandemic resulting in the disproportionate infection of women compared to men; as well as having drastic effects on women’s reproductive choices and outcomes because of mother-to-child transmission of the virus.
Fast forward thirty-odd years to 2014 and the height of the Ebola outbreak in West Africa. What we knew at that time was that Ebola is spread by contact with bodily fluids, but what we were still to learn is that Ebola can also be sexually transmitted. While only one case of sexual transmission has been confirmed, the consequences of this type of transmission are huge both in terms of the possibility of additional Ebola transmission, but also in terms of sexual behavior and reproductive choices that women and their partners will need to make to ensure their safety. WHO’s “Interim Advice on the Sexual Transmission of the Ebola Virus Disease,”[i] issued in January 2016, calls for couples counseling, use of condoms, and twelve months of regular semen testing for male survivors of Ebola. The practicalities and feasibility of putting this advice into practice in an Ebola-ravaged community are not addressed by this advice document, and are presumably left to the health system and individuals to figure out.
And now, as Ebola fades into the background of public consciousness, we are faced with the rapidly spreading Zika epidemic. The gravity of the Zika crisis was initially identified with the appearance in Brazil of an unexpectedly high number of babies born with microcephaly to women who had been infected with Zika during pregnancy. Immediately the sexual and reproductive health implications of the disease started to become clear – women were warned to postpone pregnancy; pregnancy termination was also offered as a theoretical option for fetuses identified with microcephaly. However these options pre-suppose availability of and access to reproductive health services and commodities – i.e. modern contraceptives and safe abortion. The reaction of the Catholic Church starkly underlines the political, practical, and ethical chaos surrounding the development of an appropriate response to the Zika pandemic. And, to make matters more complicated, sexual transmission of Zika has now been identified.
The upshot is this: while we fear infectious disease for its rapid spread, debilitating illness, and possible mortality, the real impact of a pandemic can be wider and more devastating than its immediately visible trajectory appears. The world’s women, most of whom have inadequate access to reproductive health, often pay a higher price and bear a heavier burden when pandemics occur; at the same time, policy makers and cultural leaders are slow to respond. The striking examples of HIV/AIDS, Ebola, and Zika must be heeded and used as the basis for strong and appropriate strategies that ensure women’s sexual and reproductive health, even, and especially, in times of widespread health crisis.
[i] This area of concern is so new it receives only “advice” rather than “guidance”!