Placing Young Women at the Centre: Reducing Young Women’s Vulnerability to HIV in India

Executive Summary The Self-Employed Women's Association (SEWA), a trade union of close to one million women workers in India's informal economy, organises poor women to attain self-reliance and full employment. Over the past decade, HIV/AIDS has emerged as a growing concern amongst SEWA members and their communities. Although women who are not sex workers have traditionally been thought to be shielded from risk, SEWA's experience and increasingly, national data, show that the vulnerability of young women should also be assessed and further understood. Using SEWA's field experience in Gujarat and a synthesis of existing research in India, this paper seeks to explore the factors that may render young women and adolescents vulnerable to HIV infection. Rather than categorise women only by age, we set forth a framework in which multiple layers of vulnerabilities can be recognised at the individual, social and programmatic levels. Within the home, early age at marriage combined with limited negotiating power, places women at risk within marriage or through unsafe sexual activity. Outside the home, women workers – whose occupational categories are fluid – may face sexual exploitation, without being addressed by existing programs. Programmatically, women's vulnerability stems from a health care system that simply does not target information and services to young women effectively. Although married and unmarried women have differing needs, overall it emerges that young women are largely not equipped to prevent HIV infection. India's national AIDS program has made considerable progress in recognising that adolescents and youth – both married and unmarried – have specific information and service needs vis-à-vis HIV/AIDS. However, like most of India's health system, 2 implementation remains far behind policy. At the policy level, young women are not amenable to common behaviour pattern grouping. Marital status and relationship dynamics, sexual behaviour patterns, socioeconomic status and access to services – which all may be interlinked – must be taken into account. SEWA's experience in HIV prevention with women workers provides four key areas in which program implementers and policymakers can improve current efforts. 1) Empower young women through holistic, community-based programs; 2) Promote women's organizing; 3) Develop bottom-up health services; 4) Improve communication tools and techniques; and 5) Involve men at the local level. Further, research with an operations component will be critical to designing effective, localised programmes to address young women's needs. The potential to implement widescale, integrated prevention programs for young women does exist in India. SEWA's …