A new definition for professional disability, or professional disability from a gender perspective

The following article delves deeper into how the gender perspective (or lack of it) affects women in this aspect.

Gender perspective in the definition of health
According to the World Health Organization (WHO), health is an overall condition of physical, mental and social wellbeing, and not just a mere absence of illness, and special attention must not only be focused on the medical aspects of health services but also on ”the basic justice system of how society functions, with particular reference to the access and control that the different sexes have over health resources“.

If we use this perspective of health as a base, we can see that the use of the term ”disability“ can in practice translate into discrimination when this denomination extends to define the person as a whole, referring to her/him as ”disabled“ or, even worse, as ”incapable“.

In 2002, WHO convened representatives from 70 countries to meet in Italy in order to examine the traditional indicators of health, these being based at the time on mortality rates, and adopt a new focus on life which would take into account how people live with their health problems and how those problems can be overcome so that they may live a productive and satisfying life.

If we put aside the definition of ”disability“ in a work context -which is the evolution of the effects of an illness or accident that in turn makes a person unable of doing a determined professional activity-, and we focus on the wider definition of health, we find that women in general, and HIV+ women in particular, experience a series of afflictions specific to them only, or ones that happen with more frequency or intensity, causing the female gender to be more susceptible to a declining quality of life. In general this idea is not even addressed and in some cases it is even ridiculed, which makes it extremely difficult to adequately tackle the problem. In the end this can damage the development of essential activities in daily life.

Going beyond biological differences, the roles that men and women have assigned and assumed in society have a great influence on how we live our health conditions and how we use health systems. Despite this fact there is no gender perspective in health systems that would allow us to tackle this effect. In fact, it has been observed that even though women have a longer life expectancy, if we delve deeper into studies on health conditions we see that women have a higher probability of developing non life threatening chronic ailments which lead to greater rates of disability. To put it in other words, women live longer but with disabilities and ailments that extend over more years. Some examples like anemia, depression, chronic fatigue and pain, can illustrate these types of afflictions that can be highly disabling, that is to say which have a very negative effect on one’s quality of life, and are not always adequately diagnosed or treated.

Anemia
Anemia is commonly seen in people with HIV -in approximately 30% of people with asymptomatic infection and 75-80% of those in the clinical stage of AIDS.

Although the rate of serious anemia has reduced since the introduction of combination therapies, this condition is still present in 30% of people who are on HAART, and according to some studies is associated to a lower quality of life and also a decline in survival rates.

Anemia, which includes symptoms of fatigue, depression, dizziness, respiratory difficulties, and coldness, can be caused by medications, or be the result of an HIV-related illness or HIV itself. Also, some circumstances specific to women only, cannot be overlooked. This is the case of menstruation, which can contribute to the onset or the worsening of anemia.

Depression
In an article published in January 2005 in the magazine Science in Africa, Dr. Soraya Seedat presented the results of a study conducted at the University of Stellenbosch in South Africa, in 149 recently diagnosed people (44 men and 105 women) in order to evaluate their reactions after being diagnosed. One of the most frequent effects was depression (34.9%), the rates being similar in both men and women, and different in regards to the general population where women are twice as likely to develop depression. More frequently, women experience an alteration known as post-traumatic stress, while men are more likely to abuse alcohol or start having risky sexual relations.

According to Dr. Seedat, women living with HIV make up a population that is at higher risk of developing depression, with a rate up to four times greater than those observed in HIV-negative women. She also adds that an adequate evaluation of one’s mental health in people with HIV should be included in the general examination.

She concludes that the results of the study could indicate that men’s and women’s treatment focus should be different, because of hormonal cycles that can influence how they respond to medication, including the possible treatments for physical and mental problems.

Other professionals indicate that there is a relation between chronic depression in women and a decline in their CD4 counts, although the reasons why are not clear. One thing that has been proved is that depression is one of the leading cause of poor treatment adhesion.

Furthermore there has been a relation between the presence of depressive symptoms and a higher possibility of death. For this reason it is important to do a proper diagnosis as soon as possible in order to obtain positive results.

Pain and fatigue
According to data from the CDC (U.S. Centers for Disease Control),symptoms related to pain and fatigue can cause in women with HIV a very stressing and frustrating feeling. In a study done in 104 HIV-positive women with ages between 20 and 66 to evaluate the symptoms of disability and the disability related to these symptoms, more than half of the women stated that they experienced problems in sleeping, lack of strength, loss of appetite, nauseas and breathing difficulties.

These women did keep a moderate level of physical mobility, although the majority of them showed to be at high risk of developing depression, and the ability to do self-care activities (such as taking a walk) was greatly related to the number of somatic symptoms and depression.

HIV-positive women experience diverse symptoms that can affect their physical functions, and they can greatly benefit from interventions that help them improve their emotional well-being and their ability to caring for themselves.

Another study held at the Sloan Kettering Memorial Hospital to evaluate pain in HIV-positive women suggested that they experience it more frequently and with more intensity than HIV-positive men. These results may be a reflection that it is twice as likely that pain symptoms related to HIV receive worse treatment in women than in men.

Despite their frequency and their intensity, these symptoms are not included in the possible evaluation of one’s ability to continue or not their current professional activity, but their ”disabling“ effect is undeniable for the development of a fulfilling life within society.

Maria José Vazquez, Creacion Positiva, HIV/AIDS NGO with gender perspective (Barcelona, Spain)

http://www.creacionpositiva.net

http://www.scienceinafrica.co.za/2005/january/hivpsyche.htm

http://www.meds.com/conrad/pmcd/breit.html

EATN - European AIDS Treatment News, Volume 13, I – Spring 2005

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