I've been hearing a lot of people lately talking about the problems they're having in providing care and services for HIV-positive women, or women at risk for infection. Women, it seems, don't take care of themselves very well. They don't show up for appointments. They aren't very compliant with medications. They run themselves ragged taking care of the family and the house . . .they never take time off for rest and relaxation . . . and they still aren't very good at that "consistent condom use" thing, even after all these years! These "challenges," we're told, have a lot to do with women's low sense of self-worth and assertiveness in taking control of their lives. Over and over again, we hear clinicians, social workers, and prevention people declaring, "Someone has got to get women some self-esteem! Women have got to start taking better care of themselves!"

And you know what? This is absolutely true -- women do need greater self-esteem, and we do need to start taking better care of ourselves. Unfortunately, we still have a shitload of work to do while we're developing this self-esteem, and we still have a lot of institutionalized sexist tree stumps blocking our path to improved self-care. So before we get that self-esteem, can we try a little anger?

As for the many people who are actively concerned about our low self-esteem, I'm sure folks won't mind rising to the occasion in order to help us out. So while all the world's HIV-positive and at-risk women go on a big Paths-To-Wellness Retreat for a few days, we'd like everyone else to address some of our more noticeable "challenges." We limited it to a random five (didn't want to overwhelm anyone), so here you go:

1. Help us with child/elder care, home maintenance, and transportation. Yes, many women do take care of everyone and everything else before taking care of themselves. We do this because families require a lot of care-taking, and we're trained from infancy to take on the bulk of this work. It's going to take us a while to break down generation upon generation of conditioning -- and in the meantime, our children still need to be played with, meals need to be prepared, laundry and shopping needs to done, elderly parents require care, and money needs to be earned to support ourselves and our families. Some of us have partners and family to help us with these responsibilities, but many of us do not. So please: Come over! Stay with our kids and elders while we go to doctor's appointments, drug/alcohol rehab, support groups, and desperately needed mental health retreats. Come by and do our shopping or clean our bathroom when we're sick from our meds. If you have a car, drive us to appointments or go pick up our medications from the pharmacy. Revive the "Buddy" programs, especially as they pertain to child care, elder care, and transportation assistance.

2. Give us information we can understand and apply to our daily lives. Given the difficulty many of us have even going to doctor's appointments, we need quality educational materials we can use at home -- including materials printed in the languages we understand, especially if our doctors do not speak our language. Nutritional information must reflect the foods we eat at home, not the foods most commonly eaten by the people who make nutritional pamphlets. Additionally, we need materials for those of us who don't read in any language, especially regarding our medications -- it's hard to be compliant when you don't know how to take your meds, or which side effects are dangerous vs. merely annoying. We're working on this among ourselves, but we generally don't have as much time and money as do hospitals, clinics, universities, and pharmaceutical companies . . . so please feel free to help us out.

3. Men who have sex with us must accept responsibility for condom use. Even the most empowered, self-loving woman in the world cannot force a man to wear a condom. Guys, you need to quit giving us a hard time about protecting ourselves. You need to quit acting like cavemen when we try to put the "No Glove, No Love" rule into practice, and you need to stop dishonest portrayals of monogamy if you're having sex with other people. If you're going to lie, outright or through omission, protect yourself so we don't pay the price for your fun. We don't have the power to control your behavior, and you don't have the right to hurt our health. Ditto for drug use.

   Plus, you never know if we have something we could pass to you . . . self-care goes both ways, boys.

4. Fund microbicide development. "Consistent condom use" aside, I hope that by now everyone acknowledges that most of the world's women don't have a lot of control over when they will and will not have sex. Therefore, insisting that we develop enough "self-esteem" to control our male partner's actions (i.e., condom use) is a remarkably cruel avoidance of medical responsibility to women. We need woman-controlled methods of HIV and STD protection -- including methods that will allow us to conceive children, if we want them. Microbicides will also allow us to help protect our partners and children from infections. So please, consider microbicide development a Family Value.

5. Quit abusing women verbally, emotionally, physically, sexually, and economically -- especially when we are children. Developing and maintaining self-esteem is difficult for all of us, but immeasurably more so if we're encouraged to believe that we're powerless pieces of crap. Abuse in childhood is particularly damaging to self-esteem and leads many of us into dangerous behaviors in adolescence and adulthood -- sexual risk-taking, drug and alcohol misuse, dependence on romantic relationships and/or motherhood for a sense of self-worth, and lack of confidence in our ability to learn and to sustain ourselves economically. Sexual abuse can also make it difficult for us to seek out health care when we need it, especially sexual-health and gyn care.

If you abuse women or girls, knock it off and get some help. If you see girls or women being abused in any of the above-mentioned ways (and if you don't see it at least once an hour, you're not looking very hard), do something! If you are a man, examine both your own actions toward women and your interactions with other men when talking about and interacting with women. Refuse to support "male-bonding" activities that involve disrespect and/or violence toward women and girls. If you are a woman, examine the image of womanhood you reflect to other women, especially girls. Refuse to support aspects of "femininity" that bring down our self-esteem, including acrimony among women. We need to help each other be strong, not tear each other down. And anything we can get for ourselves here needs to be expanded to include women everywhere, or we won't have the right to feel very good about our "progress." We all deserve safety and good health, no matter where we live or what we look like.

Women's self-esteem will grow when the people with the greatest power to affect change start acting like women matter -- like women are human beings whose life realities are to be taken seriously and addressed. Telling women to "get some self-esteem" and "take better care of themselves" without acknowledging our reality is like telling closeted gay men to come out in a roomful of God Hates Fags disciples, or suggesting that people starving in a famine-stricken area really just need to plant more crops.

But anyway . . . when we come back from our retreat, bursting with self-esteem and all the tools we need for proper self-care, we expect to see at least these five realities addressed and corrected (you'll notice that we left off the really complicated ones like access to health care, clinical trials, economic self-sufficiency, and complete overthrow of patriarchy). And who knows? If y'all can fix these five for us, maybe we can harness enough collective self-esteem to take care of everything else.

Laura Jones is the Hotline Coordinator for the Illinois AIDS/HIV & STD Hotline.