This World AIDS Day, Population Action International is exploring a different side of the HIV/AIDS epidemic, one that many people might not even realize is an issue - the prevalence of HIV in marriage.  Our new documentary, The Silent Partner: HIV and Marriage, explores this very issue.  It tells the stories of women from different backgrounds who were infected with HIV in their own homes, in their own beds, from their own husbands. 

Most people believe that if a woman makes it to marriage without contracting HIV, she is safe.  However, the reality can be quite different. Judy Atieno, one of the women profiled in The Silent Partner, found out she was HIV-positive while she was pregnant with her fourth child.  She says, "You have to depend on this man for everything - the husband, he pays the school fees for the kids, he buys food for the house... you don't question where he walks, how many women he has outside - for the sake of these children."

Current research shows that, increasingly, marriage is not as protective as previously thought - for men or for women.  In Rwanda and Zambia, for example, an estimated 55-93% of new infections occur within marriage or in cohabiting relationships.  Condom use within marriage is infrequent, and rates of extramarital partners are higher among men than women in Africa. As Marita Barrassa, one of the women profiled in The Silent Partner, tells us, ".. As a woman I cannot tell my husband to use a condom; that's just the way I cannot tell my husband not to have sex."

The institution of marriage cannot be considered a safe haven from HIV infection.  With evidence-based HIV prevention as the foundation, we must look to integrate sexual and reproductive health and rights programs as well as broader social and economic policies to improve the lives of women and their families.  Increasing the involvement of men in reproductive health decision-making, providing couples counseling and testing for HIV, and enacting and enforcing laws against domestic violence and rape are good ways to begin. 

As we mark the 20th anniversary of World AIDS Day, we need to recognize that everyone, no matter their social, economic or marital status, is at risk of HIV if they don't have access to the education, services and supplies to protect themselves.

Watch a clip from The Silent Partner: HIV in Marriage:

I am incredibly proud of Population Action International (PAI) and our new report A Measure of Survival: Calculating Women's Sexual and Reproductive Risk, which we are releasing today at the Women Deliver conference in London. This report is unique because it recognizes that there are many factors that contribute to a woman's sexual and reproductive health. A Measure of Survival puts all the pieces of the puzzle together to form a complete picture. The report ranks 130 developing and developed countries according to sexual and reproductive risks, and provides steps to improve the lives of women, particularly in regards to their reproductive health, in all countries.

I am also very proud of the organizers of Women Deliver - they are champions of change! Women Deliver is going to be a watershed event for women, which is why PAI has done all we can to support this momentous event. After working on this issue for 30 years, it's time for women's survival and well-being around pregnancy and childbirth to take center stage.

We are presenting A Measure of Survival at Women Deliver so that advocates around the world can use the numbers to pressure their governments, ministers of health and their communities to invest in women's sexual and reproductive health.

What's YOUR number? It's a measure of your country's dedication to women's well-being. But make no mistake, behind each number is a woman, a family, a community and a possibility for a better future.

Women are at highest sexual and reproductive health risk in Niger, Chad, Mali, Yemen and Ethiopia, while the Netherlands, Switzerland, Singapore, Germany and Belgium are the safest countries for women's health. In general, women's sexual and reproductive health are riskiest in sub-Saharan Africa and South Asia, and the need for reproductive health services is greatest among the poorest women and men residing in the world's lowest-income countries.

Some countries - including low-income countries - have successfully reduced maternal mortality. Romania, Thailand, Malaysia, Sri Lanka, Egypt and Honduras have used a variety of strategies including increasing access to hospitals and midwives, improving quality of care and controlling infectious diseases.

Youth are our future - they must have the opportunity to blossom into adulthood. Yet the United States still has the highest teen pregnancy rate of all developed countries, which leads to higher death and injury rates for young mothers and their infants. This keeps the U.S. from leading the world in women's sexual and reproductive health; we barely make it into the top 25 in the "lowest risk" category of A Measure of Survival, behind a few surprising leaders like Croatia and Cuba.

This report is especially critical for U.S. policymakers as they consider repealing the harmful Global Gag Rule. Also known as the Mexico City policy, these restrictions undermine sexual and reproductive health services around the world - leading to more unplanned pregnancies and more unsafe abortions.

Investing in women also improves the health and well-being of families, communities and even nations. It contributes towards reducing poverty and stimulating economic development. It is critical that policymakers, advocates and the media begin to understand these connections. As long as family planning and reproductive health are perceived as only having to do with a woman's body, achieving progress on critical global issues will remain out of our reach.

Main findings from the report:

• Unsafe sex destroys lives and decimates societies
• We must smooth young women's transition through adolescence
• Skilled attendance at childbirth makes the difference between life and death
• The consequences of unsafe abortion echo for generations
• Planned pregnancies lead to healthy mothers and families
• The leading cause of death for women in developing countries is preventable

It is astonishing that in 2007 we must release a report called "A Measure of Survival." We are long past the time when our report should be called "A Measure of Women's Well-Being." In order for societies to flourish, women's survival must be taken for granted and opportunities for education, good health and self-determination must be within the realm of possibility.

Recommendations:

• Reach youth with comprehensive sexual and reproductive health education
• Scale-up sexually transmitted infection (STI) interventions
• End harmful practices like very early marriage, intimate partner violence and female genital mutilation
• Recommit to voluntary family planning
• Make childbirth safer by increasing access to reproductive health care
• Make abortion safe, legal and accessible
• Focus on the distribution of services
• Involve communities in building networks of health workers
• Coordinate sexual and reproductive health with HIV/AIDS efforts
• Finance reproductive health supplies
• Make country ownership a reality by including local officials and civil society in decision-making
• Improve research of sexual and reproductive health

Even though this is 2007, too many communities are still living in the dark ages regarding women! Discussing women's survival as an end point is no longer acceptable. Let's commit ourselves to doing everything in our grasp during this next decade so that success is the well-being of a woman measured by her rights, choices, health, prosperity and full participation in her community - regardless of where she lives. Our urgent call to action is NOW and each person reading this has a role to play. Please join us!

More information about the report is available online at http://www.populationaction.org/mos.