Self-identified sex workers have talked about reproductive health care providers who go so far as to avoid making eye contact during visits. I’ve heard from women living with HIV in countries from Namibia to Chile about being forcibly sterilized, violating their right to make informed decisions about reproduction free from coercion. I’ve swapped stories with acquaintances about the rising costs of contraception in the United States and the ever-growing legal barriers to accessing safe abortion, especially for young people.
While these stories crisscross continents and issues, they show how much we have in common. And they illuminate how we as advocates can’t tease apart HIV from maternal health from family planning, just as women don’t experience their health in boxes or compartments.
Achieving comprehensive sexual and reproductive health care for all people was a rallying point at the NGO Forum on Sexual and Reproductive Health and Development I recently attended in Berlin, Germany. Leaders of non-governmental organizations from more than 130 countries met to formulate a Call to Action for governments and donors to strengthen their commitment to the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA)–a landmark agreement that placed women, gender equality, and sexual and reproductive health and human rights at the center of sustainable development.
Now, just as fifteen years ago, these groups called for a comprehensive approach to achieving the ICPD and Millennium Development Goal target of universal access to sexual and reproductive health and rights (SRHR).
I attended one workshop on HIV/AIDS services and barriers to care that stressed why comprehensive SRHR is so urgently needed. A speaker from Botswana recounted the multiple oppressions and rights violations she faced as a woman living with HIV. For example, in order to be a peer counselor for an HIV/AIDS network in her country, she had to sign a pledge that she would not get pregnant – a clear abrogation of her right to make reproductive decisions free from coercion. She also spoke of numerous human rights violations faced by women living with HIV in Botswana, including the right to life, the right to health, the right to choose the number and spacing of children and to have access to the information and means to do so, and the right to make reproductive decisions free from coercion, discrimination and violence. Her stories illustrated that HIV/AIDS and sexually transmitted infections, family planning, maternal health, and sexuality education are fundamentally connected.
All women – whether living with HIV, married, young, transgender, poor, queer – experience their reproductive health in overlapping ways throughout their lives, and reproductive health programs and services should reflect this reality. And yet when thinking in particular about the U.S. and its role in fulfilling the ICPD PoA at home and abroad, it’s clear that U.S. policies and funding are falling short in promoting comprehensive approaches to SRHR.
Take the issue of safe abortion. The U.S. restricts access to safe abortion for women in the United States by denying public funding for most abortions through the Hyde Amendment, unfairly denying low-income women a procedure that wealthier women can access. In a similar vein, the Helms Amendment precludes women across the world from obtaining safe abortion by restricting U.S. foreign assistance dollars from supporting the procedure. This runs counter to the ICPD PoA—which the U.S. endorsed—that stipulates that unsafe abortion is a major public health concern and that where abortion is legal, it should be safe and accessible. Abortion is just one instance of many where the U.S. is failing to promote comprehensive sexual and reproductive health care for its own citizens and for women worldwide.
It’s clear that we have a lot of work to do to hold the U.S. accountable to the ICPD PoA, specifically around ensuring comprehensive SRHR for women, men, and youth at home and abroad. A first step is to get educated to better inform our advocacy. A new report from CHANGE, Investing in Reproductive Justice for All, highlights the advantages and challenges of comprehensive approaches to sexual and reproductive health and rights and the role of U.S. foreign policy and serves as a useful tool to urge our own U.S. government officials to adopt ICPD principles in domestic and international policy and funding.
The Berlin forum and its Call to Action are timely with the 2015 endpoint for the ICPD PoA quickly approaching. We have an urgent mandate to join advocates from around the world to push governments and donors to carry out their commitment to achieving universal access to comprehensive sexual and reproductive health and human rights.
There are many reasons to celebrate.
First and foremost, the "prevention toolkit" is expanding - women
and men now have another option to prevent HIV infection. And women
in particular now have another safe and effective method designed for
them to initiate (even though men
can initiate female condom use too!).
The FC2 is designed to overcome some of the reported barriers faced
by its predecessor, the FC1 - it is apparently less noisy to use during
sex - and yet shares all the benefits of the FC1, such as the ability
to use water and oil-based lubricants or to insert the condom up to
eight hours before intercourse. But the reason that is grabbing
the most headlines is the FC2 is cheaper to produce than the FC1, which
means that cost-savings will be passed on to the consumer. In
fact, the FC2 will sell for about 30% less than the FC1.
This of course has positive implications for the affordability and accessibility of female condoms in the U.S. and internationally. For instance, the United States Agency for International Development plans to phase out procurement of the FC1 upon FDA approval of the FC2 according to Saving Lives Now, a report by the Center for Health and Gender Equity. This means that potentially more female condoms can be procured, distributed and programmed overseas due to lower costs.
Cheers are definitely in order for the decrease in manufacturing costs. But it's also important to recognize that lower cost to the consumer is not a silver bullet to rapid female condom uptake and use in the U.S. or internationally. Without adequate investments in technical support and programming, how will women in men learn about the female condom-about how to insert it and use it correctly and consistently, and how to negotiate and communicate with their partners?
With the drop in cost for the
new female condom, we also need a surge in education and advocacy, at
the local, national and international level. Local service providers
and departments of health, ministries of health and other decision makers
need to hear from advocates that increased investment in female condom
procurement, distribution and programming is essential.
We encourage you to join the Prevention Now! Campaign - a global campaign to dramatically increase donor and government funding for the purchase, distribution and program support needed to expand access to female and male condoms and other existing prevention options for women and men. Let's build on this momentum together to make universal access to female condoms a reality!
]]>"I would love to go back in time and change the name of the ‘female condom,'" said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, who spoke at the session. It's not that he was discounting the importance of female condoms for women's reproductive health and empowerment. After all, female condoms are still the only available HIV and pregnancy prevention method designed for women's initiation, and they can help put the power of prevention in women's hands. Rather, "female" condom is a misnomer, since it obscures the fact that men can and do initiate female condom negotiation, and often participate in their insertion and use.
According to panelist Edinah Masiyiwa, executive director of the Women's Action Group (WAG) of Zimbabwe, many men in WAG's male and female condom trainings prefer to lead insertion of the female condom when having intercourse with their female partners. And the exciting thing about men getting involved in female condom use is that it can help improve and increase communication between partners, contribute toward joint responsibility for HIV prevention and even lead to increased pleasure and satisfaction.
The same concept holds true for male condoms, which tend to be implicitly associated with men. But we know that many women play a major role in male condom use and initiation-from suggesting that men use a condom to actually putting it on their partner. I think it's safe to say that this "dichotomy" between men / women and female condoms / male condoms is false, and both women and men have roles and responsibilities when it comes to negotiating and using female and male condoms.
But how do we get to a place where partner negotiation and communication around condom use are fluid and non-threatening, where women and men assume equal responsibility for initiating HIV prevention?
As Mitchell stated, "products
don't protect people, people do." Male and female condoms
that sit in warehouses or on store counters aren't protecting people.
Even condoms that aren't used correctly aren't fully protecting
people! Women and men who use condoms correctly and consistently
protect themselves and each other, but they can't do it alone.
Women and men - and youth - must have access to female and male condoms
and to education and skills-building programs, particularly in cultures
and locations where condoms are stigmatized.
Comprehensive sex education is one critical avenue for cultivating these skills, but it must be truly "comprehensive." Maxwell Ciardullo of the Sexuality Information and Education Council of the United States (SIECUS) stressed this during his presentation on the importance of thorough discussions about condom use within sex education programs in the U.S. "We have to make sure we don't allow ‘comprehensive' sex ed programs to be abstinence plus a condom demonstration," he said.
In fact, Maxwell argued we need to go way beyond a stand-alone condom lesson and take social, environmental and personal factors into account. Truly comprehensive programs should address gender roles and expectations (does a "real" man carry a condom? Does a "good" girl carry one?), men and women's familiarity and comfort with their sexual anatomy, trust issues, gender-based violence, sexual orientation (what about condom use for men who have sex with men and lesbians who may have occasional male partners?), risk perception and homophobia.
Edinah echoed Max about the
need for comprehensive sex education and raised additional considerations,
such as cultural sensitivities and the role of pleasure. For example,
WAG's trainings in Zimbabwe address cultural issues affecting women's
agency and their reproductive health, such as violence, wife inheritance
and polygamy. WAG's programs on sexual and reproductive health
are holistic, nonjudgmental, and empower participants regardless of
their HIV status, gender or other social location.
WAG's programs do not shy away from talking about male and female condoms in a "sexy" way. WAG actively promotes women and men's right to pleasurable sex, teaching that condoms can be a tool for pleasure. For instance, Edinah reported that many men love the "tickle" they feel from the inner ring of the female condom, and many women love the "tickle" they get from the outer ring.
So where do we go from here? "It takes a village to achieve comprehensive responsibility for prevention," as Mitchell aptly stated. Even when women and men have the information and skills to use female and male condoms effectively, we still need to ensure that policies and programs are in place to support successful procurement, distribution and training, in addition to adequate financial investment.
One way people can help make comprehensive male and female condom programming a reality is to join the Center for Health and Gender Equity's Prevention Now! Campaign at www.preventionnow.net. The Prevention Now! Campaign is a global campaign to dramatically increase donor and government funding for the purchase, distribution and program support needed to expand access to female and male condoms and other existing prevention options for women and men, and the campaign is always looking for new advocates.
HIV/AIDS, women's rights, and sexual and reproductive health and rights advocates must demand access to male and female condom supplies and programming today. Together we can bring about policy and program change at the local, national and global levels-so make your voices heard!
]]>So who will be speaking this truth about HIV and effective prevention on World AIDS Day?
Faith leaders are taking the charge, along with civil society and HIV-positive leaders. A broad coalition of faith-based and secular organizations is holding a World AIDS Day Interfaith Service on December 1, in Washington, D.C., that seeks to elevate faith and civil society voices on critical issues like comprehensive sex education and access to the full range of sexual and reproductive health services and information.
On a pre-service media briefing, we heard from HIV-positive and faith leaders about just how desperately the U.S. needs to promote prevention policies and programs at home and abroad that are comprehensive, integrated and based on evidence rather than ideology.
Max Siegel, an American young man living with HIV remarked that narrow, abstinence-only-until-marriage programs failed to address his realities and did not equip him with the knowledge and tools to prevent infection. "In my gym teacher's class, my male peers and I were told that sex was dangerous and that we should think more seriously about it when we grow up and marry. The teacher made clear that only one kind of sexuality, heterosexuality ending in marriage, was acceptable to talk about. Already aware of my sexual orientation, which is not heterosexual, I found no value in his speech. It did not speak to me and my life."
Grace Sedio, a woman living with HIV who is a human rights advocate in Botswana told us about the challenges women in developing countries face in protecting themselves from HIV infection. "For me as a grassroots woman living in Africa, a major problem is that most of us here are poor. Most of us are unemployed. This puts us at risk of getting infected. You find yourself having a partner that you can't say no to sex, that you can't say no to anything... and you find yourself pregnant..."
The great news is that faith leaders are speaking out about the urgent need for effective prevention efforts, in addition to the role that faith communities can play in providing honest talk and education about HIV and how to combat stigma and discrimination. "The faith community has an enormous capacity for creating awareness, education, and providing services that can prevent infection and give support and care to those affected," said Rev. Michael Schuenemeyer, Executive for Health and Wellness Advocacy, with the United Church of Christ.
These messages will be amplified at the Interfaith Observance on December 1. All are welcome to attend! The service will take place from 6:00p.m. - 7:30p.m. at the Foundry United Methodist Church, 1500 16th Street NW, Washington, D.C. 20036.
Speakers include:
This World AIDS Day, on the eve of a new U.S. administration, I am hopeful that the U.S. will promote evidence, equality and human rights in its HIV prevention efforts and take a holistic approach to combating the global pandemic.
As Rev. William G. Sinkford stated on the media briefing, "there will [likely] be continued political pressure to pick and choose among our HIV/AIDS policy options. But a piecemeal approach simply will not work. We have to address the full social and economic contexts in which real people live or the pandemic will continue to spread. We won't defeat AIDS without first defeating poverty, injustice and hatred."
The transcript of the World AIDS Day media briefing is available by clicking here and the flyer for the Interfaith Observance is available for download here (PDF).
Cosponsors include: Advocates for Youth; American Jewish World Service; Black AIDS Institute; Catholics for Choice; Center for Health and Gender Equity (CHANGE); Foundry United Methodist AIDS Mission; General Board of Church & Society, United Methodist Church; International Women's Health Coalition; National Council of Jewish Women; Religious Coalition for Reproductive Choice; Secular Coalition of America; Sexuality Information and Education Council of the United States (SIECUS); Union for Reform Judaism; Unitarian Universalist Association of Congregations; United Church of Christ (Justice and Witness Ministries); Women of Reform Judaism; The Women's Collective