Beth Fredrick's blog

A Misguided Prescription for Women and Girls

2008-02-08T13:43:24+00:00

A group of people held a press conference today on Capitol Hill to explain why they couldn't possibly support a U.S. Global HIV/AIDS strategy (PEPFAR) unless the bill reauthorizing funding for the strategy requires that at least 33% of prevention funds go to support abstinence-until-marriage programs.

The trouble with their position is that this earmark for abstinence-only prevention programs puts more lives at risk...so how can we, who are committed to confronting the epidemic, not fix this misguided law?

Protestors stand behind Pastor Rick Warren, one of the speakers at today's press conference.

The group at the press conference today - which included Reps. Chris Smith (R-NJ) and Steve Chabot (R-OH), Pastor Rick Warren of Saddleback Church, and Chuck Colson, Founder of Prison Fellowship - were so focused on ensuring a dedicated amount remain in the re-authorization bill to abstinence-only-until-marriage programs, they failed to see the whole picture:

The number of new HIV infections continues to grow around the world, especially among women and girls, precisely because we haven't invested in prevention resources that address their real-life circumstances.

The fixation on abstinence-only-until-marriage programs is out of step with the crushing weight of the evidence.

It's not just a bunch of uppity women wanting this abstinence-only earmark gone. An Institute of Medicine report calls for removing the earmark, as does the Government Accountability Office.

As the Elizabeth Glaser Pediatric AIDS Foundation's President, Pamela Barnes, said today,

"Proposals to maintain partisan, ideologically-driven mandates that constrain countries' abilities to respond to their own epidemics threaten the continued success of the President's Emergency Plan for AIDS Relief (PEPFAR)."

Furthermore, the 33% of funds set aside is a completely arbitrary number. It could have easily been 99% if Congress would have gone along with it in 2003.

At the time, when amendment author Rep. Joe Pitts (R-PA) called for the earmark, he couldn't really explain why it should be 33% - just that it should be there. My guess is that he thought it was one part of the A-B-C prevention message, and since it's one letter of the first three in the alphabet, it should get one third of the funds. But, really, who knows?

None of these reports - or the bill that Congress will soon take up - call for ending work that encourages abstinence and delaying sexual debut. The new legislation simply allows for the U.S. staff in-country to look at what is specifically needed there to prevent and reduce HIV transmission and decide what prevention efforts should be undertaken.

The bottom line is that not providing people with what they need to protect themselves is a sin. The abstinence earmark skews the programs and gives short shrift to all the other prevention efforts that need to be undertaken as well.

Next week, the House Committee on Foreign Affairs will mark up the U.S. Global HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.

Among the improvements to the existing law are increased flexibility for developing country programs, and for addressing the vulnerability of specific populations, including women, youth, and men who have sex with men. The bill also provides increased technical and financial support to countries that would support the training of health workers and fund scientific research for new vaccines and prevention technologies.

Simply put, there is another way forward.

Two Steps Forward, Three Steps Back

2007-10-30T12:17:40+00:00

Taking a page from the Clinton Global Initiative, the recent Women Deliver Conference in London was full of commitments. The U.K. government announced a $200 million grant to the United Nations Population Fund for contraceptive commodities, and the Japanese government vowed to make global health a priority at the Group of Eight Summit meeting next year in Japan. The John D. and Catherine T. Mac Arthur Foundation placed an extremely large bet--$11 million--on a four-part intervention strategy to dramatically reduce maternal mortality. First implemented in Nigeria and India (where 30% of all maternal deaths occur), the strategy is significant in that it specifically trusts and empowers women, families and communities to take action when a woman's health and life are in danger during childbirth. Following on the heels of Women Deliver, the Global Safe Abortion Conference may not have played host to the grand gestures made at Women Deliver, but private and public donor agencies, with the notable absence of the U.S. government, were there in force.

The take-home message was clear: At least a few thousand people from among the world's 6.6 billion are ready to shake up priorities for women's health and end the unnecessary suffering that in much of the world endures. Both conferences attracted policymakers who actually hold much of the power over that progress. But it was the final policymaker in the final plenary who brought home just how much of an uphill climb we still have to ensure a woman's health and dignity during pregnancy.

In addressing the Global Safe Abortion Conference, Lord David Steel--architect of the 1967 law legalizing abortion in England--underscored his preference for contraception over abortion. His remarks reinforced quotes in that day's Guardian, where he lamented that the law had led to far too many abortions: "If things go wrong you can get an abortion, and it is irresponsible, really...people should be a bit more responsible in their activities, and in particular in the use of contraception." Ann Furedi, Chief Executive of the British Pregnancy Advisory Services, responded that, "Abortion is not in itself the problem. The problem is the unwanted pregnancy and abortion can be the solution to that for many women. There's no right or wrong number; we need as many abortions as are necessary to solve the problem pregnancies that women face." It is unfortunate that Lord Steel's remarks come at a time when the U.K Parliament reviews its abortion law. Though the British public is firmly prochoice, 1 in 10 say that a woman does not have the right to decide to have an abortion.

The debate underscores just how important these two conferences were. Nothing is ever assured when it comes to women's rights and health, and we gain strength from one another. There is no hiding from the fact that achieving Millennium Development Goal number five, to improve maternal health, will require drastic course correction.

Though the conferences were two significant steps forward, we were put at least three steps back by Lord Steel's remarks, the absence of many policymakers at the Global Safe Abortion Conference (especially those who support reproductive rights) and the great distance we have to bridge between maternal health and gender equality and equity.

We need to acknowledge that until women gain equal status, health systems improve and laws change, many women will have a baby or an abortion on their own or with unskilled help. We will have to be vigilantly on the lookout for policymakers who forget or ignore that women have the right and the sense to make their own decisions when it comes to pregnancy and deserve every support that communities and societies can provide.

Does the Breeze Kill HIV?

2006-10-23T13:01:00+00:00

Beth Fredrick is Executive Vice President of the International Women's Health Coalition.

The session starts simply: eight young men stand at the front of a room in Minna, Nigeria. Each young man holds up a large piece of paper with a word written on it, each word a type of sexual activity.

From there it becomes more complicated.

First, the youngest boys are asked to leave. This is not a lesson on birds and bees and community leaders, though supportive, need to be reassured that this workshop is only for those who are mature enough. The 50 or more young men, ranging in age from 16 to 19, are learning how to stay safe from HIV. That will require frank conversation about what will put them at risk and what they can do to protect themselves and their sexual partners. In other words, this is a life-saving conversation.

Three professionals in the room stand back and observe as each card is raised. Idris, Rose, and Helena are there from the International Centre for Reproductive Health and Sexual Rights (INCRESE), a six-year-old Nigerian organization that works to protect and promote sexual and reproductive health and rights. They want the questions and concerns of the young men themselves to drive the conversation.

In Hausa, the common language of this village in a largely Muslim State in Nigeria, the young men discuss what they learned about preventing HIV transmission in previous lessons and whether the activity on the card places them at any health risk, including HIV infection.

Their misconceptions are understandable. At first, the young men define oral sex as a conversation between a boyfriend and girlfriend. But it soon becomes clear that some of the young men are well aware of what oral sex really is. What they don't know - and I hadn't fully appreciated - is that lack of oral hygiene in much of the developing world means bleeding gums and persistent sores. Both can facilitate transmission of HIV/AIDS, if one or both people are infected.

For over two hours, the young men Beth Fredrick with classdiscuss a range of similar issues and Idris, Rose and Helena field a battery of questions:

"When blood leaves a person's body, does the breeze kill HIV?"

"I cut myself when I shave; am I at risk of getting HIV?

"Is masturbation dangerous?"

"If I want to be intimate with a girl, what will keep us from becoming infected?"

When Idris, Rose and Helena were teenagers, Nigeria was only beginning to awake to the realities of HIV and AIDS. Nigerian leaders increasingly face challenges in tracking and preventing new HIV infections and ensuring care and treatment. Nigeria ranks second only to South Africa in the number of people living with HIV among countries in Africa.

The need for programs such as the one that INCRESE has pioneered is acute. According to UNAIDS, one in five Nigerian young women (aged 15 to 19) had her first sexual experience before age 15. Though young men begin later, 8% of them will have had sex before they turn 15. Schools are one avenue for learning about HIV/AIDS and prevention, yet only one in five primary or secondary schools have teachers who have been trained in life skills-based HIV education and who taught it within the last year.

Last month, the World Bank released its World Development Report. Rightly, it focuses on young people and the challenges they face in reaching their full potential to spur healthy development - for themselves and their communities. The Bank goes far in prescribing some fundamentals to protect and empower young people. Implementing prescriptions like these - and bolder - will require coordinated action at all levels, from governments to parents and families, including young people themselves.

First, we must invest in programs like INCRESE, which educate and empower boys and young men to understand their sexual responsibility, listen to their partners, and use condoms. Change requires more men like Idris and the young men in the INCRESE program.

Second, we must empower young women to share equally in the knowledge and agency needed to determine when, where, and under what circumstances to have sex. The healthiest exchanges will be open exchanges, with input from both partners.

Finally, we must provide all young people with information and services. In too many places, marriage is a prerequisite for health services or knowledge. Community leaders need to embrace and encourage any means of starting a dialogue with youth about gender equality, life skills and sexuality.

When you look into the eyes of a young person, for a moment, you see the future - theirs and ours. Working with them, we can make that future healthier and happier. We have an obligation to them from which the world can no longer shrink away.