Prevention policy and programs have generally been driven by two paradigms. One says that we can contain HIV/AIDS by focusing on high risk populations such as sex workers, intravenous drug users, and men who have sex with men. This work is vitally important. But, it has also left vast numbers of girls and women unprotected.
The second dominant prevention paradigm -- given to us by the U.S. government -- is ABC: Abstain, Be Faithful, and use Condoms if you engage in risky behavior. Fortunately, more and more people recognize that this framework is irrelevant for many, even most, vulnerable women and girls. They cannot abstain, they are already faithful, and their partners refuse to use condoms. More than four-fifths of new HIV infections in women occur in marriage or long-term relationships with primary partners. In sub-Saharan Africa, an estimated 60 to 80 percent of HIV-positive women have been infected by their husbands or sole partner.
These are all fundamentally sexual and reproductive rights issues -- issues that must become central to our HIV/AIDS prevention, treatment, and care paradigm.
First, imagine a pregnant woman seeking antenatal care. If the clinic she visits offers her HIV testing at all, it is likely for one of two purposes: either anonymous HIV surveillance or prevention of mother-to-child transmission (PMTCT) -- typically not for the purpose of promoting her own health.
Imagine that she tests positive for HIV. It is still quite unlikely she will receive services to prevent transmission to her infant. Only 11 percent of pregnant women living with HIV/AIDS globally currently receive antiretroviral prophylaxis for the infant, and almost no PMTCT programs treat the mother herself. Furthermore, a pregnant woman who tests positive is often denied other reproductive health services outright, including skilled help during child birth.
Imagine, on the other hand, that the woman tests negative for HIV. She will receive inadequate antenatal care from overtaxed health workers, which will likely not include screening for sexually transmitted diseases or any information about how to protect herself from STDs, including HIV/AIDS. The health workers she sees will not have been trained to ask whether her husband or partner has other partners or visits sex workers, if she is forced to have sex against her will, or has been subjected to other violence. Nor will she be referred to support services that could help her in these circumstances and support her in asking her partner to be tested.
These policy and programmatic failures do not only affect pregnant women.
Imagine, now, a woman who seeks reproductive health services because she does not want to have a child. If she is unmarried, she may not even make it past the front door, because many countries have laws against services for unmarried people. Women who do get past the door will likely receive contraception, but not help for an STD or HIV counseling and testing.
Or imagine a woman who accesses the health system through HIV/AIDS services, such as a freestanding testing site. She almost certainly will not receive any family planning or other reproductive health services.
These gaps are not simply due to weak health systems or shortages of money. They are due to political divides, professional divides, and overall neglect of women. As Congress considers changes to the President's Emergency Plan for AIDS Relief (PEPFAR), it must stay focused on the real life needs of women and girls. Making the necessary investments in sexual and reproductive health services and protection of sexual and reproductive rights is an efficient and effective use of our tax dollars-and will save even more lives along the way.
]]>From new commitments to sex education programs to progress on securing a women's right to abortion, these ten developments show that women's health was a priority concern in 2007, and will continue to require our attention and dedication in 2008.
1. GLOBAL HIV INITIATIVES PRIORITIZE WOMEN
The Global Fund to Fight AIDS, Tuberculosis, and Malaria decides to develop gender policy to encourage and support national AIDS control programs to invest in girls and women. more>>
2. HEALTH AND RIGHTS TRUMP ABORTION BANS
Mexico City's legislature legalized abortion, making it the largest Latin American city to allow abortion. In the first 100 days following legalization, doctors performed some 1,500 legal abortions with no fatalities, compared to an estimated 3,500 deaths from unsafe abortion in the year before legalization. more>>
3. MATERNAL DEATHS MADE A GLOBAL PRIORITY
Global donors pledge new funds to end more than half a million deaths and 10 million injuries-annually, including $1 billion over ten years from Norway, $175 million over three years from the Netherlands, and $200 million over five years from the United Kingdom. more>>
4. "ABSTINENCE-ONLY" GETS A FAILING GRADE, AGAIN
Two new reviews of "abstinence-only" sex education found no evidence of the effectiveness of this approach in preventing pregnancy or sexually transmitted infections, including HIV. more>>
5. NIGERIA SUPPORTS SEXUAL RIGHTS
Under pressure from a coalition of NGOs, the Nigerian Parliament rejected an anti-gay bill, citing converns over possible human rights violations and recognizing its encouragement of far-reaching discrimination on the basis of sexual orientation. more>>
6. STATES ENSURE ACCESS TO EMERGENCY CONTRACEPTION
Several states, including Connecticut, Oregon, and Colorado mandated hospitals, including Catholic hospitals, to inform sexual assault survivors about emergency contraception (EC) and make it available upon request. more>>
7. NEW HAMPSHIRE RESPECTS THE RIGHTS OF MINORS
In June, New Hampshire repealed a law requiring health care providers to notify parents at least 48 hours before providing an abortion to a woman under the age of 18. Alaska followed suit in November when its State Supreme Court declared a similar law unconstitutional. more>>
8. SEX EDUCATION IN INDIA GOES NATIONAL
Faced with an estimated 2.5 million HIV cases, India's national government recommended twice weekly sex education classes for students 14 to 18. more>>
9. MORE U.S. STATES MANDATE PRESCRIPTION EQUITY
Oregon joins 26 other states in requiring that health insurance plans include contraceptives in prescription drug coverage. Many insurers refuse to cover contraception, even though they cover drugs like Viagra. Supporters say the bill, which goes into effect on Jan. 1, 2008, will affect nearly 1.5 million women. more>>
10. SCIENTISTS ADVANCE WOMEN-INITIATED HIV PREVENTION
PATH, a nonprofit research group based in Seattle, recently designed a cheaper and improved female condom, which is the only female-initiated method to prevent sexually transmitted infections (STIs) and pregnancy and allows women greater control over safe-sex negotiations. more>>
]]>This piece is republished with permission from IWHC. The full report is available here.
Adrienne Germain is the President of the International Women's Health Coaltion.
A lot of the buzz from Toronto this week centered on women, led by the "Bill and Bill show," and especially the Gates' attention to microbicides.
Microbicides will be a key HIV prevention tool, but no technology is going to end this pandemic. Girls' and women's vulnerability is driven by discrimination in education, employment, and property rights, and by sexual coercion and violence. These fundamental issues - and ways to fix them - were not on the lips of most of the conference "star power."
]]>Adrienne Germain is the President of the International Women's Health Coaltion.
A lot of the buzz from Toronto this week centered on women, led by the "Bill and Bill show," and especially the Gates' attention to microbicides.
Microbicides will be a key HIV prevention tool, but no technology is going to end this pandemic. Girls' and women's vulnerability is driven by discrimination in education, employment, and property rights, and by sexual coercion and violence. These fundamental issues - and ways to fix them - were not on the lips of most of the conference "star power."
When gender inequality was addressed, the record was disgraceful. A telling example comes from Richard Feachem, soon to step down as head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. He acknowledged at a high level meeting, "Time to deliver for women and girls," on August 13, that his agency knows nothing and has done little, using four indicators.
First, he suggested that although nine out of 20 voting board members are women, including the Chair and Vice Chair, given the statistics on the pandemic, 11 or 12 women would be more representative. He gave the Fund an "OK" grade on this indicator.
Next, he considered whether the Country Coordinating Mechanisms (CCMs), which are responsible for writing proposals to submit to the Fund, are gender-balanced. While gender balance is encouraged, it is not required, he said. The Fund doesn't ask CCMs what their record is, so he doesn't know whether they are gender-balanced or not.
His rating? Poor.
Third, he asked himself whether the Global Fund invests in programs that emphasize gender. Again, he didn't know, because the Fund doesn't ask and doesn't track.
Rating? Poor.
The final criteria in his rating system was whether the Fund is learning systematically about gender issues. On this measure, he responded with an unequivocal "No," especially with regard to HIV/AIDS prevention.
Rating? Poor.
His conclusion? "We must do more."
We must, of course, give Mr. Feachem his due for acknowledging failure. And there are signs that things are looking up.
In June, at the United Nations High-Level meeting on HIV/AIDS, 140 governments agreed to ensure women's rights and gender equality. The UNAIDS board has since requested guidelines for governments and UN agencies on how to realize these commitments. And in Toronto this week, women and human rights leaders and the head of UNAIDS met to discuss how to get the guidelines written with strong input from women who have worked for gender equality and women's rights for decades.
So in 2008 - at the next International AIDS Conference in Mexico - the new Director of the Global Fund, Bill and Melinda Gates, President Clinton, and many more should have tangible, well-funded actions to report. It's time that they deliver!
]]>Adirenne Germain is President of the International Women's Health Coalition.
When you think of a 12-year-old girl, you probably picture a child…not a wife and mother. In the United States recently, we have learned that child marriage still occurs from time to time and needs to be confronted. For example, the Colorado Court of Appeals ruled that a 15-year-old girl is old enough to be the common-law wife of a man more than twice her age (this ruling also created the possibility of girls as young as 12 becoming common-law wives). Here in the United States, this problem is an anomaly. In much of the developing world, however, it is commonplace—a major threat to the lives and well-being of tens of millions of girls.
]]>Adirenne Germain is President of the International Women's Health Coalition.
When you think of a 12-year-old girl, you probably picture a child…not a wife and mother. In the United States recently, we have learned that child marriage still occurs from time to time and needs to be confronted. For example, the Colorado Court of Appeals ruled that a 15-year-old girl is old enough to be the comm
on-law wife of a man more than twice her age (this ruling also created the possibility of girls as young as 12 becoming common-law wives). Here in the United States, this problem is an anomaly. In much of the developing world, however, it is commonplace—a major threat to the lives and well-being of tens of millions of girls.
Estimates are that in the next 10 years over 100 million girls will be married before the age of 18. Some of these girls will be no older than 7 years of age, and all will be forced into sex at puberty – making them more vulnerable to HIV and other sexually transmitted infections, injuries and death in child bearing, and violence and discrimination. This gross human rights violation must be addressed with exigency and efficiency, or countless young girls’ lives will be inalterably undermined.
Let’s look more closely at what happens when parents of a girl of only 10 or 14 marry her off to a man who is two or three times her own age, without her consent and usually without any understanding of what is in store. Even if he is only five or 10 years older he has most certainly already been sexually active and is likely to have additional partners while married. It is unlikely that the girl knows anything about sexuality or protecting her health on her wedding night. As a wife, she will have to submit to unprotected sex on demand from a husband who often is violent and/or drunk. Even if she knows about condoms, which is unlikely, she dare not ask her husband to use one because she is expected to bear a child (preferably a son) as soon as possible or she fears, justifiably, that he will beat her. The result: she is more likely to become infected with HIV than a sexually active girl who is not married.
It is not only the increased risk of HIV infection that makes child marriage harmful. When a young girl is married she then is denied access to education, health care services and economic opportunities. The cultural norms that encourage early marriage are the same norms that require social isolation after marriage.
International agreements and national laws against this practice state that people should only marry when both spouses consent and generally require a minimum age for marriage. But, these are rarely honored.
On Thursday, Senators Dick Durbin (D-IL) and Chuck Hagel (R-NE) brought before their colleagues a common sense and practical strategy for combating child marriage. The International Child Marriage Prevention and Protection Act would promote community-based efforts to reduce child marriage, and also provide critical health, education and economic opportunities to girls who already are married. If enacted – and implemented – this policy would make real strides toward changing cultural practices and help ensure that the fundamental human rights of girls are protected.
]]>Adrienne Germain is President of the International Women's Health Coalition.
In the next five minutes, another 25 women and girls will be infected with HIV. They are students, housewives, teachers, mothers, and more. HIV/AIDS programs have failed them, just as they have failed the 17 million women currently living with HIV/AIDS, and the countless others who have already died. We must do better.
Let’s take a look at the failure and its causes. In 2001, governments of the world declared that we would empower women and girls against the pandemic. When the world’s governments and civil society again convene at the United Nations next week they need to recognize that the situation is worse for women and girls today than it was five years ago. Infection rates among women and girls are rising in all regions, not only sub-Saharan Africa, because policies and funded programs to empower and protect them have not been a priority.
]]>Let’s take a look at the failure and its causes. In 2001, governments of the world declared that we would empower women and girls against the pandemic. When the world’s governments and civil society again convene at the United Nations next week they need to recognize that the situation is worse for women and girls today than it was five years ago. Infection rates among women and girls are rising in all regions, not only sub-Saharan Africa, because policies and funded programs to empower and protect them have not been a priority.
Girls and young women are the epicenter of this pandemic. The majority are married and do not have the option to negotiate “safer” sex. They are beaten or divorced if they ask their husband or partner to use a condom. They don’t even get their fair share of the health services and education needed to prevent or treat HIV, or to learn their HIV status.
To reflect these realities, we must shift HIV/AIDS policy and budget priorities dramatically. Today, a new social movement has mobilized to do just that, engaging activists from the global North and South, some living with HIV/AIDS and many who are not, from separate, often competing constituencies. This broad coalition agrees on and is promoting an action agenda – With Women Worldwide: A Compact to End HIV/AIDS – to bring about needed change in HIV/AIDS policies and budgets.
These changes in the agenda are not rocket science, but they do require generating political will and jettisoning social taboos. They aim to end the circumstances that make girls and women so vulnerable to HIV/AIDS ― discrimination, violence, early marriage and pregnancy, weak health services (especially sexual and reproductive health), the refusal of families and societies to educate young people about sexuality and safer sex, and our failure to teach them to relate to each other on the basis of equality and respect for human rights.
Working to make antiretroviral drugs available is important and a moral imperative. Prevention is as well. Prevention, which until now has focused on condom distribution and men who have sex with men, sex workers, and intravenous drug users, needs to be expanded to address the real-life circumstances of girls and women.
We need a real commitment, backed by resources, to ensuring sexual and reproductive health services for all women, in particular because these are the health services women most often seek out – they provide a perfect entry point for addressing HIV prevention among those who would not think about it otherwise, or who can’t access HIV services directly because of stigma and discrimination. These services need to include confidential, voluntary HIV counseling, testing, and support, as well as greatly increased access to subsidized female condoms, and development of microbicides and vaccines. Prevention budgets must also finance comprehensive sexuality education programs for all young people, that promote gender equality, girls’ empowerment, and mutual respect, not just information about HIV and the warning, “sex is dangerous ― abstain.”
Sex is both a part of healthy human relations and, unfortunately, a life and death matter. Bold, visionary leadership is desperately needed to promote prevention for all and by all.
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