The UK Consortium on AIDS and International Development welcomes the report of the High-Level Panel of the Eminent Persons on the Post-2015 Development Agenda.
The report, combining months of consultation with stakeholders across the world, sets out an ambitious vision to end extreme poverty. It has human rights and addressing inequality at its core and acknowledges health as an essential component of ending poverty.
As HIV advocates, we wholeheartedly support the Panel’s transformative shift that proposes that no one should be left behind. People living with HIV and key populations including people who use drugs, sex workers and LGBT communities are amongst those marginalised groups who are excluded from accessing human rights and development. Through the disaggregation of data, the HLP commitment that targets should only be considered achieved if they are met by all relevant social groups must include people living with HIV and key affected populations.
Too much progress has been made on the current MDGs for us to drop them now. We are therefore pleased that the Panel reinforced the need to continue with the unfinished business of the MDGs. With seven million people still unable to access HIV treatment and 8.7 million new TB cases a year, we must continue to honour the commitments we made to those people living with and affected by HIV and AIDS.
We are pleased with the health goal that focuses on ensuring healthy lives – we agree that the goals must be outcome focused and that synergies between goals are maximised. We welcome the specific inclusion of a target on HIV, TB and malaria and the recognition of other burdens of disease including NCDs. However, we feel that this target should be a candidate for a zero goal rather than just a reduction in disease burden. In line with commitments made by member states on HIV, we are calling for an END to AIDS and TB related deaths. Recognising the many complex and bi-directional linkages between mitigating HIV and the ability for all people to fulfil their sexual and reproductive health and rights, the inclusion of SRHR as a health target is much welcomed.
We also support the focus on international trade law and strengthened accountability of businesses, remembering that MDG 8E (access to affordable essential medicines) will not be met. Governments and business must come to agreement on international trade laws that work for the poorest communities of the world.
The specific goal on achieving gender equality is also welcomed, as is the integrated focus on women and girls as an issue cutting across goals, and through data disaggregation, recognising the fact that the poorest of the poor are women, and that women and girls continue to face structural barriers to achieving basic human rights. We are pleased to see that ending violence against women, and addressing property rights and access to credit, are among the focus areas of the gender equality goal.
We are encouraged that the Panel sees civil society as a vital partner in designing, realising and monitoring the new Post-2015 agenda. The report pointed to the fact that civil society organisations are often the ones who provide basic services (including health care) to those most vulnerable and marginalised, so our part in ensuring the Panel’s vision of no-one left behind cannot be understated. We now appeal to the UN Secretary General to ensure that civil society are included in a meaningful way in the remaining process to decide the Post-MDG agenda.
May 18th is World AIDS Vaccine Day. This day serves as a reminder that the development of an effective, preventive AIDS vaccine remains an urgent global priority.
This year’s World AIDS Vaccine Day coincides with the post-Millennium Development Goals (MDGs) G8 meeting, which will be held in Ireland in June. The UK prime minister is one of three co-chairs of the high level panel set up by the secretary general of the UN, Ban Ki-moon. Members of the panel have the challenging task of looking at where the existing MDGs have had the greatest impact – where most gains have been made – and where the greatest needs remain. The world will be watching as the panel prioritises the multitude of competing issues.
For the last 13 years MDG 6 – which pledges to combat HIV/AIDS, Malaria and TB – has played a vital galvanising role for action on meeting the global HIV challenge. We have seen significant progress, with over eight million people in low- and middle-income countries accessing life-saving antiretroviral treatment, and a reduction in new HIV infections by half, but we have a great distance yet to travel. Mathematical modelling from the International AIDS Vaccine Initiative (IAVI) shows that without continued progress in HIV prevention, population growth will overtake recent trends of declining HIV incidence. This means that without rapid scale up of current HIV prevention strategies and innovation to develop an AIDS vaccine, the pandemic appears unsustainable.
There is no question that vaccines have the power to save and improve lives, no pandemic in history has ever been controlled without one. Yet vaccine development can take decades of laboratory and clinical research and scientifically informed trial and error. The good news is that today most HIV researchers believe that the pertinent question is no longer whether an AIDS vaccine can be developed, but when that will happen, and how quickly such a vaccine will be rolled out. Much progress has been made but finishing the job will require sustained investment. It is vital that post-MDGs leaders make a renewed commitment to health research and development, including the commitment to develop an AIDS vaccine.
IAVI – an active member of the UK Consortium on AIDS – exists to spur the development of an effective, preventive AIDS vaccine and to get it into the arms of those who need it most. Together with others engaged in the search for an AIDS vaccine, they face one of the greatest scientific enterprises of our time. While the challenge may be great, the rewards are too. Vaccines are one of the most cost effective global public health tools we have. DFID’s investment in GAVI is testament to this. DFID has invested in the development of an AIDS vaccine, including through IAVI, as part of a broader research portfolio through multi-year grants since 1998. However, there are signs that DFID funding for this effort, as well as others supported from the same research and development budget line, is under threat. It is crucial that DFID continues to ensure sufficient funding to organisations such as IAVI, resisting the temptation to cut funding levels which could harm the pace and intensity of scientific advances. Modelling from IAVI has shown that even under conservative assumptions a 70 per cent effective vaccine could avert 8.9 million infections over ten years, and could save between £9.2 billion and £62 billion in averted treatment costs in the first decade alone.
Today on World AIDS Vaccine Day we are reminded that persistence and determination has already been rewarded with millions of people accessing vital vaccines that offer protection from measles, pneumonia and cancer-causing viruses, among others. Now let’s imagine that AIDS takes its rightful place on that list of preventable diseases. Imagine a world without AIDS this World AIDS Vaccine Day. That day is possible if we can convince world leaders to stay the course, invest in science and give global health the ‘shot in the arm’ that it needs.
International AIDS Vaccine Initiative
Why an International Day Against Homophobia and Transphobia? And why May 17? The second question can be answered quickly. It was on May 17 1990 that the World Health Organisation finally removed homosexuality from its list of mental disorders. The answer to the first question is that since then, officially sanctioned discrimination against lesbian, gay, bisexual and transgender (LGBT) people has far from gone away. Indeed in many parts of the world, it has become worse.
Just look at Uganda, where legislation is still being discussed that could introduce the death penalty in some circumstances, and which would force doctors, teachers, parents and friends to report LGBT people to the police or face prosecution themselves.
Last year one of my colleagues from the Kaleidoscope Trust visited Uganda with Ben Simms of the AIDS Consortium. It was just one element of the collaboration between our two organisations. The fight against homophobia and the battle to halt the spread of HIV/AIDS are intrinsically linked. And nothing shows that more clearly than what is going on in Uganda.
Although the notorious Anti-Homosexuality Bill may never become law, its damage has already been done. It has fuelled an already prevalent mood of intolerance and prejudice towards gay men in particular. And if the LGBT community continues to be marginalised and criminalised then it becomes ever harder to reach them with proper health advice and exposes them to the possibility of arrest should they go to a doctor and tell the truth about their sexual practices.
Yet the LGBT community has refused to be cowed. A special sexual health clinic opened last year in Kampala, with international funding, including through the Consortium. And in the face of intense political and public hostility, activists continue to demand the same human rights as everybody else.
That is why today, International Day Against Homophobia and Transphobia, has grown and grown in recent years, with events now taking place all over the world. Transphobia was added to recognise the fact that trans people suffer abuse, discrimination and violence on a horrifying scale too. The Kaleidoscope Trust is holding a lecture this evening in London by the world’s only trans MP, Anna Grodzka from Poland, an inspiring individual who is at the forefront of LGBT rights.
There is nothing special about the rights LGBT people are demanding, but regrettably a special day to highlight those demands is necessary. In far too many countries where discrimination against women or racial minorities or the disabled would be rightly rejected, discrimination on grounds of sexual orientation or gender identity is socially acceptable and even the norm. Every day should be a day against homophobia and transphobia but today of all days we welcome your support.
Lance Price is Executive Director of the Kaleidoscope Trust www.kaleidoscopetrust.com
Today marks World Malaria Day – a day for celebrating the momentous progress made in the fight against malaria in the past decade. As Parliamentary Under-Secretary of State Lynne Featherstone MP today notes in her Huffington Post blog, since the year 2000 over 1 million lives have been saved through efforts to role out malaria prevention and treatment. As the Minister also highlights, by 2010, 145 million bednets to prevent malaria were being delivered to Sub-Saharan Africa, and a year later 278 million of the most effective malaria treatments (known as ACTs) were also being distributed, up from just 11 million in 2005.
The institution behind much of these successes is the Global Fund to Fight AIDS, TB and malaria. It’s the Global Fund which has funded 310 million of the bednets distributed from 2002 to date, and treated 260 million cases of the disease. However, the Global Fund needs to fundraise $15 billion for the coming three years, to sustain these gains, and see the trajectory of the malaria epidemic (as well as that of the HIV and AIDS, and TB epidemics) curbed for good. For malaria, meeting this $15 billion fundraising target would mean an additional 200,000 lives saved every year, on top of those saved by existing levels of financing. It would also mean the most grave threat the response to malaria faces – that of a decline in global financing, risking what the DFID Minister describes as a ‘reversal of a decade of progress’ – would be averted.
The UK government can be hailed for its commitments to the malaria response to date, its commitment to the Global Fund, its specific initiatives to combat the disease (like that announced today to protect 6 million people in the Democratic Republic of Congo), and the manifesto commitments to address malaria, including the Conservatives’ commitment to spend £500 million per year tackling this disease. The Global Fund replenishment represents the best opportunity to meet these manifesto pledges, and to see the tide turned against malaria for good. The US has already set the pace to see the Fund’s $15 billion target reached, provided other donors provide the remaining funding. The UK must now step up to the plate and make its own ambitious pledge, of £1 billion over three years, to see the US commitment realized, and the Fund’s overall fundraising goal met.
With the Fund’s $15 billion target achieved, next year’s World Malaria Day, and those in the year’s to come, could see us again optimistic, and celebrating more millions of lives saved. The alternative just can’t be an option.
One of our trustees, Robin Gorna, recalling her experiences in the Huffington Post as the UK Government’s Policy Lead on AIDS and the urgent need for Global Fund replenishment:
Being a government lead policy adviser is a funny business. Work ranges from somewhat mundane to adrenalin filled moments. Occasionally you have the unique pleasure of seeing a global bureaucratic game transform into real change – change that saves lives.
I led the UK’s policy team on AIDS from 2003, a time that spanned the last UK G8 in 2005. Tony Blair declared that Africa would be at the centre of discussions during its joint Presidency of the G8 and the EU.
It was a bold choice.
The Gleneagles G8 was preceded by massive public debate and a heady swell of protests and marches. International development was a top priority for the 8 (formerly) most powerful nations in the world.
I worked for long sighted, passionate ministers – Hilary Benn and Gareth Thomas – who had already taken the issue of AIDS to heart. They were not afraid to speak out on the gory details of sex & drugs, and put real money behind the response. With the added bonus of a big push on AIDS by US President George Bush, AIDS climbed up the priorities of the G8, as a sub-theme of “Africa”.
Life as a policy lead had just become more interesting.
One of the things I learned as a bureaucrat is that it is not just what is said but who says it that matters. Our job was to guide and craft language. Whether top political leaders then say those words and commit their country to action is what counts.
The UK did, followed by the G8. It wasn’t straightforward – behind the scenes there was delicate back & forth, especially between the countries that would have to do most to deliver such a promise. My most vivid memory of negotiating with my US counterpart was a few days before the summit: I was reading bedtime Harry Potter stories to my twin sons and broke off many times to tweak the words of the communiqué. When the US & UK say they will do something they do it – they know that the activists will chase them if they don’t.
We always knew that once the G8 committed to this, it mattered that other countries did. We turned our minds to making sure all UN Member States would step forward. By September they had made a pledge, elaborated in 2006 as moving “towards the goal of Universal Access to comprehensive prevention programmes, treatment, care and support by 2010″.
It was a game changer. Kofi Annan credits the 2005 G8 sentence as getting 5.4 million people on ARVs. In 2006 I visited the South African Treatment Action Campaign (TAC) and was astonished to see hundreds of activists gathered under a banner with the exact words I’d negotiated while reading Harry Potter. Those words became their plea to their government and donors, and helped force the political shift that turned the tide of denialism (the policy that led to the deaths of thousands of South Africans with HIV).
That Universal Access sentence loosened the pockets of donors, and persuaded countries with the biggest epidemics that they must act, and that they would be supported if they did. In 2005 just over 1 million people were on HIV treatment. Now it is over 8 million. Globally 54% of people with HIV in need of treatment access it, and 10 countries provide treatment to 80% of their citizens (Universal Access according to WHO).
Did we achieve universal access by 2010? Clearly not. But those agreements put the world on the right trajectory. A comprehensive response to AIDS is now within sight. It is beyond doubt that countries can make the changes necessary to treat their citizens with HIV and at risk of infection with the same dignity and respect as others. I am proud that the G8 played its part in that.
2013 sees the UK back in the Chair of the G8. What a great opportunity. Not only because of the great results last time, but importantly because experts tell us that a big push now can totally change the future course of AIDS, and also of TB and malaria. The drugs exist, the building blocks of the health systems are in place, the demand for services has grown. We understand what programmes are needed and how to resource them. But there is one thing missing: enough money.
This week sees two key events: the Global Fund launched its replenishment cycle on Monday and the G8 Foreign Ministers meet to prepare for the upcoming summit. US $15billion is needed to transform the world’s response to AIDS, TB and malaria. This would raise the numbers on HIV treatment from 8 million to 18 million by 2016; put 17 million people on TB drugs, saving 6 million lives over the next 3 years; and protect millions from malaria, saving an extra 200,000 lives a year.
We know that the Global Fund can support its country partners to deliver these results. The man I was busy negotiating with 8 years ago, Mark Dybul, is now the man running the Global Fund, having previously overseen the most successful roll out of AIDS services ever as head of the US PEPFAR programme.
Now the challenge is for William Hague and his G8 colleagues to have the vision and commitment to get behind the Global Fund, put Global Health back on the G8 agenda and raise the $15 billion needed to turn the curve of these three diseases.
That way we can move towards the vision of the 2005 G8: “an AIDS-free generation.”
Sports for Development (SfD) programmes have ‘fantastic potential’ to reach large numbers of marginalised people living with HIV and ‘can play a key role in increasing the number of community members who know their HIV status’. Yet, despite this, there is still room for improvement as far as this innovative approach to the AIDS response is concerned.
These were some of the illuminating findings from a new report co-launched by Comic Relief and UK Sport this week. Testing Times details the progress of SfD initiatives in southern Africa to date, the numerous challenges facing these programmes, and what shape they should take in the future.
As CEO of Tackle Africa (a charity committed to delivering HIV education to young people across Africa through football coaching), I have seen first-hand how sport programmes provide an existing infrastructure for reaching young people who may be harder to access with traditional health programmes. I am delighted with this important and timely document. It highlights some of the potential for positive impact within sport for development programmes, including the de-stigmatisation of HCT, the opportunity to engage young people, men and those who don’t access existing services and the opportunity for greater collaboration with other development projects. These findings send a clear and important message for funders and the wider development community: that sport is a credible and still undervalued tool in the HIV response.
The research – carried out by Centre for AIDS Development, Research and Evaluation (CADRE) – describes effective innovations that have come about from working within this development model, including Post-Test clubs for HIV-negative and positive youth, support groups for young people living with HIV and peer support for treatment adherence.
The paper also illustrates the ability of sports programmes to draw people in, especially when the huge reach and mobility of sports and football tournaments or Health Centres is taken in to account. The unique position that sport enjoys is that young people already choose to engage in it in huge numbers on a regular basis all over the world already – and nowhere more than in Africa. Sport develops young people’s life skills and social abilities, and has tiny resource intensity. A patch of ground in a slum and an improvised football can provide 30 young kids with hours of enjoyment on a daily basis. The potential to utilise this as a platform for structured learning and social change is enormous. These factors all add to the value SfD programming is providing to the HIV sector.
The report’s call for greater development of partnerships between SfD and specialist organisations to maximise the positives of SfD programming in HCT is very welcome, helping SfD and traditional NGOs to work together with their respective skills to deliver high quality interventions. These interventions need to be comprehensive, holistic and long term; this is why Tackle Africa uses coaching sessions rather than tournaments to get our messages across. We support the recommendations around partnerships, comprehensive service packages and that sport for development organisations are seen as valid and important players. Under successful initiatives, young people benefit from an enjoyable, integrated and effective health/sports programme, the partner benefits from our training and we benefit from local specialised knowledge which we take and share across our networks, including the UK Consortium.
Yet, despite these positive insights, there are worrying trends that must be addressed if we are to harness the full potential of HIV/sports joint programming: namely ethical considerations, access to funding and limited capacity.
The areas for serious ethical consideration and improvement include lack of sufficient provision of pre- and post-test counselling, the challenges of safeguarding confidentiality, empowering individuals to test and the provision of good quality follow-up services. We agree that the use of incentives, such as team points for testing, could lead to unintentional negative peer pressure to test and the stigmatising of those who are not displaying a post-test reward irrespective of the fact they may not have tested at all. However, we feel that the monitoring and evaluation of the programmes focuses too heavily on the numbers and fell short on reporting the quality of the service provided by the partners involved.
Finally, there is still a struggle to convince some funders that sport is as credible a development tool as say classroom education. There is also the added risk that funding for HIV may slip off the agenda due to the recent breakthroughs in treatment and reduced rates of new infection, and in times of economic austerity, funders may tend to prefer traditional approaches rather than those they perceive as new or risky.
Sport has huge potential, but like any powerful tool, it needs to be used responsibly. To equip young people to protect themselves and each other against HIV requires the creation of a supportive and open environment where sensitive issues can be discussed and difficult questions can be asked and answered. With the right support and a well-trained coach, a football team can be the perfect fit, with players working together and supporting each other to achieve their goals.
Charlie Gamble, CEO, Tackle Africa
Tom Warren, UK Consortium on AIDS and International Development
The UK Consortium welcomes the consensus reached on agreed conclusions of the 57th Commission on the Status of Women (CSW). After the impasse of last year that resulted in no agreed outcome document, it is encouraging that member states have come together on the serious issues of violence against women and women’s role in HIV caregiving.
The Commission notes that “violence against women and girls is rooted in historical and structural inequality in power relations between women and men, and persists in every country in the world as a pervasive violation of the enjoyment of human rights”, acknowledging that violence against women occurs in both public and private settings.
We are particularly encouraged to see strong recognition in the agreed conclusions of the many links between violence against women, HIV and AIDS, as well as the impact violence has more broadly on sexual and reproductive health. Research shows that intimate partner violence (IPV) doubles women’s vulnerability to acquiring HIV and that gender based violence and rape more generally are co-epidemics in countries with high burdens of HIV.
The Commission calls for the elimination of discrimination and violence against women and girls living with HIV as well as the caregivers of persons living with HIV. It also backs the acceleration of efforts to address the intersection of HIV and AIDS and violence against women and girls. But how to do this? The Commission recommends strategies to address domestic and sexual violence, the strengthening of coordination and integration of policies, programmes and services to address the intersection between HIV and violence against women and girls, and by ensuring access to HIV diagnostics, affordable and accessible treatment and prevention services.
We agree with the Commission’s stance that barriers to affordable and accessible health care services, including HIV, sexual and reproductive health, must be overcome if women are to live a full and healthy live. It is also encouraging to see that the Commission agrees to promote and protect the right of all women to have control over, and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health and access to HIV services – free of coercion, discrimination and violence. The Commission also urges Governments to take action to prevent violence against women and girls in health care settings, especially for vulnerable women and girls including those living with HIV.
We welcome the Commission’s re-focus on education as a human right, ensuring girls attend school as a lever for empowering women, reducing violence, and in addition lowering risk of HIV transmission (research shows that girls who have a secondary education are three times less likely to be living with HIV).
We agree with the Commission that men and boys must be engaged if we are to end violence against women, but caution against diverting funds from women-led organisations for this purpose. Globally many small organisations deeply committed and connected to these issues are struggling and folding over the last several years. As research from the Population Council has shown, funding to programmes led by women’s organisations spreads the beneficial outcome to men and boys also, whereas funding to men’s programmes tends to be spent more exclusively on men and boys.
The UK Consortium recognises that caregivers provide an essential HIV care and support role, without which the successes we have had in the response to HIV and AIDS would not have been achieved. Caregivers are predominately female with gender norms and stereotyping reinforcing the notion that caregiving is “women’s work”. We welcome the Commission’s call for the sharing of paid and unpaid work between women and men, as well as the need for gender-sensitive policies and programmes which promote greater understanding and recognition that caregiving is a critical societal function (and thus equal sharing of responsibilities and chores between men and women in caregiving). The Commission urges Governments to work to change attitudes that reinforce the division of labour based on gender in order to promote shared family responsibility for work in the home and reduce the domestic work burden for women and girls (allowing girls to attend school).
DFID Minister Lynne Featherstone attended the CSW, building on their leadership on women and girls rights by announcing investment in pushing for the end of female genital mutilation (FGM) worldwide within a generation. This builds on commitments made by Justine Greening on International Women’s Day which seeks to strengthen DFID work on gender inequality.
It is encouraging to see the link between HIV and violence acknowledged and whilst the Commission “strongly condemns” violence against women and girls, re-affirms the many resolutions, conventions and declarations focused on gender based violence, and “urges” Governments to strengthen legal and policy frameworks, it remains to be seen if this will change the lives of women throughout the world, including women living with HIV, who suffer violence as a part of their daily lives. Now we need to turn promises into action.
‘They go to die’ – this is the title of the film that is touring the country this month in the run up to World TB Day on Sunday 24th March. And it’s an all too accurate description of the situation faced by the South African miners the film profiles. They work in optimum conditions for contracting TB, and it is estimated that one third of TB infections in the Southern Africa region are linked to mining activities. After contracting TB underground the miners are then sent home, often to rural areas, where inadequate treatment provision and care leads to almost certain death.
The film is being toured by RESULTS, an international NGO that uses advocacy and campaigning to bring about the end of extreme poverty. The film’s title is relevant to the TB epidemic as a whole. 1.4 million people died of TB in 2011 – a completely unacceptable mortality rate for a preventable and curable disease – and it remains the leading cause of death in people living with HIV worldwide. At least a third of all people living with HIV in the world are co-infected with TB. Multi-drug resistant TB (where TB cannot be treated by first-line drugs) is on the rise, with 310,000 new cases in 2011, and extensively-drug resistant TB (where TB cannot be treated even by second-line drugs, making it sometimes impossible to treat), has been identified in 84 countries.
The World Health Organisation and the Global Fund to Fight AIDS, TB and malaria, this week said there is an urgent need for $1.6 billion per year of international financing for TB programmes, in order to see full treatment and prevention of the disease. The Global Fund itself provides 90% of all international financing for the TB response: without a fully funded Global Fund, the response to TB would be completely decimated. You can learn more about some of the lives the Global Fund’s TB funding impacts on in this video.
In addition, for the Global Fund, this year is of critical importance. The Fund’s replenishment process – whereby new finances are raised for its vital work – will be launched in April. If the funding gap of $1.6 billion can be filled, 6 million lives could be saved between 2014-16, through the provision of TB treatment for 17 million people. Without this financing now, the epidemic will continue to grow, and people living with HIV and TB, and affected by malaria, will only continue to go home to die.
For more information on ‘They Go to Die’ screenings, and to help RESULTS UK hold mining companies to account for the provision of TB treatment and care for their miners, please contact firstname.lastname@example.org , or click here.
Steve Lewis, Global Health Advocacy Manager, Results UK
Jessica Hamer, UK Consortium on AIDS and International Development
Tom Warren, UK Consortium on AIDS and International Development
The Faith Working Group of the UK Consortium on AIDS and International Development extends its warm congratulations to former Cardinal Jorge Bergoglio on his election as Pope Francis I on Wednesday, 13th March.
During his time as Archbishop of Buenos Aires, Cardinal Bergoglio developed a reputation as a champion for the poor and the marginalised in society. In Argentina, despite a low prevalence overall, HIV disproportionally affects the poor, the socially excluded and minority populations. As a result, people living with HIV are subject to considerable stigma in Argentine society. This is, of course, not unique to Argentina – people living with HIV and AIDS are grossly stigmatised and marginalised in most parts of the world.
We therefore encourage His Holiness Pope Francis to continue working with and advocating for those living with HIV, and the many Catholic agencies, churches and hospitals around the world who care for and support them. The Roman Catholic Church is one of the world’s major providers of treatment, care and support to people living with HIV. Many in the Catholic Church, especially those who are members of religious orders, are a major force for fighting the stigma and marginalisation associated with a diagnosis of HIV or AIDS.
The Pope’s voice carries tremendous geopolitical weight and can change people’s attitudes and perceptions on a global scale. We therefore urge His Holiness to continue to support the vital work being done by his Church around the world, and to speak out publicly and frequently in support of those living with HIV.
Faith Working Group of the UK Consortium on AIDS
International Women’s Day is an opportunity to celebrate the achievements and emphasise the potential of women and girls throughout the world. It is also a time to highlight the barriers that women still face in the struggle to live an empowered, fulfilled and healthy life.
Despite the biomedical advances made over the last three decades, HIV continues to have a disproportionate impact on women. In every region of the world, HIV incidence among young women is increasing. AIDS continues to be the leading cause of death and disease for women of reproductive age and it is widely recognised that violence is both a cause and consequence of HIV transmission.
Women, especially young women living with HIV, continue to experience gross human rights violations that relate to their sexual and reproductive health. Gender inequality has long been recognised as – and continues to be – both a cause and a consequence of HIV. The intertwined pandemics of HIV and violence against women begin to illustrate the complexity of the way gender power imbalances play out in the context of HIV.
There is now clear evidence globally that intimate partner violence (IPV) doubles women’s vulnerability to acquiring HIV*. At least one in three women will be beaten, coerced into sex or abused in her lifetime. Recent evidence suggests that the pathways between IPV and HIV acquisition are much more complicated than originally thought. These include higher incidences of risky sex, lower ability to negotiate condom use, or discuss safer sex practices, and a tendency among men who perpetrate violence to have had more sexual partners, more risky sex, and higher prevalence of HIV and other sexually transmitted infections.
Furthermore, women who are living with HIV are more likely to suffer from violence**, as an HIV diagnosis exposes women to new sites of violence, not only from partners, family members and the wider community, but also within institutional settings, such as health care, and as a result of gender blind laws and policies around HIV
“The overlap of social determinants of HIV and social determinants of violence—means that often the violence experienced by HIV positive women mirrors that experienced by women generally. HIV, however, exposes women to violence in new situations. HIV also acts as one more ‘determinant’, pushing women further down the hierarchy of power.” (from Hale and Vazquez, 2011)
The result is a web of complex, reciprocal and self-perpetuating links between violence against women, HIV and lack of access to sexual and reproductive health rights, including family planning and HIV prevention services, which have implications for the well-being of women living with HIV and onward transmission of the virus.
The following quote bring these issues to life:
‘I started taking medication in 2006. My husband does not know. I take the medicine out of a bottle and put it in a plastic bag or in a paracetamol box … Sometimes I would miss a dose; he comes back at 18.00 hrs, drunk, closes the door and says, “today you are going to freak out.” He locks me in, he beats me up and locks me out of the house. .. I go to the neighbours, if they have mercy they will let me in, if not, I sleep under a tree until tomorrow. As a result of that I miss doses sometimes. I feel very bad. I don’t even feel like taking the medicine.’ Berta k., Lusaka (Hale and Vazquez, 2011, p.18)
This year provides abundant opportunities for world leaders to work with women and girls to take firm steps towards ending violence against women. As we write this, policy makers, including our own Minister at DFID Lynne Featherstone, are gathering in New York for the Global Commission on the Status of Women-the core focus of which is violence against women. The Foreign Office has also made violence against women a central theme of this year’s G8 through the launch of Hague’s Preventing Sexual Violence Initiative (PSVI).
In the coming months, we look forward to seeing how the UK government maximises these opportunities, builds on its commitments to HIV/AIDS, and leads concrete actions to transform the negative cycle of “violence against women leads to HIV leads to more violence against women” into a positive cycle of “safety and security for ALL women and girls leads to the promotion and protection of our human rights (including the human rights of women living with HIV) leads to the greater safety and security of women and girls”.
* Preventing HIV by preventing violence: the global prevalence of intimate partner violence against women and its links with HIV infection. Devries K et al 2010. Paper presented at the Vienna AIDS Conference.
**The Global Coalition on Women and AIDS, preventing HIV infection in girls and young women http://data.unaids.org/GCWA/GCWA_BG_preventation_en.pdf