UNFPA The United Nations Population Fund

Sex worker initiative Veshya Anyay Mukti Parishad (VAMP) give a performance at the opening of the Sex Workers’ Freedom Festival in Kolkata, India.
Credit : UNFPA/J.Cabassi

As thousands of delegates gather for the XIX International AIDS Conference (AIDS 2012) in Washington, D.C. this week, a parallel satellite hub, the Sex Worker Freedom Festival, is taking place in Kolkata, India, from 22-26 July.

The event brings together over 600 sex workers, international and national partners from more than 40 countries. The Freedom Festival has been organized by sex workers as a response to extensive visa regulations for sex workers and people who use drugs, which may have prevented many from attending the International AIDS Conference event in Washington DC. The five-day festival gives participants the opportunity to be part of the Washington event through video-conferencing link up with major conference sessions and with the Global Village.

“The Sex Worker Freedom Festival is an alternative event for sex workers and our allies to protest our exclusion and ensure the voices of those excluded are heard in Washington.” said Ruth Morgan the Global Coordinator of the Global Network of Sex Work Projects (NSWP) and Co-Organizer of the Kolkata event.

Speaking at the opening of the Kolkata hub, United Nations Secretary General’s Special Envoy on AIDS in Asia and the Pacific, Prasada Rao, stressed that freedoms and rights of sex workers are being denied on a daily basis.

“Aspects of sex work are criminalized in 116 countries around the world. Laws in many countries conflate adult consensual sex work with human trafficking. Routine police raids, often in the name of anti-trafficking, lead to arrest and harassment of adult consenting sex workers,” said Mr Rao. “These discriminatory practices drive sex workers to social exclusion and into a socially disadvantageous position, accentuating their vulnerability to HIV,” he added.

Despite progress made in reducing the spread of HIV within sex work communities, sex workers are still at increased risk of HIV infection. In the Asia-Pacific region for example, while a number of countries have reduced their HIV infection rates with intensive HIV prevention programmes among people who buy and sell sex, hotspots of high prevalence remain. Surveys of female sex workers in India show prevalence of 18% in Maharashtra and 41% in Pune—the overall adult level in the country is an estimated 0.3%.

Sharing experiences, driving progress

The Sex Worker Freedom Festival programme is structured around fundamental freedoms; human rights that all people are entitled to. These include freedom of movement; freedom to access quality health services; freedom to work and choose occupation; freedom to unionise; freedom to be protected by the law; freedom from violence; and freedom from stigma and discrimination.The Festival aims to facilitate the sharing of experiences as well as dialogue around key issues and priorities for the sex work community and HIV programming.

“Without the right to organize and unionize the sex worker community cannot advance our rights,” stated Bharati Dey, General Secretary, Durbar Mahila Samanwaya Committee (DMSC), co-organizer of the Kolkata Hub.

The stigma and discrimination experienced by sex workers was identified as a major obstacle to an effective response to AIDS. “Every day and in every location, we have to battle against stigma and discrimination,” said Lakshmi, a sex worker and the Director of Programmes at the Ashodaya sex worker initiative in Mysore, India, said. “We have found a way to be part of the solution. Our team of HIV positive sex worker volunteers has built an effective partnership between communities and health services. This has changed attitudes of health care providers and has created community confidence to access health services.”

Annah Pickering, a sex worker and Manager of the Auckland Region, New Zealand Prostitutes Collective, underlined the multiple benefits of decriminalization of sex work in her country, both for sex worker rights and the HIV response. “We appreciate many legal freedoms. We can report corrupt officials who demand free sex. We don’t hide our condoms in our bras or behind the picture or in the thermos flask. We can put up signs and promote safe sex and insist on it. Does decriminalising sex work prevent the transmission of HIV?  I strongly believe so. When you put all these elements together they contribute significantly to support sex workers in preventing the transmission of HIV,” she said.

A central theme of discussions at the Kolkata Hub has been the widespread experiences of violence faced by sex workers around the globe on a daily basis. Sessions have underlined how documentation of sex workers’ experience of violence is critical to ensuring evidence is used to inform effective responses. A sex worker led research project being conducted in Sri Lanka, Myanmar, Nepal and Indonesia by the Center for Advocacy on Stigma and Marginalization (CASAM), the Asia Pacific Network of Sex Workers (APNSW), UNFPA, UNDP, UNAIDS and Partners for Prevention was highlighted as an important initiative in better identifying the risks and factors that help protect sex workers’ from violence.

UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific Mr Prasada Rao speaks at the opening of the Sex Workers’ Freedom Festival in Kolkata, India.
Credit: UNAIDS

“This research is designed to generate quality data, that ensures sex workers’ lived experiences are used to advocate for better policy and programmes to prevent and respond to violence,” said Meena Seshu, Director of the Sampada Gramin Mahila Sanstha (SANGRAM) sex worker peer education project.

The importance of increasing sex workers’ access to quality, integrated, health services has also been a key issue of emphasis. Kay Thi Win, Director of the Targeted Outreach Programme (TOP) initiative in Myanmar, which provides peer-to-peer HIV prevention and support for sex workers said: “There are few sex worker friendly clinics. When TOP started, there was no comprehensive sexual health intervention in Myanmar for sex workers. However through our work we have been able to increase the linkages by providing a comprehensive sexual and reproductive health package that also includes HIV services.”

The Kolkata Hub is hosted by Durbar Mahila Samanwaya Committee (DMSC), and is co-organized with the Global Network of Sex Workers (NWSP) and the All India Network of Sex Workers (AINSW). It is supported by the Open Society Foundation’s Sexual Health and Rights Program, UNAIDS, the Dutch Ministry of Foreign Affairs, UNFPA, HIVOS (the Humanist Institute for Development Cooperation), AIDS Fonds (a Netherlands-based HIV project funder) and the AIDS 2012 conference secretariat.

Family planning can be a key contributor to reducing the number of unplanned pregnancies among women living with HIV.
Credit: UNAIDS/A.Gutman

Putting the spotlight back on family planning, the UK Government along with the Bill & Melinda Gates Foundation organised a summit in London to support the right of women and girls to decide, freely and for themselves, whether, when and how many children they have.

In partnership with the United Nations Population Fund (UNFPA), national governments, donors, civil society, the private sector, the research and development community, and others from across the world, the London Summit on Family Planning called for global political commitments and resources that will enable 120 million more women and girls to use contraceptives by 2020. Reaching this goal could result in over 200 000 fewer women and girls dying in pregnancy and childbirth and nearly 3 million fewer infants dying in their first year of life.

The event explored the linkages between family planning and sexual and reproductive health and rights, including HIV, violence against women, and abortion-related mortality. It also invited delegates to raise the bar for women and girls by linking family planning with HIV programs. HIV is the leading cause of death among women of reproductive age.

Speaking at a special HIV-focussed session at the conference, Ms Anna Zakowicz from GNP+ talked about how accessing family planning was the number one barrier for women living with HIV. The South African Minister of Health, Mr Aaron Motsoaledi, discussed opportunities to strengthen integration with programmes that prevent HIV transmission from mother to child.

UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay, emphasised the opportunities that lie ahead for transformative change, and how integrating family planning, sexual and reproductive health and rights, and HIV can contribute to achieving women’s sexual and reproductive health and rights.

"UNAIDS is committed to integrated, evidence-informed programming with a focus on results,” said Dr De Lay. “Whether at national or global levels, the AIDS movement’s prime commitment is saving lives and promoting the dignity and rights of all people,” he added.

The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive convened by UNAIDS and PEPFAR aims to ensure, among other things that HIV, maternal health, newborn and child health, and family planning programmes work together, deliver quality results and lead to improved health outcomes.

The Global Plan contributes directly towards achieving the fifth Millennium Development Goal of improving maternal health by preventing HIV among women and providing family planning for women living with HIV of childbearing age. Family planning can be a key contributor to reducing the number of unplanned pregnancies among women living with HIV. Linkages with HIV services should therefore be a priority.

Group picture at the launch of the GlobalPOWER Women Network Africa meeting in Harareon 24 May. From left to right: Mr Michel Sidibé, UNAIDS Executive Director; HE Morgan Tsvangirai, Prime Minister of Zimbabwe; Dr Navanethem Pillay, United Nations High Commissioner for Human Rights; Hon Thokozani Khupe, Deputy Prime Minister of Zimbabwe; HE Robert Mugabe, President of Zimbabwe; Hon Erastus Mwencha, Deputy Chairperson of the African Union Commission; and Dr Ngozi Okonjo-Iweala, Minister of Finance, Nigeria.
Credit: UNAIDS/D.Kwande

UNAIDS Executive Director Michel Sidibé concluded his first official visit to Zimbabwe on 25 May after meeting with President Robert Mugabe and Prime Minister Morgan R. Tsvangirai to highlight the country’s progress in the AIDS response.

President Mugabe and Mr Sidibé met on the sidelines of the inaugural meeting of the GlobalPOWER Women Network Africa, which was launched in Harare on 24 May. In their meeting, they reviewed Zimbabwe’s success in mitigating the impact of HIV as well as the opportunities to further the country’s response.

Mr Sidibé commended the collective efforts made by the Government of Zimbabwe for having maintained community engagement and service provision to expand access to HIV prevention and treatment services during a difficult period. “The Government of Zimbabwe’s support for the national AIDS response bridges parties and portfolios,” said Mr Sidibé. “This has resulted in a significant reduction of adult HIV prevalence and a steady decline in the number of new HIV infections.”

Zimbabwe has achieved one of the sharpest declines in HIV prevalence in Southern Africa, from 27% in 1997 to just over 14% in 2010. With 10 times fewer resources for AIDS per capita than other countries in sub-Saharan Africa, Zimbabwe has expanded coverage of antiretroviral treatment among adults, from 15% in 2007 to 80% in 2010. At the end of 2011, nearly half a million people in the country were receiving lifesaving HIV treatment and care.

President Mugabe and Mr Sidibé discussed country ownership and shared responsibility, highlighting the importance of African countries to contribute greater domestic resources to complement the investments from international partners. President Mugabe agreed to support the agenda for country ownership and shared responsibility with other African Heads of State at the upcoming Africa Union Summit in Lilongwe, Malawi.

Boosting domestic AIDS investments

In a separate meeting with Zimbabwe’s Prime Minister, Morgan R. Tsvangirai, Mr Sidibé lauded the success of Zimbabwe’s ‘AIDS Levy’, a tax on income to increase domestic resources for the national HIV programme. This innovative approach has enabled Zimbabwe to diversify its domestic funding for its AIDS response, raising an estimated US$ 26 million in 2011. This year the levy is expected to raise US$ 30 million.

“The Zimbabwe AIDS Levy is an excellent example that demonstrates to other African countries how to generate domestic resources to maintain and own their national AIDS responses,” said Mr. Sidibé. “I encourage the Government of Zimbabwe to explore how this initiative could be expanded to tap into the informal sector to boost the resources of the trust fund.”

An important focus of the national AIDS response in Zimbabwe is the elimination of new HIV infections among children and keeping their mothers alive. The number of sites providing services to prevent mother-to-child transmission of HIV (PMTCT) in the country has nearly doubled in recent years, from 920 in 2008 to 1 560 in 2010. According to the Progress report 2011: Global HIV/AIDS response, an estimated 86% of HIV-positive pregnant Zimbabwean women received antiretroviral prophylaxis in 2010, compared to only 17% in 2008.

Commenting on Zimbabwe’s progress in this key area, Prime Minister Tsvangirai highlighted that more work remains ahead in the national AIDS response. “There is improvement in Zimbabwe when it comes to AIDS, but we still have many challenges and need to closely collaborate with the international community,” stressed the Prime Minister. “Zimbabwe needs to recognize and build on the encouraging progress we made so far.”

While applauding the Government’s commitment to eliminate new HIV infections among children and keeping their mothers alive by 2015, the UNAIDS Executive Director encouraged the Prime Minister to take additional measures to protect the health and rights of women and girls.

The UNAIDS Executive Director with Zimbabwean Deputy Prime Minister, Honourable Thokozani Khupe in Harare, 23 May 2012.
Credit: UNAIDS/D.Kwande

“Zimbabwe’s constitution-making process presents unprecedented opportunities to revisit laws to better protect women and girls,” said Mr Sidibe. “The government should considering amending the legal age of marriage for girls from 16 to 18, which is the age of majority in Zimbabwe.”

Mr Sidibe further emphasized the importance of an inclusive AIDS response that ensures the provision of live-saving services to all people, including sex workers, people who use drugs, mobile populations and men who have sex with men.

Shortly after his arrival in Harare on 23 May, the UNAIDS Executive Director visited the Epworth Polyclinic in Harare to see Zimbabwe’s efforts in bringing integrated health and social services to eliminate new HIV infections among children. At the clinic, he met many mothers with their children who—thanks to effective PMTCT services—were born HIV free.

The Epworth Polyclinic is one of the 1 560 facilities in the country that provide integrated maternal and child health services, including antenatal care, HIV counselling and testing, PMTCT interventions, early infant diagnosis, immunization, reproductive health counselling and nutritional support. The clinic also promotes male involvement through its partnership with Padare, a social practice that brings together traditional and local leaders, grandfathers, fathers, uncles and brothers to discuss issues related to gender equality and HIV prevention, including among children.

During the visit to the Epworth Polyclinic, Mr Sidibé said, “It is evident that Zimbabwe is facing major challenges, but what I am seeing today is a bold example of how you have united to establish community-centred services that integrate health, nutrition and social aspects. This kind of partnership which is not limited only to the international community at the top but also with communities at the household level can bring about radical change.”

On 24 May, Mr Sidibé addressed the inaugural GlobalPOWER Africa Women Network meeting in Harare. In his remarks, the Executive Director applauded Zimbabwe’s Deputy Prime Minister, Honourable Thokozani Khupe, for her key role as President of the GlobalPOWER Women Network Africa. The two-day high-level meeting brought together hundreds of women leaders from across Africa and beyond to generate greater action for women’s empowerment and the advancement of sexual and reproductive health and rights of women and girls.

Zimbabwean President HE Robert Mugabe addresses participants at the opening of the GlobalPOWER Woman Network Africa meeting in Harare. Joining the President were UNAIDS Executive Director Michel Sidibé, Prime Minister Morgan Tsvangirai, and the United Nations High Commissioner for Human Rights, Navi Pillay. 24 May 2012.
Credit: UNAIDS/D.Kwande

Leading African women from national ministries and parliaments, the business community, networks of women living with HIV, and civil society and development organizations are in Zimbabwe’s capital to attend the inaugural meeting of the GlobalPOWER Women Network Africa. This women-led initiative will provide a strategic political platform to accelerate HIV prevention and sexual and reproductive health and rights responses for women and girls in sub-Saharan Africa.

Across the African continent, women and girls carry a disproportionate burden of the HIV epidemic, constituting 59% of all people living with HIV. In some countries, young women aged 15-24 years are as much as eight times more likely to be HIV-positive than young men. Prevailing gender inequalities, including gender-based violence, socio-economic disparities, and disempowering laws and policies increase women’s and girls’ risk of HIV infection.

Held in collaboration with the African Union and UNAIDS, the meeting was officially opened by HE President of Zimbabwe, Robert Mugabe. “One of the objectives of this conference is to call upon governments and partners to mobilize national high-level leadership and country ownership in the mitigation of HIV and sexual and reproductive health,” said President Mugabe. He used his speech to draw attention to the role of men in fully supporting women in accessing health services and helping change the inequalities faced by women and girls.

In his remarks, HE Prime Minister Morgan Tsvangirai called for greater gender equality. “Fifty-nine percent of people living with HIV in Africa are women—it is imperative we address and mitigate this striking fact. In Zimbabwe, this is mainly linked with gender inequality,” said Mr Tsvangirai. “Zimbabwe and Africa as a whole will benefit greatly from addressing gender inequality, which, coupled with lack of education and economic empowerment, hinders women’s active participation in the development agenda."

Addressing participants, UNAIDS Executive Director Michel Sidibé highlighted the important role of the women’s network in accelerating the AIDS response. “This inaugural meeting of the GlobalPower Women Network Africa comes at a critical time,” said Mr Sidibé. “It is perfectly positioned as a strategic political platform to advance innovative approaches that positively impact the lives of women and girls in Africa. And not just in relation to HIV but also to promote sexual and reproductive health and rights and zero tolerance for gender-based violence.”

Over the next two days, more than 300 participants will engage in a series of plenary discussions and panels surrounding key issues impacting the lives of women and girls across the continent. These include HIV prevention, maternal and child health, gender-based violence, gender equality, leadership accountability, and national ownership of the UNAIDS Action Agenda for Women and Girls. Examples of successful approaches will also be shared to foster greater innovation in the delivery of services.

Speaking at the opening ceremony, the United Nations High Commissioner for Human Rights, Navi Pillay, emphasized the intrinsic link between maternal and child health and human rights. “When women’s rights are violated, it stops them from leading a healthy and prosperous life—it takes away their freedom of choice to have or start a family,” she said. Ms Pillay also stressed that gender-based violence and stigma and discrimination impedes women’s access to maternal health services.

Nigerian Minister of finance Dr Ngozi Okonjo-Lweala addressing the delegates at the official opening of the Global Power Woman Network Africa in Harare at Harare International Conference Center on 24 May 2012.
Credit: UNAIDS/D.Kwande

Zimbabwe’s Deputy Prime Minister, Hon Thokozani Khupe, also acting as the President of the GlobalPOWER Women Network Africa, drew attention to the central role of women and girls in the AIDS response across the continent. “To achieve the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, it is critical to recognize women and girls as key agents in making this vision a reality. Society has to invest in the health of women and girls,” said Ms Khupe.

Representing the African Union Commission at the meeting, Deputy Chairperson, HE Erastus Mwencha, stated, “The burden of HIV cannot be successfully undertaken without paying due attention to issues of reproductive health and rights. Individuals, families and communities must have a say in the implementation of programmes."

Dr Ngozi Okonjo-Iweala, Nigeria’s Minister of Finance, was the Guest of Honour at the opening and delivered the keynote address. In her remarks, she told participants that a country’s progress is linked to the health of its female population.

"Any country that neglects investing in women and girls should not expect real growth. It is smart economics to invest in girls’ education, health and social well-being as no woman should die of [AIDS] and child birth,” she said,  "We can make a difference in Africa, and change is already happening—but we women have to push harder for greater change because no one can do it for us. This is why the GlobalPOWER Africa is so important. We need our women leaders to call for investment in women and girls and monitor how money is spent.”

The meeting will result in the “Harare Call for Action”, a unified action plan for women’s health with a specific focus on sexual and reproductive health and rights in the context of HIV. The Call for Action will serve as an important political and advocacy tool, strongly promoting regional ownership and shared responsibility to advance the AIDS response and the wider gender equality agenda.

The idea to create an Africa-specific GlobalPOWER Women Network stemmed from a September 2010 meeting in Washington, DC. At that meeting prominent African female decision-makers came together alongside their American peers to discuss how to accelerate the implementation of the UNAIDS Agenda for Women and Girls. The GlobalPOWER initiative was founded in 2006 by the Center for Women Policy Studies, a US-based women’s organization.

Several other high-level representatives attended the launch of the women’s network including the United States Ambassador to Zimbabwe, Charles A. Ray, the Vice-President of Zimbabwe, Hon Joyce Mujuru, and the Deputy Prime Minister of Zimbabwe, Hon Professor Arthur Mutambara. A message of support was received from the Executive Director of UN Women, Michelle Bachelet.

The UN delegation visited Cama Hospital and the Sir J.J. Hospital—two leading health facilities in the Indian state of Maharashtra that provide health services for pregnant women and children.

On 28 April, United Nations Secretary-General Ban Ki-moon led a high-level mission to Mumbai, India in support of the Every Woman Every Child initiative. During the visit, the Secretary-General commended Indian officials for the progress made in the AIDS response. Mr Ban also encouraged the Government of India to continue efforts to eliminate new paediatric HIV infections by 2015—one of the objectives of the Secretary-General’s five-year action plan.

The Every Woman Every Child initiative is a global effort that was launched in 2010 by Secretary-General Ban Ki-moon to mobilize and intensify global action to save the lives of 16 million women and children and improve the lives of millions more.

Mr Ban was joined by senior UN health officials including the Director-General of the World Health Organization Margaret Chan, the Executive Director of the UN Population Fund Babatunde Osotimehin, the Executive Director of the Joint United Nations Programme on HIV/AIDS, Michel Sidibé, the Deputy Executive Director from the UN Children's Fund, Geeta Rao Gupta and the United Nations Secretary-General’s Special Envoy for Malaria Ray Chambers.

During the visit the Secretary-General, Mrs Ban and his delegation visited Cama Hospital and the Sir J.J. Hospital—two leading health facilities in the Indian state of Maharashtra that provide health services for pregnant women and children.

Mr Ban’s mission concluded with a high level reception hosted by Millennium Development Goals advocates Mukesh Ambani and Ray Chambers, which featured interaction with some of India’s leading AIDS activists, people living with HIV, business and government officials as well as film stars and sports legends. During the reception the Mr Ban announced the appointment of Mr Prasada Rao as his new Special Envoy for HIV/AIDS in the Asia-Pacific region.

L to R: Millennium Development Goals advocate Mukesh Ambani, Kausalya from Positive women network (PWN+), UNAIDS Executive Director Michel Sidibé, Daksha Patel from Gujarat Network of People Living with HIV (GNP+) and United Nations Secretary-General Ban Ki-moon.

The UNAIDS Executive Director Michel Sidibé travelled to India’s capital New Delhi where he met with the Minister of Health and Family Welfare Shri Ghulam Nabi Azad. During their meeting, Mr Sidibé commended India for its new National AIDS Control Programme (NACP-IV) which was developed by national experts and will be funded primarily from domestic sources.

Mr Sidibé paid special attention to India’s role and contribution as a priority country in the implementation of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. It is expected that the national recommendations on the elimination of new HIV infections among children in India will phase-out of single dose nevirapine in the coming months. Mr Sidibé had the opportunity to see first-hand  how services to prevent mother-to-child HIV transmission are being scaled-up at the Ambedkar Hospital, one of Delhi’s largest hospitals.

A high level round table organized by the Federation of Indian Chambers of Commerce and Industry (FICCI) and UNAIDS brought together more than 50 participants including leading representatives from the Indian pharmaceutical industry and the government under the theme “India’s partnership with Africa in pharmaceuticals”. Mr Sidibé encouraged the Indian pharmaceutical industry to seize the opportunities to scale up access to HIV treatment in Africa and engage as strategic partner for the development of pharmaceutical production in Africa.

A new report provides an extensive synthesis and analysis of recent data, gaps and challenges in AIDS prevention, treatment, care and support for young people in Zambia.

For Zambia’s young people the AIDS response has seen a number of important successes, with a significant 25% decline in HIV incidence over the last decade. However, according to a groundbreaking new report, the AIDS epidemic continues to have a huge effect on the country’s youth, especially young women, and much more needs to be done to achieve an HIV-free generation.

Situation Assessment of the HIV Response among Young People in Zambia provides an extensive synthesis and analysis of recent data, gaps and challenges in AIDS prevention, treatment, care and support for this key age group. It was launched at a high level meeting held from 17-18 April in Lusaka.

The event was supported by Zambia’s United Nations Joint Team in collaboration with the National HIV/AIDS/STI/TB Council (NAC), and the ministries of Health; Education; Youth and Sport; and Community Development, Mother and Child Health.

“We must reduce the number of new HIV infections among young people if we are to meet the targets set in the 2011 Political Declaration on AIDS,” said Deputy Minister of Youth and Sport Nathaniel Mubukwanu. “We are committed to continue developing high impact interventions using a combination of HIV prevention strategies to effectively respond to the epidemic,” he added.

Good progress but gaps remain

The assessment, focusing on 10 to 24 year olds, shows that HIV incidence decreased between 2001 and 2009 among young people and the proportion of young people having sex before the age of 15 has halved, from about 17% in 2000 to some 8% in 2009. There has also been a rise in the number of young people who were tested and received their HIV test results, from 7% in 2005 to 34% in 2009.

Despite these achievements, HIV prevalence among young people remains high. In 2007 prevalence among those aged 15-19, for example, was 6% for women and 4% for men.

This is attributed to a number of factors. Dr Clement Chela, NAC Director General, citing the report said these factors included, “Poor comprehensive knowledge of HIV; gender inequality, poverty and the combination of transactional and intergenerational sex, early marriage, alcohol use, peer pressure and the negative gatekeeper attitudes towards condom promotion among young people.”  Data shows that only 53% of adults expressed support for condom education for HIV prevention among young people.

The report also highlights that there is no comprehensive sexuality education package for pupils in school and a high level of stigma towards young people on treatment from their peers.

Way forward

One of the key recommendations in the report for increasing protection of young people is the promotion of their meaningful involvement in HIV policy and programme design and implementation. This can be facilitated by building their capacity as change agents and service providers and encouraging them to generate demand for HIV-related services.

As Youth Representative Chipasha Mwansa contended, while hoping that her peers’ recommendations would be taken with the seriousness they deserve: “Nothing for young people without meaningful involvement of young people.”

According to the report, bottlenecks that need to be addressed in order to meet young people’s needs are those that affect access to condoms, HIV counseling and testing, male circumcision and behavior change communication among young people in and out of school. Furthermore, youth friendly services should be expanded at the health facility and community level, including those integrating HIV care and treatment and legal protection for adolescents living with the virus.

Helen Frary, UNAIDS Country Coordinator, noted that a multipronged approach was necessary. “Providing young people with access to HIV testing, condoms, male circumcision and other reproductive health services, including sexuality education,  will significantly contribute to Zambia achieving the UNAIDS’ vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

To ensure that measurable progress is made in Zambia, the UN has pledged to work with relevant ministries and stakeholders to translate these main recommendations –and others— into a clear, costed and time-bound action plan which puts young people centre-stage.

Women returning from a farm with vegetables to be sold in a market on the outskirts of Monrovia, Liberia.
Credit: VII Photo/Marcus Bleasdale

Cynthia Quaqua is a mother, wife, the president of the Liberian Women’s Empowerment Network (LIWEN), and, perhaps most importantly, a survivor. Raped by soldiers during the Liberian civil war, she became pregnant as a young woman. Years later she fell ill and was diagnosed with HIV. Suddenly, she found herself abandoned by her relatives even began discussing where to bury her.

Fortunately, a Lutheran pastor gave her a place to live and directed her to a clinic where she could receive HIV treatment. She then found social support through a women’s group, where members had, like her, experienced sexual violence. Today, Cynthia is a picture of health and a powerful presence, taking her anti-retroviral medications twice daily. “The support from other women showed me that I was not alone and has allowed me to come this far,” she said.

Although Liberia is on the recovery from conflict, sexual violence remains prevalent. Research shows that 29% of ever married women experienced physical or sexual violence from a male intimate partner in the last 12 months.

Violence is both cause and consequence of women’s vulnerability to HIV. In Liberia, women account for 58% of all adults living with HIV. Young women and girls are particularly affected with an HIV prevalence more than double that of their male peers. The stigma associated with HIV and gender based violence is a major barrier to women accessing and adhering to HIV treatment and prevention services.

The President of Liberia and first ever female elected head of government in African, H.E. Ellen Sirleaf Johnson,  has put gender equality and the empowerment of women at the centre of Liberia’s post-conflict and development agenda. Liberia was the first country to put into practice the UNAIDS Agenda for Women and Girls, setting strategic priorities for supporting women and girls’ rights, and gender equality through HIV responses.

Equally, the national response to HIV is prioritising gender equality as a smart investment for more effective programmes, under the leadership of the Minister of Gender and Development Julia Duncan Cassell. “We are fully cognizant that if the issues of HIV are to be fully addressed in Liberia, Africa and the rest of the world, we need to empower women living with HIV and get them involved at all levels,” said Mrs Cassell.

Cynthia Quaqua is a mother, wife, the president of the Liberian Women’s Empowerment Network, and, perhaps most importantly, a survivor.
Credit: UNAIDS

A mid-term review of the implementation of the national operational plan took place in Monrovia the first week of April involving partners from government, civil society, faith-based organisations, networks of women living with HIV and the UN system.

The review found that significant progress had been made in generating and maintaining political commitment to address HIV and sexual violence in Liberia. Data collection on sexual and gender based violence has increased and reporting structures have been harmonized, allowing for the routine collection of strategic information to inform national programmes.

Since the launch of the operational plan, government Ministries have put in place HIV and Gender co-ordination offices with domestic resources to champion HIV and gender programming, and HIV, gender and sexual and reproductive health services has been integrated into national polices. A coalition of actors has been established to address gender based violence and HIV, as well as contributing to addressing gender based violence broadly. The coalition meets monthly to monitor progress of activities.

Other positive developments include the active engagement of associations and networks of women living with HIV in addressing sexual and gender based violence and increasing access to integrated HIV and health services for women.

But challenges remain, including the need to increase access to sufficient domestic financial resources and more effective coordination of different actors to maximise collective impact.

“UNAIDS and its co-sponsors recommit to intensify efforts against HIV and sexual violence by focusing on developing mutual accountability for results, partnerships for country ownership and generating program efficiencies through innovation and integration,” said David Chipanta, UNAIDS Country Co-ordinator for Liberia.   

Men gather to discuss cultural and social issues related to gender justice and equality.

Sitting on a traditional stool at a Dare—a special meeting platform, Chief Chiveso of Mashonaland Central Province in Zimbabwe speaks to men about the possibility of having babies born HIV free and keeping their mothers alive. For that to happen, stresses the Chief, there is a need to challenge harmful cultural and religious practices that can affect community responses to HIV.  "As a Chief, I am going to continue supporting and leading health issues in my village so that families can live better.”

Chief Chiveso has the support of Padare/Men’s Forum on Gender—a Zimbabwean organisation that works with traditional leaders in Mashonaland to influence public opinion on various community issues. These include the promotion of HIV services and mobilising men to actively participate in preventing new HIV infections among children.

Men play a significant role in defining community practices. Traditionally, Zimbabwean men would gather around a fire or under a tree to discuss community issues and make decisions about the community while excluding women and children. This practice fuelled gender inequalities since most decisions did not take into account women’s views.

Padare’s goal is to subvert this exclusive male practice and bring together traditional and local leaders, pastors, grandfathers, fathers, uncles and brothers to discuss cultural and social issues related to gender justice and equality, including the support for programmes to stop new HIV infections among children.

"In these communities men have positions, power and privileges that come from patriarchal values. We are harnessing their power so that they can be agents of social change in their communities," said Kevin Hazangwi, Director of Padare.

Zimbabwe’s National AIDS Strategic Plan aims to reduce transmission of HIV from mothers to children from 14% in 2010 to 7% in 2013 and to less than 5% by 2015. Currently, Government figures indicate 70% coverage of prevention of mother-to-child HIV transmission services in the country.

Rising community voices in HIV action

Through the Padare initiative, Chief Chiveso engages men in open dialogues where community members are encouraged to challenge low health seeking behaviours in the village and to understand HIV prevention, treatment and care services. These interactive dialogues—known as Community Conversations—enable community decision-making and actions concerning the elimination of HIV.

“This programme gave me a lot of knowledge about existing antiretroviral drugs and HIV prevention services,” said Tatenda, a proud father living with HIV. “I was supporting my wife when she was in labour. I now have twins who were born HIV negative.”

Padare also conducts consultative meetings that tap into the local rich traditions. These meetings enable communities to identify gaps in knowledge and attitudes, behaviours and cultural practices that are harmful to the AIDS response. In these open discussions, community members are able to raise key issues and provide solutions without personalising the issues. Spousal inheritance and girl pledging for spirit appeasement—offering of a young girl to remedy criminal offences or to appease the spirit of a murdered person—are among the negative cultural practices that are discussed.

A higher-level platform known as Indaba is also used by Padare to engage the Chiefs themselves to advocate for greater action in their respective communities. Such dialogue enables the Chiefs to agree on sound HIV policies ensuring the involvement of men in preventing new HIV infections at community and national level.

“As Chiefs we should play a major role in sensitising our communities. Over and above the right of children to a dignified life, the babies we are losing are potential nurses, doctors and teachers for our society’s tomorrow,” added Chief Chiveso.

Traditional leaders as custodians of culture

Faith-based leaders in Mashonaland Central are also taking action to change negative religious and cultural practices and boost service uptake in their communities.

“Religion and the church have been accused for being the source of male chauvinism and patriarchy. We pledge to keep it as a fountain of hope, a source of information and health,” said Pastor Sifelani, of the Anglican Church in Bindura. “Gone are the days when we would encourage people to flush away antiretroviral drugs because they have been healed and we blamed witchcraft for sickness and death instead of HIV.”

Traditional leaders are considered the custodians of culture and are therefore critical to shift society’s attitudes. Bringing together communities to discuss issues in their own terms has a positive effect in increasing HIV service uptake. There is greater scope for replicating this programming model in sub-Saharan Africa where the idea of men’s forums is culturally appropriate and can be traced to past and current practices.

Julia Lasker participated in a panel discussion entitled Achieving MDG6 in Eastern Europe and Central Asia: Focus on Women and Girls.
Credit: UNAIDS/Stan Honda

The glamorous world of pop music and the grim realities of the HIV epidemic in Eastern Europe and Central Asia may seem like strange bedfellows. However, Russian singer and AIDS activist, Julia Lasker, engages in both with full commitment.

Ms Lasker became interested in AIDS in 2009 as she had friends living with HIV. She realised how limited the understanding of AIDS was among young women and, since then, has used her public profile and popularity with young audiences to raise awareness of HIV. “I feel personally responsible for many young girls whom I may prevent from being infected just by providing them with knowledge about the virus and how to prevent it,” she said.

Last week, Ms Lasker returned from New York, where she participated in a panel discussion entitled Achieving MDG6 in Eastern Europe and Central Asia: Focus on Women and Girls organized as part of the UN Commission on the Status of Women. During the discussion she called for a new approach to HIV.  “There is a huge need to openly discuss the issue in the society, encourage people to test for HIV, encourage young people to protect themselves and their loved ones, call for tolerance.”

Hosted by the Government of Russia together with the Governments of Finland and Sweden and UNAIDS, the panel discussion brought together government, civil society and UN representatives to find ways to effectively respond to the growing HIV epidemic in Eastern Europe and Central. The event was a follow up to the International Forum on MDG 6—to combat HIV/AIDS, malaria and other diseases—convened in October 2011 under the leadership of the Government of Russia.

“It is clear that countries in Eastern Europe and Central Asia need to act quickly to stop the growing HIV epidemic among women and girls,” said Dimitry Maksimychev, Deputy Permanent Representative of the Russian Federation to the United Nations. “With less than 1,000 days now until 2015, we need to work together—governments, donors, international organizations and civil society—to maximize our impact. Russia stands ready to put its leadership into action assisting countries in the region to achieve MDG6,” added Mr Maksimychev.

Julia Lasker, like many other women and men engaged in the HIV response in the region, remains determined. “If I can get this message to at least a few people, it's a step in achieving the goal of zero new HIV infections, zero AIDS-related deaths and zero discrimination.”

Women and HIV in Eastern Europe and Central Asia

“Women are especially at risk of HIV due to multiple factors such as economic vulnerability, fearing or experiencing violence, and difficulties in negotiating for safe sex,” said UNAIDS Regional Director for Eastern Europe and Central Asia a.i., Dr Jean-Elie Malkin. “In extreme cases women combine all vulnerabilities associated with drug use, sex work, social marginalisation and stigma and discrimination which prevent them from accessing HIV services,” he added.

Julia Lasker meeting with Deputy Secretary-General of the United Nations, Dr Asha-Rose Migiro
Credit: UNAIDS/Stan Honda

The number of people living with HIV in Eastern Europe and Central Asia almost tripled between 2000 and 2009. In 2010 there were an estimated 1.5 million people living with HIV in the region. The number of new HIV infections acquired through heterosexual contact has increased by 150% in the last decade. HIV represents a growing threat for women in the region. Women make up a rising proportion of people living with HIV—up to 50% in some countries in Eastern Europe and Central Asia. In Russia, for example, the number of young women with HIV aged 15-24 is two times higher than among men of the same age.

While significant progress has been made in some areas—in 2010, 88% of pregnant women living with HIV in Eastern Europe and Central Asia received treatment to prevent HIV transmission to their child—challenges remain. Recognising that not all women are reached by HIV services and programmes, the Government of Russia together with UNAIDS and partners are collaborating to develop guidance on how to increase access to HIV treatment, care and support services for all women—including people who use drugs, their sexual partners, sex workers, prisoners and other key populations at higher risk of infection.

“There is opportunity and space for addressing the HIV needs of women, using their sexual and reproductive health concerns as an entry point,” said Evgenia Maron, of the Astra Foundation, an AIDS service organization in Russia. “There is a need to meaningfully involve women living with and affected by HIV in all aspects of the AIDS response. We know what our realities are, we know what we need and we know what the solutions are,” she added.

Prof. Shiela Tlou, UNAIDS Director, Regional Support Team for Eastern and Southern Africa speaks at the launch of the High-Level Taskforce on Women, Girls, Gender Equality and HIV for Eastern and Southern Africa.
Credit: UNAIDS/J.Ose

A new High-Level Taskforce on Women, Girls, Gender Equality and HIV for Eastern and Southern Africa was launched at the 16^th International Conference on AIDS and STIs in Africa (ICASA). The Taskforce will engage in high-level political advocacy in support of accelerated country actions and monitoring the implementation of the draft Windhoek Declaration for Women, Girls, Gender Equality and HIV.

The draft Windhoek Declaration (April 2011), recommends action in seven key thematic areas including sexual and reproductive health, adopting a multi-stakeholder approach to adders violence against women and HIV and the law, gender and HIV. 

Immediately after the launch of the Taskforce, its members participated in a special session titled Universal Access:  Are we failing to meet the needs of women and girls where they took stock of challenges faced by women and girls throughout Africa.

“We see women at the top of HIV infection numbers, but when it comes to leadership women are at the bottom,” said Dr Speciosa Wandira, former Vice President of Uganda. “The world is insecure because it is in the hands of only half of the gender. But the job of identifying what we need to do is in our hands.”

Young women are particularly vulnerable to HIV, accounting for 64% of infections among young people worldwide. In sub-Saharan Africa, young women make about 70% of young people living with HIV.

Dr Specioza was joined by Dr Fatma Mrisho, Chair of the Taskforce and Executive Chairperson of the Tanzanian AIDS Commission, Dr Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa, Prof Shiela Tlou, UNAIDS Director, Regional Support Team for Eastern and Southern Africa, Ms Louis Chingandu, Executive Director of SAfAIDS, Hon Naomi Shaban Minister of Gender of Kenya and Hon Thandi Shongwe Senator and Member of Parliament of Swaziland.

The Taskforce members outlined the directions the group will follow to empower women as well as to hold governments accountable to ensure positive policy development and implementation of legal environments to protect women and girls.

“Many countries have legal support systems in place. However, its implementation is difficult due to social pressure and archaic cultural laws,” said Senator Shongwe.

Participants outlined the need to engage political leadership to challenge harmful cultural norms and laws such as early marriage and wife inheritance. Equally important is the involvement of men and boys in the gender equality equation. “We know what we want,” said Minister Shaban. “But we have not educated men on what we want.”

Prof. Tlou added that, “We need to use good men as role models to show that it is masculine to love and care for women.”

The Taskforce was first conceived at the Technical Meeting on Women, Girls, Gender Equality and HIV, which was jointly convened by the East African Community (EAC), the Common Market for Eastern and Southern Africa (COMESA), the Southern African Development Community (SADC) and UNAIDS.

The meeting, held in Windhoek, Namibia in April 2011,  brought together government and civil society representatives from Comoros, Ethiopia, Kenya, Malawi, Rwanda, Swaziland, Tanzania, Uganda and Zambia and Regional Directors from UNAIDS, UNICEF, UNFPA and UN Women.