State of the Worlds Population, 2009
Credit: UNFPA

The success of the global response to AIDS will rely on tackling not only the encroaching virus itself but also the affects of climate change such as food and water shortages, growth in poverty and an increase in natural disasters, argues the State of World Population 2009, released today by the United Nations Population Fund (UNFPA).

The report also contends that, equally, strengthening the response to the AIDS epidemic will mean that individuals, communities and societies will have greater social resilience in the face of a range of climate change threats and will be better able to deal with their consequences. HIV and climate change are perceived as profoundly linked, a perception shared by a range of UN bodies, including UNAIDS and the United Nations Environment Programme, UNEP.

Subtitled, ‘Facing a changing world: women population and climate’, The State of World Population places women at the very centre of the attempt to confront climate change and maintains that policies, programmes and interventions are more likely to mitigate its worst effects if they reflect the rights and needs of women.

Women are said to bear the brunt of climate change, partly because in many countries they make up the majority of the agricultural workforce hard hit in an environmental crisis, and because they often do not have sufficient control of their lives and access to as many opportunities to generate income as men – they are more likely to be poor and to see their poverty increase. As UNFPA Executive Director Thoraya Ahmed Obaid has it, “Poor women in poor countries are among the hardest hit by climate change, even though they contributed the least to it.”

Numerous examples of extreme climate change are cited, from melting glaciers in Bolivia, to the destruction of crops by typhoons in the Philippines, and from drought in east and southern Africa to floods in Vietnam. In each scenario, women are shown struggling to keep their livelihoods and families intact, and, in some cases, fighting for their lives.

According to the report, empowering women and girls, especially through investments in health and education, help boost economic development and reduce poverty, thus having a beneficial impact on coping with climate change. Girls with more education are more likely to protect themselves against HIV and to have smaller and healthier families as adults. In general, access to reproductive health services such as family planning means lower fertility rates and this has a clear bearing on lessening the potential impact of environmental crises and making sustainable development more likely.

“Women should be part of any agreement on climate change—not as an afterthought or because it’s politically correct, but because it’s the right thing to do,” says Ms Obaid. “Our future as humanity depends on unleashing the full potential of all human beings, and the full capacity of women, to bring about change.”

The State of World Population 2009 argues that ensuring gender inequity is challenged in all its facets is an urgent necessity, not just to improve the lives of individual women but to stave off the worst consequences of environmental crisis. This sense of urgency is relayed to the leaders and negotiators due to meet in Copenhagen for December’s critical climate change conference. They are urged to “think creatively” not just about emissions and targets but about population, reproductive health and gender equality and how they can contribute to “a just and environmentally sustainable world.”

Yulia Lasker, Russian singer, who purchased a tapestry at the opening of the exhibition.
Credit: UNAIDS

UNAIDS and the All-Russian Union of People Living with HIV came together for the second time to support the international project Art Against AIDS that unites well-known artists in the response to the HIV epidemic in Russia. This year, proceeds from the sale of art at the exhibition went to low-income families raising children living with HIV.

More than 30 contemporary artists, photographers, and musicians from Russia, the United States, Japan, Greece and Spain offered their work for the charitable exhibition-sale held at the Central House of Artists from 12 - 26 November 2009. Last year, funds raised during the exhibition-sale went to children living with HIV at the Vsevolozhsk Orphanage in Leningrad Oblast.

There is increasing political and financial commitment for universal access to HIV prevention, treatment and care in Russia, even in the face of a global financial crisis. The country is set to increase the number of people on antiretroviral treatment by 50,000 in 2009. Through this exhibition, artists, photographers and musicians are helping to speak openly about HIV and to draw the attention of the wider public towards this issue.

One of the art pieces sold at the launch of Art Against AIDS on the 12 of November.
Credit: UNAIDS

Earlier in October during the 3rd HIV/AIDS Conference in Eastern Europe and Central Asia, UNAIDS Executive Director Michel Sidibé said that there has been progress in the region with many countries set to achieve universal access target goals. But the UNAIDS head also noted that the AIDS epidemic continues to outpace the response as the estimated number of adults and children living with HIV in the Eastern Europe and Central Asia region has doubled since 2001.

Injecting drug use is the main mode of HIV transmission across Eastern Europe and Central Asia. HIV prevention among drug users and their sexual partners is a vital component of an evidence-informed response. Although the HIV epidemic in the Russian Federation is the largest in the region, there are rising numbers in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan, and Uzbekistan.

New campaign to be broadcast by television across Brazil highlights rights of students, gay men, lesbians, people living with HIV, the Afro-Brazilian population, sex workers, refugees, transsexuals and transvestites and drug users.

Equal rights and a call to Brazilian society on the issue of the discrimination experienced daily by men, women and children in the country are the messages of a powerful ”Just like you” video campaign, launched 16 November in Rio de Janeiro, by UNAIDS in partnership with other United Nations agencies with the participation of civil society and the government authorities on human rights.

Ten thirty second films were shown during the launch, films that present a panorama of the reality faced by each population covered by the campaign – school students, gay men, lesbians, people living with HIV, the Afro-Brazilians, sex workers, refugees, transsexuals and transvestites and drug users. The films will be broadcast in Portuguese on television stations throughout the country. DVDs and CDs will also be distributed to health care facilities, schools and the National Business Council on HIV. The films are also available with subtitles in English and Spanish so they can be shown internationally.

The campaign launch ceremony was followed by a press conference, at the Palácio do Itamaraty with the community leaders who recorded the campaign messages as well as UN officials from UNODC, UNAIDS, UNIFEM, UNESCO, UNHCR and UNIC. Representatives of the Special Secretariats of Human Rights and of Policies in Promotion of Racial Equality, the Ministry of Education and civil society were also present.

“Just like you, I want respect,” still from one of the videos in the “Just like you” campaigne launched in Rio de Janeiro on 16 November, 2009.
Credit: UNAIDS

Human rights visibility

“Just like you” is a campaign against stigma and prejudice, giving voice and visibility to the human rights of people often overlooked by society in Brazil. The films communicate the messages of leaders of each of the discriminated groups.

The campaign is an initiative against human rights violations and inequalities in the areas of health, education, employment, public security and everyday life. It is an opportunity to raise the awareness of Brazilian society with regard to respecting the differences that characterize each of the social groups represented in the campaign, reaffirming equal rights.

Everyday stigmas and prejudices

Data from the Brazilian Institute of Geography and Statistics reveal the racial and gender inequalities in Brazil through the disparity in average monthly income: white men earn on average R$ 1,200, considerably more than white women (R$700), twice that of black men (R$ 600), and three times that of black women (R$ 400).

The school environment is another example of resistance to diversity. A 2009 survey of 500 state schools done by Anísio Teixeira National Institute of Educational Research and Studies and Economic Research Institute Foundation, between 55% and 72% of students, teachers, head teachers and education workers showed a resistance to diversity and the greatest distance was seen in relation to homosexuals (72%).

Campaign signature

Prejudice manifests itself through discriminatory attitudes and practices, such as humiliation, aggression and unfair accusations merely because people belong to a specific social group.

The United Nations agencies in Brazil joined with a number of civil society groups for this equal rights campaign including ABGLT (Brazilian Gay, Lesbian, Bisexual, Transvestite and Transsexual Association), AMNB (Association of Black Brazilian Women), ANTRA (National Articulation of Transvestites, Transsexual and Transgender Persons), the Brazilian Movement of People Living with HIV/AIDS and the Brazilian Network of Prostitutes.

The World Summit on Food Security opens 16 November in Rome. In many parts of the world, lack of food security and poor nutrition are worsening the effects of the HIV epidemic.

Although HIV testing is increasingly available and efforts to support the nutritional needs of people living with HIV have intensified appreciably, antiretroviral therapy (ART) service providers continue to report large numbers of clients presenting with advanced disease and acute malnutrition. In some ART programmes, as many as 33 percent of all first-visit clients are unable to walk into the clinic without assistance, correlating with high rates of mortality in the first 90 days of treatment. In response, there has been a rapid proliferation of Food by Prescription (FBP) programmes, designed to ensure efficient and effective nutrition care and rehabilitation for people enrolled in HIV care and treatment programmes.

This paper from the Global Alliance for Improved Nutrition (GAIN) provides an overview of current thinking on modes of delivery and the salient issues surrounding FBP programme implementation. Its purpose is to document current thinking and experience, and identify areas of convergence and divergence. This will provide a starting point for future consultations where key issues can be elaborated and prioritized, and a plan for future action developed. Given the dearth of literature on FBP, information for this report was gathered primarily through semi-structured interviews with key informants from governments, civil society organizations, technical assistance agencies, donors and beneficiary groups.

This document reveals that, in less than a decade, a wide variety of creative FBP mechanisms and designs have emerged, catering to one or more of three core objectives. The primary emphasis of FBP programmes is on the nutritional rehabilitation and/or nutrition support of the patient to improve well-being and treatment outcomes. However, many FBP programmes have expanded this mandate to include provision of social safety nets to support treatment adherence and protect household integrity. Moreover, several FBP programmes have begun to support livelihood activities with the aim of encouraging a productive recovery and sustaining adherence. Programme designs are highly contextualized: some focus on one or two of these objectives while others aim for a comprehensive approach through partnerships and referral networks. Some programmes operate from a clinical base while others operate from an established foothold in the community, while still others have formed strategic linkages which span home, community and clinical settings.

Among all those interviewed, there is a sense of urgency driving the rapid rollout of this programming and an acknowledgement that there is much to learn about how to do it well. There is (at this point) no consensus about the optimal location of FBP programmes. There is general agreement on the use of anthropometric criteria for programme entry, but less agreement on discharge criteria. There are several different commodity options in use, with no evidence base to guide decision-making. In many settings, there is a need to more clearly differentiate between client-level nutritional rehabilitation and household-level food insecurity. There is a call for guidance and harmonization of objectives, standards and protocols.

This document was constructed according to themes, which were identified early in the process.

These included potential for integration and standardization; allocation of resources; human resource requirements and challenges; commodity management; wraparound services; monitoring and evaluation; the beneficiary perspective and the long-term outlook. The report closes with a summary of common issues and a preliminary list of issues for follow-up

Participants of the Study Tour in Kolkata with staff and Board Members of the NGO, SCIR.

National police officers and National AIDS Programme heads from Cambodia, Maldives, Mongolia, Philippines, and Sri Lanka visited India last mnth to get a firsthand experience of law enforcement initiatives on interventions related to high risk populations.

Organised by the UNAIDS India office with support from the Regional Support Team of Asia-Pacific, the 16 participants visited and interacted with programme staff of police-initiated and supported projects in Kolkata and New Delhi. The purpose of the Study Tour was to learn the approaches of and lessons learned from law enforcement efforts for sex workers and injecting drug users and their vital role in creating a supportive environment for HIV interventions.

In Delhi, the participants visited Shakti Vahini, a non-governmental organization (NGO) working with sex workers on GB Road, one of Delhi’s oldest red light areas. Personal interactions with sex workers provided them with first-person stories of the realities of brothel-based sex work and the relationships the workers have built with the district police. The Tihar Prison, India’s largest prison, showcased the prison’s innovative and comprehensive programme for recovering injecting drug users, a model programme now being promoted in other prisons in India.

The Toll-free Hotline run by the Central Reserve Police Force (CRPF) - which has a national workforce of a million workers – was of great interest to the group. With the assistance of software developed especially for the project, the Hotline takes calls from police personnel from all parts of India on HIV, sexually transmitted infections, drug and substance abuse and provides addresses of counselling centres and welfare schemes of CRPF. The Helpline has responded to thousands of calls for information and for referrals to counselling services.

In West Bengal, the group travelled from Kolkata to Asansol, a large industrial town with a settlement of sex workers. The project DISHA Jana Kalyan Kendra began its work in 1995 with a collaboration with the district police force with the aim of improving the health and socio-economic conditions of sex workers in the town. In addition to providing health services, vocational and job skills training, and pre-school education for children of sex workers, DISHA has worked with the police in reducing criminality in the community.

In Kolkata, the Study Tour participants visited the NGO Society for Community Intervention and Research (SCIR) to observe their work with people who inject drugs (IDUs). The NGO works in the community of Tiljala, the largest slum settlement in Kolkata. It offers educational programmes for children, livelihood training for IDUs as well as an oral substitution treatment programme.

The projects covered in the Study Tour gave a novel perspective on the role of the police sector not only as law enforcers but also as community enablers. Given the legal and judicial frameworks in the countries represented by the participants, these innovations gave rise to challenges on how they may be replicated in their countries. The Study Tour, as a South-South learning opportunity, demonstrated encouraging prospects of police leadership to break new ground.

The Global Fund to Fight AIDS, Tuberculosis and Malaria’s Board of Directors has approved new grants with a two-year commitment of US$2.4 billion. The Global Fund Board concluded its 20th meeting in Addis Ababa, Ethiopia on 11 November. High on the agenda were discussions on the implications of the global financial crisis for a fully funded AIDS response.

The Global Fund Board also announced the launch its next round of grants in May 2010. This round of funding will be considered for approval at a Board meeting to be held some time between November 2010 and January 2011.

“We are seeing a tremendous demand for funding,” said Michel Kazatchkine, the Executive Director of the Global Fund. “Countries are showing that they are able to effectively turn large amounts of money from donors into prevention, care and treatment of AIDS, TB and malaria, which in turn will save millions of lives.”

Addressing the Global Fund Board earlier in the week UNAIDS Executive Director, Mr Michel Sidibé congratulated Dr Kazatchkine on the excellent progress made over the last year.

Mr Sidibé expressed concern that because overall resource demand is higher than anticipated in the funding scenario of the replenishment meeting in Berlin in 2007, the Global Fund risks facing a resource gap for the period 2009-2010. He reiterated his call to donor countries to ensure that the Global Fund is fully funded. He also called for appropriate prevention investments that match the nature of the epidemic, for example in Eastern Europe where HIV is mainly transmitted via injecting drug use.

Speaking on the potential impact of the financial crisis on the AIDS response, Mr Sidibé called for innovative approaches and the need to establish new partnerships in the AIDS response.

With its key approaches – country ownership, inclusiveness, accountability and performance-based funding – the Global Fund is setting the standard in development financing and is strongly aligned with aid effectiveness principles. Praising this approach, Mr Sidibé encouraged even greater engagement with implementing countries and communities in decision-making processes.

Mr Sidibé also committed to scaling up technical support from the UN system and that UNAIDS programme at the country and regional level would expand its support to the Global Fund.

“A strengthened partnership at country level will lead to greater cohesiveness and sustainability of the response,” said Mr Sidibé.

The Global Fund Board also approved a new grant architecture to simplify grant management and reporting by countries and facilitate their strategic, long-term planning.

The Global Fund was created in 2002 with a mandate to dramatically increase resources to fight three of the world's most devastating diseases – HIV, TB and Malaria, and to direct resources to areas of greatest need. It has since approved a total funding of US$18.4 billion for 144 countries. It’s a global public/private partnership between governments, civil society, the private sector and affected communities the Global Fund represents a new approach to international health financing.

In a supplement of the Journal of AIDS’ December issue published yesterday, UNAIDS explores some of the current challenges to monitoring the progress towards global HIV targets.

The supplement, called Progress Towards Global HIV Targets: Challenges in Monitoring National Indicators, explores thematic, technical analysis of data and key findings derived from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) reporting system.

The issue was guest co-edited by Dr Deborah Rugg, Chief Monitoring and Evaluation UNAIDS and covers issues such as human rights in the global response to HIV and estimating the level of HIV prevention coverage, as well as addressing the key question: Are we on course for reporting on the Millennium Development Goals in 2015?

“In a time of ever more acute resource limitation, more and better studies are required that effectively evaluate whether programmes achieved their desired results, and whether those results lead to their intended outcomes,” said Dr Rugg.

The 2001 UNGASS Declaration set forth concrete, time-bound commitments to promote a comprehensive and effective global response to the epidemic. The UNAIDS Secretariat was subsequently given a mandate to develop an international monitoring system for national HIV responses in order to manage this reporting.

The resulting system has generated an unparalleled global body of evidence across the range of national HIV responses and key thematic areas.

The articles included in the supplement uses data and key findings derived from the UNGASS reporting system, combined with complimentary data from other sources, on the status of both the global HIV epidemic and the response.

A new report by Health Canada’s International Affairs Directorate has called for a greater focus on rights of people with disabilities in HIV policy. The report makes recommendations for policy change and follows an International Policy Dialogue held between UNAIDS, Health Canada and the Public Health Agency of Canada in Ottawa in March 2009.

Titled “HIV/AIDS and Disability: Final Report of the 4th International Policy Dialogue”, it calls for the United Nations' Convention on the Rights of Persons with Disabilities (CRPD) to become a catalyst for change by shifting the disability discourse from charity-based or medical-based approaches to a rights-based approach. This approach views people with disabilities as active participants in society, ensuring their wellbeing rather than treating them as passive recipients of charitable goodwill.

The report recommends the involvement of stakeholders in helping CRPD become a tool for change. These stakeholders include WHO, UNICEF, UNAIDS, national governments and ministries and civil society organizations working in the areas of disability and HIV.

There is a double stigma experienced by people living with both HIV and disability. Much effort is required to overcome this, beginning with raising awareness and open communication. For example, in South Africa youth with disabilities are trained to provide HIV prevention and treatment information to their peers; in Kenya HIV screening information is provided to the deaf by the deaf; and Uganda has established mental health clinics for people living with HIV. The report suggests taking a lead from these programmes.

It calls for service providers in the AIDS response to be sensitised on how to interact with people with disabilities and to establish mobile voluntary counselling and treatment services to increase access to people living with disabilities who are unable to reach them on their own.

The HIV and Disability report recognises the need for more education and awareness for children, youth and adults living with developmental disabilities, and also suggests working on providing information on sexual and mental to people with disabilities.

The report discusses challenges related to sustaining pilot projects, securing funds, sharing the results and benefits of HIV, AIDS and disability projects, and educating donor countries, governments and NGOs in the value of investing in this area.

UNAIDS, along with WHO and the United Nations Office of the High Commissioner for Human Rights, has collaborated on a policy brief exploring the links between HIV and disability and that also makes recommendations for policy change.

Apart from discussing the actions needed to increase the participation of persons with disabilities in the HIV response and to ensure they have access to HIV services, it also recommends for governments to incorporate persons with disabilities into their national HIV policies.

It also urges civil society to ensure campaigns to combat stigma and discrimination of people living with HIV are also accessible to persons with disabilities and advocates for the latter to be included in planning, implementation and evaluation of HIV programmes.

People with disability

Around 650 million people, or 10% of the world’s population, have a disability. Although people with disabilities are found within the populations at higher risk of exposure to HIV, not much attention has been paid in the past to the relationship between HIV and disability.

Participants in breakout groups at the International Policy Dialogue, held in Ottawa, Canada, March 2009
Credit: Health Canada

People with disabilities and people living with HIV shared their personal experiences during the International Policy Dialogue in March to give voice to both the challenges they face and the abilities they hold.

Persons with disabilities experience all of the risk factors associated with HIV, and are often at increased risk because of poverty, severely limited access to education and health care, lack of information and resources, lack of legal protection, increased risk of violence and rape, vulnerability to substance abuse, and stigma.

Women living with HIV are more likely to have experienced violence, and women who have experienced violence are more likely to have HIV infection. Credit: UNAIDS/P.Virot

Numerous studies from around the globe confirm the links between violence against women and HIV. These studies show that women living with HIV are more likely to have experienced violence, and that, women who have experienced violence are more likely to have HIV infection.

From 27-29 October the World Health Organization (WHO), on behalf of the UNAIDS family, convened a working group of experts and practitioners to review evidence around the links between violence against women and HIV, as well as programmatic interventions and strategies which address the intersections of violence and HIV. The aim of the meeting was to make policy and programmatic recommendations for national and international AIDS programmes as well as to develop an agenda for future programme development, evaluation and research efforts based on a review of evidence from different interventions.

The meeting was part of UNAIDS efforts to operationalize the Joint Action for Results: the UNAIDS Outcome Framework, which includes violence against women and girls as one of its nine priority areas.

Violence and HIV

According to a 2006 report by United Nations Secretary-General one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime, usually by someone known to her.

Violence and the threat of violence dramatically increase the vulnerability of women and girls to HIV by making it difficult or impossible for women to abstain from sex, to get their partners to be faithful, or to use a condom. The risk of HIV transmission increases during violent or forced-sex situations as the abrasions caused through forced penetration can facilitate entry of the virus.

Violence, or fear of violence, also makes it difficult for women and girls to disclose their HIV status and access essential HIV prevention, care, and treatment services. Women may also avoid HIV testing due to fears of violence and abandonment in a resulting discovery of HIV-positive status.

As noted by Dr. Claudia Garcia-Moreno, from WHO’s Department of Reproductive Heatlh and Research and Coordinator of the WHO Multi-country Study on women's health and domestic violence, “Violence against women is a fundamental violation of human rights and is often fueled by longstanding social and cultural norms that reinforce its acceptability in society – by both men and women. But there are concrete steps we can take in the AIDS and development responses to address violence, thereby dramatically improving women’s health and quality of life”.

Behaviour and societal change

According to participants at the consultation, policies and programmes addressing gender inequality and gender-based violence will help achieve universal targets to HIV prevention, treatment and care. Investment in responses in these areas is an essential part of HIV programming.

“Long-term interventions which address structural factors, gender inequalities and harmful gender norms, are essential if one is to reduce violence against women and HIV,” said Kristan Schoultz, Director of the Global Coalition on Women and AIDS. “At the same time there is also a need to move forward urgently to achieve shorter-term gains such as enhanced voluntary counselling and testing services and the provision of comprehensive post-rape care that addresses the psychological and physical health needs of sexual violence survivors”.

Participants believe that a “mosaic” of action addressing both long-term and short-term needs related to violence and HIV has the potential to have an impact upon not only MDG 6 (HIV), but all the health MDGs, including reduction of maternal mortality and achievement of sexual and reproductive health and rights; in addition, this approach is at the heart of MDG 3 (gender equality and empowerment of women) and MDG1 (poverty reduction).

The outcomes and recommendations from the meeting will feed into ongoing national and global advocacy efforts such as those of the Global Coalition on Women and AIDS, the UN Secretary General's Campaign for the Elimination of Violence against Women, and the Africa-Wide Campaign for the elimination of Violence against Women. Recommendations will also assist national AIDS authorities to better address the intersections between HIV and violence in national programming.

In a landmark report on the health of women and girls across the globe, the World Health Organization (WHO) states that AIDS-related illness is the leading cause of death and disease among women of reproductive age in low and middle income countries, particularly in Africa. Also, globally, unsafe sex is the single leading risk factor contributing to deaths among women of reproductive age. These findings support the contention in Women and Health: Today’s Evidence, Tomorrow’s Agenda that in a multiplicity of areas female health is neglected and must now be considered an urgent priority

The report maintains that women and girls are especially vulnerable to HIV infection due to a variety of biological and social factors. These include low socio-economic status that can limit choices and lead to high risk behaviours and norms and laws that subjugate women and which discourage them from seeking and obtaining the information they need to keep themselves safe. For example, globally only 38% of young women are able to describe the main ways to avoid infection and they are less likely to know that condoms can protect against HIV than young men. Data from 16 countries in sub-Saharan Africa from 2001-2007 also show that HIV prevalence is generally higher among adolescent girls aged 15-19 than their male counterparts. A significant cause of this is young girls partnering with older men who are more sexually experienced and more likely to be infected.

Violence against women

Violence against women is also a major cause of their increased vulnerability to HIV. It can make it difficult or impossible for them to control their sexual lives, abstain from sex or get their partners to use condoms. Violence, or the threat of it, can also result in women avoiding HIV prevention, treatment, care and support services.

For UNAIDS, this is a major area of concern and its Outcome Framework 2009-11 has stopping violence against women and girls as one of nine priority areas. According to Michel Sidibe, Executive Director of UNAIDS, “‘We know that there is a strong relationship between violence against women and HIV. We need to help young people develop the skills for mutual consent in sex and marriage and put an end to violence and sexual coercion. This is key to preventing HIV and to achieving gender equality in all aspects of life.”

Gender inequalities

Women and Health has an extremely broad scope and addresses a range of women’s health issues. The factors that come into play to increase women’s vulnerability to AIDS are also shown to profoundly affect women and girls’ general health and well-being. As the report contends, gender inequalities in the allocation of resources such as education, income, health care, nutrition and having a political voice are very much associated with poor health and reduced well-being.

“Despite considerable progress over the past two decades, societies are still failing women at key moments in their lives,” says Dr Margaret Chan, WHO Director-General, in the foreword to Women and Health. “These failures are most acute in poor countries, and among the poorest women in all countries. Not everyone has benefited equally from recent progress and too many girls and women are still unable to reach their full potential because of persistent health, social and gender inequalities and health system inadequacies.”

Key stages relevant for health: early childhood, adolescence, adulthood and older age

The report explores the lives of women and girls through key stages relevant for health: early childhood, adolescence, adulthood and older age, and shows that women face “widespread and persistent inequities” during each of these stages. It not only highlights women’s health needs- and how they are not being currently met in terms of HIV and other areas- but also the valuable contribution that they make to the health sector and society in general.

By using today’s evidence, sharing what is currently known about the health of women from all regions and throughout their lives, the report attempts to set out tomorrow’s agenda, a key element of which is championing reforms to enable women to not only be seen in their sexual and reproductive capacity, but to become active agents in health-care provision, playing a central role in the design, management and delivery of health services.

Women and Health draws attention to four areas where policy action could make a real difference to women’s health: building strong leadership and a coherent institutional response coalescing around a clear agenda; making health systems work for women; leveraging changes in public policy to encourage fundamental social change (through, for instance, targeted action to help girls enrol in school); and finally, building the knowledge base and monitoring progress.

WHO hopes that by reviewing the available data and charting a cogent way forward that the health of women and girls, and society as a whole, can be ameliorated. As the report has it, “Improve women’s health, improve the world.”