Tuesday, December 1, marks World AIDS Day and this year there is a lot to celebrate. According to the UNAIDS 2009 Epidemic Update, close to four million people are now on antiretroviral treatment; the rate of new HIV infections is decreasing; and people with HIV are living longer and healthier lives than ever before. This is the result of unprecedented effort and money to fight this disease.
And yet at the same time there are many reasons why we should not be celebrating. More than two million people died last year due to AIDS-related illnesses. More than fifty percent of people who need treatment still are not getting it. And much, much more needs to be done to meet the prevention, treatment, care and support needs of people who are most at risk: sex workers, men who have sex with men, injection drug users, and in sub-Saharan Africa, women and girls.
Let’s focus for a minute on women and girls. Just over two weeks ago, WHO released a new report on women’s health, which found that unprotected sex is the largest risk factor for death or disability among women of reproductive age. Globally, HIV/AIDS is the leading cause of mortality among women between the ages of 15 and 49.
According to the UNAIDS 2009 Epidemic Update just over half of the 31.3 million people living with HIV/AIDS are women. Women in sub-Saharan Africa continue to be disproportionately affected, with young women three or four times more likely to be infected with HIV than young men in Kenya and Tanzania respectively.
None of this information is new. The causes of women’s higher HIV risk are not new either: women are biologically more susceptible to HIV/AIDS and pervasive discrimination, inequalities, and violence compound the risk.
As far back as 1994 at the International Conference on Population and Development governments recognized these problems and pledged to ensure universal access to reproductive health services, sexuality education, and programs to promote gender equality. These pledges were strengthened a year later in Beijing at the Fourth World Conference on Women and reaffirmed in 2000 during the Millennium Summit, in 2001 at the UN General Assembly Special Session on HIV/AIDS, in 2005 at the World Summit, and at many other conferences since. However, fifteen years later, with the exception of programs to prevent mother to child transmission of HIV (PMTCT)—which often focus more on the child than the mother—few, if any, countries have brought any HIV intervention that specifically targets women’s prevention, treatment, care and support needs to scale.
So what is the problem? A complete lack of political will? Discomfit with women’s sexuality? So sick of hearing about the need to address women’s health and rights, that government officials just ignore it altogether? A lack of knowledge about what to do or how to do it? In truth, it is probably a combination of all of the above.
There are no silver bullets to reduce women’s HIV risk. It requires a complex set of interventions: comprehensive sexual and reproductive health care, gender equality and sexuality education in schools, keeping girls in school for as long as possible, changing gender norms and eradicating violence against women, protecting women’s legal rights, and empowering women to be able to negotiate sex on their terms, especially condom use, among many other things. This takes time and effort and money, and the latter two at least have been in short supply.
Recognizing the lack of progress in scaling up programs for women, the Global Fund to Fight AIDS, Tuberculosis and Malaria adopted a gender equality strategy last year that aims to provide incentives to countries to scale up gender-transformative responses. This year, UNAIDS followed up with an Action Framework addressing women, girls and gender equality that pledges specific actions by UNAIDS co-sponsors at all levels to improve HIV/AIDS response for women.
But that is all just talk. Now, it’s time for action.
I’m sick of being outraged. Next year I want something to celebrate: a stronger focus on women’s health and rights in the HIV/AIDS response.
P.S. The UNAIDS 2010 Outlook Report did tell us something new: up to 50,000 maternal deaths annually may be HIV-related, just one of the reasons why the world is making little-to-no progress in reducing maternal mortality.
Global Health Policy at NYU-Wagner 