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Preventing HIV/AIDS
Over two decades into the AIDS pandemic, some 38
million people are living with HIV/AIDS and over 20
million people have died.1 Despite expanding prevention
activities, some 5 million new infections are
occurring each year. In the hardest-hit countries, the
pandemic is reversing decades of development gains.
In 1994, the ICPD Programme of Action noted the
severity of the pandemic and projected that the
number of people infected with HIV would “rise to
between 30 million and 40 million by the end of the
decade if effective prevention strategies are not
pursued”.2
The ICPD called for a multisectoral approach
to AIDS that included raising awareness about the
disastrous consequences of the disease, providing
information on means of prevention, and addressing
the “social, economic, gender and racial inequalities
that increase vulnerability”.3 It recognized the
harm of stigma and discrimination and the need
to protect the human rights of people living with
HIV/AIDS.
The Programme of Action also noted that the
“social and economic disadvantages that women face
make them especially vulnerable to sexually transmitted
infections, including HIV”.4 In Africa today, women are 1.3 times more likely than men to be
infected with HIV. Young women aged 15-24 are two
and a half times more likely to be infected than
young men.
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| INTEGRATE HIV/AIDS PREVENTION WITH REPRODUCTIVE HEALTH SERVICES |
Governments should ensure that prevention of and services for sexually transmitted diseases and
HIV/AIDS are an integral component of reproductive and sexual health programmes at the
primary health-care level. |
—Key Actions for the Further Implementation of the Programme of Action
of the International Conference on Population and Development, para. 68 |
Reproductive health programmes were recognized
as essential to preventing HIV through: prevention,
detection and treatment of sexually transmitted
infections; provision of information, education and
counselling for responsible sexual behaviour; and
ensuring a reliable supply of condoms.
In its five-year review of ICPD implementation in
1999, the United Nations took note of the worsening
pandemic and called for increased resources and
stepped-up efforts to combat its spread. Targets were
set for reducing HIV prevalence among young people,
and for expanding their access to information and
services for preventing infection.
Given that more than three fourths of HIV cases
are transmitted sexually and an additional 10 per cent
are transmitted from mothers to children during
labour or delivery or through breastfeeding,(5)linking
HIV and reproductive health services is crucial. The
pandemic has highlighted the urgent need to improve
both primary health services and sexual and reproductive
health services.
HIV/AIDS is taking a terrible toll on individuals and
communities in countries with high prevalence. In
some sub-Saharan African countries, one quarter of
the workforce is infected with HIV. By one estimate,
if 15 per cent of a country’s population is HIV positive
(a level nine countries are expected to reach by 2010),
gross domestic product declines by about 1 per cent
each year.(6 )Using this measure, South Africa’s GDP
may fall by 17 per cent by 2010.
A recent report from the World Bank and
Heidelberg University warns that the long-term
impact of AIDS may be even more damaging.(7) AIDS
destroys human capital by killing people in the prime
of their lives and also affects the way knowledge and
skills are transferred from generation to generation.
Furthermore, premature adult mortality associated with AIDS weakens investments in education and
reduces the proportion of families that can afford
to send their children to school.
Fewer than one in five people at high risk of HIV
infection have access to proven prevention interventions,
according to a 2003 report by the Global HIV
Prevention Working Group, an international panel of
AIDS experts. Dramatically scaling up proven prevention
strategies could avert 29 million of the 45 million
new HIV infections expected by 2010, the report said.(8)
Treatment regimes for HIV improved throughout
the 1990s, but their cost remained prohibitive for all
but the wealthiest countries. While there is now a
concerted effort to expand access to treatment—
including the WHO-led UNAIDS “3 by 5 Initiative” to
reach 3 million people by 2005 and lower drug costs—
the vast majority of infected people still do not have access to antiretroviral (ARV) therapy, which can
transform AIDS into a chronic disease.
A June 2004 report(9) by the Global HIV Prevention
Working Group stressed the importance of integrating
HIV prevention interventions into expanding treatment
programmes. Increased availability of ARVs, the
report stated, will bring more people into health care
facilities where they can be reached by HIV prevention
messages. But it could also lead to an increase
in risky behaviour unless prevention counselling is
incorporated into treatment programmes. The group
recommended making VCT available in all health care
settings where people have access to ARVs.
FEMINIZATION OF THE PANDEMIC. Half of all adults
living with HIV/AIDS are female, compared to 41 per cent
in 1997. In sub-Saharan Africa, the most affected
region, the figure is nearly 60 per cent. The rising
rates of infection among women and adolescent girls
reflect their greater vulnerability, due to both biological
and social factors. Gender inequities and male
domination in relationships can increase women’s
risk of infection and limit their ability to negotiate
condom use. Poverty leads many women and girls into
unsafe sexual relations, often with older partners.
This “feminization” of the epidemic is further
exacerbated by women’s roles as managers of the
household and primary caregivers for family members
infected with HIV. Other factors that make the
impacts disproportionate include the legal, economic
and social inequalities women often face in the areas
of education, health care, livelihood opportunities,
legal protection and decision-making.
COUNTRIES RESPOND. Three fourths of the countries
responding to UNFPA’s 2003 global survey reported
adopting a national strategy on HIV/AIDS and 36
per cent said they had specific strategies aimed at
high-risk groups. Many countries have established
national AIDS commissions and developed policies
and programmes to address the impact of the pandemic.
A growing number of countries are taking a
multisectoral approach, involving a wide range of
ministries and increased involvement of NGOs. But
just 16 per cent reported having passed legislation
in support of HIV/AIDS efforts.
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CONFRONTING INEQUALITY |
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To address the disproportionate
impact of HIV/AIDS on women and girls, UNAIDS launched the Global Coalition on
Women and AIDS at a February 2004 meeting chaired by UNFPA Executive
Director Thoraya Obaid. The advocacy initiative will focus on preventing new HIV
infections among women and girls, promoting equal access to HIV care and
treatment, accelerating microbicides research, protecting women’s property and
inheritance rights and reducing violence against women.
UNAIDS, the United Nations Development
Fund for Women (UNIFEM) and UNFPA issued a joint report in July 2004,
Women and AIDS, Confronting the Crisis. It calls on governments and the world community
to:
- Ensure that adolescent girls and women have the knowledge and
means to prevent HIV infection through advocacy campaigns that
convey basic facts about women’s heightened physiological vulnerability
and dispel harmful myths and stereotypical notions of masculinity and
femininity, warn that marriage does not necessarily offer protection from HIV
transmission, and involve both young men and women in promoting sexual
and reproductive health.
- Promote equal and universal access to treatment by ensuring that women
make up 50 per cent of people able to access expanded treatment interventions,
increasing access to confidential voluntary counselling and testing (VCT)
services that take into account unequal power relations and encourage partner
testing, expanding reproductive and sexual health services, and training health
providers in gender-sensitive care and treatment.
- Promote girls’ primary and secondary education and women’s literacy by
eliminating school fees, promoting zero tolerance for gender-based violence and
sexual harassment, offering literacy classes for women that focus on
HIV/AIDS and gender equality, providing life skills education both in and out of
school, and creating curricula that challenge gender stereotypes and promote
girls’ self-esteem.
- Relieve the unequal domestic workload and caring responsibilities of women and girls for sick family members and orphans by providing social protection mechanisms and support for
caregivers, promoting more equitable gender roles in the household, distributing
home-care kits, and establishing community fields and kitchens to
supplement individual household responsibilities.
- End all forms of violence against women and girls by undertaking media
campaigns on zero tolerance for violence, male responsibility and respect for
women, and dangerous behaviour norms, and by providing counselling and
post-exposure prophylaxis to all who experience sexual violence.
- Promote and protect the human rights of women and girls by enacting,
strengthening and enforcing laws protecting their rights, reporting violations
to the UN Committee on the Elimination of Discrimination Against Women,
protecting women’s property and inheritance rights, and supporting free or
affordable legal services for women affected by HIV/AIDS.
See Sources
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