Carin Jämtin, Hilde F. Johnson, Paula Lehtomäki, Per Stig Moller, and Peter Piot: Women's inequality fuelling AIDS epidemic
19 April, 2004
Ms Carin Jämtin is Sweden’s Minister of Development Cooperation,
Ms Hilde F. Johnson is Norway’s Minister of International Development, Ms Paula Lehtomäki is Finland’s Minister for Foreign Trade and Development, Dr Per Stig Moller is Denmark’s Minister of Foreign Affairs, and Dr Peter Piot is Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Today, over twenty years into the AIDS epidemic, women account for half of the 40 million people living with HIV worldwide. In Africa, where the epidemic is longer-standing, 60% of people living with HIV are women. And young women aged 15 to 24 are 2.5 times more likely to be infected than young men.
Women’s vulnerability to HIV is primarily due to inadequate knowledge about AIDS, insufficient access to sexual and reproductive health and educational services, inability to negotiate safer sex due to gender discrimination and imbalances of power, and a lack of female-controlled HIV prevention methods, such as the female condom and microbicides. Formulated as a gel, film, sponge, lubricant or time-released suppository, a successful microbicide could help protect women and couples who cannot or do not use condoms against HIV. For as long as women and girls are unable to enjoy education, property rights, freedom from violence and economic security, progress on the AIDS front will pass them by.
The ‘ABC’ slogan – ‘abstain, be faithful, use a condom’ is the mainstay of many HIV prevention programmes. But for too many women and girls, this message is insufficient. Where rape and other forms of sexual violence are widespread – whether during conflicts or in times of peace, abstaining or insisting on condom use is not a realistic option.
Across the world, between one fifth and a half of all girls and young women report that their first sexual encounter was forced. Only 11% of women in Zambia believed they have the right to ask a husband to use a condom.
Nor does marriage provide the answer. The reality across the developing world is that the majority of women will be married by age 20, and have higher rates of HIV than their unmarried, sexually active peers.
At the same time, women bear a disproportionate share of the burden of AIDS care. In poor households, the presence of an AIDS patient can absorb a third of all household labour, most of it by women. In many parts of Africa, for example, this is clearly affecting families’ and communities’ ability to ensure their own livelihood in a sustainable manner, and to contribute to national economic development.
The knock-on effects of the plunge in household income caused by AIDS is often to pull children out of school – and girls are usually the first to go. Across Africa, formal school participation is declining.
The answers to reducing women’s vulnerability to AIDS clearly lie deeper than the use of slogans. To address AIDS effectively, we first have to understand how women are being treated and why. A comprehensive strategy is needed to boost girls’ access to education – particularly secondary education, strengthen legal protection for women’s property and inheritance rights, eradicate sexual harassment and violence against women and girls, and ensure they have fair access to HIV care and prevention services.
Around the world, issues of access to, and ownership of, land, housing and other property are enshrined in many national constitutions and international human rights documents. However, a large majority of women and girls are denied this right, rendering them even more vulnerable to increased violence, poverty and homelessness. Poverty can also fuel HIV transmission as women engage in unsafe sex in exchange for money, housing, food or education.
Tackling these inequalities is not just a matter for women – men must be fully involved. For starters, they need to declare zero tolerance for violence against women, be committed to their daughters’ education and help alleviate the burden of care.
The Nordic countries have a long tradition in asserting the rights of women, both nationally and internationally. We are fully aware that we need to do more to ensure that these rights are respected in all our efforts to fight HIV/AIDS across the board, from policy formulation to implementing programmes. We know that targeting women is not enough. It is equally important to address the male side of the gender equation. Unless men change their behaviour, we will make limited progress on this front.
Moves are under way – for example the global push to achieve education for all, or the campaign by the World Health Organization and UNAIDS to ensure that three million people in the developing world have access to HIV treatment by 2005 – and that half are women. But more is needed, and more urgently.
The escalating global struggle against AIDS cannot afford to neglect women, and special efforts will be needed to ensure it is not allowed to. To that end, UNAIDS has pulled together a high profile group of men and women -- the Global Coalition on Women and AIDS -- which gathers activists, government representatives, celebrities, and community workers who are committed to improving the lives of women and girls.
The call to empower women is not new, but the devastation of AIDS makes it more urgent. Millions of women around the world were already facing a lifetime of hard labour for few rewards. AIDS has turned it into a death sentence.
The skills, knowledge and resources to relieve women of the devastating burden of AIDS already exist. What is needed now is the political will to ensure that they make a difference on the ground. There is no doubt that this will involve, among other things, changing traditional power structures.