Project Description

In Focus…
Turning the Tide for Women and Girls…
Whats inside:
Special report:
Is the Global Plan
Feedback from
the Global
Ending involuntary
A real
and plan
Sex workers’ call to
Women’s voices…
In her opinion…
Human rights in a
new era
In the 1990’s, before HIV cocktails
and clearly defined social
determinants of health, a then
progressive TLC sang: ‘Don’t go
chasing waterfalls. Please stick to the
rivers and the lakes that you’re used
to’. However, after three decades of
messages to ‘just be abstinent’ and
‘just be faithful’ we know that there
is more to be done to protect the
life and avert new HIV infections for
women and girls.
At the 55th Commission on
the Status of Women (CSW)
Michel Sidibé may have said it best
when he remarked that ‘we must take
AIDS out of isolation and provide
young girls with opportunities to
negotiate their sexual relationships
and receive sexuality education so
that they can protect themselves
from infection. If we don’t do this,
our vision of zero new infections will
remain a dream’. To Turn the Tide,
we must address the full context of
social, cultural and political factors
that increase the vulnerability and
risk for women and girls.
A woman should never have
to choose between buying lifesustaining
food for her children and
purchasing live-saving medications
for herself. However, this is indeed
a lived reality for many women
in the world who shoulder a
disproportionate burden of HIV
The World Health Organization
Report on the Global HIV/AIDS
Response provides a sobering
snapshot of women and girls in the
HIV epidemic stating that women
account for 50% of people living
with HIV worldwide. Of that, the
report highlights that a resounding
64% of people living with HIV
between 15-24 years of age are
women and girls. The rates are even
higher in sub-Saharan Africa where
girls and young women make-up
71% of all young people living with
HIV. Even here, as DC plays host to
IAC2012, we too have tremendous
work to do, as we boast the highest
HIV rates in the U.S., with Black
women at the heart of the epidemic
with staggering infection rates.
The revolution will be televised
and the time is now. This was made
resoundingly clear merely weeks ago
when the flagship report of the HIV
and the Law Commission, ‘Risk,
Rights, Health’, vividly captured
the IT:
Laws and legally condones
customs – from genital
mutilation to denial of property
– produce profound gender
inequality; domestic violence
also robs women of personal
power. These factors undermine
women and girls’ ability to
protect themselves from HIV
infection and cope with its
To Turn the Tide we must be bold,
honest and willing to take HIV out
of isolation as a biological disease,
Mujeres Adelante Sunday•22 July 2012
Daily newsletter on women’s rights and HIV – Washington 2012
Ebony Johnson
2 Sunday • 22 July 2012 and address the underpinning social drivers
and variant context of gender inequity. We
can ill afford to reinforce and normalise
social, political and cultural norms that
increase the vulnerability of women and
girls and limit our access to education,
opportunity, health and choice.
The needs of women and girls are
urgent and the time is now! Babatunde
Osotimehin, UNFPA Executive Director,
was clear that we can do more and we
can develop better with his passionate call
to action:
Empowering young people,
particularly girls and women, living
with HIV to defend their rights and
have access to education, information,
and services would be a major
Turning the Tide will mean expansion of
the Global Fund and bilateral programmes
providing micro-financing, educational
incentives and innovative mechanisms
to reduce poverty, and increase the
independence of women
and girls.
Sam Cooke will be forever famous for
his eternally relevant lyrics, ‘It’s been
a long time coming, but I know, change
gonna come’. At the International AIDS
Conference (IAC) of 2010 in Vienna,
Austria, there was an air of infinite
possibility when the results of CAPRISA
were released. CAPRISA confirmed that
a microbicide could reduce women’s
risk for acquiring both HIV and herpes.
This discovery could provide women an
invaluable ability to negotiate safer sex
and preserve our health, even when male
partners refuse to use condoms or when
social or cultural contexts forbid their use.
However, two years later, we return to the
IAC asking, ‘Where the Hell is the Gel?’.
If we are to Turn the Tide, it is imperative
that women-centred research is funded and
prioritised, and that we too are a part of the
‘Prevention Revolution’.
Surveys say, the research results are in
and the HIV Tide is Turning with new treatment options creating
new possibilities. In May, 2011 more game-changing research
results were announced. HPTN 052 demonstrated that people
living with HIV who took ARV’s and were able to stay healthier
and suppress their viral loads were 96% less likely to transmit HIV
to the negative sexual partners. This could mean healthier women
and girls, increased options for safe conception, creating ease in
disclosure and proven strategies for safer sex in sero-discordant
relationships. Additionally, the Report on the Global HIV/AIDS
Response stated that when people are healthier, they are better able
to cope financially. The report acknowledges that investment in HIV
services could lead to total gains of up to US$ 34 billion by 2020 in
increased economic activity and productivity. We know what works.
The question is, are we willing to do what it takes.
A pinch of fairy dust and sprinkle of sugar… a few magic words
and presto! Everything is lovely. Unfortunately, it only works
that way in the fairy tales. With the United States Federal Drug
Administration (FDA) decision to allow Pre-Exposure Prophylaxis
(PrEP) for prevention of HIV, we must keep this in mind. While the
thought of women (and men) now having another tool in the toolbox
to prevent becoming HIV positive; this is by no means a magic pill.
PrEP will require intricate community and provider education to
ensure that people understand the limitations of PrEP, which is not
100% effective against HIV, and doesn’t offer any protection against
pregnancy or STI’s. There also is an issue of who gets it and when, as
many uninsured and underinsured women who already have higher
vulnerability to HIV through a confounding of social ‘isms’ may not
be able to access PrEP. So, while it is an important moment on the
journey, it is not the ‘destination’! Women need clear and factual
information to understand what using PrEP means, and to make clear
decisions for knowledge is power and powerful women will be at the
core of us creating waves and living better!
If we really are ready to Turn the Tide for women and girls, the
financing must follow with increased funding and implementation
of the Global Plan towards the elimination of new HIV infections
among children and keeping their mothers alive, and increased
efforts to ensure that women are centre of HLM 15 by 15.
‘We must do what is hard while it is easy’. We have identified
the issues. Scientists have brought forth the science. Women are
in position for revolution. Politicians, thought leaders, husbands,
physicians, brothers, gate-keepers, pharmaceuticals, funders, allies,
religious leaders, teachers – all who make decisions, hold influence,
and promote change in every corner of the globe… we need you to
brave the waves with us and help us to Turn the Tide for Women
and Girls!
Ebony is a consultant with A Drop Of Prevention, LLC
and with the ATHENA Network.
… we must be
bold, honest
and willing to
take HIV out
of isolation…
and address the
social drivers
and variant
of gender
…the needs
of women and
girls are urgent
and the time is
A real commitment and plan… Louise Binder
My expectations,
demands and dreams
for AIDS2012:
I expect that the prevention researchers
will be loudly tooting their horns about
treatment as prevention (aka, ‘treatment is
primarily prevention and if it treats people that’s
good too’) and the cure (aka, even though
most of the world still doesn’t have access
to existing treatments, let’s spend more
money on new treatments for secondary
compartments and vaccines). Another way
of saying: I don’t have high expectations that
the practical realities of those affected with
and at greatest risk for HIV will be dealt with,
except by communities themselves and
some behavioural researchers. I expect some
monetary commitments will be made, but
they will amount to a lot of the shell games
we have seen before.
My demands – Adequate funding so that
every person who needs treatment related
to HIV will have treatments, no matter where
they live or what money they have; that
people living with HIV in all their diversity will
have a meaningful seat at every important
decision-making table internationally and
nationally, with a veto power for decisions
with which they disagree and that will impact
their communities; and that we get serious
about violence against women at the policy
and practical level everywhere.
My dreams – A real commitment and plan
to mentor young leaders in all aspects of
this epidemic, from research to healthcare
providers to community leaders, with women
being provided whatever discreet forms of
experience they require, due to the specific
adverse impacts of the social determinants of
health on women of all ages.
Louise is with ICW Global.
Sunday • 22 July 2012 3
News from the Global Village…
Ending involuntary
sterilisation of women living
with HIV…
Despite the long-term advocacy efforts of various women’s and
human rights organisations towards addressing and redressing
rights violations in the context of sexual and reproductive healthcare,
such violations continue to manifest in various parts of the world,
in countries experiencing both generalised and concentrated
epidemics, without showing significant signs of abatement. Indeed,
recent data indicate that the scale of coerced sterilisation of women
living with HIV is significantly more widespread, than was previously
understood. Nevertheless, nationally and internationally, the issue
has been side-lined and received little more than lip-service from
policy and programme makers.
On the eve of a historic judgment in Namibia, where cases of
forced sterilisation have been taken to the highest court in the
country, women’s rights activists, including women and young
women living with HIV, convene in the Women’s Networking
Zone during the week of the 19th International AIDS Conference
in Washington DC. Join us to deepen our understanding of these
issues, and plan on-going advocacy to ensure that the sexual and
reproductive health and rights of women and girls in all of our
diversity are met.
Wednesday July 25th
10:30 – 11:30am: Using Film as Activism to end Involuntary
Sterilisation of Women Living with HIV – African Gender and Media
17:00 – 18:00: Sterilisation and Human Rights Think Tank –
Thursday July 26th
14:15 – 15:15pm: ‘In the Hospital There are No Human Rights’:
Positive Women’s Sexual and Reproductive Health Rights Violations in
Hospitals in Namibia – Namibia Women’s Health Network
4 Sunday • 22 July 2012 restrictions, criminalisation of HIV
transmission, and confiscation
and evidentiary use of condoms to
arrest and prosecute sex workers.
• Ceasing to subject sex workers
to arrests, court proceedings,
detention, mandatory testing
or government-mandated
‘rehabilitation’ programmes.
Instead, enable sex workers to
find redress for human rights
violations. Implement rigorous
training of law enforcement
officials on legal and human
rights standards.
• Reorienting anti-trafficking
campaigns to conform to the
standards set by the United
Nations and engage sex workers,
themselves, in the work of
stopping exploitation in the
sex sector.
…one of the three
‘most at risk
are barred from
Women’s Realities…
Sex workers’ call to change…
Anna Forbes
How many times are sex workers and
their needs mentioned in the U.S.
National HIV/AIDS Strategy?
Answer: Zero
What percentage of sex workers does
the U.S. government estimate are
living with HIV?
Answer: It has no estimate.
So U.S. policy doesn’t have much
effect on sex workers and their HIV
risk, right?
Answer: Wrong.
The International AIDS Conference
is opening today in Washington
DC, just blocks from the White House
and the U.S. Capitol. But sex workers
– one of the three WHO-defined ‘most
at risk populations’ – are barred from
attending. U.S. immigration law forbids
entry by anyone who has ‘engaged in
U.S.-based sex workers and
advocates are responding by organising
a collective demand that the U.S.
government change its approach to
the health and rights of people in
the sex trade. Our Call to Change
U.S. Policy on Sex Work and HIV
enables conference attendees and
other supporters to stand in solidarity
with international sex workers, speak
out against human rights violations,
and demand expanded access to
treatment and prevention. We invite
you to join us in demanding that the
U.S. Government reform laws and
policies that harm sex workers and
inhibits effective HIV responses.
These policies fail to differentiate
between people who have chosen sex
work as an income-generating option,
and those that have been forced into it
against their will. The critical difference
is self-determination. Confusing these
two categories leads to ineffective antitrafficking
efforts and multiple human
rights violations. Sex workers have a
vital stake in ending human trafficking
– and they are well-positioned to
assist with anti-trafficking efforts.
Disturbingly, those designing antitrafficking
efforts too often disregard
their expertise and, instead, respond
to sex workers only by advocating
imposition of legal penalties and other
human rights abuses against them and
their communities.
Structural issues drive the HIV
epidemic within the sex sector,
just as they do throughout society.
Criminalisation and stigma compound
the health disparities that many sex
workers already suffer, because of
being on the wrong end of racial,
economic and gender inequality.
Sex workers empowered as leaders,
however – once provided with
appropriate access to resources and the
freedom to legally challenge injustices
– have shown their ability to be highly
effective in curtailing the spread of HIV.
Harmful U.S. government policies
increase HIV risk among sex workers.
Domestically, sex workers’ omission
from HIV prevention planning and
budgets exacerbates stigma and results
in a desperate lack of appropriately
targeted services. The ‘Anti-Prostitution
Loyalty Oath’ in the President’s
Emergency Plan for AIDS Relief
(PEPFAR) legislation unnecessarily
restricts how millions of U.S. dollars
are used by PEPFAR grantee countries,
and specifically damages their ability
to provide effective HIV prevention
services to sex workers.
In 2011, during the UN’s
examination of the U.S. human rights
record via the Universal Periodic
Review, the U.S. agreed ‘that no one
should face violence or discrimination
in access to public services based on
their status as a person in prostitution’.
We are calling on the U.S. government
to make good on that commitment by:
• Eliminating restrictions placed
on domestic and global AIDS
funds, such as the PEPFAR’s
Anti-Prostitution Loyalty Oath.
Instead, invest in evidence-based
best practices for HIV prevention,
treatment and care targeted to sex
• Stopping law enforcement
interference with HIV prevention
efforts, including immigration
Why are these demands important? Here are just a few of
the reasons:
1. A 2012 meta-analysis of data from nearly 10,000 sex
workers in 50 countries concluded that while ‘data
characterising HIV risk among female sex workers is
scarce, the burden of disease is disproportionately high.
These data suggest an urgent need to scale up access to
quality HIV prevention programmes’.
2. The Lancet reports on ‘structural conditions that increase
risk of HIV and prevent engagement in interventions among
female sex workers, including criminalised legal and policy
environments, violence, stigma, and restrictive funding
3. Many international NGOs have stopped providing services
to sex workers, despite the urgent need for them, rather than
risk losing their access to PEPFAR funding due to the Anti-
Prostitution Loyalty Oath.
4. In several U.S. cities, including Washington DC, police
destroy or confiscate condoms found on suspected sex
workers and have used possession of multiple condoms to
justify arrest, claiming that they are ‘evidence’ of intention
to do sex work.
Evidence-based best practices and human rights principles
must inform the global response to AIDS – not bigotry and the
politics of coercive ‘morality’.
To help build a movement for change, please send a
message to endorsing the Call.
Anne is a women’s health and rights advocate,
organiser and writer.
Women’s Voices…
On conference expectations and outcomes…
Eugenia Lopez, Mexico
At AIDS 2012, I hope to see greater
representation of young women
in all their diversity at plenaries, nonabstract
driven sessions, and oral
presentations. I expect an official
apology from the US government for
the barriers that sex workers, people
with HIV, and other activists have
experienced for acquiring visas to
attend the conference – and a promise
to eliminate those barriers in the future.
I expect to take part in the celebration
of community-based interventions at
the Global Village, as well as during the
official opening of the IAC.
Prudence Mabele, South Africa
My personal expectation is that
AIDS2012 would not be ‘business
as usual’ and talk shows, but instead
that we will share all our experience and
expertise and take them back to our own
communities and work in collaboration.
Especially with the global financial
crisis, we need women’s groups to work
together, not compete. I would like to
see a shift from raising more challenges
to giving more solutions and resolving
most challenges.
I am expecting that we will have more
programmes that help young women
to understand sexuality and sexual and
reproductive health and rights, and
programmes that ensure women’s access
to justice. I expect women’s organisations
to truly work together in making sure
that gender-based violence is addressed,
and that women have access to
comprehensive women-centred health
services, including access to screening
of all the cancers for women. I am
expecting that we will talk about poverty
and women’s livelihoods, as
they contribute to our vulnerabilities.
I would like us to hold ourselves
responsible for what we are supposed
to implement, and hold our leaders
accountable for all what they have
committed to and promised for women
and women’s rights.
Alice Welbourn, UK
My hope for this conference is that
the UN and donors will truly listen
to and heed the united voices of millions
of women from around the world calling
for our rights to be upheld in this year of
‘turning the tide’. An ‘AIDS-free’ generation
is indeed within our grasp – but only if
the full rights of all women and girls in
all our diversities are upheld. Women
and girls are the foundations and the
engine houses of all our communities
worldwide. If we are healthy and strong,
in body, mind and spirit, then all our
communities and societies will be. Invest
in us and you invest in all our futures.
Mabel Bianco, Argentina
Although progress has been made on
incorporating women and girls into
the International AIDS Conferences, since
we started pushing for this in Amsterdam
in 1992 as the International AIDS Women’s
Caucus (IAWC), we have not managed to
overcome the difficulties that women and
girls, and especially those living with HIV
and AIDS, face in achieving their sexual
and reproductive health and rights, and
their other basic human rights that are
undermined daily, such as living free of all
forms of gender-based violence, coercion
and discrimination.
At the XIX International AIDS
Conference, we need to strengthen the
visibility of women’s and girls’ issues,
especially those that increase their
vulnerability to HIV. I hope we can
develop new alliances and strengthen
those already existing among different
women’s groups, and with other actors
including UN agencies. And we must
keep on insisting: We need actions
NOW to stop HIV and AIDS in women
and girls! We know it, we can do it!
Sunday • 22 July 2012 5
Sunday, 22 July
09:00-11:00 A Call to Action: Global Sex Workers
Recommend Policy Change for Better HIV Prevention
and Treatment Session Room 3
Start Making Sense: Weighing the Evidence on Hormonal
Contraception and HIV Mini Room 4
11:15-13:15 Gender-Based Violence and HIV/AIDS:
Taking Stock of Evidence and Setting an Implementation
Research Agenda Mini Room 5
Gender and HIV – What’ve Men Got to Do with It? The
Changing Field of Men and Masculinities in Prevention and Care
Session Room 3
13:30-15:30 The Great TRANSformation: Towards a Holistic
Approach for Healthier and Happier Trans Communities in Latin
America and the Caribbean Session Room 7
Women Leading, Organising and Inspiring Change in the AIDS
Response Mini Room 2
Pre-Exposure Prophylaxis (PrEP) for HIV Prevention:
Maximising Success Mini Room 9
Elimination Paediatric AIDS and Keeping Mothers Alive from
an Implementation Perspective – Best Practices, Programmatic
Barriers, and Bottlenecks in the Field Mini Room 1
15:45–17:45 Women and Girls Turning the Tide
Mini Room 10
Reaching Key Populations through HIB/SRH Integration:
Opportunities for Impact GV Session Room 1
The Politics of Condoms: Cock-ups, Controversies and Cucumbers
Mini Room 3
19:00-21:00 Opening Plenary – featuring Anna Sango
from Zimbabwe
6 Sunday • 22 July 2012 The Global Plan for the
Elimination of HIV Infection
in Children and Keeping their
Mothers Alive (the Global Plan)
was launched in 2011 to provide
the foundation for countryled
movement, and chart a
roadmap to achieving this goal
by 2015, and contributing to
the achievement of Millennium
Development Goals 4 and 5 as
well as 6. The Global Plan was
developed through a consultative
process by a high level Global Task
Team convened by UNAIDS. The
plan covers all low- and middleincome
countries, but focuses on
the 22 countries1 with the highest
estimated numbers of pregnant
women living with HIV.
The Plan is based on a four-pronged
Prong 1:
Prevention of HIV among women
of reproductive age within services
related to reproductive health such
as antenatal care, postpartum and
postnatal care and other health
and HIV service delivery points,
including working with community
Prong 2:
Providing appropriate counselling
and support, and contraceptives, to
women living with HIV to meet their
unmet needs for family planning and
spacing of births, and to optimise
health outcomes for these women
and their children
Prong 3:
For pregnant women living
with HIV, ensure HIV testing
and counselling and access to
the antiretroviral drugs needed
to prevent HIV infection from
being passed on to their babies
during pregnancy, delivery and
Prong 4:
HIV care, treatment and support
for women, and children living with
HIV and their families
This week in the Women’s
Networking Zone, a number of
sessions will explore the key
issues affecting women living with
HIV that the Global Plan seeks to
address; the implications of the
roll-out of the Plan for women and
children; emerging models of good
practice for ensuring that the sexual
and reproductive health needs,
rights and desires of women living
with HIV are met; and, on-going
While the Global Plan is gaining
ground apace, women’s rights
and HIV activists have raised
concerns that the emphasis has
been biased towards saving babies,
with little attention paid to women
themselves. Fundamental principles
of both HIV testing and broader
health service access and uptake,
such as confidentiality, informed
consent and voluntary uptake, are
missing from the Plan itself and key
supporting documents.
The Global Plan sets as a
first principle of success that
women living with HIV should
be at the centre of rights-based
HIV responses. However, scant
attention is paid to structural
barriers to women’s access, such as
criminalisation of HIV, gender-based
violence, including violence against
women at the intimate, community
and service level, health workers’
attitudes and practices, to name but
three. It is crucial to recognise and
respond to the gendered barriers, as
experienced by women, in accessing
prevention of vertical transmission
In 2011 a virtual consultation was carried out by AIDS Legal
Network, in collaboration with Global Coalition on Women and
AIDS, in the 22 priority countries of the Global Plan with the
aim of understanding women’s realities and needs with regards
to prevention of vertical transmission programs. Nearly 300
women participated in the consultation. Responses revealed
that gendered socio-cultural and religious values and norms
greatly impact women’s position to make informed sexual and
reproductive health choices; to access healthcare services; and
to ultimately benefit from available HIV prevention, treatment,
care and support. Barriers commonly highlighted by women
included stigma and discrimination; abandonment, abuse and
violence; lack of male involvement; poverty and economic
dependency; limited availability of comprehensive services;
inadequate access in rural and remote areas; and a general
lack of meaningful participation of women living with HIV in
programme and policy design and development.
These issues call for greater engagement by women living
with HIV, including on-going dialogue between women’s rights
activists and clinicians seeking to provide a ‘PMTCT’ service,
as well as policy makers.
The Asia-Pacific Network of People Living with HIV
(APN+) has advocated on similar issues. Women with HIV
in Asia confront challenges including violence in the home,
and violations of sexual and reproductive rights in the health
sector. In India, increasing numbers of women are tested
during pregnancy without pre-test counselling or guaranteed
confidentiality. In Indonesia, women known to be HIV-positive
are often coerced or forced into sterilisation. Programmes to
prevent HIV among newborn infants
are implemented with little or no
regard for the consequences and
impact on the health and well-being
of women with HIV or their older
Positive women in Asia are working
to enabling their peers to enjoy full
and equal rights, but face considerable
obstacles, including lack of funding
and support to positive women’s
organisations and networks.
In Canada, the Women and HIV
Research Program, of the Women’s
College Research Institute has
devised evidence-based Canadian
HIV Pregnancy Planning Guidelines
(CHPPG) to assist people living with
HIV with their conception planning
and fertility needs. Internationally,
the CHPPG are the first stand-alone
pregnancy planning guidelines for
people living with HIV. Uniquely, the
guidelines include all people living
emphasis has
been biased
towards saving
babies, with
little attention
paid to women
Special report:
Is the Global Plan enough…?
Luisa Orza, Emma Bell
Sunday • 22 July 2012 7
Jennifer Gatsi, Namibia
We need to change! We need to really see things moving! So, I am
just hoping that maybe with AIDS2012 we are going to see these
changes which are really going to promote women’s health. We
have all these laws and policies in place, but we also need to start to
implement them. We also have to have a serious look at all those laws
and policies, which continue to be detrimental to women’s health. We
need to make sure that all the different kinds of violations women face
are addressed; no matter what your sexuality is, no matter what your
background is. Governments have to take responsibility, because they
must fulfil what they have promised and signed for. I hope AIDS2012
is turning the tide towards change.
Assumpta Reginald, Nigeria
My expectations are that there will be increased funding for women
living HIV&AIDS organisations, most especially in Africa; that
there will be the fulfilment of all pronouncements, commitments and
promises by our leaders towards health budgets; and that there will
be meaningful involvement of and investment in women living with
HIV&AIDS worldwide.
I am hoping that more partners will be committed in eliminating
new childhood infections and keeping their mothers alive, and that the
outcome of the conference will be translated into action.
I demand that PEPFAR funds should be increased in Africa to enable
quality access to treatment. So many treatment sites are closing down,
due to funding cuts, and so I urge Barack Obama and G8 Leaders to
invest more funds for AIDS treatment in Africa.
Vuyiseka Dubula, South Africa
We are now in the second decade of access to ART in Africa, which
has taken a very slow pace, because of lack or no political will. HIV
still remains very feminised in Africa, and women are still the most
vulnerable to HIV transmissions.
AIDS2012 must affirm that the fight is not over, instead it just
began. This conference must affirm the urgency to getting to Zero
now, not in the future. Too many women are still dying of preventable
diseases and still face high levels of violence and poverty.
We cannot afford to have another conference that talks the talks and
shows very little commitments to act as a matter of urgency.
Regional Voices…
On conference expectations…
Join us to explore and discuss these
issues in greater depth and detail at
the Women’s Networking Zone:
The Global Plan: What does it mean for
women’s rights? – Salamander Trust
Monday 23rd July, 12:45 – 1:45 (Annex)
Ensure that women’s voices are heard:
Barriers to women’s access to prevention of
vertical transmission programmes – ALN
Wednesday 25th July, 3:30 – 4:30 (Main Stage)
Women with HIV in Asia: Working to uphold
our rights – APN+
Thursday 26th July, 11:45 – 12:45 (Main Stage)
Canadian HIV Pregnancy Planning
Guidelines: From Knowledge Translation to
Action – Women and HIV Research Program,
Women’s College Research Institute
Tuesday 24th July, 9:15 – 10:15, (Main Stage)
with breakfast from 8:30
The Pregnancy Intentions of HIV-Positive
Women: Forwarding the Research and
Advocacy Agenda – Program on Global
Health and Human Rights, Institute for
Global Health, University of Southern
Wednesday 25th July, 11:45 – 12:45 (Main Stage)
with HIV regardless of marital
status or sexuality. Consistent with
a community-based or participatory
action approach, guideline
development included members of
the affected community from diverse
demographic and geographic groups
in all aspects of the project from
inception to publication.
Despite these and other efforts of
HIV positive women to put issues
concerning HIV and pregnancy
intentions on the agenda, only
recently have these issues received
even modest attention from
researchers and policy makers.
While the Global Plan represents an
advance in addressing these issues
at the international and national
policy level, research has been
fragmented and important gaps in
knowledge remain at policy and
programmatic levels about how
living with HIV affects the options
and decisions women face regarding
all aspects of reproduction. With
a particular focus on reproductive
and sexual rights, The Program on
Global Health and Human Rights
of USC, in collaboration with
Reproductive Health Matters, is
producing a journal supplement
that attempts to foster a more
complete understanding of how
women’s reproductive decisions are
being fulfilled, and where there are
existing gaps.
These attempts to develop the
evidence base and fill existing
gaps in global understanding and
guidelines represent crucial pieces
of the jigsaw in all our efforts to
promote and uphold the sexual and
reproductive health and rights of
women living with HIV.
1. Angola, Botswana, Burundi, Cameroon,
Chad, Côte d’Ivoire, Democratic Republic of
the Congo, Ethiopia, Ghana, India, Kenya,
Lesotho, Malawi, Mozambique, Namibia,
Nigeria, South Africa, Swaziland, Uganda,
United Republic of Tanzania, Zambia and
Luisa and Emma are
independent consultants and
women’s rights advocates
…women living
with HIV should
be at the
centre of rights
based HIV
is paid to
barriers to
Supported by the Oxfam HIV and AIDS Programme
(South Africa) and the South Africa Development Fund
Editors: Johanna Kehler
E. Tyler Crone
Photography: Johanna Kehler
DTP Design: Melissa Smith
Printing: B&B Duplicators INC.
8 Sunday • 22 July 2012
In my opinion…
Human rights in an era of treatment as prevention
Michaela Clayton
difficult to comprehend why a
woman in southern Africa might be
reluctant to go for an HIV test. As long
as this situation prevails, universal
access targets will remain unmet
and treatment as prevention will not
If universal access targets are to be
met and the promise of treatment
as prevention is to be realised, more
focus must be placed on, and more
investment made in, programmes
that place human rights at the centre
of the response to HIV and promote
the establishment and strengthening
of an enabling legal, policy and social
environment in which all people who
need it are able to access prevention
and treatment services without
discrimination. It is not a question of
human rights or public health.
Although there may be specific
human rights considerations that are
of particular relevance to treatment as
prevention strategies, such as concerns
about the risks of compromised
consent and confidentiality that
accompany mass testing campaigns,
the issues essentially remain the same.
Just as universal access will not be
realised as long as there is HIV-related
stigma and discrimination and laws in
place that violate the rights of people
living with HIV and criminalise key
populations at higher risk of HIV, neither
will the potential impact of treatment as
Michaela Clayton,
Director AIDS & Rights Alliance
for Southern Africa (ARASA)
Respect for and protection of
human rights have long been
recognised as being essential to an
effective response to HIV. The fear of
discrimination associated with HIV has
been a significant deterrent against
accessing testing and treatment and
thus, human rights protections for
people living with HIV or at risk of HIV
are critical; not only to protect the rights
of people living with or at risk of HIV,
but also for the realisation of universal
access to testing, treatment and care.
It is critical, if HIV prevention and
the use of ART as either prevention
or treatment are to succeed, that we
interrogate the human rights violations
that act as barriers to accessing testing
and treatment services, as well as those
that render people more vulnerable to
HIV, and that we articulate the human
rights elements of treatment and
prevention interventions. Failure to do
so will result in the potential benefits of
treatment as prevention, as well as in
universal access targets, not being met.
The ability of people living with HIV
and of key populations to enforce their
human rights (and more particularly
their right to health) and to access
prevention and treatment services is
compromised both by stigma and
discrimination faced at the hands of
families, communities, employers,
law enforcement officers and
healthcare workers, and by legal and
policy frameworks that fail to protect
their human rights, criminalise their
behaviour and, in many cases, actually
violate their human rights.
In Africa, the response to HIV has
seen the proliferation of an epidemic of
HIV-specific laws that have proved to be
a double-edged sword. In an attempt
to address stigma and discrimination
on the basis of real or perceived HIV
status, these laws contain provisions
that outlaw discrimination. At the same
time however, they often provide for
mandatory HIV-testing and disclosure
of HIV status by, for example, members
of key populations (e.g. sex workers),
all pregnant women, or those wishing
to marry. Additionally, a number of HIV
laws provide for mandatory disclosure
of a person’s HIV status to others –
such as a spouse or sexual partner.
Mandatory HIV testing and forced
disclosure not only violate basic human
rights, but also have broader human
rights and public health implications
for the HIV response. They target
and increase stigmatisation against
key populations at higher risk of HIV
exposure, and discourage people from
accessing HIV prevention, treatment,
care and support.
Many of these laws also criminalise
HIV transmission and exposure and
in several instances the wording of
these provisions is sufficiently broad
to criminalise the transmission of HIV
from mother to baby in utero, even
in instances where the mother has
no access to prevention of mother
to child transmission services. Whilst
criminalisation clauses were introduced
in HIV laws in Africa primarily with a
view to protecting women against
HIV transmission, paradoxically these
provisions, as well as those that make
disclosure mandatory, expose women
to be tested for HIV during antenatal
care, to potential violence, abuse and
Given the high levels of stigma
and discrimination, the inequality in
power relations between women
and men, and the high levels of
gender-based violence, it is not
…as long as
this situation
access targets
will remain
unmet and
treatment as
prevention will
not succeed…
…it is not a
question of
human rights or
public health…