Project Description

In Focus…
The challenges of prevention and
covering the cost…
Two presentations at
Tuesday’s plenary integrated
comprehensive visions, while
maintaining a keen eye for
how their conclusions could
or would be implemented to
make tangible differences in
the real lives of the people and
communities they affect. The
final presentation outlined
the contributions of the
Obama administration in the
development of a US National
HIV/AIDS strategy and
the creation of the Affordable
Care Act.
Dr. Nelly Mugo’s presentation
reflected a grounded
understanding of women’s issues
and made clear that in many parts
of Africa, the epidemic is very
much about family life and children.
She pointed out that in Kenya,
44% of new infections are among
married and cohabiting couples.
In addition, 50% of partners are
sero-discordant and many do not
know their status. She also noted
that among many couples, the
desire for children overshadows the
fear of infection, leading to further
infections. In addition, while 42%
of new infections worldwide are
among youth 15-24, 80% (4million)
of these are in sub-Saharan Africa,
where young women infected with
the virus out-number men by two
to one.
Having outlined the shape of
the epidemic in Kenya and many
parts of Sub-Saharan Africa, Dr.
Mugo considered where the new
prevention opportunities might
be useful. As researchers have
been reminding us throughout
this conference, PrEP (treating
uninfected individuals to prevent
infection), and early treatment,
no matter how successful in
experimental situations, only
work when they are taken. For
this reason, Mugo insisted that
all interventions must have a
behavioural arm and, more
importantly, that any interventions
must be owned by communities to
be successful. She gave the example
of the Luo Council of Elders,
which endorsed male circumcision
and led to a popular acceptance
of the procedure in Kenya in
contrast to other regions, where
the introduction was less effective.
In general, Mugo argued that the
process of prevention must be
multi-faceted and be discussed
and adopted by the communities
themselves.
Mugo emphasised that effective
prevention must involve male
circumcision, treating STIs,
condoms, Tenofovir gel and many
other tools. However, she saw a role
for the use of PrEP, for limited time
periods: perhaps among high risk
Mujeres Adelante Wednesday•25 July 2012
Daily newsletter on women’s rights and HIV – Washington 2012
Ida Susser, Jonah Kreniske, Zena Stein
Whats inside:
Special report:
Risks, rights and
health
Feedback from
the Global
Village…
Meaningful
research
participation
News from the
‘margins’…
Transgender
vulnerability
Women’s
realities…
Criminalising sex
work…
The Global Fund
gender agenda
Women’s Voices…
How can PrEP
work for women
In our opinion…
Time to de-silo our
thinking
2 Wednesday • 25 July 2012
youth aged 16-24 or among discordant
couples when they want to conceive. She
also suggested that PrEP might be useful
for vulnerable populations, such as couples
in situations of intimate partner violence
or even people in conflict zones. However,
it would be precisely in these situations
that adherence would be most difficult.
Patient empowerment, support groups,
and testing linked to services and the
home delivery of pills might help to foster
adherence in such difficult circumstances.
Dr. Berhard Schwartländer, the Director
of Evidence, Innovation and Policy at
UNAIDS, offered an insightful and wellorganised
presentation of the changing
global economic scene and its impact on
the world community’s response to the
AIDS epidemic. In years past, he noted,
we spoke of wealthy countries and poor
countries, in a paradigm of charity and
need. Today, however, we operate in an
international economic climate where
many lower income countries have
experienced unprecedented development
sufficient to change the conversation on
resource allocation. Schwartländer was,
however, careful to note that while there
has been financial progress in parts of the
developing world, the wealth produced
has not been well distributed. As one
slide illustrated, for example, despite a
doubling of GDP in South Africa over a
given period, the income of the poorest
20% has remained stagnant, a difference
that is likely even more striking amongst
women. This uneven progress exacerbates
inequality, a well-established social risk
factor for HIV.
Schwartländer also discussed alternative
modes of funding for this new global
economic order. Rather than the old
charity-based conception, he envisions
a world where middle-income countries
take control of their epidemics through
comprehensive funding initiatives, some independent and some in
partnership with the international community. Some foreseeable
fundraising tactics he described included various tax-based
programmes focused on international commerce, with revenue earmarked
for HIV spending.
While much of the talk focused on fiscal realities, Schwartländer
did not neglect the socio-political and human aspects of HIV
prevention and treatment. In one comparison of the AIDS response
in Brazil and Russia, he demonstrated that in these two countries
of similar population, epidemic severity and GDP, Brazil achieved
far superior results than did Russia. Schwartländer attributed
this difference to Russia’s refusal to address human rights issues,
especially with regards to the epidemic amongst IDU and MSM
populations. Schwartländer presented a salient and empowering
vision for a financially changing world, but until that vision includes
an explicit understanding of the challenges facing 21st century
women, it will remain incomplete.
It was particularly cheering at the end of the plenary session this
morning to be reminded by the Assistant Secretary for Health,
Howard Koh, of the ways in which the Affordable Care Act,
such a long fought and still fraught battle, will make life easier for
people with HIV. From January 2014, insurance companies will
not be allowed to refuse adults insurance because of pre-existing
conditions. In addition, as the Act goes into effect, insurance
companies will no longer be allowed to cap expenses for care.
Although we did not win anything like what we need, the Affordable
Care Act is a landmark in the provision of healthcare nationwide,
and will be particularly significant for people living with HIV,
specifically for women who predominate in the jobs without health
insurance or benefits in this country.
Ida is a professor of anthropology and
Zena is an epidemiologist of Columbia University.
…the process of
prevention must
be multi-faceted
and be discussed
and adopted by
the communities
themselves…
…any
interventions
must be owned
by communities
to be
successful…
News from the ‘margins’… He-Jin Kim
Moving forward
on transgender
vulnerability to HIV
Transgender people are acknowledged
as a most at risk population. At
AIDS2012, there have been several sessions
addressing the issues of transgender people
in the HIV pandemic, and several transgender
people have presented on the diverse
issues that they face in their communities,
ranging from violence and discrimination,
to a lack of access to information and
services. Interestingly, these sessions have
been speaking specifically to transgender
issues, not simply in the context of MSM; an
improvement over previous conferences,
especially since they took place at the main
conference, not the Global Village. However,
it still seems that the issue is still largely
considered to be transgender women’s
issues, as the voices of transgender men
have barely been featured. Furthermore, the
absence of so many sex workers from the
conference also means the absence of many
transgender people from across the world,
as many transgender people resort to sex
work, due to their socio-economic position
in societies where people who transgress
gender norms are severely stigmatised.
Sessions addressed the vulnerability of
transgender people, the violence that
transgender people all over the world
face, and how access to services in any
country has still not been realised. There is,
unfortunately, little emphasis on intersections
of these vulnerabilities. Transgender people
face violence and discrimination, due to
gender-based stigma, the violence they
face is gender-based, and the basis of
their vulnerability is not isolated from the
vulnerability that women in general face.
In order to truly address the structural issues
that fuel the HIV pandemic, we need to think
further than populations, or treatment and
care; we need to consider the human rights
issues that most at risk populations face, and
understand that these are interlinked, and
often gender-based.
Transgender rights benefit not only
transgender people; they challenge the
gender norms that fuel vulnerability for
women in general.
He-Jin is with GenderDynamix, South Africa.
Wednesday • 25 July 2012 3
News from the Global Village…
Meaningful involvement
in research…?
Doris Peltier illuminated the unique position aboriginal
women in Canada face in terms of involvement in research
methods during the session Meaningful Involvement of Women
Living with HIV: Women-specific Community-based Research
Model. Peltier’s perspective on HIV research, cultural insensitivity,
and questionnaire rhetoric offers a multi-dimensional look
into the changes that need to be made in community-based
research practices.
As an aboriginal woman living with HIV, Peltier outlined her
concerns with the treatment of her community in research. Every
time Peltier is asked to participate in research, she questions why
she is approached to be involved because, as she puts it, ‘we’ve
been researched to death’. Many questionnaires are insensitive
to cultural backgrounds of aboriginal women living with HIV
in Canada. Even the term ‘aboriginal’ is used to describe a
community of indigenous women that is composed of over 200
nations within the indigenous community. But for health service,
government, and research-intensive purposes, the nations are
grouped together under one banner, further demonstrating the
dismissal of cultural backgrounds. This ‘one-brush-stroke’ approach
to research also leads to tension and mistrust between women
and the researcher.
Peltier believes it is important to emphasise the qualitative
approach to research, instead of quantitative, as women’s voices
are limited in quantitative methods and only produce a ‘snap shot’
of women’s realities. Qualitative research however empowers
women to articulate their voices and experiences.
Finally, when research is released, Peltier criticised the
sensationalised rhetoric usually used to describe the findings.
Rhetoric, such as under-served, marginalised, vulnerable, injecting
drug user, disproportionate, uneducated, and poverty are commonly
presented in association with statistics about HIV in the aboriginal
community. She admits that although the statistics in reality may
be alarming, these sensational words used in research documents
do not describe numbers or statistics, but actual people and
communities. The use of the vindictive language ‘tells a very
dangerous story’. She questions, if this language is beneficial or
instead the new language of racism, paternalism and colonialism?
Sierra is with the AIDS Legal Network, South Africa.
Sierra Mead
4 Wednesday • 25 July 2012
Women’s Realities…
Criminalising sex work…
Human rights abuses in the United States
Kate Griffiths-Dingani
…undermines
public health
efforts in these
cities to distribute
condoms and
promote safer
sex among
sex workers
and among
transgender
women…
An excellent panel on the
criminalisation of sex work on
Monday boasted contributors from
all over the world, documenting
the similar legal problems facing
sex workers in various countries,
despite differing legal frameworks.
Globally, sex workers face both
prosecution, coercion using threats
of prosecution and marginalisation
from fear of prosecution, as well
as from migration status, and
intersecting forms of oppression,
such as gender-based violence
and stigma against ‘queer’ and
transgender people.
Presentations by Wen Zhai of
China, Laurent Geffroy of France,
and Hajdi Shterjova Simonovikj
of Macedonia highlighted the
often contradictory, competing and
confounding relationship between
law enforcement and public health
measures as search, detention, fines
and imprisonment prevent sex
workers from seeking healthcare
or make them suspicious – often
justifiably – of medical outreach
workers, clinic staff and health
officials. Wen asked poignantly,
whether governments and public
health policy makers ‘are not
making the same mistakes?’ with
sex workers as those recognised and
condemned by IAS in Vienna in
2010 with regard to drug users.
While the session provided
insight into these shared experiences
of sex workers worldwide, it
also highlighted criminalisation,
stigmatisation and marginalisation
by local and national authorities
in the United States. The panel
included an informal remote
presentation by a sex worker
from Calcutta whose presence in
absentia (and official exclusion
from the panel and programme)
reflect the impact of the ongoing
U.S. travel ban against sex workers
and drug users. As the panel chair
noted – losing the voice of sex
workers from outside the US at
this conference deprives delegates
of nuanced understandings of the
interplay between criminalisation,
marginalisation and its effects,
including addiction and violence.
Megan McLemore of Human
Rights Watch (HRW) also expanded
on the theme of criminalisation
and marginalisation in the U.S. by
presenting the findings of a recent
HRW report focusing on four major
cities; Washington D.C., New York,
Los Angeles and San Francisco.
The report meticulously documents
the widespread practice of police
using condoms carried in a purse
or elsewhere as evidence of illegal
sex work, often threatening to arrest
sex workers carrying condoms, and
sometimes doing so. As a result,
many women and other workers
believe it that it is illegal to carry a
certain number of condoms – or any
at all! This police practice therefore
undermines public health efforts in
these cities to distribute condoms and promote safer sex among
sex workers and among transgender women who are often
profiled by police and searched for ‘evidence’, regardless of
their profess.
Human Rights Watch is calling on the Justice Department to
investigate this practice.
Kate is an anthropologist and writer, who lives in Brooklyn, NY
and frequently works in Durban, South Africa.
Are women and gender
still on the agenda at the Global Fund?
After years of dialogue and debate,
advocates for the human rights of women
celebrated a major victory when, in 2009,
The Global Fund to Fight AIDS, TB and
Malaria adopted its first explicit document
outlining a strategic commitment to
gender equality, called the Global Fund
Gender Equality Strategy. The document
outlined a strategy for bringing a new
positive ‘bias’ in favour of programmes that
enhance gender equality.
The ambitious plan would see the
Global Fund get behind proposals that
could scale-up services and interventions
that reduce gender-related risks and
vulnerabilities to HIV infection; those that
would decrease the burden of disease
for women and girls most at-risk, such
as women using users, sex workers and
adolescent girls; proposals that would
mitigate the impact of HIV, TB and Malaria,
as well as programmes that would address
structural inequalities and discrimination
against women. This strategy seemed to
be a crucial step on the road to ending
‘gender-blindness’ in the institution, and
a process whereby prevention and
treatment strategies with the potential to
harm women and girls could be identified
before they are implemented. The strategy
is particularly challenging in that it asks a
funder that deals primarily with biomedical
interventions to bring the same rigor to
social and cultural aspects of treatment
and prevention.
As the strategy was being developed,
The Global Fund started to feel the effects
of the globally uncertain financial climate.
After failing to meet funding targets, the
Global Fund both scaled-back on some
grant making, as well as suspended a
round of grants in 2011.
That same year, two years into the new
gender strategy, its success in terms of
being implemented was reviewed by
neutral outside evaluators. The resulting
report by the Pangaea Global AIDS
Foundation indicated that, according to
major stakeholders in the fund’s process,
there was still a long way to go in terms
of both remaking the institutional ‘lens’
into one that could identify harmful
gender bias, as well as proposals likely to
successfully impact women and girls most
likely to be infected and affected by HIV.
The Global Fund responded positively to
the constructive criticism, but released
a statement in which its ‘gender’ focus
was restated in a way that advocates
interpreted to be a narrowing of emphasis.
The Secretariat would now focus grant
making on prevention of mother to child
and maternal, new born and child health;
the prevention of gender-based violence
and harmful gender norms; and most at
risk populations of women, specifically
female sex workers and women using
drugs. This new, more focused scope is
problematic, not least because two of the
three areas of work replicate focus from
elsewhere in the Global Fund’s agenda,
and because too often ‘mothers’ remain the
forgotten aspect of ‘maternal child health’,
while women who are not mothers are
excluded entirely.
Yesterday, activists and Fund staff met
in the Women’s Networking Zone to
brainstorm next steps on moving the
gender agenda forward at the Global Fund.
In addition to the economic environment,
the participants identified challenges, such
as developing national strategic plans for
HIV and AIDS that go beyond lip service to
gender equality. They discussed the need
to develop the capacity of women’s rights
organisation around the globe, as well as
the need for successful models of genderaware
policy on HIV.
Despite the increasingly austere grant
making environment, advocates for the
rights of women and girls will continue
to call for the full implementation of the
comprehensive gender strategy by the
Global Fund and by similarly situated
organisations and institutions. The
economic crisis makes this task more
difficult, but it also more needed, as
increasing numbers of women worldwide
now live in poverty, exacerbating their
vulnerability to HIV, TB and Malaria.
Kate is an anthropologist and writer, who
lives in Brooklyn, NY and frequently works
in Durban, South Africa.
Wednesday • 25 July 2012 5
Wednesday, 25 July
07:00-08:30 Messages that Matter: Reaching
the Worldís Women with Effective, Evidence-Based
HIV Prevention Strategies Mini Room 3
08:40-10:30 Plenary: Turning the Tide on Transmission
Session Room 1
10:30-11:30 At the Centre: Intergenerational Dialogue on
Young Womenís SRHR in the context of HIV WNZ, Annex
11:30-12:30 Positive Women: Reducing Vulnerability and
Reinforcing Empowerment Opportunities Session Room 2
11:45-12:45 Pregnancy Intentions of HIV-Positive Women:
Forwarding the Research and Advocacy Agenda WNZ
14:30-16:00 Hormonal Contraception and HIV:
An Evolving Controversy Session Room 3
14:30-18:00 Turning the Tide for Women and Girls:
How to Advance Positive Womenís Leadership and Advocacy
for HIV Action in One-Minute Mini Room 5
15:30-16:30 Ensure that women’s voices are heard:
Barriers to Women’s Access to Prevention of
Vertical Transmission Programmes WNZ
16:30-18:00 Stigma: Breaking the Silence – Dealing with
Stigma and Exclusion for People Living With HIV
and Affected Populations Session Room 1
Young People, HIV and Sexual and Reproductive Health Services
Session Room 8
Maximising Reproductive Possibilities and Choices for Women
Living with HIV Session Room 6
17:00-18:00 Sterilisation and Human Rights Think Tank
WNZ
18:30-20:30 Advancing the Integration of HIV and Sexual
and Reproductive Health: An Interactive Dialogue
Session Room 6
Paving the Way to an AIDS-free Generation: The Role of Female
Condoms in Comprehensive HIV Prevention Mini Room 5
UPCOMING
EVENTS
Kate Griffiths-Dingani
6 Wednesday • 25 July 2012
Activists have long argued
that a legal environment
centred on defining and
protecting human rights is
a critical factor in producing
an effective AIDS response
and an essential element of
‘turning the tide’.
AIDS2010 saw this approach take
centre stage with the Vienna
Declaration. Since then, the United
Nations Development Program
(UNDP) and the Programme
Coordinating Board of the Joint
United Nations Programme on
HIV/AIDS (UNAIDS) convened
The Global Commission on HIV and
the Law. The Commission spent
one and half years investigating
the intersections between HIV and
various aspects of law, including
through a number of regional
dialogues, which offered grassroots
organisations of sex workers,
LGBTQ people, people living
with HIV, and activists to give
voice to their experiences with the
intersections between law and life
with HIV.
Yesterday, the Commission’s
findings were presented in a special
panel at AIDS2012. The panel not
only summarised the broad findings
of the report, but also pointed to the
potential usefulness of the findings
for changes in policy and the law,
and raised the critical question; how
can we build a movement for HIV
law reform and human rights for all?
Criminalisation and reform in the
USA
The first section of the report was
presented by a representative of the
office of California Congresswoman
Barbara Lee. The report noted
that laws around the USA vary by
state, but that in some transmission
of HIV is criminalised, regardless
of intent; even mothers who
inadvertently pass the virus on to
their children before birth have
been prosecuted. Commissioners
discovered what people living with
HIV have long known; such laws
discourage testing and treatment.
Lee has argued that ‘if we are going
to get serious about ending AIDS, we
are going to have to get serious about
ending criminalisation’.
As a start, she has introduced
two bills into Congress. HR 3053
would subject state laws to review
and require them to comply with
existing international human rights
standards, which preclude HIVspecific
laws aimed at transmission.
The second bill, HR6138 – named
the Ending the HIV/AIDS
Epidemic Act – is an omnibus bill
that includes strong language on
state laws targeting people living
with HIV. Lee is particularly
insistent that vertical transmission
between mothers and children
remain free of legal sanction.
Gender and HIV law
For women, the intersection
between the law and HIV goes
beyond the enforcement of unjust
laws against people living with
the virus. Shereen El Feki, of the
Economist and a commissioner,
reported in depth on the
relationship between gender and
HIV law, focusing mainly on North
Africa and the Middle East, though
the interconnections, she suggests,
have significant overlap with many
other countries. ‘Given that we
were investigating issues relating to
LGBTQ rights, the rights of injection
drug users and sex workers’, she said,
‘one would have thought the rights of
women as a group would be relatively
uncontroversial’. Not so, according
to el Feki.
Instead, she pointed out that
in many countries a surface
commitment to gender equality
is belied by a lack of enforcement
of both laws affording gender equalityand basic criminal
statues (such as laws against rape and assault), when crimes
are committed against women. Last, she notes that in many
countries multiple legal frameworks, including customary or
religious law, confound national policies on gender equality,
depriving women of property rights, and protecting and
entrenching practices, like early marriage, that make women
vulnerable to HIV.
Women living with HIV also face violence at the hands
of intimate partners and family; a quarter of women who
reported disclosing their HIV status also reported being beaten
as a result. In the care of medical staff, the report notes that
women living with HIV face discrimination and stigma, as well
as too-frequent abuse, such as forced testing, sterilisation and
abortion, with ‘consent’ often illegally obtained for the former,
while the women is in labour. El Feki is for prosecution of any
health professionals engaged in such degrading and violent
treatment immediately.
‘Key Populations’
Commissioners also noted that specific populations with
significance with respect to the epidemic and response had
particular relationships to the legal aspects of HIV. The
report concluded that criminalisation and stigma against men
who have sex with men (MSM), drug users, sex workers and
transgender people have undermined public health efforts
aimed at these populations in a number of countries, and
violated individual’s human rights. Countries with punitive
laws targeting these groups also tend to have higher rates
of transmission and infection. In
some cases, countries also tend to
‘underinvest’ in inexpensive prevention
strategies, such as condoms and
lubricant, perhaps in large part
out of moral concerns that such
interventions could perpetuate the
stigmatised behaviour. Stigma may
also explain why to this day, two
years after the Vienna Declaration,
only 8% of funding for prevention
research goes to investigate these key
populations. Kenya emerged as an
exemplar nation, where reform of
stigmatising and criminalising laws
has been undertaken to strengthen the
AIDS response.
How can we build a movement?
This question was posed by
the chair of the panel Mandeep
Dhaliwal to the audience, many
of whom have been engaged with
just that question for years, if not
…go beyond
amassing
evidence of
the problem
and toward
mobilising
constituencies
for change…
Special report:
Risks, rights and health…for all?
Kate Griffiths-Dingani
Wednesday • 25 July 2012 7
AVAC, Sister Love and the Women’s HIV Research Collaborative,
combined their sessions in the Women’s Networking Zone to
host a joint dialogue session on the HIV clinical research agenda for
women. The session created an opportunity for women to ask the
urgent current questions on the clinical research agenda for women,
and in particular on ARVs as prevention.
Recent developments in Pre-Exposure Prophylaxis (PrEP), are
well-rehearsed at the AIDS 2012 conference. For women advocates,
the priority now is to determine how women can benefit from
advances in PrEP science.
Different women and different populations will be impacted by
and benefit from ARVs as prevention in different ways. Context is
everything, as always. In this session, the focus was on single HIV
negative women, but all women will equally need and be entitled to
the information they need to make their own choice about whether
PrEP is right for them.
The key questions that we all need to ask, are:
1. How will women identify and understand their own HIV risk
in order to consider whether PrEP is relevant to them? How will
clinicians and service providers do the same?
2. What information will women be provided on the potential side
effects and protective effect of PrEP, in order to make an informed
choice? How will they access this information?
3. How can PrEP be useful in contexts such as violence, and how
will providers of related services be informed and supported to
introduce PrEP to their discussions with women they support?
4. How do services find HIV negative women, in order to provide the
information and support they need? In the absence of community
services specific to negative women, or in absence of access to
clinicians, how can PrEP reach the women who need it?
5. How affordable and accessible will PrEP be? How can it be
rolled-out to ensure that no woman who wants it, is priced-out of
getting it?
Implementing PrEP successfully to benefit single HIV negative women
will depend on first answering these questions, and on recognising
and responding to the fact that while questions remain the same
across contexts, the answers will vary.
Jacqui is Head of Policy at the
UK African Health Policy Network (AHPN).
Women’s Voices…
How can ARVs as prevention work for HIV negative women?
Sterilisation and human rights think tank
On Wednesday at the WNZ advocates for the sexual and reproductive health and
rights of women living with HIV will be launching a new issue paper assessing
efforts to halt forced and coerced sterilisation of women living with HIV. The
issue paper emerged from a Think Tank session organised on the eve of the 2011
International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa. This
collaborative Think Tank mapped emerging trends at the intersection of sexual
and reproductive health and rights and HIV, with a specific emphasis on the
sexual and reproductive health and rights of women living with HIV. Our particular
interest was to assess the state of the field in relation to violations of the rights of
women living with HIV in sexual and reproductive healthcare settings. Given the
current attention to and global consensus around the importance of integrating
HIV and sexual and reproductive health, these violations pose a serious risk to the
effectiveness of sexual and reproductive health and HIV integration efforts.
Among the general conclusions and recommendations of the issue paper is
that we need more research and documentation of cases of forced and coerced
sterilisation. This is particularly important for getting the attention of influential
actors in the HIV and healthcare development sectors. In addition, we need
urgently to educate women on their sexual and reproductive health and rights
and at all levels, and empower them to challenge healthcare professionals.
Furthermore, women living with HIV need to lead collective advocacy based
on a common agenda. The session will discuss these actions part of the way
forward, and define the next concrete steps to realise them.
Please come and join us in the Women’s Networking Zone
on Wednesday, 25 July, 17:00-18h00.
decades. In the question and answer
session a number of approaches
emerged, though many argued for
the need to go beyond amassing
evidence of the problem and toward
mobilising constituencies for change.
One aspect of the Commission
findings emphasised a nationlevel
response. According to
the Commission, the reality of
the TRIPPS agreement – along
with newly negotiated free trade
agreements – have placed too
much power in the hands of
pharmaceutical companies, and too
little in the hands of people living
with HIV. The agreement has ‘failed
to reward innovation’ that would
bring life-saving treatment to more
people around the globe. The rights
of companies to their ‘intellectual
property’ must, according to the
Commission, be balanced with the
human rights of women and other
vulnerable people infected and
affected by HIV.
Kate is an anthropologist and writer,
who lives in Brooklyn, NY and frequently
works in Durban, South Africa.
…too-frequent
abuse, such as
forced testing,
sterilisation
and abortion,
with ‘consent’
often illegally
obtained
during times of
labour…
Jacqui Stevenson
Supported by the Oxfam HIV and AIDS Programme
(South Africa) and the South Africa Development Fund
Editors: Johanna Kehler jkehler@icon.co.za
E. Tyler Crone tyler.crone@gmail.com
Photography: Johanna Kehler jkehler@icon.co.za
DTP Design: Melissa Smith melissas1@telkomsa.net
Printing: B&B Duplicators INC. bandbduplicators.com
www.aln.org.za www.athenanetwork.org
8 Wednesday • 25 July 2012
In our opinion…
Time to de-silo our thinking…
context of intimate relationships, but also in
institutional services. Policies, services and
relationships that ensure women’s safety
are fundamental to realising sexual and
reproductive health and rights.
The way policy makers think and
the way we think about women – as
mothers. Of course we need to keep
mothers healthy, but women are not only
mothers. They are much more. Why is it
that women get access to ARVs when they
are pregnant, but we are not using STI
clinics, violence survivor services, abortion
places and all the other places women go
to get healthcare? Why are we not offering
women as women access to ARVs through
those channels?
How can SRHR and HIV advocates
collaborate most effectively to fully realise
the SRHR of women living with HIV?
By looking at the ways in which HIV and
SRHR intersect and addressing them at
their points of intersection.
By providing capacity and training to
HIV providers … to reduce discrimination
and build their confidence, so that they in
turn can build the trust of their clients.
By calling for a WHO-endorsed
comprehensive harm reduction package
of interventions for women who use drugs
that goes beyond provision of condoms, to
provide international guidance on the
needs of women who use drugs in relation
to HIV.
By de-siloing funding … and by
de-siloing our heads. Coming together at
fora like this to learn about the different
experiences and contexts in which people
live, have sex, have children, and do
whatever else they do … and to
learn about the different strategies
that are working.
By switching careers more often!
*Luisa Orza summarised the conversation.
Women living with and affected by HIV
in diverse contexts face multiple barriers
to fulfilling their sexual and reproductive
health and rights. Women’s rights
advocates Jennifer Marshall (Choices,
Memphis Center for Reproductive Health),
Jeni Gatsi Mallet (Namibia Women’s Health
Network), Maria De Bruyn (Ipas), Claudia
Stoicescu (harm Reduction international),
and Luisa Orza (ATHENA) met in the WNZ
on Monday to explore priority gaps,
challenges and strategies to achieve
women’s sexual and reproductive health
and rights through innovative genderbased
community approaches. Dustin
James, Executive Director of the Midsouth
AIDS Fund, moderated the conversation.*
What do you believe will make the most
meaningful impact on the sexual and
reproductive health and rights of women
living with HIV in the next 3 to 5 years?
We need funding agencies to get into
a room and talk to one another, and
work out ways for their grantees to
collaborate, and provide capacity building
and models of good practice to grantees to
achieve that.
We need law reform. Women bear the
brunt of laws that prohibit ownership or
inheritance of land; laws that criminalise
HIV transmission; laws that inhibit access
to comprehensive sexuality education,
and laws that prevent women from
having safe legal abortions. Laws that are
discriminatory against women in any way
need to be changed – and changed laws
implemented.
We need to legalise abortion.
We need to ensure access to integrated
HIV and sexual and reproductive health
services for women who use drugs. In
settings where integration is not possible,
we need strong referral systems between
HIV services, harm reduction services, SRHR
services, abortion services, and genderbased
violence support services, tailored to
the needs of women who use drugs.
We need investment in networks and
organisations of women living with
and affected by HIV, to have safe spaces
in which to share and explore issues,
and to organise to make sure that their
lived realities are shaping policy and
programmes.
We need policy makers to face the
reality that young people are having sex,
and we need access to family planning
and youth-centred clinics to provide
information and services to young
women and adolescents on sexual and
reproductive health.
What do you believe is currently the biggest
challenge to the SRHR of women living
with HIV?
Lack of information on sexual and
reproductive health and rights –
including for women living with HIV – that
reaches both young girls and older women.
Laws and policies that criminalise drug
use and possession. Many women do not
access drug treatment or ARVs, because
they fear that their children will be taken
away from them because of their drug use.
When we are talking about women who
live with HIV, who use drugs, and who also
do sex work, we are talking about so many
layers of stigma that you cannot expect
that just by providing a service women are
going to use it.
Lack of awareness of existing services.
For many, many years women living with
HIV were told that they could not or should
not have children. Overcoming messaging
that has been around for so long – and
building women’s belief that yes, there is
somewhere in their community where you
can receive those services; that yes, we will
provide those services; that yes, we believe
you have a right to a healthy pregnancy if
that’s what you want …
Violence against women, especially
against women living with HIV – and
the structural set-up that makes us believe
that this is basically ok – not only in the
…policies,
services and
relationships
that ensure
women’s
safety are
fundamental
to realising
sexual and
reproductive
health and
rights…