Project Description

In Focus…
Where are we now? What’s holding us back and how do
we move faster?
What’s inside:
Special report:
The law and sex
workers’ health
Women’s voices…
Where are the
spaces?
Women’s
realities…
Visibility is
essential
News from the
‘margins’…
Unpacking risks
Women’s
realities…
Mitigating
violence
Advocate’s
voices…
A challenge that
has to be faced
Opinion…
Gender
concerns…
Speaking during the Plenary on
Monday, Dr. Lydia Mungherera of
Uganda, raised the question ‘where
are we now?’, and recognised the
various roles people living with HIV,
and in particular women living
with HIV, play at the centre of
the response.
She explained that, since
the beginning of the
epidemic, people living with
HIV have played a central role
in ‘breaking the silence’ on
HIV, and confronting stigma
and discrimination at various
levels. They have highlighted
human rights violations and
lead advocacy to ensure that the
voices of people infected and
affected by HIV were meaningfully
involved in the conceptualisation,
implementation and evaluation
of HIV-related programmes;
thus pushing for a rights-based
response and promoting the
dignity of people living with HIV.
People living with HIV have
played a pivotal role in advocacy
at national, regional and
international levels for resources to
HIV responses, with a focus on the
establishment and replenishment
of the Global Fund. They have
been involved in scientific research
by setting the research agenda
and taking part in the research
processes, as well as in the analysis
and distribution of the findings.
The advocacy efforts
of people living with
HIV have resulted in
significant advances in
access to anti-retroviral
treatment for adults
and children. At the
community level,
people living with
HIV have increased
treatment literacy,
resulting in the
retaining of patients
in care and treatment
services. They have also
placed a spotlight on
co-infections of TB and
HIV, and led the path
to the integration of
HIV, SRHR, and TB
services. Further, they
have led the advocacy
for the provision of
sexual and reproductive
health services and protection
of related rights, particularly for
women and girls living with and at
risk of HIV.
Women living with HIV have
played an important role in
prevention of vertical transmission
programmes, amongst others as peer
mentor mothers, increasing uptake to
services aimed at preventing vertical
transmission of HIV by followingup
with the mothers and exposed
babies, as well as engaging fathers
to ensure adherence. They have also
contributed to advocacy efforts to
demand women-centred prevention
services and commodities, such as
female condoms.
Notwithstanding the progress,
Lydia called for an increase in
political leadership to address
challenges related to HIV, urging
African governments to increase
domestic financing for treatment,
demanding that people living
with HIV be at the centre of
developments to set up AIDS
Trust funds.
She called for continued
research for a microbicide, an HIV
vaccine, and a new TB vaccine,
as well as more meaningful
involvement of women in scientific
research. She also called for an
increase in services to prevent
vertical transmission of HIV,
including peer education and
Mujeres Adelante Thursday • 24 July 2014
Daily newsletter on women’s rights and HIV – Melbourne 2014
Felicita Hikuam
2 Thursday • 24 July 2014
support to help retain mothers and
babies in care. Access to sexual and
reproductive health and rights for all
women and girls should be increased,
and people living with HIV should
be involved in addressing the major
drivers of this pandemic, such as gender
inequality and gender-based violence.
Men should be engaged in addressing
gender inequality, because not all men
are unsupportive and violent.
In her presentation entitled ‘What’s
holding us back and how do we move
faster’, during the Plenary on Tuesday,
Jennifer Gatsi-Mallet of the Namibian
Women’s Health Network and ICW,
continued the conversation and spoke in
further detail about gender inequalities
and the HIV response.
She recognised that, more than 30
years into the epidemic, unequal gender
relations contribute significantly to
HIV-related risks and vulnerabilities
for women. Women and girls are at a
disproportionate risk of HIV infection
for various biological and structural
reasons, and bear a disproportionate
role of care.
Gender norms, embedded in the
‘fabric of society’, define what is ‘socially
acceptable’ for women and men, and
influence risk taking and expression of
sexuality, and vulnerability. Due to the
pervasiveness of patriarchy, women and
gender non-confirming men are deprived
of agency and their ability to take
steps to protect themselves, due to
gender inequalities.
Further, intimate partner violence
presents a significant challenge to
women’s vulnerability and ability to
negotiate safer sex. Around the world,
women are seen as ‘perpetrators of
promiscuity’ and, although men are
most often the perpetrators of violence
against women, they are seen as ‘victims
of seduction’ by women, resulting in
insignificant or no sanctions for crimes
against women. Marginalised women,
such as sex workers, transgender
women, migrants and refugees and
other women in vulnerable situations,
are particularly at risk of gender-based
violence. Therefore, men’s engagement in
addressing gender inequalities is crucial.
Although a lot of work still remains to
be done, there has been some progress in
addressing gender inequalities, including
the adoption of a resolution by the
African Commission on Human and
People’s Rights to condemn the forced
sterilisation of women living with HIV.
Jenni also mentioned that several UN and government agencies,
such as UNDP, UNAIDS, Global Fund and US President’s
Emergency Plan for AIDS Relief (PEPFAR), have taken steps to
mainstream gender issues within their HIV-related programming.
Several examples of effective community engagement promoting
women’s empowerment and mainstreaming of gender issues
in HIV-related programming were cited, including those from
India, Thailand, Albania and Namibia. These interventions
have begun to challenge gender norms and gender inequalities
at the community level, and ‘elevated’ women living with HIV to
political and traditional leadership positions. Further, national
HIV programmes have begun to acknowledge the importance of
gender mainstreaming in HIV programming.
In order to turn around the tide of HIV, we need to step up
the pace in addressing gender inequalities, which is complex,
long-term and often hard to measure. Gender inequalities are
multi-dimensional and require multi-dimensional responses at
all social levels, focusing on community engagement to address
gender-biased norms at the family and household levels. It is
crucial that HIV-related programmes recognise local views –
instead of undermining them as ‘outdated and evil’ – as this could
build resistance in the local response. This could also lead to
the strengthening of counter-productive measures, such as the
adoption of outrageous punitive laws against gender
non-conforming people.
HIV programmers should understand and mainstream gender
dimensions in programme planning, implementation and
evaluation. Gender equity should be promoted, and addressing
gender-based violence should be included in the post 2015
development agenda. The enjoyment of legal rights of women,
and non-conforming people, should be ensured and masculinity,
traditional norms and patriarchy should be addressed. Gender
positive religious involvement should be increased along with
funding for community-based gender and HIV work. The
economic empowerment and meaningful involvement of women
living with HIV, and other populations affected by gender
inequalities, are key to effective HIV responses. There needs to be
an end to forced sterilisation of women living with HIV, whilst
simultaneously promoting women’s sexual and reproductive
health and rights. At the same time, the work of communitybased
organisations, who reach communities others may not have
access to, should be supported.
But ultimately, it is everyone’s duty to support community
initiatives to address gender inequalities, so that communities can
strengthen their resilience and ability to meet their own needs.
Felicita is with ARASA.
…resulting in
insignificant or
no sanctions for
crimes against
women…
…we need to
step up the pace
in addressing
gender
inequalities,
which is
complex,
long-term and
often hard to
measure…
…focusing on
community
engagement to
address genderbiased
norms…
Thursday • 24 July 2014 3
Thursday – 24 Jul 2014
08:20-10:30 Plenary: Stepping up the pace: Making the long
term short term
Plenary 2
11:00-12:00 Community Dialogue: Criminalisation and
justice
Women’s Networking Zone, Global Village
11:00-12:30 Structural and gender-based prevention
approaches
Melbourne Room 1 [Oral Abstract Session]
Criminalisation: The barrier to effective responses to
HIV in Africa
Room 109-110 [Community Skills Development Workshop]
13:00:14:00 Young women experts: Shaping the world
Clarendon Auditorium
Freedom to fully control my body: What does sexual and reproductive
health rights mean for young people living with HIV?
Youth Pavilion, Global Village
14:30-16:00 Successful HIV prevention strategies with female
sex workers
Plenary 2 [Oral Abstract Session]
Transforming gender inequalities for Zero new HIV infections,
Zero discrimination and Zero AIDS-related deaths
Clarendon Auditorium [Symposia Session]
Contraception and HIV: Difficult choices?
Melbourne Room 2 [Oral Abstract Session]
14:30-17:30 Let’s talk sexuality: How sacred texts help us
Room 103 [Community Skills Development Workshop]
Gender approaches in monitoring and evaluation: Focus on HIV,
gender-based violence and women’s economic empowerment
Room 104 [Scientific Development Workshop]
16:00-17:00 Exploring attitudes and concerns about
Pre-Exposure Prophylaxis (PrEP) among transgender women,
sex workers and women using illicit drugs
Clarendon Room D&E, Global Village
16:30-18:00 Option B+: Benefits and challenges
Plenary 3 [Oral Abstract Session]
18:30-20:30 Women and ARV-based HIV prevention:
Challenges and opportunities
Room 111-112 [Non-Commercial Satellite]
Integrating cervical cancer and HIV/AIDS service delivery for
sustainable impact at scale: A women-centred approach
Room 111-112 [Non-Commercial Satellite]
Friday – 25 Jul 2014
11:00-12:30 Violence, culture and conflict: Strategies for
safety in a time of AIDS
Room 203-204 [Symposia Session]
15:30-17:00 Plenary: Closing Session Plenary 2
Upcoming
events
News from the ‘margins’…
Unpacking risks…
A session on Wednesday entitled ‘Unpacking risk and HIV in
transgender communities’ discussed the challenges facing
transgender communities in the United States, Argentina and
Indonesia. Participants shared various models and interventions
that have been adopted to create enabling legal and policy
environments for transgender people,
and also improve their living conditions.
The key challenges facing transgender
people are repressive legal and policy
frameworks and high levels of stigma
and discrimination. This affects their
family, health, work, housing and safety.
The presentation by Cecilia Chung
from SERO demonstrated that states,
which criminalise HIV transmission,
create a disabling legal environment
for transgender people. Laws are so
arbitrarily enforced that people do not
know how to protect themselves legally. A study revealed that
a majority of transgender people felt that HIV disclosure was
complicated and depended on the circumstances. They also
felt that it was reasonable to avoid HIV testing, if there was fear
of prosecution.
Inge Aristegui from Argentina highlighted the importance
of legal frameworks that recognise the gender identity
of transgender people in improving their overall living
conditions. The adoption of the Argentinian Gender Identity
Law in 2012 has significantly improved the quality of life of
transgender communities in the country. A study revealed
that since passing the law, they had more access to education,
healthcare and employment opportunities
and could exercise their political rights by
registering to vote in national elections. The
law also contributed to a decrease in police
violence against transgender people.
Vinola Wakijo from Indonesia shared how the Kebaya
project is assisting transgender people living with HIV
to start ARVs in the treatment as prevention era. Safe
accommodation provided as part of the project also
acts as a HIV testing mobile clinic. Volunteers assist
them with food, support with ARV adherence and
side effects, and take them to doctors’ appointments.
Virginia Schubert from Housing Works highlighted
how using housing as a structural intervention has
created a less risky environment for transgender people in America.
The stable accommodation has facilitated safer sex and has helped
them connect to services which translate to better health choices.
4 Thursday • 24 July 2014
Women’s Realities…
Visibility is essential to making change…
Discrimination and violence are global
issues, affecting women living with
HIV in every country and community.
Both are driven by and exacerbated
by silence. Fear of further violence
and discrimination creates a barrier
to women speaking out. Failures by
policymakers, scientists, researchers and
decision-makers alike to recognise the
real prevalence and impact of violence
and discrimination, lead to a lack of
resources, research and evidence, further
invisibilising the experiences of women
living with HIV.
Visibility is essential to making change.
On Wednesday, an international panel
of ICW activists discussed violence and
discrimination in the Dialogue Session
in the WNZ. Chairing, Susan Paxton of
Australia emphasised that ICW research
and advocacy has highlighted abuses,
such as forced and coerced sterilisation
and discriminatory treatment by health
workers, occurring in many different
countries. This was reflected in the
panellist’s presentations.
Jennifer Gatsi, an activist instrumental
in the extraordinary advocacy campaign
against the forced and coerced
sterilisation of women living with HIV in
Namibia, described the work undertaken
to challenge the government in court on
these cases, and ongoing work to prove
in court that HIV-related discrimination
is the driver of forced and coerced
sterilisation.
Further, Jennifer described a growing
climate of violence in Namibia, with
increasing media reports of violence
against women and girls, compounded
by evidence suggesting discrimination
is increasing among the younger
generation, despite evidence of a
decrease in discriminatory attitudes
held by older people. Discrimination by
health workers is also an issue, as women
living with HIV are refused treatment and
denied care.
Attitudes condoning violence are also
a challenge. Jennifer described a public
statement released by the Minister
of Gender on International Women’s
Day, which called on women to reduce
violence by acting as peacemakers, avoid
provoking their husbands
and not be ‘cheeky’. Such
regressive attitudes from
supposed allies are a
huge barrier to
achieving progress.
Overcoming these barriers
and achieving positive
change for women living
with HIV falls on activists
when governments are
failing. This is an especially
difficult role for women
facing violence and
discrimination to take on,
compounded, as argued
by Olimbi Hoxhaj from
Albania, in countries and
communities with low HIV prevalence.
Stigma, blame, failure to provide or
ensure access to services and violence
are all enormous challenges. Despite this,
Olimbi said:
I find the courage and I become a
strong and powerful representative for
people living with HIV in my country.
Women who are discriminated against
on the basis of other aspects of their
lives and identities face magnified and
amplified discrimination. Speaking of
the experiences of women living with
HIV who use drugs in India, Nukshinaro
Ao described how the HIV-related
discrimination they face is increased.
Gender-based discrimination is already
a significant issue for women in India,
within the family, community and
society. When HIV and
drug use are also factors,
women face violence and
discrimination within the
family, denial of services
including treatment and
care, and all forms of
violence, including structural
and institutional violence.
Nukshinaro emphasised
though that many women
in India would not recognise
their experiences as
violence, as only physical
violence is considered as
such, while emotional,
psychological and other
violence are thought of
differently.
We go through that every second of
our lives but we do not think of it as
violence, we think of it as our fate.
Deloris Dockery from the US emphasised
that these issues also affect women in
so-called resource rich settings where
resources are not directed towards
addressing violence and discrimination.
She called for resources to be made
available, especially to support the
collection of data and research to
demonstrate the scale and breadth of
violence and discrimination against
women living with HIV.
Lack of evidence allows the silence
around this issue to continue.
Jacqui is with the Athena Network.
Jacqui Stevenson
…HIV-related
discrimination is
the driver of forced
and coerced
sterilisation…
Thursday • 24 July 2014 5
such as MSM issues, but the
voices of transgender populations,
the voices of women are not yet
strong enough in this space.
It is often the more ‘informal’
sessions and dialogue sessions at
the various Networking Zones of
the Global Village, which give the
much needed ‘prominence and voice’
to the realities and risks of ‘key
populations’ – yet, these dialogues
‘address relevant issues’, which
should form an integral part of the conference discourse.
…some groups have more power in negotiating these
spaces – and I think it is this power that is instrumental to
the invisibility of other groups.
The intersectionalities between race, class, and gender
(and their impact on HIV risks and vulnerabilities, as well
as movement building and mobilisation) are well recognised.
Reflecting on the fragmentation of the transgender
movement, Leigh Ann feels strongly about the need to
…do away with the little boxes of race and class and
gender in our movement. Yes, they are important issues
and we have to highlight them; we need to acknowledge
our unique differences. But we also have to see the
common ground on which we should be standing on as
a movement.
For Leigh Ann, the ‘common ground’ to ‘stand on as a
movement’, is access to sexual and reproductive health and
rights, because
…my health is tied to so many things; my ability to get a job
as a woman, and my ability to actually do a job. My health is
tied to my community contexts, and my self-confidence and
how I present myself in that community.
Looking forward to Durban, ‘we need to see a place
where the community and academics can come together’ and
dialogue, as at AIDS2014 it still feels like the Global Village
is the ‘created space’ where communities can meet and have
activities, and there is the ‘other’ space where the scientists
are, ‘which is very troublesome for me’.
Where are the spaces for real dialogue?
** The article is based on an interview conducted by
Johanna Kehler, AIDS Legal Network, South Africa.
Stepping up the pace and no
one left behind, have
been two main themes for
AIDS 2014 in Melbourne, with
various plenaries and sessions
exploring as to whether or not
(and to what extent) we are
indeed ‘stepping up the pace’
and/or ‘leaving no one behind’.
While these are admirable
aspirations (and we are
making progress in some areas),
Leigh Ann van der Merwe of
S.H.E., a Feminist Collective of
Transgender and Intersex Women
in Africa, was clear about the areas
in which we are not ‘stepping up the
pace’ enough.
…the one thing we are not
seeing enough is a focus on
gender inequalities, as there
is still a lot that needs to
happen. Yes, we stepped up
the pace in some areas, but I
think we now need to escalate
the conversation to a higher
level, and start talking about
issues outside the vacuum.
For instance, women’s issues
are addressed, trans issues are
addressed – but all in a vacuum.
I think what we need is to
connect the dots and making it
a unified conversation.
We have seen a number of
sessions focusing on the realities,
risks and needs of transgender
communities – yet, many of these
sessions were not amplifying the
voices of transgender people,
or happened in the Global
Village, outside the ‘formal’
conference programme. Making
specific reference to a session on
Wednesday (‘unpacking the risks
of transgender communities’) she
recalled that only two of the four
presenters were transgender, which
is of great concern, and nonreflective
of the ‘no one left behind’
commitment. She adds,
…when we talk about leaving
no one behind I would also like
to see the empowerment of the
transgender community for
coming out and speaking on
their own behalf. Some issues
have been given great visibility,
…it is this power
that is instrumental
to the invisibility of
other groups…
Women’s Voices…
Where are the spaces for real dialogue…?
Interview with Leigh Ann van der Merwe
6 Thursday • 24 July 2014
When people talk about
criminalising the clients of
sex workers, they often talk
about it in the context of
anti-trafficking measures,
the so-called Swedish Model
(a.k.a the ‘Nordic Model
of Prostitution’) or to ‘end
demand for prostitution’).
What people often do not
consider is that criminalising
the clients of sex workers has
significant negative impacts
on the health of sex workers.
The impact on HIV prevention
when the clients of sex
workers are criminalised is a
key issue in this debate.
Criminalising clients might,
at first glance, appear like a
noble intention with the stated
aim of ‘protecting sex workers’ or
‘protecting vulnerable women’ who
have been exploited. However, in
reality it is sex workers themselves,
who bear the brunt of policies
and legislation that criminalise the
purchase of sex.
We know that stigma and
discrimination are two of the
main drivers of HIV infection. We
know that criminalising people for
the work they do, for their sexual
behaviour, or for the choices they
make, stigmatises those people as
different and unworthy of society’s
acceptance. Consequently, society
behaves in a way that can and does
often deny the very same people
the right to live openly and freely
within a given society. We have
seen countless times how this
stigma has led to unimaginable
violence being perpetrated against
sex workers, LGBTI people, and
people who use drugs. Numerous
human rights violations are
perpetrated, some from within the
HIV field, against sex workers,
such as the 100% condom use
programme in Cambodia where
the police were tasked with
enforcing condom use by sex
workers, or the rounding up of sex
workers and forced HIV testing, as
happened recently in Tajikistan.
Laws criminalising clients, and
laws against brothels, impede sex
workers’ ability to protect their
health at work. In Sweden, a study
by the Norwegian National Police
Board found that many streetbased
sex workers compensate
for loss of earnings, as a result of
client criminalisation, by not using
condoms. In South Korea, indoor
venues, such as massage parlours,
tend not to keep condoms on the
premises, because they can be
used as evidence of sex work
in prosecutions.
Police harassment compels
many sex workers to frequently
change areas of work to more
hidden locations. This hinders
their ability to connect with health
and social services. In South Korea
and Sweden, health authorities
have expressed concerns about
the negative consequences of the
law on sex workers’ health. In
addition, researchers in South
Korea have found a correlation
between the new ‘Prostitution
Acts’ and an increase in sexually
transmitted infections.
Funding for health projects
that support sex workers’ rights
is seriously compromised by
‘end demand’ approaches, which
call for the criminalisation of
the purchase of sex. The most
successful HIV interventions
…criminalising
the clients of
sex workers
has significant
negative
impacts on the
health of sex
workers…
Special report:
Consequences of the law on sex workers’ health…
Anelda Grové
Thursday • 24 July 2014 7
Candle light vigil at AIDS 2014…
Every year there are an estimated 2.3 million new infection
– that is 6500 each day. Currently, there are an estimated
35 million people living with HIV. More than 50% of these
are women and 10% are children. In our patriarchal world
the feminisation of the epidemic is often forgotten, as
HIV has had a disproportionate burden on women and
children. HIV is still very present today.
While we may be two self-identified women standing in front
of you today, with an ocean between our homes, we have
histories and experiences that are often un-acknowledged,
hidden and marginalised. We would like to go beyond gender
on a quest for transformative change.
We are here to honour the rest of ourselves and our
communities and families – as people who use drugs,
sex workers, transgender people, men who have sex
with men, as well as other who embrace their sexuality
beyond heterosexual norms, migrants, indigenous people,
incarcerated, people with disabilities, and the many others
who circumstances cause them to bare a disproportionate
burden of HIV in their communities.
To be fair, HIV has touched every sector of life. As we know
it does not discriminate. It does not allow for anyone from
any community, from any lifestyle, from any class or race or
geographic location to hide from its global effects. All of us
here tonight have heard the words ‘your test came back positive’
– either your own or a loved one’s. We have all seen the tears,
the headache and the sorrow that HIV leaves as a painful
reminder of just how unfair and unjust it can be.
In total, 36 million people have died because of HIV since 1981.
Millions of people living with HIV still do not have access to
treatment and as we know, there will another 1.8 million that
will die this year.
HIV is unfinished business and we must step up the pace.
Teresia and Jessica are with ICW.
This is the first tool of its kind to
bring sex workers to the forefront
of HIV programming, and we hope
that the tool will replace outdated
HIV programming structures,
ensuring interventions and
programmes are designed with the
full and meaningful involvement of
sex workers themselves.
Anelda is with the Global Network
of Sex Work Projects.
to date have been those that are
peer-led, relying on individual
and collective empowerment to
improve sex workers’ working
and living conditions. However,
these types of projects receive
little or no funding or support
from governments, or from other
agencies that are informed by
models that construe sex work
as violence. In South Korea and
Sweden, only projects which
target women leaving sex work
receive funding. These projects are
inherently discriminatory as access
to educational and vocational
training, health and counselling
services is contingent upon
stopping sex work.
Criminalising the clients of
sex workers makes sex workers,
a ‘key population’ in the response
to the HIV epidemic, more
vulnerable to HIV. It does not
make sense for states around the
world to maintain this type of
legislation when the evidence has
shown that criminalisation of
sex work combined with stigma
and discrimination are significant
drivers of the HIV epidemic.
The Global Commission on
HIV and the Law highlighted
this in its report, which included
extensive consultations with sex
workers in 2011. In response
to this evidence, WHO,
UNFPA, UNAIDS, NSWP
and the World Bank worked
with sex workers to develop
‘Implementing Comprehensive
HIV/STI Programmes with Sex
Workers: Practical approaches
from collaborative interventions’
(the ‘Sex Worker Implementation
Tool’), as a comprehensive guide.
…impede sex
workers’ ability
to protect
their health at
work…
Teresia Otieno and
Jessica Whitbread
8 Thursday • 24 July 2014
Making a point…
Thursday • 24 July 2014 9
highlighted further the potential conflict between gender
equality, religion and culture, and that this can be magnified
where laws promoting all these elements are in place. Legal
change alone is not enough, Sethembiso argued, where the
law is in conflict with existing social or cultural values, which
also need to change. Additionally, laws intended to promote
gender equality or to protect the rights of women can be
counter-productive, where these conflict with other rights –
as evidenced by laws on HIV transmission, claimed to ‘protect’
women but in fact criminalising women living with HIV.
The advancement of human rights and gender equality
requires both a supportive, enabling and non-discriminatory
legal and social environment.
How this is to be achieved is a challenge that has to
be faced…
Jacqui is with the Athena Network.
Punitive laws are a
significant barrier to the
HIV response. The
criminalisation of sexual
orientation and gender
identity; HIV exposure,
transmission and
non-disclosure; sex work;
and drug use, combine to
ensure people most affected
by HIV and related violence
are often the very same
people least able to access
information, services and
support. Legal barriers are a
roadblock far from overcome,
and even growing in some
settings. Amidst the rhetoric
of ‘no one left behind’,
echoing around AIDS 2014,
the reality of many is one
of being left outside, left in
prison, left very much, and
very deliberately, behind.
Addressing these issues
in the context of gender
equality and human rights, the
special session ‘No One Left Behind:
Stepping up the pace on the removal
of laws to advance human rights
and gender equality’ examined
the different vectors across which
punitive laws restrict both
gender equity and an effective
rights-based HIV response.
Michael Kirby, retired Australian
High Court Judge, began by
reiterating the recommendations
of the Global Commission on HIV
and the Law to decriminalise sex
work, drug use and homosexuality.
He further called on the audience
to recognise the equally punitive
impact of intellectual property
laws, and the conflict between
patents and human rights.
The importance of engaging and
building champions amongst
parliamentarians in advocating
for the removal for punitive laws
was outlined in a presentation
by Charles Chauvel of UNDP’s
parliamentary programming.
Educating lawmakers who may
ignore epidemiological information
due to ignorance or ideology was
emphasised as critical to achieving
legal reform.
Subsequent speakers spoke
from their lived experience, of
discrimination by law against gay
men in Nigeria in a presentation
by gay rights advocate Michael
Ighodaro, sex workers and trans
people in India presented by
Abhina Aher, Programme Manager
for Alliance India’s Pehchan
Programme and women living
with HIV in southern Africa,
presented by Sethembiso Promise
Mthembu of ICW Southern Africa.
Each speaker highlighted the
multiple impacts of punitive
laws on the individual’s ability to
access information and services,
as well as social support, where
criminalisation extends to family,
friends, the community and service
provision.
Speaking of experiences in
Southern Africa, Sethembiso
Advocate’s voices…
A challenge that has to be faced…
Jacqui Stevenson
10 Thursday • 24 July 2014
News from the Global Village…
The Global Village is once again
the ‘heart beat’ for community
engagements of the International
AIDS Conference, providing spaces
for activists to share, exchange
and influence. Networking Zones
in particular provide visibility,
organising and a platform for activists
and communities to network,
be heard, be visible, demand and
make change.
For the first time at AIDS 2014, there
is a dedicated Trans Networking
Zone – Trans People Step Forward!
Activists hope this will be a
precedent for future conferences.
Nicola Summers, a transgender
rights activist, explained that the
space is vital as an opportunity for
collective action and visibility:
Here we are, and we want to be
part of this, want to be recognised
as a community in its own right.
The chance to network and share
experiences across borders and
cultural contexts is vital, and the
Zone has been busy with debates
and exchanges since its opening.
Nicola described the value of the
opportunity to meet and inform
especially doctors and scientists, who
have been seeking out the Zone, to
learn more about transgender issues.
Educating and raising awareness
amongst the medical profession is
a core advocacy goal for the Trans
Networking Zone.
Over on the other side of the Global
Village, the Coolibah Networking
Zone is a space to promote young
people’s leadership in sexual and
reproductive health and rights.
Co-convened by IPPF and UNFPA,
the zone is hosting a full programme
of panels and presentations. On
Tuesday morning, a panel of young
people from key populations
affected by HIV, debated the
integration of HIV and SRHR services
for young people. The panel was
convened by Link Up, a five country
project which aims to improve the
sexual and reproductive health
and rights (SRHR) of more than one
million young people living with
and affected by HIV in Bangladesh,
Burundi, Ethiopia, Myanmar
and Uganda.
Link Up is led by the International
HIV/AIDS Alliance, funded by BUZA,
and delivered by a consortium of
national and global partners, including
GYCA and the ATHENA Network. Young
women living with HIV on the panel
described the discrimination and
barriers they face in accessing sexual
and reproductive health information
and services, and called for youth
leadership to develop youth-friendly
integrated services.
Thursday • 24 July 2014 11
Women’s Realities…
Mitigating violence in their lives…
The Women’s
Networking Zone
held a session
on Wednesday
addressing some
of the challenges
faced by women
living with HIV with
a specific focus
on gender-based
violence. Studies
have demonstrated
that women living with HIV are
more likely to have experienced
violence. Similarly, women who have
experienced violence are at higher
risk of HIV exposure and transmission.
Violence against women is, therefore,
both a cause and a consequence
of HIV; and is further increased in
circumstances where women are
vulnerable and lack access to support
and justice.
Rebecca Matheson from ICW shared
how, as a woman living with HIV in
Australia, she has been pre-judged and
discriminated against by healthcare
workers. She was forced to have a
caesarean section when she gave birth
to her child and encouraged to bottle
feed. Baby Rivona highlighted how
Indonesian women are dealing with an
increased number of cases of coerced
sterilisation and gender based violence.
Violence and the threat of violence have
made women fearful of speaking out.
The lack of programmes which deal
with HIV and violence against women in
Asia-Pacific is also a consequence of the
lack of evidence and data, she added.
A pilot project has just been launched
in Indonesia to try and advocate for
women’s rights in the
context of violence
and HIV.
Lydia Mungherera of
Mama’s Club shared how
the organisation has
helped improve the lives
of pregnant adolescents
living with HIV in Uganda
by offering family and peer
support groups. These
young girls run away from
home, because they are
rejected by their families.
They then find men who
take advantage of their
vulnerability and low self-esteem by
using them as sex slaves. The girls also
fear approaching health services, as
they are judged by healthcare workers.
Termination of pregnancy in Uganda is
illegal, so young women and girls opt for
unsafe abortions. Those that choose to
keep their children usually give birth in
circumstances where they do not have
access to treatment that reduces the risks
of mother-to-child transmission. Cultural
practices, such as widow inheritance,
early marriage, marital rape and female
genital mutilation, contribute to
unsafe environments.
A woman living with HIV and disability
from the audience expressed how
women with disabilities have been lost
in the women’s movement; and are left
with little to no access to support. Their
challenges are compounded by the fact
that they do not receive sexual education
and are further stigmatised by health
workers when living with HIV. She also
emphasised that women with disabilities
are also vulnerable to rape and other
forms of sexual assault, as they are often
‘targeted’ for sexual assault and rape.
The realities shared at this session
demonstrate only a fraction of the
multiple realities and risks
faced by women with
regards to HIV, discrimination
and violence.
Revealing avenues of moving
forward (and a hopeful future),
discussions highlighted that
women’s access to justice and
support groups had the effect
of mitigating violence in their
lives. This goes back to the
notion that women need to
come together and express
their needs, as this will result
in actions that are best suited
to meet their needs.
Concluding the session, Rebecca urged
that women need to step up and
mobilise at a local level. High levels
of stigma and discrimination among
healthcare workers also highlight the
need to train healthcare providers
on issues of women’s rights and HIV;
especially as stigma and discrimination
have been proven to act as barriers to
accessing care, treatment, and support.
Dialogues with policy makers and
parliamentarians, which include women,
will also ensure that policy and legal
frameworks promote and protect the
rights of women.
Nelago is with ARASA.
Nelago Amadhila
…HIV-related
discrimination is
the driver of forced
and coerced
sterilisation…
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: Minuteman Press Melbourne minuteman@spencerprint.com.au
12 Thursday • 24 July 2014
Opinion…
Addressing gender concerns…
Jacqui Stevenson
resilience financially. Male participants
reported more equitable gender
attitudes, while female participants
report less experience of intimate
partner violence.
Additional abstracts covered bullying,
social marginalisation and HIV
vulnerability among Thai lesbian and
bisexual women high school students.
Presented by Thasaporn Damri, Mahidol
University and Center for Health Policy
Studies Nakorn Paton, the study found
young lesbian and bisexual women
face multiple forms of discriminatory
attitudes and treatment within the
school environment. Finally, Ameeta
Kalokhe, Emory University School of
Medicine and Emory University Rollins
School of Public Health, presented research on the scale of
domestic violence against married women in India, and the
impact this has on both increasing HIV vulnerabilities and
reducing access to and uptake of HIV prevention.
The breadth of forms and contexts of violence presented in
the session is a strong indicator of the extent of the violence
epidemic faced by women in the context of HIV.
Jacqui is with the Athena Network.
This session, held on Wednesday
afternoon, featured oral abstracts
of research exploring different
aspects of gender-based violence
and HIV. The various links between
gender-based violence and HIV are
significant, multi-faceted, growing
and yet, under-recognised. The
session was therefore a welcome
feature of the conference agenda.
The first abstract was presented by
Graeme Hoddinott, of the University
of Stellenbosch in South Africa, and
entitled ‘When your life is threatened,
HIV is a peripheral concern: Qualitative
perceptions of HIV risk and
crime/violence in 9 HPTN 071 (PopART)
community sites in South Africa’.
The research explored the relative
perceptions and prioritising of risks
of HIV transmission in communities
affected by high levels of violence.
The study found that violence both
increases the risk of HIV exposure
and transmission, and creates a
structural barrier to the uptake of HIV
prevention, as avoiding violence is
prioritised more highly.
The second presentation, by Tamil
Kendall, Harvard School of Public
Health and Balance, covered the
findings of a four-country study
into the forced and coerced
sterilisation of women living with
HIV in Mesoamerica. In a
community-based survey of 285
women living with HIV, the study
found 23% of women responding
had experienced forced and coerced
sterilisation. This included women
given false information about the
prevention of vertical transmission
or the potential risks in terms of
health outcomes. Others were
denied choice, and told that as a
woman living with HIV it was not
possible to refuse. Coercion was
also experienced through the denial
or threatened denial of services
including caesereans.
Forced sterilisation was also
reported, including women who
believed the consent form they were
signing related to other treatment
or procedures. In one example, a
woman in Mexico was sterilised
while under anaesthetic for another
procedure, and her thumb was
inked to provide a thumbprint to
show ‘consent’.
The study authors conclude that
there is evidence that HIV-related
discrimination motivates healthcare
workers to commit these violations,
and consequently recommend that
providers are educated about HIV
and reproductive rights. Further,
that informed consent should
require comprehensive education
and information on SRHR and
vertical transmission. Finally, they
recommend state mechanisms to
investigate and sanction coercive
and forced sterilisation.
Andy Gibbs from the University of
KwaZulu Natal HEARD programme
in South Africa presented a
livelihoods strengthening
intervention with young people
in informal settlements. Utilising
the Stepping Stones manual
developed by Alice Welbourn, and
Creating Futures, a livelihoods
programme developed for the
study, the intervention comprised
both gender and livelihoods
elements. The study outcomes
demonstrate higher monthly
incomes and greater shock
…there is
evidence that
HIV-related
discrimination
motivates
healthcare
workers to
commit these
violations…
www.aln.org.za www.arasa.info www.athenanetwork.org
Supported by Oxfam