Project Description

What’s inside:
The Women’s
Protocol…
A useful tool?
In Women’s Words:
Where the hell…
are the young
women?
Women’s Realities:
The means
to protect
ourselves…
Women’s Voices:
Listened to and
acted upon?…
Special Report:
Women’s rights in
the African AIDS
response?
In my opinion:
HIV prevention
methods and
‘barriers’ for
women…
In Focus…
Creating new pathways of change…
Since the spring of 2011 in
the lead up to the High Level
Meeting on HIV (HLM); there has
been a renewed spirit of tenacity,
advocacy and determination to
ensure that all women have universal
access to HIV prevention, treatment
and care; sexual and reproductive
health and rights, and moreover
a robust call for all women to
have ownership, voice and choice
in the decisions that impact our
lives. Leading up to the HLM, the
Global Coalition of Women and
AIDS (GCWA) and the ATHENA
Network cast a broad net across the
globe through a virtual consultation
on universal access. This virtual
consultation was the only avenue that
captured the voices of young women,
sex workers, women living through
chemical dependency, women living
with HIV, migrant women – women
from across the spectrum – bringing
together voices of nearly 1000 women
to ensure that the concerns and needs
of all women were incorporated in the
2011 UNGASS Political Declaration.
In Women’s Words
What started as a process to
inform the Declaration has now
become a global campaign,
In Women’s Words, being utilised by
women in every corner of the world,
from grassroots advocacy to global
policy platforms, ensuring that the
priorities deemed by women are
integrated in policy and planning in
National AIDS Strategies (NAS);
monitoring and evaluation processes,
funding allocations, and across
multi-stakeholder collaborations.
Change does not happen by
accident, it happens by collective
action. In different languages, women
across the globe came together
for the common good of women
and girls. We spoke collectively…
passionately… and deliberately.
Mujeres Adelante 04 – 08 December 2011
Newsletter on women’s rights and HIV • ICASA 2011• Addis Ababa
Ebony Johnson
Sam Cooke may have said it best, ‘It’s been a long time coming, but I know;
Change Gonna Come. Oh yes it will’.
2 ICASA 2011 Addis Ababa • 04 – 08 December 2011 Together, we spoke in one voice. Our
voices echoed 5 key priority areas:
• Services that address the
visions, life-long needs, and
rights of women and girls in all
our diversity
• Eliminate stigma and
discrimination, and ensure
full protection of the human
rights of all women and girls,
including our sexual and
reproductive rights
• Strengthen, invest in, and
champion our leadership and
equality to ensure the full and
meaningful participation of
women and girls, in particular
those of us living with and
affected by HIV, in the
HIV response
• Empower us to be catalysts
of social justice and positive
change, and eliminate all forms
of violence against us
• Ensure full access to
information and education,
including comprehensive
sexuality education for all
women and girls
Responding to these calls from
In Women’s Words to ‘invest in and
champion leadership’, to ‘ensure
full protection of the human rights
of all women and girls’, and to
‘empower us to be catalysts of
social justice’; the GCWA launched
the Young Women’s Leadership
Initiative at the IAS Pathogenesis
Conference in Rome in July
2011. This empowering initiative
brought together a diverse cadre of
amazing young women leaders to
develop a vast knowledge base on
HIV research, sexual and
reproductive health and rights,
gender equity, human rights and
effective advocacy. This bold group
of visionaries has been taking
young women’s health and HIV
out of isolation and demystifying
the notion that young people are
voiceless, sexless and needless. We
demonstrated that young women
have vivid voice and vision, need
tailored SRHR services, and are
ripe to speak up and speak out!
With this, we as young women
changed the discourse in Rome
demanding, ‘Where the Hell is the
Gel?’, leading off to a press conference
highlighting the importance of
female-initiated prevention tools, like
microbicides, PrEP and treatment as
prevention. Our compelling voices
of change, impassioned by lived
realities of the inadequacy of the
current prevention tools for women,
called HIV researchers to stop and
take heed.
In Women’s Words: Africa
The GCWA will be continuing this
legacy of leadership at ICASA in
December 2011. Through the Young
Women’s Leadership Initiative, the
GCWA, in collaboration with the
ATHENA Network and the Network
of Positive Women Ethiopia, will
bring 10 young women from across
Africa to expand their skills, broaden
their advocacy networks, and to make
compelling conference presentations.
The young women leader will lead as
panellists in the Community Village,
as Critical Dialogue moderators in
the Women’s Networking Zone, as
featured plenary speakers in the
main conference, and through a
number of Athena satellite sessions.
The young women will be key in
the development of ‘Africa: In
Women’s Words’; giving voice to the
particular challenges and calls to
action for young women and HIV
across Africa.
With the torrential volume of new
HIV infections for young women in
Africa; this is the moment to build
new messages, push for new policy
and programming, and make way
for a new generation of unapologetic
women’s leadership. As I, alongside
the young women, tackle the battles
of today, we create fertile ground to
win the victories of tomorrow, as we
head towards the 2012 International
AIDS Conference (IAC) in
Washington, D.C.
Make Women Count!
As we move toward IAC 2012;
ATHENA, Positive Women’s
Network (North America) and ICW
Global have united along with nearly
100 women-centred networks and
organisations, carrying the torch to
give voice and vision to the priorities
of women in their full diversity
through ‘Make Women Count’.
The campaign, brings together
…change does
not happen
by accident,
it happens
by collective
action…
…we spoke
collectively…
passionately…
and
deliberately…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 3
representatives of women and HIV
communities, including women
living with HIV who account for
over half of all people living with
HIV globally, to urge the leadership
of the 2012 IAC to ensure that there
is a central platform throughout the
conference that comprehensively
addresses and engages women, girls,
and gender equality through the
formal conference programme, and
all related initiatives, including the
Global Village.
Since its inception in Spring
2011, the Make Women Count
Campaign has been an effective
and strategic advocacy tool to
highlight the imperative nature of
research, interventions, expertise
and community response lead by
and specific to women in the overall
success and utility of the IAC 2012.
As, IAC 2012 promises to be a
historical moment for people living
with HIV, while commemorating the
repeal of punitive laws in the U.S.
that in previous decades denied entry
to people living with HIV into the
United States, Make Women Count
strives to make IAC 2012 a historical
moment for women globally, as
we push for greater representation,
visibility and priority of the alarming
rates of HIV infections among
women, fuelling social drivers,
and ways forward to keep women
healthy. Through the Make Women
Count Campaign, we have begun
to see major success, as we secured
key wins for women, including 50%
dedicated scholarships for women,
close to 40% of plenary presentations
by women, and a focus on ‘Turning
the Tide for Women’ on day three of
the conference.
Towards IAC 2012
As we continue to move closer
toward IAC 2012; we continue
robust advocacy for the inclusion
of gender parity; scientific data and
analyses relevant to and specific to
women, community-led sessions
throughout Track D (Social Science,
Human Rights and Political Science);
equitable presence of presentations
specific to women across all
Scientific tracks; and dedicated
space in the Global Village for the
continued presence of the Women’s
Networking Zone (WNZ).
As the Buddhist says, ‘we can
turn poison into medicine!’. Through
addressing HIV, we, as women, are
lifting up a lifetime of cultural, social
and political practices and thoughts
that reinforced gender inequity,
disparity, vulnerability and human
rights infringement for women; and
creating new pathways of change that
span far beyond HIV and delve into
the core of living well as women. As
we reflect on the past year, it has not
been through one action or a single
voice; it has been through a united
voice, collaborative advocacy and
investment, and through a shared
will and belief that ‘It Gets Better!’.
Incrementally from the virtual
consultation to beyond IAC 2012,
we swing the pendulum a little bit
further and we move us leaps and
bounds closer to a better way and a
better world for women.
Ebony is with the ATHENA
Network. For more information:
athenainitiative@gmail.com.
…demystifying
the notion that
young people
are voiceless,
sexless and
needless…
…make way
for a new
generation of
unapologetic
women’s
leadership…
Women’s Voices:
We need women who are living with HIV to be the
drivers of the services, because they are the people
who are facing the situation and they can be able to identify
with people in the same situation…
[South Africa]
There is also the weight of traditions, religions,
husbands, and socio-cultural burdens that
affect women… [Cameroon]
Ithink there can be a serious change, if we
change mindsets… [Swaziland]
4 ICASA 2011 Addis Ababa • 04 – 08 December 2011 Women’s Realities…
We have to have the means to protect ourselves…
HIV Prevention for Women
AIDS Legal Network
HIV prevention interventions focussing on women’s needs,
such as female condom promotion and distribution.2
The Study
The AIDS Legal Network (ALN) engaged in a study intended to
document and analyse women’s HIV prevention realities and
needs in light of the renewed focus on, and commitment to,
HIV prevention efforts, including women’s realities and needs in
the context of the introduction and roll-out of new HIV prevention
technologies, such as medical male circumcision – so as to enhance
women’s access to, participation in, and benefit from available
and newly emerging HIV prevention
strategies and methods.3
The study was conducted
between April and July 2011 in
three areas of KwaZulu Natal,
namely KwaMakhuta, Umlazi and
Mandeni. While KwaMakhuta and
Umlazi can be described as urban
and semi-urban areas south of
Durban (approximately 30km from
Durban), Mandeni is a rural area,
approximately 100 kilometres west
of Durban.
A total of 559 questionnaires
were administered to women (192 in
KwaMakhuta, 177 in Mandeni, and
190 in Umlazi), and 3 focus group
discussions were facilitated in the
respective communities.
The study design was based on the
principled understanding that since
The need to scale-up
HIV prevention efforts,
and to focus specifically on
women and HIV prevention,
has been widely
recognised, and has also
been the centre of debate
and renewed commitment
for quite some time.
HIV prevention for women
Given the commitment to place
HIV prevention at the core of
all interventions and to address
women’s realities, national responses
to HIV and AIDS should arguably
have been marked with a rapid
increase in women-centred and
women-controlled HIV prevention
strategies; should have seen a drastic
increase in resource allocations for
HIV prevention options for women;
and thus could potentially have led
to a decrease in women’s risks
and vulnerabilities.
In reality, however, women’s
greater risks and vulnerabilities to
HIV transmission prevail, as
prevention strategies focusing
specifically on the realities, risks
and needs of women remain rather
scarce, and prevention options
available continue to be
…neither centred around women’s
realities, rights and needs, nor
are women placed in the position
to have control over decisions
regarding their own HIV risks1.
In addition to ongoing debates
focusing on women’s realities,
rights and needs in the context of
HIV prevention, recently emerging
issues of discourse also focus on
potential negative impacts
on women, and women’s
HIV prevention realities and risks,
associated with the introduction
of medical male circumcision
(MMC) for HIV prevention. A
potential decrease in the extent to
which women are in the position
to negotiate condom use, due to
beliefs that MMC affords full
protection from the risk of
HIV transmission; further
stigmatisation of positive women;
as well as an increase in gender
violence and abuse are but some
of the examples of the emerging
discourse. Concerns have also been
raised that the introduction and
roll-out of MMC for HIV prevention
diverts funds from existing
…women
are, however,
concerned about
their lesser power
to negotiate and to
have control over
their own HIV risks
and prevention
needs…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 5
partners about their fears of being infected with HIV and
their individual prevention needs, only about a quarter of
women participating were in a position to do so. Reasons most
frequently mentioned for not talking to their partners included
fear of partner’s reaction and ‘fear of being rejected’, the fact that
‘such things are not open for discussion with my partner’ and
‘have never been part of our conversation’, and that ‘it’s against
our culture’.
…it’s not easy to talk to a man about this, because they get
aggressive, make accusations that you are seeing somebody
else…so rather be quiet…I don’t even know how I would
approach him… [Woman, 40s]
Awareness of new HIV prevention methods
Levels of knowledge and awareness in relation to
HIV prevention methods and technologies were extremely low
amongst the study participants, greatly impacting on the extent
to which especially women are in the position to make informed
decisions and to take control of their own HIV prevention
needs. Recognising the key role of access to information in
effective HIV prevention strategies, it is of grave concern that
the vast majority of women in the sample (95%) indicated that
they did not receive any HIV prevention information in the last
six months. Moreover, only 7% of women participating in the
study knew about PEP, as compared to 30% of women who
heard about MMC for HIV prevention.
Women are much more aware
about newer HIV prevention
options, than existing prevention
methods. However, this does
not necessarily translate into
being knowledgeable about the
impact and limitations of newly
introduced methods. The relatively
high number of respondents
who believe that men who
have undergone medical male
circumcision are safe from
HIV transmission is a clear
indication of misconceptions
newly emerging HIV prevention
technologies do not exist in isolation
from available HIV prevention
realities, challenges, needs and
options, women’s HIV prevention
realities and needs have to be
documented and assessed in
its entirety, encompassing both
available and newly emerging
HIV prevention strategies and
methods.
Main Findings
Perceptions of HIV risks and
needs for prevention
…we have to have the means to
protect ourselves…
[Woman, 40s]
The study clearly highlights
women’s levels of awareness and
understanding about the need
for women-centred and womencontrolled
HIV prevention options.
Women are, however, concerned
about their lesser power to negotiate
and to have control over their own
HIV risks and prevention needs,
which is partly due to the lack of
access to and availability of
HIV prevention options for women.
More than half of the women
participating in the study perceived
themselves to be at risk of HIV,
most qualifying their responses
with reference to ‘inconsistent
condom use’, ‘unsure about partner’s
faithfulness’, and the ‘risk of
being raped’.
The impact of high levels of
sexual violence in communities on
women’s perceptions of HIV risks
was most evident in the Mandeni
sample, with more than a third of
respondents linking their individual
risk of HIV transmission with the
‘risk of being raped’.
The need for HIV prevention
options for women to be available
and accessible was stressed by
participants throughout the study, as
women need ‘to be protected and be
able to protect themselves’, be ‘in
control of their lives’, and ‘be safe’.
…if we can’t talk about HIV…
rather we protect ourselves
because the men then blame us
for this… [Woman, 50s]
Women perceive access to
female-controlled prevention options
as key to their own protection and
raised concerns about current
HIV prevention strategies and the
continuing lack of female condom
availability and access, as well as
the failure to adequately respond to
women’s realities.
…the only thing that’s missing
are the female condoms,
but treatment is available…
[Woman, 40s]
…we need posters that talk
about the reality of women, not
what women should be behaving
like… [Woman, 30s]
Although recognising the
importance of talking with their
…more than half
of the women
participating in the
study perceived
themselves to be
at risk of HIV…
submit to our partners, so that’s why men will always feel
superior… [Woman, 20s]
Women feel strongly that gender violence increases
the risks of HIV, as ‘women are raped’ and ‘violence and
abuse has become a norm’. Lack of control and power over
decisions affecting women’s lives, including women’s
HIV prevention choices, are further exacerbated by
women ‘living their lives in fear and in abuse’, and being
‘forced to agree on things they don’t like’, because ‘if
you are beaten up all the time you can’t make your
own decisions’.
Recommendations
Women’s responses highlight the perceived lack of adequate
and effective responses to women’s HIV prevention realities
and needs, as women perceive access to female-controlled
prevention options as key to their own protection.
What do women recommend?
Women participating in the study clearly expressed their
understanding of how to further prevention efforts and better respond
to women’s HIV prevention realities and needs.
• Education and information on HIV prevention
…people need more information and there needs to be
programmes that address the real challenges
in communities… [Woman, 30s]
and inadequate information
disseminated about the
introduction of medical male
circumcision for HIV prevention.
…if they remove the foreskin
men should be protected from
HIV, even if they don’t use
condoms… [Woman, 50s]
Notwithstanding women’s
perception that men may feel
protected from HIV after being
circumcised, women also have
concerns about the potential
negative impact of MMC on women
and women’s risks, as men will be
even less inclined to use condoms.
…already men are having sex
without a condom, because they
say they can’t get HIV…things
were bad enough without this
MMC and now it’s worse…
[Woman, 30s]
While women do perceive medical
male circumcision to be part of
HIV prevention efforts, women
question the continued lack of
access to HIV prevention options for
women, at a time where resources
and attention seem to be given to
medical male circumcision as an
HIV prevention option for men. The
data also seems to suggest a need
to focus as much on existing and
proven HIV prevention technologies
as on new prevention technologies,
such as MMC – so as to ensure that
women’s HIV prevention options are
indeed increasing, as
compared to new
HIV prevention
technologies replacing
both in emphasis and
budget existing and
proven technologies,
such as female condoms
and post-exposure
prophylaxis.
Awareness of
underlying factors
…it reduces the capacity for
women to make their own
decisions… [Woman, 20s]
The study shows that women have
far greater levels of awareness and
understanding of the links
between gender violence and
HIV risks, than the correlations
between gender inequality and
women’s risks of HIV. The data also
suggests a strong influence of
socio-cultural values and norms used
to ‘justify’ inequalities and violence
against women.
Affirming that gender inequalities
impact on women’s risks to HIV,
women’s explanations mostly
referred to an environment in
which ‘men are controlling
women’ and ‘women are then
treated as minors’, as well as the
fact that ‘culture plays a
role in this because it
teaches us to treat each
other differently’.
…we have been taught to
6 ICASA 2011 Addis Ababa • 04 – 08 December 2011
Policy and programme design and implementation
• Guarantee women’s central participation in policy and
programme design and implementation, including new
HIV prevention strategies, such as medical male
circumcision for HIV prevention
• Ensure that women and women’s needs are prioritised in
HIV prevention strategies in a sustained way
Women-centred and -controlled HIV prevention options
• Ensure adequate and sustained access to and availability
of HIV prevention options for women, particularly
female condoms
• Re-intensify and sustain information and education on
available HIV prevention options, such as PEP
New HIV prevention technologies
• Assess and evaluate the impact of new HIV prevention
technologies, such as medical male circumcision for
HIV prevention, on women, so as to ensure that women are
not adversely impacted by the introduction of new
prevention technologies
• Ensure women’s involvement and participation in the design
and implementation of strategies promoting new
prevention technologies
FOOTNOTES:
1. Kehler, J. & Radebe, B. 2010. ‘Moving beyond the commitments and
rhetoric: HIV prevention interventions for women’. In: ALQ/Mujeres
Adelante, March 2010 Edition, p24.
2. The Clearinghouse on Male Circumcision for HIV Prevention. 2011.
Male circumcision and women.
[www.malecircumcision.org/advocacy/male_circumcision_
advocacy_women.html]
3. Kehler, J. & Massawe, D. 2011. We have to have the means to protect
ourselves: HIV Prevention for Women. Cape Town, AIDS Legal
Network. [www.aln.org.za]
The report is available at www.aln.org.za.
For more information : alncpt@mweb.co.za
• HIV Prevention options for
women
…women should have their own
prevention tool, so that they can
be able to protect themselves
instead of depending on men for
their protection… [Woman, 40s]
• Greater involvement of women
…government should not
assume what we want…in
fact, we should be asked and
participate to avoid going
back and forth where women’s
prevention is concerned…
[Woman, 30s]
• Greater focus on women
…we need new strategies and
the focus to be on women…
[Woman, 20s]
• Better communication between
partners
…women need to talk to
their partners about their
fears of getting infected and
to condomise all the time…
[Woman, 20s]
Advocacy responses
To ensure that a) HIV prevention
efforts are adequately responding to
women’s realities and needs;
b) HIV prevention for women is
prioritised in programme design
and implementation; and c) new
HIV prevention technologies, such
as medical male circumcision,
have no adverse effect on women
and women’s risks, it is essential to
advocate for and create sustained
change in the following areas:
Societal and community
• Address gender and power
imbalances so as to ensure
that women are in the position
to freely access and benefit
from available HIV prevention
methods
• Enhance levels of awareness
and understanding of women’s
HIV prevention realities and
needs, as well as women’s
rights in the context of
HIV prevention
ICASA 2011 Addis Ababa • 04 – 08 December 2011 7
8 ICASA 2011 Addis Ababa • 04 – 08 December 2011 The HIV epidemic remains a major global public
health and human rights challenge, being
the leading cause of death among women of
reproductive age (15-49 years)1.
State of the epidemic Of the total estimated 33.4 million people living with
HIV worldwide, women account for over half (15.9
million) of adults living with HIV. The vulnerability
of women and girls to HIV remains particularly high in sub-
Saharan Africa; 80% of all women in the world living with HIV
live in this region.2 In addition, in the majority of countries the
epidemic shows the most growth among young women between
the ages of 15 and 24; in sub-Saharan Africa young women of
this age group are up to 8 times more likely to acquire HIV than
their male peers. In Asia overall, women account for a growing
proportion of HIV infections: from 21% in 1990 to 35% in 2009;
however among young people aged 15-24, this percentage rises
to 45% in East Asia and the Pacific, 47% in South Asia, and up
to 64% in Central and Eastern Europe and the Commonwealth
of Independent States.3
In every region of the world, incidence rates of infection among
young women are increasing. Gender inequality, including
violence, continues to be both a cause and a consequence of
HIV. At least one in three women will be beaten, coerced into
sex or abused in her lifetime. Women subjected to violence are
at higher risk of acquiring HIV, and women who are living with
HIV are more likely to experience violence.4 Further, women,
especially young women living with HIV, continue to experience
violence and human rights violations that relate to their sexual
and reproductive health within health services, including
breaches of privacy or confidentiality by health workers; stigma
and discrimination, as well as judgmental attitudes regarding the
rights of women living with HIV to start sexual relationships,
get married, or have children; lack of information about and
access to sexual and reproductive health and rights services;
and mandatory or coerced HIV testing, and coerced or forced
abortion and sterilisation.
While young women living with and affected by HIV are
affected by many of the same issues as older women or men, they
also face particular, nuanced, or exacerbated issues, including:
• Exclusion from fora where decisions that affect their
lives are made, including at the level of the family,
community, health institutions, and in local, national and
international policy.
• Sexual and reproductive health violations, including
lack of access to information and services; negative or
judgmental attitudes of healthcare staff, compromising
the ability of young women living with HIV in particular
to realise their sexual and reproductive health and rights,
even to the point of coercion or force around sexual and
reproductive decision making; stigma and discrimination
at the family, community and health service level; fear of
disclosure, breaches of confidentiality and violence; and
the criminalisation of sexual transmission or exposure,
and/or vertical transmission.
• Violence against young women and other human rights
violations, including rape and sexual violence, forced/coerced
sex and marital rape, early marriage, female genital
cutting, and lack of property and inheritance rights.
Violence against young women is also a consequence of
HIV transmission, creating a barrier to treatment and care
In Women’s Words:
‘Where the hell….are the young women?’
Luisa Orza and Ebony Johnson
ICASA 2011 Addis Ababa • 04 – 08 December 2011 9
services, vertical transmission, and secondary prevention,
and increasing the vulnerability of young women living
with HIV to abandonment, destitution and ‘survival sex’.
• Lack of economic empowerment opportunities.
• Pervasive cultural and social norms that reinforce
abstinence and associate guilt and/or penalty with
sexual debut outside marriage, which serves to reinforce
internal stigma and isolate sexually active young women
from needed sexual and reproductive health rights, care,
treatment and open
inclusive processes
with their medical
providers.
Furthermore, the HIV
epidemic is entering a new
phase whereby young people
who have acquired HIV
perinatal are now entering adolescence and young adulthood5.
Young women who have grown up with HIV again face a
nuanced and particular set of challenges, as they transition
from paediatric to adult services and navigate not only the
uncharted waters of early sexual encounters, changing bodies,
and increasing independence, but also have to deal with issues
around disclosure, treatment adherence and often conflicting
messages from policy- and programme makers, service
providers and family members
regarding their sexuality. This group
of young people constitute a ‘hidden’
– and silent – epidemic, and are in
need of supportive environments,
including psycho-social support and
tailored information on their sexual
and reproductive health and rights
and living healthy with HIV.
Political Declaration 2011
The Political Declaration of 20116, which came out of the
High Level Meeting on HIV and AIDS in June 2011, recognises
with concern ‘that globally women and girls are still the
most affected by the epidemic’ (para 21), and ‘that young
people aged 15 to 24 account for more than one third of all
new HIV infections, with some 3000 young people becoming
infected with HIV each day’ (para 25). The Declaration further
acknowledges that underpinning the vulnerabilities both among
women and young people are ‘insufficient access to … sexual
and reproductive health’ (para 21), as well as ‘limited access
to sexual and reproductive health programmes that provide
the information, skills, services and commodities they need to
protect themselves’ (para 25).
The Declaration also recognises that ‘close co-operation
with people living with HIV and populations at higher risk of
HIV infection will facilitate the achievement of a more
effective HIV and AIDS response’ (para 40), and makes a
strong commitment to ‘encouraging and supporting the active
involvement and leadership of young people, including those
living with HIV, in the fight against the epidemic at local,
national and global levels’ (para 56).
Further, the Declaration pledges to ensure that young people
are spear-heading HIV prevention efforts, by
• harnessing the energy of young people in helping to lead
global HIV awareness (para 59b) and,
• ensuring that all people, particularly young people,
…I want for us, the developing communities, to have a say and a choice in what Africa
wants and I want to change how Africa is defined by the international community…
I want to see a change in people’s attitudes towards vulnerability…I don’t want people to
be categorised into vulnerable groups, I want all of us to be seen as one people…
[Young Woman, July 2011]
…face particular,
nuanced, or
exacerbated
issues…
10 ICASA 2011 Addis Ababa • 04 – 08 December 2011 have the means to exploit the potential of new modes of
connection and communication (para 59e).
These commitments underpin the need to ensure that young
people – and young women in particular – living with and
affected by HIV, are meaningfully engaged at all levels of the
HIV response; that safe spaces are available for young women
in all their diversity to meet, share and learn from one another
towards developing and agreeing on advocacy priorities and
action agendas; and, that their leadership is supported and
an enabling environment is created in which young women in
all their diversity can safely give voice to these priorities and
be heard.
Bold New Commitments
In addition to the recognitions and pledges made above,
the Political Declaration of 2011, also articulated three bold
new numerical targets in relation to redoubling efforts around
HIV prevention, with the aims of Reducing sexual transmission
of HIV by 50 per cent by 2015 (para 62); Reducing transmission
of HIV among people who inject drugs by 50 per cent by 2015
(para 63); and Eliminating mother-to-child transmission
of HIV by 2015 and substantially reducing AIDS-related
maternal deaths (para 64). In addition, and in relation to these
targets, the Declaration re-iterates the commitment made in the
2006 Declaration to bring an end to gender inequality.
In order to meet these targets and realise these ambitions, the
meaningful involvement of young women and men is a pressing
imperative. As seen above, young women account for up to 75%
of new HIV infections in some areas of sub-Saharan Africa,
and in concentrated epidemics, while drug use remains higher
among men than women overall, there is evidence to show that
among women who inject drugs,
the proportion of women affected
by drug-related harms – including
acquisition of HIV – can be vastly
greater than among their male
counterparts, with some countries
reporting the incidence of HIV
amongst female drug users to be as
high as 85%.7
Finally, while support and
involvement from men as partners
and fathers in vertical prevention
programmes is desirable, these programmes clearly ‘target’
women. For this target to be achieved, women living with
HIV – and young women
in particular – need to feel
fully supported in their
decision to have children.
Currently, many young
women living with HIV are
treated judgmentally when
they decide to have children,
on the grounds of both their
youth, and their HIV status.
For others, fear of disclosure
may act as a barrier to
service use; which needs to
be urgently addressed. Yet
…young women
in all their diversity
can safely give
voice to these
priorities and
be heard…
Pledge to eliminate gender inequalities, gender-based abuse and violence; increase the
capacity of women and adolescent girls to protect themselves from the risk of
HIV infection, principally through the provision of health care and services, including,
inter alia, sexual and reproductive health, and the provision of full access to
comprehensive information and education; ensure that women can exercise their right to
have control over, and decide freely and responsibly on, matters related to their sexuality
in order to increase their ability to protect themselves from HIV infection, including their
sexual and reproductive health, free of coercion, discrimination and violence; and take all
necessary measures to create an enabling environment for the empowerment of women
and strengthen their economic independence.
[Political Declaration 2011, para 53]
ICASA 2011 Addis Ababa • 04 – 08 December 2011 11
others lack the information, access to services, and economic
and social empowerment to make informed or voluntary
reproductive choices, and need to be supported to do so, in order
for this target to be met.
For young women living with or affected by HIV – especially
for those with additional long term health issues or disabilities;
in hard-to-reach or rural areas; in poverty; in asylum or
displacement; for those affected by migration, imprisonment
or detainment, or homelessness; for those expressing diverse
sexual orientation or gender identities, or engage in transactional
sex or sex work – the enjoyment of the basic rights, needs and
aspirations necessary to meet these goals may seem an elusive
dream. It is, therefore, the more imperative that young women
living in contexts of vulnerability are drawn into the centre of
these discussions, and that their meaningful participation is
promoted and supported at every level.
Participation at international and regional
conferences
The biennial International AIDS Conferences, the HIV
Pathogenesis, Prevention and Treatment Conferences, and the
regional HIV Conferences, such as ICASA, constitute important
fixtures in the international HIV calendar, and remain a central
pillar to the HIV response, supporting knowledge sharing and
-generation around every aspect of the HIV response. These
conferences also provide important
and varied fora and platforms for
advocacy and leadership at different
levels, and the priority events, themes
and outcomes of the conferences act
as important markers for tracking the
trajectory of both the HIV epidemic
and the global HIV response.
As such, the participation of women
and men living with HIV has been an
integral – if hard-won – aspect of such
conference spaces over the last two decades. Indeed, the lack
of representation of women living with HIV at the International
AIDS Conference in Amsterdam in 1992 led to the storming of
the stage by 53 women living with HIV, an event that marked the
foundation of the International Community of Women Living
with HIV and AIDS (ICW)
– which remains today the
only global network of
women living with HIV. The
ATHENA Network also owes
its genesis to the lack of
space for local participation
in the International AIDS
Conference at Durban, and
the spontaneous parallel
organising – led by women’s
civil society organisations
and networks – that
took place there, and on which the tradition of the Women’s
Networking Zone has been built.
Women’s international organising and leadership in the AIDS
response is an on-going process with long-term goals and
outcomes, which requires a coherent and cohesive momentum.
Since the 2010 International AIDS Conference that took
place in Vienna, a growing movement of youth activists, and
a growing attention to young women and men living with and
…in need of
supportive
environments…
…I wish to have the power to change everything…I would love to see all the young
women empowered and to see women in the highest decision-making positions, sitting
right there on top, not only men on top of everything…women are just being ignored,
we are not being cared for, people are not listening to us and they think because some
of us are not educated, we have nothing to say…and so, I would really love to see
women, young girls, HIV positive women to be empowered…women generally to be
empowered…and to have the power to make decisions…
[Young Woman, July 2011]
12 ICASA 2011 Addis Ababa • 04 – 08 December 2011 affected by HIV has been finding its place within the conference
environment.
A delegation of young women emerging activists, who
attended the International AIDS Society Pathogenesis,
Prevention and Treatment conference in Rome in July 2011,
articulated what the opportunity to participate in such a forum
meant to them:
…I’m expecting to hear different life experiences from the
young women; expect myself to grow stronger – I went
for different conferences, but I’ve never experienced a big
conference where I see a white person or an Asian person
telling me she is HIV positive – HIV has a woman’s face,
but those speaking about it are from Africa…8
…I want to meet new people; establish new contacts;
feel the spirit of different networks and orgs – forge close
relationships…feel empowerment and energy from our
community to continue working in our country…9
…I think it’s about taking this experience and translating
it into best practice – sustainable beyond the conference –
stay connected, continue to build other young women, and
increase our knowledge together…10
These comments speak not
only to the opportunities to learn,
network, and to define and give
voice to priority issues for the sake
of moving the collective goals of the
epidemic forward; to hold policy and
programme makers to account; to
claim leadership; and to link local
and national efforts to region-wide
and global responses. They also speak
to the challenge of being a leader
and activist in a competitive and
ever-changing environment; to the need for not only financial,
but emotional and spiritual support to do this work.
Because regional and international conferences of this size
are among the few occasions to meet and interact with other
activists, they provide important opportunities for mentoring,
learning and skills-building in addition to the building and
consolidating of global networks and friendships. Paradoxically,
despite the incredibly hard physical and mental work that
goes into engaging at large conferences, they can also be an
opportunity to refuel, reflect and re-engage on a spiritual and
emotional level for the next stage of the journey.
FOOTNOTES:
1. World Health Organisation. 2010. Women and health: Today’s
evidence tomorrow’s agenda. Geneva, WHO.
2. UNAIDS. 2010. The Global Report. UNAIDS Report on the Global
AIDS Epidemic. Geneva, UNAIDS.
3. UNAIDS. 2011. Opportunity in Crisis: Preventing HIV from Early
Adolescence to Young Adulthood. p4.
4. The Global Coalition on Women and AIDS. Preventing HIV
infection in girls and young women. [http://data.unaids.org/GCWA/
GCWA_BG_preventation_en.pdf]
5. There are an estimated 2 million people aged 10-19 living with
HIV globally of whom some will have acquired HIV vertically, and
others horizontally, primarily through unprotected sex, sharing on
injecting drug paraphernalia. See also UNAIDS. 2011. Opportunity
in Crisis: Preventing HIV from Early Adolescence to Young
Adulthood. p24.
6. Political Declaration on HIV/AIDS. 2011. [www.
unaids.org/en/media/unaids/contentassets/documents/
document/2011/06/20110610_UN_A-RES-65-277_en.pdf]
7. Pinkham, S. & Malinowska-Sempruch, K. 2007, Women, Harm
Reduction and HIV. New York, Open Society Institute.
8. Authors’ personal conversations with young women in July 2011.
9. Ibid.
10. Ibid.
Luisa is a women’s rights and HIV activist and was the
coordinator of WNZ2011 in Rome on behalf of the
ATHENA Network and Salamander Trust , and Ebony is
with the ATHENA Network.
For more information: athenainiative@gmail.com
…the enjoyment
of the basic
rights, needs and
aspirations…
may seem an
elusive dream…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 13
Women’s Voices:
…on prevention of vertical transmission programmes…
After so many years of projects
and programmes, lives of women
have not changed and neither has the
attitudes towards women…
[Malawi]
Have women’s rights experts as
part of the process, so it is not
only about the baby…
[Ethiopia]
It does not cater for the health of the mother,
but addresses relatively well the needs of the
child…women have to fend for themselves and
as a result, they sometimes die leaving their
infant child…
[Swaziland]
Not all women have access to or know about the
services…there is often a shortage of ARVs
because of poor distribution and many women are
forced to breastfeed because of the stigma attached to
not breastfeeding…
[Tanzania]
We need consultation with women at all levels and
areas on their challenges in accessing services
and how these can be alleviated…women should be involved
in all planning, design, implementation, monitoring
and evaluation of interventions for women…
[Zimbabwe]
Though efforts are there, women are still neglected
when it comes to their SRH&H…efforts are geared
towards preventing transmission to the child, but the
mother’s needs are not taken care of…
[Botswana]
Women’s realities are never
addressed, thus the poor
results in the programmes…
women are tested at the
antenatal clinics and if infected
with HIV, the discrimination
begins immediately…this makes
women turn to traditional birth
attendants…
[Kenya]
Our local clinics and hospitals are so unfriendly and this propel women to
shy away from seeking medical attention and thus results in grievous harm
to both women and baby…if only government could stress the necessity of
commitment and treatment…more women, young or old, will frequent the clinics
and hospitals…
[South Africa]
T he programme is accessible
to women in the urban areas,
but very difficult or inaccessible to
women in some rural areas, due
to poor road and communication
networks… [Cameroon]
D ue to cultural practices and lack of
health infrastructure in rural areas,
many women do not benefit from the
pregnancy assistance and this reason they
aren’t reached by the programmes…
[Mozambique]
It is the fear of being stigmatised
that stops women from going
to clinics…
[Cote d’Ivoire]
14 ICASA 2011 Addis Ababa • 04 – 08 December 2011 Violations of civil, political,
economic, social and cultural
rights increase vulnerabilities
to HIV and related rights
abuses. HIV-related stigma,
discrimination and other
violations of rights impede
effective responses to HIV
and AIDS at a national and
regional level.
In order to effectively respond
to the AIDS pandemic globally
we need to ensure that human
rights are at the centre of our
response to AIDS. Recognising
especially women’s HIV risks
and vulnerabilities in Africa, it is
essential that in the African response
women’s human rights are at the
centre of our response, so as to
ensure that the laws, policies and
protections in place actually do what
they are intended to do – protect the
rights of women in Africa.
HIV risks and vulnerabilities
It is widely recognised that risks
and vulnerabilities to both
HIV transmission and related rights
abuses in the region are based
within, and largely determined by,
the gendered, unequal and powered
societal contexts, which place
women and girl children at greater
risk.2 Furthermore, women’s
HIV risks and vulnerabilities in the
region are further exacerbated by
high levels of sexual and gender
violence.3 Moreover,
…persistent gender inequality
and human rights violations that
put women and girls at greater
risk and vulnerability to HIV,
continue to hamper progress
and threaten the gains that have
been made in preventing
HIV transmission and
increasing access to
anti-retroviral treatment.4
Some of the specific risks and
vulnerabilities in the context of
women and HIV in Africa include:
• Limited control over life and
body. Women are not in the
position to equally participate
in decision-making regarding
their lives. This includes
decisions about their sexual and
reproductive choices, which
are often linked to limited
access to women-initiated and -controlled HIV prevention
options, high levels of violence and abuse, and prevailing
socio-cultural gendered expectations for women to bear
children. This impacts on the extent to which women are in
the position to access, claim and realise their rights, and to
access and benefit from available HIV prevention options5.
Without adequate responses to women and HIV, these
realities will continue to
…not only limit women’s and girls’ autonomy and skills
to protect themselves from HIV, but also hinder access
to services and ultimately women’s and girls’ ability to
exercise their human rights.6
• More likely to access services which often results in increased
risks of abuse. Women are more likely to access health
services. This means that HIV testing initiatives that
appear neutral often target women in implementation and
Special report:
Making (women’s) human rights
central to the AIDS response in Africa1
Meaka Biggs and Johanna Kehler
ICASA 2011 Addis Ababa • 04 – 08 December 2011 15
practice. Subsequently, women
are more likely to be subjected
to mandatory and/or coercive
HIV testing practices, severely
limiting women’s rights to
equality and security of the
person, and increasing women’s
risks to rights abuses in the
context of HIV testing and
sexual and reproductive
health services7.
• First to know HIV status – first to
face negative consequences. The
promotion of HIV disclosure
in its implementation is often
discriminatory and biased
against women, as women are
often the ones first to know of
a positive HIV diagnosis – as
such, negative consequences
of HIV disclosure, such as
stigma, discrimination, violence,
destitution and even death is, in
reality, mostly experienced by
women. As such women living
with HIV ‘may also avoid
HIV-related services to prevent
such disclosure’8.
• Inadequate access to services
and secondary victimisation.
High levels of violence and
abuse, including sexual violence
and rape, impact greatly on
especially women’s risks to
HIV transmission. Violence
against women is both a
cause and a consequence of
HIV infection’.9 Given the
limited and often inadequate
access to socio-medical and
legal services for victims and
survivors of sexual violence,
women’s rights are violated
not only by the sexual offence
itself, but also by the subsequent
inadequate access to, and
secondary victimisation by,
health, psycho-social and
legal services.10
• Limited access to integrated
health services. Although the
need to incorporate sexual and
reproductive
health into
the AIDS
response is well
recognised,
‘present HIV
services do not
comprehensively include the
promotion and protection of the
right to sexual and reproductive
health of all women and girls’11,
and subsequently, many women
continue to have severely limited
access to integrated health
services.12 Women living with
HIV experience additional
barriers to accessing sexual and
reproductive health services, as
their rights are
…compromised by
discriminatory legal
frameworks, rigid health care
systems, misinformed medical
practices, and stigmatising
attitudes of healthcare
workers…[and women] continue to experience serious
violations, including poor standards of medical care,
coerced abortion, forced sterilisation and lack
of confidentiality.13
HIV risks and vulnerabilities in Africa have to be effectively
addressed as a matter of urgency by all relevant State and
non-State actors, as well as regional human rights bodies and
mechanisms. The newly established African Commission
on Human and People’s Rights (ACHPR) Committee on the
Protection of the Rights of People Living with HIV and Those
at Risk, Vulnerable to and Affected by HIV is one of the actors
who should, by its mandate, take an active role in promoting and
protecting human rights in the context of HIV, and in addressing
HIV risks and vulnerabilities in Africa.
Human rights and HIV
Globally, as well as in Africa, it is widely recognised that
human rights are to be at the centre of the AIDS response, and
particularly in the response to women and HIV, so as to ensure
both an adequate response to public health needs and concerns
and the protection of human rights
in the response to HIV and AIDS.14
Acknowledging that human rights
and gender equality are effective
responses to HIV further implies
that realities and needs of women
and other key populations at
higher risk are to be a central
component of programme design,
implementation and monitoring
of the AIDS response at a global,
regional and national level.15
…implementation
is often
discriminatory
and biased
against women…
www.aln.org.za
We need supportive legislation…
…not criminalisation
10 Reasons Why Criminalisation Harms Women
16 ICASA 2011 Addis Ababa • 04 – 08 December 2011 A rights-based approach to
HIV requires: realisation and
protection of the rights people
need to avoid exposure to
HIV; enabling and protecting
people living with HIV so
that they can live and thrive
with dignity; attention to the
most marginalised within
societies; and empowerment
of key populations through
encouraging social
participation, promoting
inclusion and raising
rights awareness.16
However, human rights, and
especially women’s human
rights, seem to be continuously
compromised, threatened and
violated in the response to HIV
and AIDS, despite the commitment
globally, and in the African context,
to promote and protect women’s
human rights.17 Responses to HIV
and AIDS globally, and in the
African context, for example, often
seem to place public health needs
and concerns for increased
HIV testing over the need to protect
individual human rights of consent,
confidentiality and counselling in
the context of HIV testing, in that
the shift from a ‘voluntary’ approach
to a ‘provider-initiated’ approach
to HIV testing potentially threatens
and compromises human rights
protections in the context of
HIV testing both in policy and
practice.18 In addition, ‘services to
prevent vertical transmission of HIV
fail to take into consideration the
rights and needs of women living
with HIV’19.
As many of the human rights
threats and violations occur
within the context of programme
implementation and service delivery,
and women are the ones mostly
accessing HIV-related programmes,
interventions and health services,
including sexual and reproductive
health services, it is women who are
most vulnerable to, and at risk of,
rights abuses in the context of HIV
and AIDS.20
…HIV services equally neglect
the empowerment of women and
girls to exercise their rights,
access services, and make
autonomous choices about their
bodies and lives.21
It is also widely acknowledged
that women living with HIV
experience gross violations of
their rights, particularly in relation
to their sexual and reproductive
health and rights within service
provision, since ‘women living
with HIV are frequently unable
to exercise reproductive selfdetermination’
22 – which both
‘severely undermine utilisation of
health services and information’,
and is counterproductive to effective
HIV and health responses.23 There
is growing evidence of coercive
sterilisation of positive women in the
region (e.g., Namibia24), as well as
‘forced’ termination of pregnancy25;
coercive practices of HIV testing
during pregnancy and subsequent
rights violations, including denial
of services (e.g., South Africa26);
and lack of access to safe, legal
termination of pregnancy and impact
of unsafe abortions on women’s
health, well-being and rights27.
These realities not only constitute
a violation of the rights to dignity
and security of a person, but
also impact negatively on the
overall progress made towards
the promotion and advancement
of gender equality, as well as the
promotion and protection of people
living with, and affected by, HIV and AIDS. Furthermore, the
persistent violations of women’s human rights in the context
of HIV and AIDS as much perpetuate women’s risks and
vulnerabilities to HIV transmission and related rights abuses, as
it continues to impede on the effectiveness of responses to HIV
and AIDS at a national and regional level.28
To end the violation of human rights in the context of HIV
in Africa and to improve access to services especially for
women, it is argued that the ACHPR and its Committee on the
Protection of the Rights of People Living with HIV and Those
at Risk, Vulnerable to and Affected by HIV should:
• Urge State Parties to remove discriminatory laws and
policies that hinder just and equitable access to health
services for women and other key populations at higher risk
• Engage State Parties and relevant non-state actors to
scale-up comprehensive programmes that build capacities
of HIV-related service providers and address stigma and
discrimination in laws, institutions and communities
• Recommend to State Parties to ensure the promotion and
protection of human rights within health services, by means
…to be
effectively
addressed as
a matter
of urgency…
of rights-based education and
training as an integral part
of the curriculum of health
professionals, as well as by
means of measurable outcomes
in national strategic plans
outlining the response to HIV
and AIDS
• Urge State Parties to ensure
sufficient budgetary allocations
for the implementation and
monitoring of national
responses to HIV and AIDS,
with a particular focus on
resources allocated toward
women-centred HIV prevention,
testing, treatment, care and
support services
• Advise State Parties and relevant
non-state actors to include clear
and measurable indicators for
the education and training of
law enforcement agencies and
the judiciary to ensure quality,
timely and just access to services
for victims and survivors of
sexual violence and rape
• Strongly recommend the
removal of legal barriers to
accessing quality and timely
health, psycho-social and
other related services in the
context of sexual violence
and rape, including access to
post-exposure prophylaxis and
emergency contraceptives, such
as laying a charge at the police
station as a pre-requisite for rape
survivors’ access to available
and much-needed services
• Urge State Parties to ensure the
provision of quality integrated
services so as to facilitate
that women, and especially
women living with HIV, and
other key populations at
higher risk are treated with
dignity and respect, are free of
violence, coercion, stigma and
discrimination, whilst ensuring
access to services based on
counselling, informed consent
and confidentiality
• Support the development and
implementation of stigma
indicators within health services
to ascertain country specific
data on levels, as well as impact,
of stigma and discrimination
and to ensure evidence-based
stigma mitigation programme
development at a national and
regional level
Criminalisation laws and
policies
Given the above context of
the HIV and AIDS pandemics,
especially in light of women’s
HIV risks and vulnerabilities in the
African context, recent legislative
trends towards the criminalisation of
HIV exposure and/or transmission
have been responded to with
concern and opposition. The fact that
criminalisation laws are unjust and
a threat to human rights; and will
have an adverse impact on women
and women’s risks to both HIV and
related rights abuses, are but some of
the concerns raised.29 According to
the UN Secretary General,
…these laws stigmatise people
living with HIV and key
populations at higher risk without
promoting public health goals.30.
In addition, as highlighted by the Special Rapporteur on the
right of everyone to the enjoyment of the highest attainable
standard of physical and mental health, the criminalisation
of HIV exposure or transmission has no impact on behaviour
change or the spread of HIV31. It undermines existing public
health efforts32, disproportionately impacts on vulnerable
communities33, increases prevailing stigma, discrimination
and violence34, and constitutes an infringement of the right to
health35. Laws criminalising HIV exposure, transmission and/or
failure to disclose one’s HIV positive status also contradict the
commitment made by governments in the Political Declaration
on HIV/AIDS in 200636
…to promote a social and legal environment that is
supportive of and safe for voluntary disclosure of
HIV status.37
The call to apply criminal law to HIV exposure and
transmission is often driven by a well-intentioned wish to
protect women and women’s rights, as well as to serious
concerns about the rapid spread of HIV in many countries.
Criminalisation laws are not in the position to prevent new
HIV transmissions or to respond to women’s HIV risks
and vulnerabilities. Laws criminalising HIV exposure
or transmission
…unjustifiably penalise women, who, in many settings, are
unable to prevent HIV transmission, because they have
no power to negotiate conditions of sex or to make the
…human rights
and gender
equality are
effective
responses
to HIV…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 17
18 ICASA 2011 Addis Ababa • 04 – 08 December 2011 decisions whether or not to have
children…[and women may]
face prosecution as a result of
their failure to disclose, despite
having valid reasons for
non-disclosure.38
In addition, the responses to
HIV risks and vulnerabilities in
the African context are severely
impacted in their adequacy and
effectiveness through the growing
and renewed calls to criminalise
homosexuality (e.g., Uganda39); the
continuing criminalisation of sex
work across the continent; and the
failure to adequately address risks
and vulnerabilities of people who
inject drugs in national and regional
responses to the pandemics. The
continuing failure to adequately
address key populations at higher
risk is especially alarming given
statistics that clearly indicate that
…unprotected paid sex, sex
between men, and the use of
contaminated drug-injecting
equipment by two or more
people on the same occasion are
significant factors in the
HIV epidemics of several countries
with generalised epidemics.40
These legislative and policy trends
are not only a clear reflection of the
persistent human rights abuses of
already marginalised people and key
populations at higher risk, but also
a clear indication that national and
regional responses to HIV and AIDS
are limited accordingly. It is also
widely recognised that criminalising
the already ‘marginalised’ will
perpetuate and manifest existing
risks and vulnerabilities to
HIV transmission and related rights
abuses (instead of addressing these
realities), as well as justify both
continuing limited access to (and
even denial of) available
HIV prevention, testing, treatment,
care and support
services, and gross
human rights
violations based
on the criminalised
status of key
populations at
higher risk.41
Legislative and policy provisions
are crucial elements in the response
to HIV and AIDS and are key in
creating enabling and supportive
environments for the advancement
and protection of human rights in
the context of HIV, as well as in
ensuring that AIDS responses at a
national, regional and global level
are in the position to adequately and
effectively respond to people’s
HIV risks, vulnerabilities, realities
and challenges.42
It is within this context, the
ACHPR and its Committee on the
Protection of the Rights of People
Living with HIV and Those at Risk,
Vulnerable to and Affected by HIV
is called to:
• Urge all African Commission
member states to reaffirm their commitment to human
rights and HIV in general, and to women’s human rights
in the context of HIV in particular, by ensuring that all
countries are not only signatories to the Protocol to the
African Charter on Human and People’s Rights on the
Rights of Women in Africa, but also ascend and domesticate
the provisions of the Protocol at a national level; and to take
necessary measures to ensure the timely implementation
of the Maputo Plan of Action on Sexual and Reproductive
Health and Rights and the Abuja Declaration
• Urge State Parties to take measurable actions to translate
the political commitment to women’s human rights and
HIV into effective programmes and interventions, including
sufficient budgetary allocations, that adequately address
women and HIV in Africa43
• Engage State Parties at a national and regional level to
repeal all laws that facilitate gross human rights violations
in the context of HIV and AIDS
• Recommend the removal of
punitive laws and discriminatory
legislative and policy provisions
that promote human rights
abuses at a national and regional
level, including in relation to
• Criminalisation of HIV
exposure and transmission
• Mandatory and/or forced
HIV testing
• Mandatory and/or forced
HIV disclosure
www.aln.org.za
Women need agency…
…not prosecution
10 Reasons Why Criminalisation Harms Women
…continuously
compromised,
threatened
and violated
in the
response to
HIV and AIDS…
• Strongly support law review
and reform, where necessary,
with respect to restrictive
abortion laws, in order to create
enabling legal environments
for safe, legal and choice-based
terminations of pregnancy,
especially for women living
with HIV
• Recommend to State Parties
and relevant non-state actors to
establish effective enforcement
mechanisms of protective
laws and policies for women,
especially women living with
HIV, and other key populations
at higher risk, so as to ensure
access to justice and redress
through HIV-related legal
services and legal literacy
programmes44
• Conduct fact finding missions
to ensure an enhanced evidence
base on the adverse impacts
of laws criminalising
HIV exposure and transmission
on women and women’s risks
to HIV transmission, and other
related rights abuses adversely
impacting on women, especially
women living with HIV
• Recommend documenting
best practices at a national and
regional level, with a specific
focus on the promotion and
advancement of human rights
in the context of HIV and
AIDS, with a specific focus
on promoting and advancing
women’s rights in the response
to women and HIV
• Urge State Parties to take
appropriate measures to ensure
that the right to freedom of
association can be effectively
enjoyed without discrimination
on grounds of sexual orientation
or gender identity
• Urge State Parties to take
necessary measures to prevent
and remove discriminatory
administrative procedures,
including excessive formalities
for the registration and practical
functioning of associations
• Strongly recommend to State
Parties to take all necessary
measures to prevent the abuse
of legal and administrative
provisions and to discriminate
against, and violate the rights
of, sex workers, people in
same-sex relationships
and other key populations at
higher risk
• Engage State Parties and
relevant non-state actors to
promote and protect the rights
and well-being of sex workers,
same-sex practicing people and
other key populations at higher
risk so as to ensure adequate
access to and benefit from
available HIV prevention, testing,
treatment, care and
support services
• Strongly recommend to State
Parties and relevant nonstate
actors to take actions to
decriminalise sex workers,
same-sex practicing people,
people who inject drugs and other
populations at higher risk
FOOTNOTES:
1. This contribution is based on a Position
Paper prepared by a Regional Civil
Society Consortium of human and
women’s rights organisations and
submitted to the ACHPR Committee
on the Protection of the Rights of People Living with HIV, Those at
Risk, and Vulnerable to and Affected by HIV in April 2011.
2. UNAIDS. 2010c. Agenda for Accelerated Country Actions for
Women, Girls, Gender Equality and HIV: Operational Plan for
UNAIDS Action Framework: Addressing women, girls, gender
equality and HIV. Geneva, UNAIDS; Report of UN Secretary
General on the Implementation of the Declaration of Commitment
on HIV/AIDS and the Political Declaration on HIV/AIDS. 31
March 2011; UNAIDS, 2010a, Global Report.
3. UNAIDS, 2010a:134-136.
4. UNAIDS, 2010c:1.
5. Ibid, pp6-9; UNAIDS, 2010a, Chapter 5; Report of UN Secretary
General, 31 March 2011, paras 55-57.
6. UNAIDS, 2010c:p6.
7. See also Jürgens, R. 2007. Increasing access to HIV testing and
counselling while respecting human rights: Background paper.
New York: Public Health Program of the Open Society Institute;
Women and HIV Testing: Policies, practices and the impact on
health and human rights. Public Health Fact Sheet. OSI Public
Health Program; Gruskin, S. 2006. ‘It is time to deliver right!
HIV testing in the era of treatment scale up: Concerns and
considerations’. In: ALQ, September 2006 Edition.
8. Gerntholtz, L. & Grant, C. 2010. International, African and
country legal obligations on women’s equality in relation to sexual
and reproductive health, including HIV and AIDS. HEARD and
ARASA. Durban, South Africa, p20.
9. UNAIDS, 2010c:10.
10. See also WHO/UNAIDS. 2010. Addressing violence against women
and HIV/AIDS: What works? Geneva, World Health Organisation.
11. UNAIDS, 2010c:11.
12. See also Report of UN Secretary General, 31 March 2011, paras
77-78.
13. High Level Consultation of Influential Leaders and Women’s
Advocates. One day consultation on the sexual and reproductive
health and rights of women and girls living with HIV. 24 February
2011. Meeting Report, p5.
14. UNAIDS, 2010a:122; OSI. 2007. Human Rights and HIV/AIDS:
Now More Than Ever. 10 Reasons Why Human Rights Should
Occupy the Centre of the Global AIDS Struggle. New York: Open
Society Institute.
15. See also UNAIDS, 2010c:pp6-21.
16. Ibid, p122.
17. Ibid, pp121-137.
18. Jürgens, 2007; UNAIDS/WHO. 2007. Guidance on Provider-
Initiated HIV Testing and Counselling. Geneva, World Health
…impede
on the
effectiveness
of responses to
HIV and AIDS
at a national
and regional
level…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 19
20 ICASA 2011 Addis Ababa • 04 – 08 December 2011 Organisation; Women and HIV
Testing: Policies, practices and the
impact on health and human rights.
Public Health Fact Sheet. OSI Public
Health Program.
19. UNAIDS, 2010c:11.
20. UNAIDS, 2010a:121-137; UNAIDS,
2010:1-3.
21. UNAIDS, 2010c:11.
22. Gerntholtz & Grant, 2010:19.
23. High Level Consultation of
Influential Leaders and Women’s
Advocates, 2011:3.
24. CW. 2009. The Forced and Coerced
Sterilization of HIV Positive
Women in Namibia. [www.icw.org/
files/The%20forced%20and%20
coerced%20sterilization%20
of%20HIV%20positive%20
women%20in%20Namibia%2009.
pdf]; Anand, N., Erdman, J., Kelly,
L. & Robonson, C. 2009. Policy
Brief: Developing a Human Rights
Framework to Address Coerced
Sterilization and Abortion. Bridging
the Gap. Athena Network. [www.
athenanetwork.org/assets/files/
Bridging%20the%20Gap%20
Policy%20Brief.pdf.]; Gatsi, J.,
Kehler, J. & Crone, T. 2010. Make
it everybody’s business: Lessons
learned from addressing the coerced
sterilisation of positive women in
Namibia. A best practice model.
Namibia Women’s Health Network,
Namibia.
25. Anecdotal evidence from Namibia
and South Africa suggests that
positive women are coerced to
terminate their pregnancies.
26. Kehler, J., Howard Cornelius, A.,
Blosse, S. & Mthembu, P. 2010.
Where are the Human Rights
for Pregnant Women? Scale-up
provider-initiated HIV testing and
counselling of pregnant women:
The South African experience. Cape
Town: AIDS Legal Network.
27. Grimes,D. A. et al. 2006. Unsafe
abortion: the preventable pandemic.
The Lancet Sexual and Reproductive
Health Series, October 2006.
28. See also Gerntholtz & Grant,
2010; High Level Consultation of
Influential Leaders and Women’s
Advocates, 2011; UNAIDS,
2010c:1-3.
29. Eba, P. 2008. ‘One size punishes
all: A critical appraisal of
the criminalisation of HIV
transmission’. In: ALQ, September/
November 2008 Special Edition,
pp1-10; OSI. 2008. Ten Reasons to
Oppose the Criminalisation of HIV
Exposure or Transmission. New
York, Open Society Institute; Athena
Network. 2009. 10 Reasons Why
Criminalisation of HIV Exposure or
Transmission Harms Women. Athena
Network & AIDS Legal Network,
South Africa.
30. Report of UN Secretary General, 31
March 2011, para 37.
31. Grover A. 2010. Report of the Special Rapporteur on the right of
everyone to the enjoyment of the highest attainable standard of
physical and mental health, Geneva, Office of the United Nations
High Commissioner for Human Rights, para 62.
32. Ibid, para 63.
33. Ibid, paras 64-65.
34. Ibid, paras 68-71.
35. Ibid, para 61.
36. UNAIDS, 2010a:128.
37. Ibid, p128.
38. Ibid.
39. Anti-Homosexuality Bill introduced as a Private Member’s Bill in
2009 in Uganda.
40. UNAIDS, 2010a:30.
41. See also Grover 2010, paras 6-26 (criminalisation of Same-sex
conduct, sexual orientation and gender identity), and paras 27-50
(criminalisation of sex work).
42. See also Gerntholtz & Grant 2010; High Level Consultation of
Influential Leaders and Women’s Advocates, 2011; UNAIDS,
2010c.
43. UNAIDS, 2010c, Recommendation 2.
44. See also Global Report Action Points Human Rights, UNAIDS,
2010a:137.
Meaka is a rights advocate and Johanna is with the
AIDS Legal Network, South Africa. For more information:
meakabiggs@gmail.com.
If in an abusive relationship, the women will be scared to access the
services because she is scared of her partner…
[South Africa]
D ue to cultural barriers, a woman doesn’t have a chance to get
information and services without her husband’s involvement, and most
of the husbands or male partners are not willing to go to the clinics…and a
woman doesn’t have money for transport and health services, unless she got
it from her husband…
[Ethiopia]
Cultural affliction, religious afflictions are most of the
barriers…for example certain cultural practices make
women more vulnerable to HIV and AIDS…therefore,
they should provide training, capacity development and
support to existing women associations to empower them
to challenge social and cultural practices…
[Nigeria]
T he programme is not accessible to all women in our country
in an equitable manner because of lack of infrastructure and
information on HIV…
[Democratic Republic of Congo]
Educate and inform women living with HIV, their
partners and mother in-laws to better understand the
treatment literacy programmes…
[Mozambique]
In Women’s Voices:
T he hierarchy within the family is never addressed in any forum…it is accepted as the cultural norm to be
subservient and humble because you are a woman… [India]
The Protocol to the African
Charter on Human and Peoples’
Rights on the Rights of Women
in Africa1, better known as the
Maputo Protocol, guarantees
comprehensive rights to
women, including the right to
take part in the political process,
to social and political equality,
to control of their reproductive
health, and an end to female
genital mutilation.
The Maputo Protocol (the Protocol) was
adopted by the African Union in the
form of a Protocol to the African Charter
on Human and Peoples’ Rights2 on
11 July 2003, at its second summit in
Maputo, Mozambique. The protocol
entered into force on 25 November 2005,
after being ratified by the required 15
member nations of the African Union,
South Africa included34.
The Protocol contains very useful
information concerning the protection,
promotion and advancement of
women’s sexual and reproductive
rights, including women living with and
affected by HIV. Moreover, the Protocol
goes beyond other binding treaties,
such as CEDAW, in recognising women’s
reproductive rights.5
Article 14 of the Protocol:
Health and reproductive rights
Article 14 of the Protocol affords women,
including women living with HIV, with
insurmountable protection of their
human rights, and states that State
parties shall ensure that the right to the
health of women, including sexual and
reproductive health is respected and
promoted, including
• the right to control their fertility,
• the right to decide whether to
have children and the number and
spacing of the children,
• the right to choose any method of
contraception, and
• the right to have family planning
education.6
In addition, the Protocol affords women
• the right to self protection and
to be protected against sexually
transmitted infections, including
HIV/AIDS, and
• the right to be informed on one’s
health status and on the health
status of one’s partner, particularly
if affected with STIs, including
HIV/AIDS, in accordance with
internationally recognised standards
and best practices.7
However, it is up to State Parties who
have ratified the Protocol to ensure that
these rights, to which it has bound itself
to, become a living reality for all women,
including women living with HIV.
Once a state has ratified the Protocol,
that state is bound under international
law to refrain from any acts that would
defy the object or purpose of the
Protocol. This means that women living in
South Africa, or any other country which
has ratified the Protocol, are entitled to
the protection afforded by the Protocol
and that State parties are obligated to take
active measures to refrain from any acts
that would defy the object or purpose of
the Protocol, including active measures
to ensure that the right to sexual and
reproductive health for all women is
respected, promoted and protected.
Conflict of rights in the South African
context?
In South Africa, everyone has the
constitutionally guaranteed right to
privacy and autonomy.8 The question
to be raised here is how this relates to
the Protocol which affords women the
right to protection, including the right to
be informed on one’s health status and on
the health status of one’s partner, particularly
if the person is affected with sexually
transmitted infections, including HIV/AIDS?
Reconciling these two provisions could
Nonandi Diko
The Women’s Protocol…
A tool for advancing women’s sexual and reproductive rights?
ICASA 2011 Addis Ababa • 04 – 08 December 2011 21
22 ICASA 2011 Addis Ababa • 04 – 08 December 2011 become challenging. Since
nobody can and should be
tested for HIV without their
informed consent, forcing
someone to go for an HIV test
against their will and without
their informed consent
would be a gross violation
of their constitutional rights
to human dignity, privacy
and autonomy, to name but
a few.
Article 14(2) of the Protocol
further requires State Parties
• to provide adequate, affordable
and accessible health services,
including information, education
and communication programmes
to women, especially those in
rural areas,
• to establish and strengthen existing
pre-natal, delivery and post-natal
and nutritional services for women
during pregnancy and while they are
breast feeding,
• to protect the reproductive rights
of women by authorising medical
abortion in cases of sexual assault,
rape, incest, and where the continued
pregnancy endangers the mental and
physical health of the mother or the
life of the mother and the foetus.9
The Protocol further prohibits all medical
or scientific experimentation on women
without their informed consent10, which
would include cases where women are
sterilised without their consent when
they attend hospitals to give birth, merely
on the basis of their HIV positive status.11
South Africa ratified the
International Covenant on
Civil and Political Rights
(ICCPR), which amongst
other things states that
‘no one shall be subjected
to arbitrary or unlawful
interference with his privacy’
and such a right to privacy12.
It would, therefore, be
unconstitutional and
contrary to the spirit of the
Constitution of South Africa
and the ICCPR to allow
someone to know another person’s
health status against their will, as this
would be an unreasonable infringement
on a person’s right to privacy, as well as
the right not to be subjected to medical
and scientific experiments.
It remains to be seen how State Parties
to the Protocol will make Article 14
relating to the right to know one’s
HIV status succeed without a gross
violation of human rights and without
conflicting with the ICCPR. In reality,
women are mostly the first ones to find
out about their HIV status, particularly
when accessing sexual and
reproductive health services,
and are also the ones mostly
subjected to HIV-related
stigma and discrimination.
A woman is hence less likely
to disclose her HIV status to
her partner, and if she does
reveal her status, she is likely
to be discriminated against
and violated by her partner
and/or by the community.
Customary and traditional practices
It has been argued that the Protocol’s
provisions on harmful cultural practices
lay to rest arguments that customary
and traditional practices can prevail over
the rights of women under the African
Charter13. This is all good and well.
However, until State Parties take active
measures to ensure that the Women’s
Protocol prevails over any harmful
cultural and traditional practice, this
will merely be just a dream for many,
and women will continue to experience
abuse in the name of tradition and
custom, increasing their risks to STIs and
HIV transmission, particularly in countries,
like South Africa, where polygamous
relationships form part of some
traditions. In these kinds of situations,
State Parties should be obligated to
take active measures to ensure that
the rights of women in polygamous
relationships, including women’s sexual
and reproductive rights, are protected.
Can the Protocol adequately ensure the
right to self protection and the right to
be protected from sexually transmitted
infections, including HIV, for women in
these relationships?
So far, studies have shown
that women continue to be
exposed to HIV infection in
the name of tradition, despite
the protection afforded
in the Protocol.14 More
often than not, women are
‘submissive’ and feel inferior
in these relationships, and
are thus less likely to be in a
position to insist on condom
…prevails over any
harmful cultural
and traditional
practice…
…concerns
about the cost
of reviewing
legislation and
implementing
reproductive
rights…
use, let alone requiring the partner to go
for an HIV test, so that the woman can
know the health status of her partner, as
envisaged in Article 14 of the Protocol.
Given this reality, women continue to be
more susceptible to and at risk of STIs and
HIV transmission, despite the provisions
in the Protocol.
Women’s experiences and
recommendations
At a Sexual, Reproductive and Maternal
Health and Rights Regional Advocacy
and Policy Forum held in Johannesburg
from 22 to 25 November 2010, a woman
from Botswana shared her experiences
with public healthcare workers who
asked her ‘why she was pregnant’ when
she was ‘sick’, and since she was informed
and knowledgeable, she told the doctor
that she had a right to choose whether
or not to be pregnant.15 This is but one
of many examples of discrimination and
denial of access to healthcare services,
including reproductive health services,
often encountered by positive women. It
is not only greatly concerning that these
kinds of attitudes are still prevalent in
healthcare, despite the Protocol affording
women the right to reproductive and
sexual decision making, but also raising
the question as to the extent to which the
Protocol can impact on women’s realities.
Recommendations made by women
who participated at the meeting included
the following:16
Recommendations to policy-makers
Our governments • need to urgently
and effectively respond to the
sexual and reproductive rights and
needs of women and young women
living with HIV, in accordance with
The Protocol to the African Charter
on Human and Peoples’ Rights on
the Rights of Women in Africa. All
African member states must ratify
the aforementioned
Protocol and report on
its implementation.
• Policies and laws, such
as those criminalising
the transmission of HIV,
only increase violence
and abuses against
women living with HIV
while legalising their
discrimination. These legislative
issues need to be urgently
addressed by our governments.
• Recognising that the voices of
young women and women living
with HIV are critically lacking in
policy-making, consequently their
issues are not addressed effectively,
with dramatic consequences
on attaining the gender
equality and health Millennium
Development Goals.
• Women living with HIV are calling
on African Heads of States to live
up to their commitments to women
and girls, by allocating much
needed resources and capitalising
on women living with HIV, in terms
of their expertise of sexual and
reproductive health and rights.
Challenges and conclusions
Countries that ratified the Protocol
frequently raise concerns about the
cost of reviewing legislation and
implementing reproductive rights.17 With
this kind of an attitude, and apparent
lack of government’s commitment
to prioritise women’s rights and to
domesticate such a potentially useful
instrument, women’s sexual
and reproductive rights will
continue to be compromised
and violated.
A further barrier seems
to be the continued
tensions between human
rights and customary
laws, polygamy being
but just one example of how women
will continue to be oppressed and
not be in the position to negotiate
for safer sex, for fear of losing shelter
and food18.
In addition, women’s right to sexual and
reproductive healthcare remains but a
dream for many women, with women in
abusive relationships least in the position
to access ARVs or female condoms.
Female condoms remain inaccessible
in many areas, especially in small towns
and rural areas in South Africa, while
there is a huge roll-out of male condoms
– demonstrating once again the reality
of gender inequalities and imbalances
despite the guarantees of equality in the
Constitution, and the commitments to
achieving gender equality, which is central
to many other instruments South Africa
has ratified.
Recognising the Protocol on the Rights
…continued
tensions between
human rights and
customary laws…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 23
24 ICASA 2011 Addis Ababa • 04 – 08 December 2011 of Women as a tool to claim
sexual and reproductive
rights, Murrithi19 raises the
question as to whether or
not the Protocol adequately
caters for all women,
including women living with
HIV. Examining women’s
realities and challenges
pertaining to their sexual
and reproductive health, and
looking at the opportunities within the
Protocol to address these, she argues that
the Protocol, despite its progressiveness
fails to adequately address the needs
and realities of women living with HIV
and thus, calls for further advocacy
and lobbying so as to ensure that the
sexual and reproductive health rights
of all women are equally protected by
the Protocol.
One way of achieving the Protocol’s
stated goal of protecting the rights of
all women would be for State parties to
domesticate these rights by making them
part of national legislation, so that these
rights can be readily invoked in the local
courts. Civil society should play an active
role in advocating for the domestication
of the rights afforded to women in the
Protocol, be involved in processes of
policy-making, and be in the position
to make submissions concerning areas
where State parties are failing to meet
the needs of women, as outlined by the
Protocol.
Adequate reporting by State Parties is
crucial in monitoring the effectiveness
of the Protocol in the realisation of the
rights of women living
with and affected by HIV.
Without reporting and
monitoring, this potentially
useful instrument will not
serve any purpose. Learning
from CEDAW, civil society
has a crucial role to play
in ensuring accountability
and implementation,
including production of
shadow reports and active lobbying
of governments to encourage further
implementation. Civil society may,
however, remain constrained without
significant resources being allocated to
this specific role20.
FOOTNOTES:
1. The Protocol to the African Charter on
Human and Peoples’ Rights on the Rights
of Women in Africa. [www.achpr.org/
english/_info/women_en.html]
2. African Charter on Human and Peoples’
Rights. [www.achpr.org]
3. South Africa ratified the Protocol in
November 2005.
4. UNICEF. 2006. Toward ending female
genital mutilation: Press Release, 7
February 2006.
5. Gerntholtz, L., Gibbs, A. & Willian, S.
2011. ‘The African Women’s Protocol:
Bringing Attention to Reproductive Rights
and the MDGs’ In: PLos Medicine, 8(4).
[www.plosmedicine.org]
6. Section 14(1) of the Protocol.
7. Section 14(1) of the Protocol.
8. The Constitution of the Republic of South
Africa, Act 108 of 1996, Section 12 and 14.
9. Section 14(2) of the Protocol.
10. Article 4(k) of the Protocol.
11. ICW. 2009. The Forced and Coerced
Sterilization of HIV Positive Women in
Namibia. [www.icw.org/files/The%20
forced%20and%20coerced%20
sterilization%20of%20HIV%20
positive%20women%20in%20Namibia%20
09.pdf]; Anand, N., Erdman, J., Kelly,
L. & Robonson, C. 2009. Policy Brief:
Developing a Human Rights Framework
to Address Coerced Sterilization and
Abortion. Bridging the Gap. Athena
Network. [www.athenanetwork.org/
assets/files/Bridging%20the%20Gap%20
Policy%20Brief.pdf.]; Gatsi, J., Kehler,
J. & Crone, T. 2010. Make it everybody’s
business: Lessons learned from addressing
the coerced sterilisation of positive women
in Namibia. A best practice model. Namibia
Women’s Health Network, Namibia.
12. Article 17(1) of the International Covenant
on Civil and Political Rights (ICCPR).
[www.who.int/hhr/civil_political_rights.
pdf]
13. Centre for Reproductive Rights. 2006.
Justice Briefing Paper: The Protocol on the
Rights of Women in Africa: An Instrument
for Advancing Reproductive and Sexual
Rights. [www.reprorights.org]
14. See also Tfwala, N. ‘Women’s control over
sexual matters in traditional marriages: A
development perspective’. [www.unisa.
ac.za/bistream/handle/…/dissertationtfwaala-
n.pdf]
15. ICW Southern Africa & ICW Eastern
Africa. 2011. Sexual, Reproductive and
Maternal Health and Rights Regional
Advocacy and Policy Forum: Meeting
report. [www.icwea.org/admin/files/
SRMHR%20Region]
16. Ibid.
17. Gernholtz et al, 2011.
18. Ibid.
19. Murrithi, C. 2007. ‘A tool for claiming
sexual and reproductive rights: The AU
Protocol on the Rights of Women’. In:
ALQ, March 2007 Edition, pp9-13.
20. Gerntholz et al, 2011.
Nonandi is a human rights lawyer with the
AIDS Legal Network, South Africa. For more
information: advocacy@aln.org.za.
…rights can be
readily invoked in
the local courts…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 25
women complained about the
smell, the noise …. Yet, it wasn’t
until sixteen years later in 2009 that
the FC2 – a more use-friendly, less
expensive model was approved.
There are now seven other
models available and four under
development, but they have been
a long time coming … and there
are other women-centred barrier
methods that, to date, remain
uncharted as potential
HIV prevention methods. Already,
as Stein points out
…we know no microbicide will
promise above 50% of protection
… why have these obviously
useful and important physical
barriers never attracted the
same interest among advocates
for women, funders, national
and private? And now, when
realistically we know they have
to be further developed, tested,
funded, distributed, we have
lost 2 decades of potential
prevention?…
Stein points to the lack of
political will and investment in
One of the highlights of
the Rome Pathogenesis
Conference in July 2011 was
In my opinion, a presentation
given by Zena Stein during
a Satellite convened by the
Global Coalition on Women
and AIDS, in partnership with
Salamander Trust, ATHENA
Network, WECARe+, and the
Italian Network of People
Living with HIV (NPS+).
Stein, now in her late 80s, may have
the look of a kindly grandmother,
but she still packs a punch. As a
feminist activist, Stein has been
involved in the discourse around
HIV prevention and research since
AIDS entered the world stage in the
1980s, and was one of the earliest
proponents of the microbicide
(at the time dubbed the ‘virucide’)
as a means of female-centred
controlled prevention. It had not
taken Stein, among other feminist
activists, long to realise that for
women – especially married
women or women in established
relationships – to attempt to
introduce condoms into their
relationships during the heyday
of the Pill, was to give voice to, or
invite, mistrust, fear and suspicion.
…The advice given to women
that they could protect
themselves from acquiring
HIV by using a male condom
was absurd … they couldn’t or
wouldn’t…1
However, Stein (also called ‘the
mother of the microbicide’) recalls
that around the time of the first
discussions on a potential
virucide/microbicide, another
conversation was taking place –
the proposal for a female condom,
a barrier method for women.
And despite limited support and
enthusiasm for the project, the first
female condom was approved by
the FDA in 1993. Few women had
access to them, and those who did,
didn’t always know what to do with
them. (I remember the bemusement
and hilarity they caused while I
was still at university – they were
so long! Where exactly was all that
slippery latex supposed to go?) Other
…the lack of
political will and
investment in
social-science
intervention…
…be undermined
by the onset of
loudly hailed
bio-medical
advances…
In my opinion…
HIV prevention methods and ‘barriers’
for women…
Luisa Orza
26 ICASA 2011 Addis Ababa • 04 – 08 December 2011 sub-Saharan African countries, the
availability of female condoms was
142 times less than male condoms.3
However, the doubts remain: are
female condoms ‘doing’ anything
different from male condoms? Do
they in any way address the issues
that cause such resistance to male
condom use? Do they address
issues of lack of
skin-to-skin contact; implied
mistrust or infidelity; diminishment
of (male) sexual pleasure;
contraceptive? Again and again
among young women in high
prevalence areas male condoms
come up as the source of tension,
impasse, control and violence in
relationships, especially within
marriage, and more especially in
marriages between adolescent
women and older men, where
an age differential exacerbates
the gender power imbalances
within the relationship. Both the
suggestion of male condom use
and use of other contraceptives are
cited as precursors to intimate
partner violence.
For women in these or similar
circumstances, does the female
condom offer a viable alternative?
As I pondered this (and not for the
first time), I met two young women
social science intervention
vis-à-vis bio-medical research
and development. While there
is a growing evidence base of
good practice in the field of social
interventions, there is a risk that
these will be undermined by the
onset of loudly hailed bio-medical
advances. (For example, there
has been great concern among
women’s rights advocates that
the discovery that medical male
circumcision reduces the risk of
HIV infection in men by up to 60%
threatens to undo the gradual
increase – albeit limited – in both
male and female condom use that
has been seen over the last
three decades). At the same time,
bio-medical advances are nothing
without community-based
interventions to roll them out,
create awareness, adherence
literacy and demand, and to
explore and address any gendered
implications of new technologies.
We live in a gendered world;
nothing is without its gender
implications, no matter how
‘scientific’ the prevention tool.
Yet, investment in the social
marketing and roll-out of the
female condom has been limited.
Zimbabwe is one of a handful
of countries, which has taken
advantage of the female condom
and made major inroads into
promoting its use. From 2005,
when the strategy was launched, to
2008 female condom distribution
by the public sector increased from
400 000 to more than 2 million.2
But to put this into perspective, the
per capita distribution of female
condoms in 2008 equated to 1.48
female condoms per woman (aged
15-64) per year, compared to 28.5
male condoms per man per year;
and on average, across 14
…male condoms
come up as
the source
of tension,
impasse, control
and violence in
relationships,
especially within
marriage…
…much greater
investment
in making
the female
condom a viable
alternative to the
male condom
is needed
than mere
distribution…
ICASA 2011 Addis Ababa • 04 – 08 December 2011 27
prevention options (such as the
female condom) receive as much
attention as ‘new’ technologies,
including microbicides. As long as
we fail to reach this balance and
women-centred HIV prevention
options remain but a dream for
most women, we will continue to
hear chants of ‘Where are the female
condoms?’ and ‘Where the hell is
the gel?’, and will continue to raise
questions as to when advances in
science will become advances in
reality for women.5
FOOTNOTES:
1. Stein, Z. 2011. ‘HIV Prevention:
Gender and MIPA: Complement or
Collission?’ Satellite Meeting at the
IAS Pathogenesis Conference, 17
July 2011, Rome.
2. Zimbabwe Country Report. 2008
– 2009. United Nations General
Assembly Special Session Report
on HIV/AIDS follow up to the
Declaration on the Commitment to
HIV/AIDS.
3. USAID. 2010. Is There A Condom
Gap in 2010? A Review of Condom
Availability, Accessibility and
Acceptability in Sub-Saharan Africa,
pp 13-14.
4. Stein, 2011.
5. See also Stein, S. & Susser, I. 2011.
‘In Focus: Science advances
become real advances for women’.
In: Mujeres Adelante, July 2011
Edition, pp1-3.
Luisa is a woman’s rights and
HIV activist and was the coordinator
of the WNZ2011 in Rome on
behalf of the ATHENA Network
and Salamander Trust. For more
information: luisa.orza@gmail.com.
from Tajikistan, where condom use
is similarly difficult to negotiate,
especially within marriage, and
where women at highest risk of
HIV acquisition are those married
to men who inject drugs, or who
are forced into economic migration
to find work. Is the female condom
available and accessible to these
women? No; it is very expensive
and there is no public sector
distribution, although there is some
demand for it among women,
particularly from sex workers.
Would women be able to use it if
it were more available? Palpable
pause. Neither of the two women
I was speaking with had ever
tried it; women would probably
need practice. And practice
would certainly require not
only provider support, but also
intimate partner support… Much
greater investment in making
the female condom a viable
alternative to the male condom is
needed than mere distribution.
…Extending the protection
afforded by female condoms
does not rest on more technical
studies: it needs active support
by governments and agencies,
funding for manufacturing
and marketing, education and
training of public health
workers [and] appreciation
of these devices by men and
women and communities…4
The microbicides gel has been
welcomed as a prevention
technology that women can
use to protect themselves
‘secretly’, without needing
partner knowledge, affirmation
or support (although in reality,
how practicable would this be?).
In contrast, the female condom
is visible, it has an external
ring, through which the penis
‘has to be rooted’ (Stein); a man
would necessarily be aware of its
presence. Stein challenges this
problematic, (‘why the hell shouldn’t
he know?’), and in doing so reminds
us that practical solutions alone
will not bring about sustainable
structural change; that there
needs to be a much more radical
shift away from the discourse
of prevention, protection and
negotiation, towards a discourse
of equitable female and male
sexuality, pleasure, and care.
And while we applaud the
advances in the science of
HIV prevention for women, we
are also reminded of the need to
balance our efforts, energies and
resources to ensure that existing
and proven women-centred
…nothing
is without
its gender
implications,
no matter how
‘scientific’…
…practical
solutions
alone will not
bring about
sustainable
structural
change…
28 ICASA 2011 Addis Ababa • 04 – 08 December 2011
Women’s Voices:
…on prevention of vertical transmission programmes…
T he programme doesn’t address the needs and realities of women,
because there are no adequate information to all the communities
and women who should access the services; thus leading to stigma and
discrimination from the communities… [Uganda]
We have a PMTCT policy and most healthcare providers have
not engaged with this document…in as much as the
programme is declaring availability of services in many healthcare
centre, women do not even access the services due to stigma and
hostility by healthcare providers at the facilities…
[Kenya]
First, they should ensure that there are women
living with HIV in the development planning
groups…and secondly, that there is support for those
women to participate and that their recommendations
are actually listened to and acted upon…
[India]
The health workers in rural areas cannot meet the large number of women who need the services…there is a shortage
of personnel and the existing few are not well conversant with the programme, due to lack of in-service training…
the most affected women are from the society of women living with HIV…we have good guidelines on vertical
transmission, but they are kept on the shelf…
[Tanzania]
Women in rural areas still face challenges in accessing
services…for starters, PMTCT is institution-based, which
brings into play issues of transport and shelter costs, particular for
rural women…an assessment of what is happening on the ground
has shown that the quality and level of prevention of vertical
transmission services offered at rural and urban health centres
differs…most of the services are found in urban areas, even
though 70% of the population is rural-based…
[Zimbabwe]
Firstly, a lot of women in rural areas have no access
to PMTCT and as such are at risk of transmitting the
virus to their unborn babies…secondly, gender barriers
are also causing a lot of harm, as some women are not
given the opportunity by their husbands to participate,
owing to cultural beliefs…thirdly, a lot of facilities
don’t carry out PMTCT programmes…and fourthly, fear
of stigma prevents many from accessing PMTC…
[Nigeria]
Supported by the Oxfam HIV and AIDS Programme
(South Africa)
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: FA Print
www.aln.org.za www.athenanetwork.org