The Global Center’s Christine Lubinski and David Bryden attended a State Department forum on HIV and gender Thursday. Here’s their report:
“HIV has a woman’s face.” That statement was part of Melanne Verveer’s opening remarks Thursday at a State Department forum. Verveer, the Obama Administration’s ambassador-at-large for global women’s issues, highlighted the now well-known facts about women and HIV: half of all HIV-infected persons are women, with the proportion increasing to 60 percent in sub-Saharan Africa, and the special vulnerability of girls, which translates into a double to quadruple risk of contracting HIV compared to their young male counterparts.
She noted with urgency that HIV is a major factor in maternal mortality and cited alarming information from a study released this month that showed that maternal mortality ratios in Johannesburg, South Africa, in HIV-infected women are more than six times higher than in HIV-negative women. “We really need to understand and work through this,” Verveer said.
She proceeded to identify the myriad factors that contribute to this epidemiological reality—from unequal power relationships between men and women, lack of educational and/or economic opportunities, the prevalence of gender violence—before turning to the Obama Administration’s Global Health Initiative.
A central principle of the GHI will be a woman-centered model of care and commitment to ensuring that women and their families have access to basic health care services, as well as disease-specific interventions. One example she highlighted, and was clearly personally outraged about, was a situation where a woman receives a PMTCT drug intervention, but neither the mother nor the child receives any follow up health care. She talked about structural changes in facilities and staff to make them more woman and family friendly.
Andrew Tusabe, Second Counsellor (Acting Chargé d’Affaires) from the Embassy of Rwanda, Washington, D.C., also spoke at the event. He pointed out the gains that women have made in Rwanda in terms of their representation in the Parliament. He also made clear his appreciation to the United States government for the assistance through PEPFAR and the President’s Malaria Initiative, which he said have saved lives in his country.
Dr. Lynn Collins, a Technical Advisor at the United Nations Population Fund, pointed out that despite significant progress on what she termed convergence of services to meet women’s needs, still far too few HIV/AIDS strategies reflect the changes that are necessary. She cited UNAIDS data showing that only 47% of the AIDS strategies at the national level include a women’s component together with a budget for these activities. This is a “terrible legacy of gender inequality,” she noted.
Michele Moloney-Kitts, Assistant Global AIDS Coordinator for PEPFAR highlighted the key gender-related cross-cutting strategies:
• Increase gender equity
• Reduce violence and coercion
• Address male norms and behaviors
• Increase women’s legal rights and protection
• Increase women’s access to income
Maloney-Kitts offered some data points on PEPFAR services—64 percent of persons receiving HIV testing services and 63 percent of women receiving PEPFAR-supported ART are women. Regarding the effectiveness of prevention, she showed the audience impressive new data showing a significant drop in HIV incidence among young women in South Africa between 2005 and 2008.
PEPFAR is supporting programs aimed at reducing gender-based violence in every country where they have a program, and there is a cross-cutting budget code for gender based violence programs. She said one hopeful sign was that that South Africans are more and more concerned about the enormous rate of gender-based violence there damaging the country’s international reputation.
PEPFAR is committed to strengthening the intersection between HIV, family planning, and safe motherhood, she said, and she stressed integration of services and the practical necessity of co-location of services. For instance, PEPFAR hopes to use PMTCT programs as a platform for expanding women and family health services. Moloney-Kitts proudly reported that PEPFAR funding was being used for cervical cancer screening and treatment in HIV positive women.
Maloney-Kitts also noted the importance of delivering services to men, citing figures that showed men were accessing AIDS care at a much lower rate than women. She said PEPFAR was responding by delivering some services in places men are more likely to feel comfortable, such as at the post office or at cafes and football clubs. She also said she was very happy that PEPFAR has been a leader in expanding access to male circumcision, which she said was “incredibly promising.”
In response to a query from the audience, she did acknowledge that, despite concerns over increasing the reporting burden on programs, it was a “disgrace” that there is no gender outcome indicator, given how important outcome indicators are for PEPFAR-funded programs. She agreed that this was essential to taking gender programs from “boutique” level to larger scale. She said this was also a huge problem for the Global Fund, which, though its new gender strategy shows progress, also lacks such an indicator.
Regarding PEPFAR’s new Partnership Frameworks she said that US ambassadors had clear instructions that gender, along with stigma and discrimination, must be included in the negotiations of the partnership agreements. She said that forthcoming documents on these partnerships would show more detail on this and other issues.
The panel was asked about the need for not only “basic care” but also advanced care such as AIDS medication and the latest in prevention technologies. Collins said treatment must be considered a human right, and she expressed her confidence that the prices of more advanced services would eventually fall. Ambassador Verveer agreed that care should not be limited to “basic care” or “basic services” narrowly defined.
Another interesting question was about genital schistosomiasis and HIV. A recent study from Zimbabwe showed that the genital lesions caused by the waterborne parasite schistoma haemotobium increased the risk of acquiring HIV infection threefold in women living in rural Zimbabwe. Malone Kitts said PEPFAR was aware of the problem and in fact had recently held a meeting about the issue.