Unfinished Business: Effective Partnerships for Human Security and Sustainable Development

HIV/AIDS and gender based violence (GBV) are global emergencies with a devastating impact on women’s health. Today, more than half of the 40 million people living with HIV/AIDS are women. The feminization of the epidemic is caused not only by women’s physiological vulnerability, but also by gender inequality and social factors such as discrimination and low socio-economic status that limit women’s access to information, education, health care and treatment.

Infection rates are growing faster in the context of marriage and among young women.  In Trinidad and Tobago, for example, young women are six times more likely to be HIV positive then men of the same age. In Honduras, AIDS is the primary cause of mortality among young women. In Sub Saharan Africa 59% of adults living with HIV/AIDS are women, with young women facing the highest risk of transmission. Increasingly, the face of HIV/AIDS is a woman’s face. The Political Declaration adopted by the UN General Assembly Special Session on HIV/AIDS in June 2006 expressed deep concern by “the overall expansion and feminization of the pandemic and … recognize[d] that gender inequalities and all forms of violence against women and girls increase their vulnerability to HIV/AIDS.” 

GBV is also a pervasive and shocking problem with grave consequences to women’s health all over the world. Globally, “one in every three women has been beaten, coerced into sex, or otherwise abused in her lifetime; between 30% and 60% of ever-partnered women have experienced physical or sexual violence, or both, by an intimate partner; and between 7% and 48% of girls and young women aged 10-24 years report their first sexual encounter as coerced.”  The proportion of women who have suffered intimate partner violence has been recorded at 11% in Colombia, 10% in Nicaragua, 17% in Haiti, and 23% in Mexico and Peru.

HIV/AIDS and GBV are linked in multiple ways. Coerced sex increases women’s vulnerability to HIV/AIDS by heavily reducing or eliminating the possibility of using condoms and also by causing injuries to the vaginal wall. Fear of violence from an intimate partner prevents many women from choosing if and when to have sex, as well as reduces their ability to negotiate safe sexual behaviors, such as the use of condoms. Moreover, women who are HIV positive face considerable risk of violence and discrimination from their partners, their family and society as a whole. This fear of violence can prevent women from seeking voluntary counseling and testing for HIV, disclosing their serostatus, and receiving adequate treatment. One study of women in four African countries found that a quarter of all HIV positive women got infected through non-consensual sex, that is, rape. Although it has been clear for some time now that HIV/AIDS and GBV are intertwined, international efforts to fight HIV/AIDS have often failed to address power disparities between men and women. GBV, one of the main risk factors for contracting HIV/AIDS, has repeatedly been ignored, severely limiting the impact of global prevention efforts.

Health care providers are in an ideal position to identify women at risk of both GBV and HIV, as well as to provide or link them to much-needed services and support. Response to these issues not only improves overall quality of health care, but also promotes a change in societal attitudes. A number of IPPF/WHR’s Member Associations have pioneered efforts to integrate GBV and HIV into their sexual and reproductive health services and provide models for ground-level actions. Profamilia, the Member Association in the Dominican Republic, offers comprehensive treatment and care for persons living with HIV/AIDS. In addition to training around HIV care, Profamilia staff participated in sensitization around GBV, with providers receiving training on counseling victims of GBV and use of local referral networks. Evaluation of Profamilia’s HIV program revealed that counselors provide frequent emotional support in particular to the HIV-positive women, who express fear about notifying a husband or partner about their status. Staff strategizes with clients about how to disclose to partners, as well as steps to ensure their safety and well-being.

Another model is that of INPPARES, our Member Association in Peru, which has begun a project to better involve men in the efforts to reduce gender disparity. Headquartered at a male-only clinic, INPPARES staff will recruit men from the community and provide them access to comprehensive sexual health services, as well as educate them on issues of gender and sexual and reproductive health issues, including HIV. These men will then become educators of their peers; facilitating improved access to services and encouraging men to be more involved in their own sexual and reproductive health, as well as that of their family members.

The facts are well known to this audience. All of us are aware that HIV/AIDS and GBV constitute dramatic health and human rights crises, yet both can be prevented. What can we do to use this knowledge to promote the social changes that are needed? 

I would like to suggest that we start right here. We start by fostering the political commitment to empower women inside this noble institution. I firmly believe that we need a new and strong entity inside the United Nations; one that is capable of promoting and furthering women’s empowerment across the globe. Such an entity “would not replace the women-targeted programs being carried out by UN agencies. Instead it would encourage more of such programs, and would help all UN departments and agencies to bring a gender perspective to all of their work … It would have the capacity to develop policy; to provide technical advise and assistance on women’s empowerment in every specialized field; to support and monitor the gender-related work of other UN agencies; and to work closely with government partners to plan and oversee programs at the national level.” I am convinced that this entity will make international efforts more efficient by putting women back into the development equation.

References:

  1. UN Millennium Project 2005a.
  3. Rothschild C, Reilly MA & Nordstrom S, 2006. Strengthening Resistance, Confronting Violence against Women and HIV/AIDS. Center for Women’s Global Leadership.  Fact Sheet on Gender
  4. Based Violence and HIV/AIDS. Pan American Health Organization. Available at: http://www.paho.org/English/AD/GE/Viol-HIV_FS0705.pdf.

 

Statement by Regional Director Carmen Barroso at the 36th Session of the Commission on Population and Development

Mr. Chairman,

It is a pleasure to address this session of the Commission on Population and Development when the important theme of population, education and development is being discussed. In the first days of the meeting it was very gratifying to hear the delegates' strong reaffirmation of the principles of the Cairo Conference. Today, more than ever, we need this firm commitment to address the tremendous obstacles that still preclude the full implementation of the visionary document adopted at the ICPD in 1994. We therefore applaud the recommendation of a non-negotiating technical review exercise, and the call for mobilization of additional resources needed to reach the Cairo objectives.

Mr. Chairman,

It is important that civil society organizations — which have greatly contributed to laying down the foundations for the Cairo agreement — continue to play an important role in the future of its implementation. The NGO community should celebrate that landmark consensus achieved almost ten years ago and develop a forward-looking strategy with a full understanding of the importance of the Cairo principles for the achievement of the Millennium Development Goals. IPPF intends to do just that, in collaboration with key partners which stand united in the defense of sexual and reproductive health and rights for women, men and adolescents around the world.

Mr. Chairman,

Regarding item 5 of the agenda, which we are now discussing, we would like to submit that policies regarding comprehensive sexuality education are one of the most important emerging policy issues, and therefore deserve much greater attention in the future program of work of the secretariat in the field of population. Governments around the world are extremely worried with the catastrophic effects of the HIV/AIDS pandemic, which has been identified as the most significant demographic concern in document E/CN.9/2003/6. The same document quotes the study done in 39 developing countries which shows that despite the widespread awareness of HIV/AIDS in many countries, behavior remains risky, and that women are generally less knowledgeable than men about HIV/AIDS. Gender power inequalities are major factors behind both of these disturbing findings. Gender stereotypes that glorify female naiveté and male recklessness need to be addressed by rights-based, gender-sensitive sexuality education focused on decreasing risks and vulnerabilities, especially of the young cohorts.

As young people begin their sexual and reproductive lives, they need to have information available to them so that they may enjoy a healthy and pleasurable sexuality. The lack of information makes young people particularly vulnerable to several reproductive health risks, including sexually transmitted infections, unplanned pregnancies and sexual violence.

Governments have recognized the need for sexuality education in international agreements such as the one reached in the Beijing + 5 conference. In addition to the ravaging effects of the HIV pandemic among youngsters and on the economy of their countries, governments have come to realize that lack of sexuality education has contributed to young people's accounting for an increased share of population growth (due to early childbearing by the largest cohort of young people in history).

Mr. Chairman,

Sexuality education is a major component of reproductive and sexual rights, which gained growing international recognition in the 1990s. NGOs and international civil society networks have been at the forefront of the development of the concept of reproductive and sexual rights. For example, the International Planned Parenthood Federation adopted the IPPF Charter on Sexual and Reproductive Rights, which is based on international human rights law and became the ethical framework for its mission and programs. The right to information and education, recognized in the Universal Declaration of Human Rights promulgated in 1948, is specified in the IPPF Charter in the following way:

 "All persons have the right of access to education and correct information related to their sexual and reproductive health, rights and responsibilities which is gender sensitive, free from stereotypes, and presented in an objective, critical and pluralistic manner.

 "All persons have the right to sufficient education and information to ensure that any decisions they make related to their sexual and reproductive life are made with full, free and informed consent.

"All persons have the right to full information as to the relative benefits, risks and effectiveness of all methods of fertility regulation and the prevention of unplanned pregnancies."

IPPF's youth strategy is built upon a commitment to the right of young people to have access to quality sexuality education and reproductive health services. To this end, IPPF promotes the development of youth programs that address young people's specific needs in a sensitive and nonjudgmental way.

Many of IPPF's associations are working in schools to integrate comprehensive sex education and STI/HIV prevention into the regular curriculum. This has proven to be an effective strategy for improving adolescents' knowledge, attitudes, and behavior related to sexuality and safe-sex practices.

The recent adoption of HIV prevention strategies in the education systems is most needed and welcome. Progress in this area could be greater, however, with a broader view of sexuality education. Going beyond HIV prevention to a sexual and reproductive health and rights approach would have the major advantage of casting the efforts in a positive light. Educators have long known that instilling fear of a negative outcome is more likely to lead to avoidance and denial than to sustained motivation. Comprehensive sexuality education, by helping young people understand and deal positively with desire, passion and pleasure, can contribute to healthy human development in line with what WHO describes as sexual health: "the integration of the somatic, emotional, intellectual, and social aspects of sexual well-being in a way that is positively enriching and that enhance personality, communication and love."

In many countries opinion research suggests that a significant majority supports sexuality education in the schools. Sexuality education can also be seen, however, as threatening by some policy makers and parents, for two main reasons. First, many know little about sexuality education. There is a growing accumulation of experience on sexuality education in different parts of the world, but it is still not well documented and disseminated. Second, some fear that sexuality education may lead to unwanted changes in sexual behavior and attitudes. Researchers have shown that sexuality education does not lead to earlier sexual activity. An authoritative review of the state of the art in comprehensive sexuality education policies and programs could help build a comfort zone for decision makers.

Thank you very much.