The Challenge to Sustainable Development in Africa: The Gender Dimension of HIV/AIDS, Peace and Economic Security
By Noeleen Heyzer, Executive Director, UNIFEM
Date: 21 June 2001
Occasion: ECOSOC High Level Panel, New York, 21 June 2001
President, Delegates, Colleagues and Friends,
I am very pleased to be invited to address this meeting of the Economic and Social Council in preparation for the upcoming meeting in Geneva in July. We would like to take the opportunity provided by this session, to further the call for increased accountability to achieving gender equality, and understanding the gender dimensions of HIV/AIDS, peace and economic security.
What is abundantly clear to us all, is that AIDS has escalated into the raging epidemic it is because the power imbalances between women and men continue to be pervasive and persistent. UNIFEM in its work on economic empowerment, peace and security and human rights has addressed these imbalances in many ways. But it is the HIV/AIDS epidemic that has underscored most dramatically the direct correlation between women's low status, the violation of their human rights and HIV transmission. If women were routinely able to negotiate safe sex the epidemic would not by out of control. If women were able to say "no" to unwanted sex and be both heard and heeded, we could tame the epidemic.
In exploring this further, I would like, this afternoon, to address four points: Firstly, why is the HIV/AIDS epidemic a gender issue? Secondly in what way conflict situations aggravate the spread of HIV/AIDS, and thirdly, what are we learning about how to address the gender dimensions and women's roles in building peace and security. My fourth point relates to some actions we can take together.
In addressing the first point, the "why " question, I want to just touch on statistics that show how women at the very epicentre of the epidemic. Of the 34.7 million adults living with HIV/AIDS world wide in the year 2000, 47 percent -- or 16.4 million - were women. Just three years earlier, in 1997, that figure was 41 percent. In sub-Saharan Africa however, women now account for 55 percent of the total number of adults living with the virus. For teenage girls in some of the hardest hit countries in the region, the reality is even bleaker: they are infected at a rate of five or six times higher than teenage boys. These numbers have both biological and social reasons.
For instance, a study in Zambia showed that less that 25 percent of the women interviewed believed that a married woman could refuse to have sex with her husband, even if she knew he had been unfaithful and was infected. Only 11 percent though that a woman could ask her husband to use a condom. Women and girls are often silenced by ignorance and fear and doomed by their powerlessness to resist the dangers they face. Women's lack knowledge of their own reproductive systems leads to a their lack of appreciation of the health risks associated with sexual activity. But girls and women may actually resist becoming informed because cultures that prize virginity for women at marriage often equate knowledge about sex with sexual experience. The legalization by some countries of measures to prevent for instance, wife inheritance, female genital mutilation, domestic violence, and polygamy provide excellent examples of government attempts to take the first steps to correct the gender imbalances reflected in cultural practices.
Because these unequal gender relations are based on power, women are at a deadly disadvantage with regard to HIV/AIDS. And, yet, we already know much of what is required to minimize risks and create a more equal balance of power between men and women. Women need to be encouraged, empowered and enabled to safely say 'no' to unsafe sex. Families need to share their resources, however limited, to provide health care not only for their men, but for their HIV-infected mothers, wives, sisters and daughters. Communities and countries need to care for - rather than isolate and stigmatize - women living with HIV and AIDS who are trying to piece together their livelihoods and their lives. Governments need to understand that women are the social safety net for infected family members and that social service programmes and other support services are needed to lighten this additional burden for women and girls.
The second point I would like to address, relates to the intersection between conflict and HIV/AIDS.
When we cast our attention to countries affected by the horrors of armed conflict we move into a darker zone with regards to the spread of HIV. Out of two dozen or more conflicts raging around the world, about half are in Africa. HIV/AIDS kills ten times more people than war in Sub-Saharan Africa. The chaotic and brutal circumstances of war aggravate all the factors that fuel the HIV/AIDS crisis. War breaks up families and communities, creating millions of refugees and placing women and children in great peril of sexual attack even within the confines of refugee camps which are supposed to provide protection. Increasingly, warring factions rely on systematic rape used to terrorise opposing forces.
The impact can be seen in Rwanda, for instance, where of the 2000 women tested for HIV in the five years following the genocide, 80 per cent were found to be positive. Many of these were young girls who were not sexually active before the genocide.
It can be seen in countries such as Sierra Leone and Northern Uganda where girls were voluntarily or forcibly recruited into rebel forces to be coerced into have sex with one or multiple male fighters, increasing their risk of being infected with HIV.
It can be seen in Uganda, where in the early years of the epidemic whole villages along the road traversed by the military were wiped out by AIDS.
Conflict also destroys the health services that might have been able to identify the diseases associated with HIV/AIDS or screen the blood that might transmit it. Schools which might have been a place for teaching about prevention are demolished.
But the upheavals that give rise to violence are not only found in situations of armed conflict and war. Violence is suffered by women at the community and the family level as well. Women and girls are frequently forced or coerced into sex, in and outside of marriage. Often, because they are pregnant and attend maternity clinics, they are the first member of a family to be tested. It is not unusual for them to be blamed for bringing the virus into the family although this is more often the role of their husbands and partners. The case of Gugu Dlamini highlights the violence afflicted at the community level. The brave young woman had the courage to declare her status as a woman living with HIV publicly on World AIDS day in South Africa in 1998. She was stoned to death, soon after, by a group of young men in her community.
And thirdly, what lessons have we learned?
We can find inspiration in the many ways that women are responding to this epidemic, including in projects that UNIFEM is supporting. In all regions, women are organizing new livelihood opportunities for networks of women living with HIV/AIDS, launching community research and advocacy strategies to educate other women about their risks and rights, and linking strategies to end HIV/AIDS with strategies to end violence and poverty. UNIFEM and its partners have been involved in numerous pilot projects that have yielded important information about how to address the scourge of HIV/AIDS. For instance, in partnership with the Senegal chapter of Society for Women and AIDS in Africa, UNIFEM piloted and tested new approaches in empowerment women to negotiate safe sex. Over a three month period women were trained in the use of female condoms, they were trained in negotiating skills and were provided with condoms. The result was a full 80 percent of the women being able to protect themselves from unsafe sex. The key to these positive results was the negotiations training.
Now, we need support and political will to ensure that lessons learned from the many good practices underpin all policies and strategies related to ending HIV/AIDS, and that women are central to prevention and treatment plans, as well as to finding sustainable solutions to this pandemic.
While it is devastating to communities and countries, the HIV/AIDS epidemic can also be heard as a wake up call. As such is requires commitment and action.
Which brings me to my final point: What actions are needed?
Alas, thus far, a gender perspective has been sorely absent from too many National AIDS Plans, public health policies, prevention, treatment and care strategies and all other mechanisms designed to address the scale of the epidemic. Unless Governments are accountable and funds are allocated at the international and national level in order to address gender inequality, unless the relationship between gender inequality and the HIV/AIDS pandemic is fully appreciated, we at UNIFEM are seriously concerned that efforts to reverse the pandemic will be futile.
UNIFEM would urge every member state, every donor, every UN agency to heed three minimum, urgent calls to action:
MAKE GENDER EQUALITY THE GUIDING PRINCIPLE of the global response to HIV/AIDS from this point forward. Our success in this third decade will depend on whether or not we apply the lessons of the first 20 years. Let us guarantee that for every plan, every programme, every campaign and every allocation, the answer to these three basic questions is an unconditional 'yes': Did women have an equal say in the design? Did women participate fully in the decision-making? And will women and girls derive equal benefit from the responses we've put in place?
TARGET ALL ACTIONS to ensure that specific efforts are undertaken to address the particular needs and special circumstances of women and girls. We now know that, at every point along the HIV/AIDS continuum, from preventing the spread of the virus to diminishing its impact, this crisis is different for females and males. Disaggregating data by sex is a first critical step - a prerequisite to fully understanding those differences, and to focusing future resource allocations, medical research, legislative reform, and social security schemes in targeted ways to guarantee equal access and benefit for women and girls.
MAKE THE CONNECTION BETWEEN VIOLENCE AND HIV/AIDS as evident in our responses as it is in the lives of women and girls. Wherever a woman lives with conflict and upheaval - in a violent home or a country at war - the threat of infection from HIV/AIDS and the effects of its damage are multiplied. Our responses must recognize this deadly alliance, and put special measures in place to protect women in already violent circumstances - in refugee camps, in militarized zones, in communities that condone marital rape and subordination of women -- from the added threat of HIV/AIDS.
Gender equality is a key solution to the spread of HIV/AIDS. In memory of the 9 million women who have died over the past two decades, use it.
I thank you.