In 1981, when the first cases of HIV/AIDS were identified in the United States and Africa, I was living in Bangladesh. Since then, I have watched with horror the gathering momentum of the AIDS pandemic. It is a dreadful disease. But for women, what AIDS also does is expose just how badly the world still treats them.
Women are affected by HIV in countless ways. They are the caretakers of husbands, children, parents and neighbors living with HIV/AIDS. They worry about how to protect themselves and their children from infection. Sexual coercion and violence against women are rampant inside and outside marriage, heightening their risk of infection. Those living with HIV/AIDS, or whose partners die of AIDS, are often beaten, stigmatized and rejected by their families.
Ensuring equal access to prevention, treatment, care and support for women and girls requires ending the gender inequality and discrimination that drive the pandemic. Women are put at risk of contracting HIV in countless ways: widespread sexual coercion and violence; marriage of young girls to much older men; lack of access to HIV information, sexuality education, and reproductive health services all fuel girls’ and women’s vulnerability. Worldwide, in diverse contexts, women and girls do not have equal access to education, or the power to earn a livelihood, control their relationships, or make their own life choices. As a result, today half of the people living with HIV/AIDS are female, and rates of infection in women and girls are rising.
Three priority actions
Changing the HIV/AIDS prevention paradigm to reduce and eliminate, as a central priority, girls’ and women’s vulnerability to HIV requires three priority actions.
First, to reach girls and women, HIV/AIDS policies and budgets must expand access to sexual and reproductive health services, not just build separate HIV facilities. Reproductive health services are established and accepted by families and communities. They have critical core capacities we can build on to provide the full range of reproductive health services, including quality pregnancy and delivery care, testing, diagnosis and treatment for sexually transmitted infections, including HIV; male and female condoms, and other contraceptives. By investing in these services, we will strengthen national health systems as a core foundation to meet all public health goals.
Our second priority is to raise new generations to treat each other differently. A major avenue for this is comprehensive sexuality and gender education—that not only provides full and accurate information about HIV/AIDS, but also helps young people build skills for equality in relationships; respect the right to consent in both sex and marriage; and end violence and sexual coercion. Such programs provide girls with safe spaces, free from harassment and discrimination; alternatives to early marriage; and activities to help build their self-esteem and confidence. These programs help boys learn to take responsibility for their own behaviors and understand that violence and coercive sex are neither their birthright, nor proof of masculinity.
Third, we must increase investment in technologies which put the power of prevention in women’s hands. This means subsidizing universal access to female condoms so that they are affordable and available to all women and girls. It means doubling research and development financing for microbicides, and continued funding for vaccine development.
Beyond these three priorities, women, who know women’s realities, must be included in decision-making and in leadership at all levels and in all sectors. This includes setting and monitoring of gender equality goals in all sectors—to secure the laws, economic opportunities and resources, education and social recognition—that will empower girls and women.
Since her pioneering work for women’s equality in all sectors in the 1970s and 80s with the Ford Foundation, including four years in Bangladesh as the Foundation’s country representative, Adrienne Germain has helped reshape global policies on women’s health and human rights. Working with U.S. and European governments, as well as government agencies of Bangladesh, India, Indonesia, Nigeria, Brazil and others, Ms. Germain has fostered national health policy and program innovations, and helped build capacity of local nongovernmental organizations, in countries of Africa, Asia and Latin America, to advocate for and deliver programs that protect the sexual and reproductive rights and health of women and young people. She is a member of UNDP’s Expert Group on Gender and AIDS Responses and participates in the UNAIDS Programme Coordinating Board. She speaks and publishes extensively on women and HIV/AIDS, global health policy and funding, and youth health and rights, and also advises donor governments and philanthropic institutions on these issues.