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HOME: STATE OF WORLD POPULATION 2004: Preventing HIV/AIDS
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Preventing HIV/AIDS

Impact and Response
Linking HIV Prevention and Reproductive Health Programmes
Condoms
Voluntary Counselling and Testing
Key Challenges

Over two decades into the AIDS pandemic, some 38 million people are living with HIV/AIDS and over 20 million people have died.1 Despite expanding prevention activities, some 5 million new infections are occurring each year. In the hardest-hit countries, the pandemic is reversing decades of development gains.

In 1994, the ICPD Programme of Action noted the severity of the pandemic and projected that the number of people infected with HIV would “rise to between 30 million and 40 million by the end of the decade if effective prevention strategies are not pursued”.2

The ICPD called for a multisectoral approach to AIDS that included raising awareness about the disastrous consequences of the disease, providing information on means of prevention, and addressing the “social, economic, gender and racial inequalities that increase vulnerability”.3 It recognized the harm of stigma and discrimination and the need to protect the human rights of people living with HIV/AIDS.

The Programme of Action also noted that the “social and economic disadvantages that women face make them especially vulnerable to sexually transmitted infections, including HIV”.4 In Africa today, women are 1.3 times more likely than men to be infected with HIV. Young women aged 15-24 are two and a half times more likely to be infected than young men.

INTEGRATE HIV/AIDS PREVENTION WITH REPRODUCTIVE HEALTH SERVICES

Governments should ensure that prevention of and services for sexually transmitted diseases and HIV/AIDS are an integral component of reproductive and sexual health programmes at the primary health-care level.

—Key Actions for the Further Implementation of the Programme of Action
of the International Conference on Population and Development, para. 68

Reproductive health programmes were recognized as essential to preventing HIV through: prevention, detection and treatment of sexually transmitted infections; provision of information, education and counselling for responsible sexual behaviour; and ensuring a reliable supply of condoms.

In its five-year review of ICPD implementation in 1999, the United Nations took note of the worsening pandemic and called for increased resources and stepped-up efforts to combat its spread. Targets were set for reducing HIV prevalence among young people, and for expanding their access to information and services for preventing infection.

Given that more than three fourths of HIV cases are transmitted sexually and an additional 10 per cent are transmitted from mothers to children during labour or delivery or through breastfeeding,(5)linking HIV and reproductive health services is crucial. The pandemic has highlighted the urgent need to improve both primary health services and sexual and reproductive health services.

Impact and Response

HIV/AIDS is taking a terrible toll on individuals and communities in countries with high prevalence. In some sub-Saharan African countries, one quarter of the workforce is infected with HIV. By one estimate, if 15 per cent of a country’s population is HIV positive (a level nine countries are expected to reach by 2010), gross domestic product declines by about 1 per cent each year.(6 )Using this measure, South Africa’s GDP may fall by 17 per cent by 2010.

A recent report from the World Bank and Heidelberg University warns that the long-term impact of AIDS may be even more damaging.(7) AIDS destroys human capital by killing people in the prime of their lives and also affects the way knowledge and skills are transferred from generation to generation. Furthermore, premature adult mortality associated with AIDS weakens investments in education and reduces the proportion of families that can afford to send their children to school.

Fewer than one in five people at high risk of HIV infection have access to proven prevention interventions, according to a 2003 report by the Global HIV Prevention Working Group, an international panel of AIDS experts. Dramatically scaling up proven prevention strategies could avert 29 million of the 45 million new HIV infections expected by 2010, the report said.(8)

Treatment regimes for HIV improved throughout the 1990s, but their cost remained prohibitive for all but the wealthiest countries. While there is now a concerted effort to expand access to treatment— including the WHO-led UNAIDS “3 by 5 Initiative” to reach 3 million people by 2005 and lower drug costs— the vast majority of infected people still do not have access to antiretroviral (ARV) therapy, which can transform AIDS into a chronic disease.

A June 2004 report(9) by the Global HIV Prevention Working Group stressed the importance of integrating HIV prevention interventions into expanding treatment programmes. Increased availability of ARVs, the report stated, will bring more people into health care facilities where they can be reached by HIV prevention messages. But it could also lead to an increase in risky behaviour unless prevention counselling is incorporated into treatment programmes. The group recommended making VCT available in all health care settings where people have access to ARVs.

FEMINIZATION OF THE PANDEMIC. Half of all adults living with HIV/AIDS are female, compared to 41 per cent in 1997. In sub-Saharan Africa, the most affected region, the figure is nearly 60 per cent. The rising rates of infection among women and adolescent girls reflect their greater vulnerability, due to both biological and social factors. Gender inequities and male domination in relationships can increase women’s risk of infection and limit their ability to negotiate condom use. Poverty leads many women and girls into unsafe sexual relations, often with older partners.

This “feminization” of the epidemic is further exacerbated by women’s roles as managers of the household and primary caregivers for family members infected with HIV. Other factors that make the impacts disproportionate include the legal, economic and social inequalities women often face in the areas of education, health care, livelihood opportunities, legal protection and decision-making.

COUNTRIES RESPOND. Three fourths of the countries responding to UNFPA’s 2003 global survey reported adopting a national strategy on HIV/AIDS and 36 per cent said they had specific strategies aimed at high-risk groups. Many countries have established national AIDS commissions and developed policies and programmes to address the impact of the pandemic. A growing number of countries are taking a multisectoral approach, involving a wide range of ministries and increased involvement of NGOs. But just 16 per cent reported having passed legislation in support of HIV/AIDS efforts.

23 CONFRONTING INEQUALITY

To address the disproportionate impact of HIV/AIDS on women and girls, UNAIDS launched the Global Coalition on Women and AIDS at a February 2004 meeting chaired by UNFPA Executive Director Thoraya Obaid. The advocacy initiative will focus on preventing new HIV infections among women and girls, promoting equal access to HIV care and treatment, accelerating microbicides research, protecting women’s property and inheritance rights and reducing violence against women.

UNAIDS, the United Nations Development Fund for Women (UNIFEM) and UNFPA issued a joint report in July 2004, Women and AIDS, Confronting the Crisis. It calls on governments and the world community to:

  • Ensure that adolescent girls and women have the knowledge and means to prevent HIV infection through advocacy campaigns that convey basic facts about women’s heightened physiological vulnerability and dispel harmful myths and stereotypical notions of masculinity and femininity, warn that marriage does not necessarily offer protection from HIV transmission, and involve both young men and women in promoting sexual and reproductive health.
  • Promote equal and universal access to treatment by ensuring that women make up 50 per cent of people able to access expanded treatment interventions, increasing access to confidential voluntary counselling and testing (VCT) services that take into account unequal power relations and encourage partner testing, expanding reproductive and sexual health services, and training health providers in gender-sensitive care and treatment.
  • Promote girls’ primary and secondary education and women’s literacy by eliminating school fees, promoting zero tolerance for gender-based violence and sexual harassment, offering literacy classes for women that focus on HIV/AIDS and gender equality, providing life skills education both in and out of school, and creating curricula that challenge gender stereotypes and promote girls’ self-esteem.
  • Relieve the unequal domestic workload and caring responsibilities of women and girls for sick family members and orphans by providing social protection mechanisms and support for caregivers, promoting more equitable gender roles in the household, distributing home-care kits, and establishing community fields and kitchens to supplement individual household responsibilities.
  • End all forms of violence against women and girls by undertaking media campaigns on zero tolerance for violence, male responsibility and respect for women, and dangerous behaviour norms, and by providing counselling and post-exposure prophylaxis to all who experience sexual violence.
  • Promote and protect the human rights of women and girls by enacting, strengthening and enforcing laws protecting their rights, reporting violations to the UN Committee on the Elimination of Discrimination Against Women, protecting women’s property and inheritance rights, and supporting free or affordable legal services for women affected by HIV/AIDS.
See Sources

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