HIV/AIDS: Feminization of the Epidemic

Statement by Thoraya Ahmed Obaid, Executive Director, UNFPA

I am pleased to be able to join you by video. I should like to thank AusAID, the Australian Agency for International Development, for inviting me to share a few opening remarks at the start of this important symposium.

We are here today in response to a terrifying trend, which personally worries me relentlessly: the feminization of the AIDS epidemic.

Over the past three years, the number of women living with HIV has risen in each and every region of the world, with the steepest increase being in East Asia.

Women now account for nearly half of all people living with HIV worldwide. The feminization of the epidemic is in full swing and it will only get worse if nothing is done.

And the sad reality is that many women, who are infected with HIV, or at greatest risk of becoming infected, do not engage in high-risk behaviour. The irony is that they are often put at risk by behaviour and circumstances that are not under their control.

There is growing recognition that, in many parts of the world, marriage and long-term monogamous relationships do not protect women from HIV. Faithfulness offers little protection to wives whose husbands have several partners or had been infected before marriage. Even when wives suspect husbands of being unfaithful, many husbands refuse to use condoms and protect their wives. Many couples are not even aware of their HIV status.

We also know that abstinence is a meaningless option to women who are married or coerced into sex.

The HIV/AIDS epidemic has exposed the deadly consequences of gender inequalities and violations of girls and women’s human rights. Where AIDS is concerned, gender inequality has become fatal.

As such, while we recognise the 'natural' biological susceptibility of women to HIV, it is the 'man-made' structural elements of culture, economic and social inequalities that are significantly pushing HIV infection rates to unacceptable levels among women and girls.

Widespread poverty compounds the issues for women. Economic vulnerability and the dependency that results, makes it more likely that women are forced to sell or exchange sex for money, goods or favours; more likely that they will not discuss fidelity with their partners; more likely that they will not be able to negotiate safer sexual practices such as condom use; and more likely that they will not be able to leave relationships that are abusive and put them at increased risk.

And at another level, the assault of inequality continues. Most of the burden of caring for people living with AIDS falls on women and girls, whether this takes place in health care facilities or in the home. Women are also most likely to lose property and assets on becoming widowed. For those women who are living with AIDS and are poor and rejected, access to anti-retroviral medications is a far-fetched dream. Even where support services may be available, women are victims of stigmatization and usually have less access to HIV/AIDS care and treatment than men.

As long as the status quo remains heavily skewed towards men, more and more women and girls will continue to get infected and be impacted by HIV and AIDS.

I do believe that we are at a turning point. And we must take decisive action to reverse this ever-growing trend. If we firmly believe that women are pivotal—the lynchpin in development, in the stability of families and communities, and that it is a ‘right’ in its own to be able to protect oneself from infection, then we must take decisive actions.

Allow me to share with you what I believe are four important elements to consider as we come together to define what needs to be done to address the feminization of the epidemic in this region and globally.

First is the need for broad structural changes that will stop the disproportionate vulnerability of women and girls to HIV/AIDS. Policies, programmes, legislative frameworks and social norms must guarantee women’s rights, ensure protection from disease and freedom from fear, particularly fear of gender-based violence and discrimination.

Despite the numerous references in national and international documents to the rights of women and girls, far too few countries have actually implemented and enforced policies and laws that protect such rights. It is one thing to realize that women have rights, it is quite another to ensure they can exercise these rights.

As experts and leaders, you are in a unique and credible position to hold your governments accountable to develop, implement and harmonize national and state policies and laws regarding women and girls, and HIV. You can also ensure that these are backed up with the resources necessary to make it happen.

Second is universal access to sexual and reproductive health.

For the vast majority of girls and women, especially those living in poverty, the only acceptable and effective source of information and services is reproductive health services.

We must ensure that sexual and reproductive health programmes are part of every country’s national AIDS plan and development framework. Experts of the United Nations Millennium Project have strongly recommended this. Reproductive health programmes and services must include HIV prevention and care for poor women who can only seek a one-stop centre for their health needs. Equal access to integrated sexual and reproductive health and HIV information and services, including male and female condoms, must be expanded to reach all women and girls, including those living with HIV. HIV prevention, treatment and support initiatives must also recognise the reproductive health needs and rights of women living with HIV and AIDS.

The third element relates to the need to take into account the centrality of culture in designing and implementing programmes to address the feminization of the epidemic.

Culture matters. Patriarchal cultural patterns often exert influences on value systems, which in turn translate into legal systems and governance structures that maintain the unequal status of girls and women.

To halt the epidemic, we must see how to reform culture in such a way as to promote the good and end the harms. Community-based awareness and education, which includes cultural and traditional leaders, is key to such change. Much work has been done in UNFPA to develop culturally sensitive approaches to programming.

My fourth and final point is partnerships. The roles of many players are crucial–health and medical community, civil society, governments, parliamentarians, private sector, donors and development agencies. You may be aware of the Global Coalition on Women and AIDS. This is a worldwide network of civil society groups, governments, United Nations agencies and concerned citizens who have come together to catalyse changes to make the AIDS response work better for women. The Coalition is dedicated to empowering women to take control of their own lives in a world with AIDS. We encourage such a regional partnership to bring greater awareness to this issue and to promote collective/concerted action in response to the feminization of the epidemic in the Asia-Pacific Region.

I am an optimist, and I have seen the potential in people, in our societies and communities, and I know that if we galvanize our authorities—national and international—equip civil society, empower women themselves and address capacity and infrastructure issues, we can and shall protect our women and girls.

I should like to end on a positive note. The factors that make women and girls vulnerable to HIV are amenable to change, given sufficient attention, commitment and resources. It is not beyond us.

I wish you successful deliberations.

Thank you.