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Women's and Girls' Health in South Asia: Challenges for Global Policy

A woman suffering from HIV/AIDS uses a stick to walk back to her bed in hospital. Cambodia. (© Masaru Goto / World Bank)

A woman suffering from HIV/AIDS uses a stick to walk back to her bed in hospital. Cambodia. (© Masaru Goto / World Bank)

October 28, 2003

Made possible by the generous support of the
Bill & Melinda Gates Foundation.

Lucille Atkin, Director of Margaret Sanger Center International/ Vice President of International Programs, Planned Parenthood of New York City
Nirmal Bista, Director-General of Family Planning Association of Nepal
Kati Marton, journalist, human rights advocate, Board Chair, International Women's Health Coalition

Moderator: Adrienne Germain, President of International Women's Health Coalition

Sheila Platt: Good evening and welcome everyone. I am Sheila Platt. I am a member of the Asia Society and also a social worker and my work in the Philippines and in Pakistan and particularly in Zambia, among other countries, has for many years involved refugees and displaced persons. I saw the beginning of the HIV/AIDS pandemic while living in Zambia in the early 1980s and I have been very aware ever since of the dreadful effect that is happening in Zambia and elsewhere to women's and girls' health and human rights.

The Asia Society is very pleased tonight to host a timely and important program, Securing Women's and Girls' Health in South Asia: Challenges for Global Policy. The panelists will discuss the critical challenges that lie ahead in securing reproductive health rights for women and girls in South Asia. They will in particular look at the impact of HIV/AIDS on women and girls in the region and consider strategies to address the growing crisis. They will argue that women must be at the heart of health policy debates, both in the US and abroad. It is my privilege to introduce tonight's distinguished panelists.

At the far side we have Adrienne Germain, president of the International Women's Health Coalition. Then there is Kati Marton. She is an award-winning journalist, a human rights advocate and the new board chair of the International Women's Health Coalition. Congratulations, Kati. Then we have Dr. Nirmal Bista, Director-General of Family planning Association of Nepal. And finally we have Dr. Lucille Atkin, Director of the Margaret Sanger Center International and also vice president of international programs, Planned Parenthood of New York. You have more information about the speakers in the program.

Tonight's program is part of the Asia Society's Asian Social Issues Program, known as ASIP around here. It is a public education initiative that looks at the critical social challenges and emerging strategies to address them in Asia in general. For the last four years ASIP has played an important convening role to discuss issues in human rights, including women's and children's rights, poverty, the environment, conflict, among others. We are also pleased to acknowledge the support of Bill and Melinda Gates, who through their foundation have funded a new initiative, AIDS in Asia. And tonight's event is part of this new initiative.

For those of you who may be new or who are coming here for the first time to the Asia Society, welcome. And let me take this opportunity to extend the invitation to join us through our various levels of membership and there are membership brochures outside in the lobby. Without further ado, let me turn to our panel and I would ask you to please welcome Adrienne Germain.

Adrienne Germain: Welcome to all of you and thank you for coming to discuss this terribly vital and important topic.

I visited India for the first time thirty years ago, in 1973. Indian colleagues of many backgrounds introduced me to women in isolated rural areas and in sprawling cities. Since then I have returned often to India, Pakistan and Bangladesh, usually focusing on the health opportunities and rights of girls and women. I have always ended my visits optimistic, due to the steadily growing strength of South Asian women leaders and organizations. I have always felt buoyed by increasing awareness of the central importance of improving women's lives, securing their human rights and moving toward gender equality across the subcontinent.

Last week I returned from a two-week stay in India that took me from villages in southern Rajasthan to the red light district of Calcutta and to India's Silicone Valley, Bangalore. I met with NGO leaders and staff, business men and women, government officials and donors. I talked with teenage boys and girls in Delhi's so-called resettlement areas and with young women living with HIV/AIDS. This time, for the first time in thirty years, I came home with a sense of desperation.

In the early 1980s when the first HIV/AIDS cases were identified in the US and Africa, I was living in Bangladesh. As the resident representative of the Ford Foundation, I funded the first ever research in the subcontinent on sexually transmitted diseases. I knew deeply and firsthand the circumstances that girls and women across South Asia faced, circumstances that would make them especially vulnerable to HIV. I had learned from South Asian women and girls themselves about child brides, about sexual coercion and violence, about sex discrimination and education and employment and about the failure of national programs to promote condoms or require men to respect women's rights. I knew and worked with many South Asian colleagues who wanted their countries to address these problems in their own way. I also knew that these countries needed to close the gender gaps that foster HIV/AIDS before it could gain a foothold. And I said so. But back then no one with power listened.

Twenty years later, South Asia is on the brink of an unprecedented catastrophe. Large populations and inadequate national policies and programs mean that the number of people infected and affected by HIV/AIDS in South Asia could dwarf anything we have yet seen, even in sub-Saharan Africa. India alone has an estimated 4.5 million people living with HIV/AIDS, the second largest number of such people in any one country. Some experts with whom I am inclined to agree actually estimate that the number of people living with HIV/AIDS in India is more likely to be close to 10 million and already 40% of these are female, most of them girls and young women. As elsewhere, young people in South Asia are disproportionately at risk, especially girls and young women. Well over one quarter of all the adolescents, the 10 to 19 year olds, in the entire world, live in South Asia. How they learn, what they learn and what they do about sex will substantially determine the course of their lives, their country's progress and survival and the course of the HIV/AIDS epidemic.

In India, HIV/AIDS has already spread to the general population, even to the isolated villages of Rajasthan that I visited two weeks ago. Across India and the entire subcontinent, the epidemic is driven by poverty, drought and other conditions that force men to migrate in search of work. Away from home, they have sex with women in brothels or along the truck routes or on construction sites. They return home to infect their wives and their babies. Other girls and women are at risk from sexual violence or child marriage to older men or unsafe health services and predominantly, ignorance. Most people in South Asia with HIV/AIDS do not know that they have it.

Unless we improve the status and opportunities of girls and women in South Asia and protect their human rights, there is no hope of controlling HIV/AIDS. We know what to do. Advocates, activists, practitioners for women's health and rights, inside and outside governments and across South Asia have worked for 30 years to identify effective strategies and interventions. What is needed now is massive mobilization of both government and civil society to end discrimination against girls and women and abuses of their human rights. Two of our panelists tonight will reflect on what is feasible in India and Nepal.

What about the international community, all of us here? And the global health policy makers and donors? What are we going to do and how well will we help South Asia meet these challenges. Sad to say, for me, right now the glass is half empty, not half full. Global actors are mobilizing to support interventions in South Asia like those used in Africa and the United States early in the epidemic, promoting condom use by sex workers and their clients, protecting blood supplies and working with the gay community and IV drug users. More recently, they have also begun to fund HIV counseling, testing and treatment. These are all critically important.