Mobilizing Women's Leadership in the Fight Against AIDS

Manifestation of women against AIDS, India (entrelec/Flickr)


October 27, 2004

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Dr. Nafis Sadik
UN Special Envoy to AIDS in Asia

Mary Robinson
Executive Director, Ethical Globalization Initiative
Former UN High Commissioner for Human Rights and President of Ireland

This event emphasizes the importance of empowering women in order to stem the spread of AIDS in Asia.

We are here today to discuss mobilizing women’s leadership in the fight against HIV and AIDS. We’ve been dealing with the HIV/AIDS problem for over 20 years, but I think we are only now beginning to appreciate just how dangerous it is. The numbers tell their own story, over 22 million have already lost their lives and more than 42 million are currently living with HIV/AIDS. The new report from UNAIDS on 2004 situation is on the table outside if you are interested. It has just been released. Even if a vaccine for HIV were discovered today, over 40 million people would still die prematurely as a result of HIV. Just think about it. Most of the worst affected countries are in Sub-Saharan African.

In these countries the pandemic will cause about 100 million additional deaths by 2025. Most AIDS related deaths are young adults and the worst affected countries are loosing a whole generation of people in the prime of their lives. HIV/AIDS is a serious long term threat to health. As we are realizing now it’s much more than that, it’s a threat to social economic progress and so many other dimensions of everyday human life. I want to say a few words about Asia, since this is part of the Asia Society and the Asian Social Issues Program.

I happen to be a board member of the Asia Society and I think this program is one of its best programs. As you know Asia is now home of some of the fastest growing HIV epidemics in the world and this translates into millions of infected and affected lives. Every 1 in 4 new infections worldwide is occurring in Asia and the Pacific in 2003 up from 1 in 5 as recently as 2001. Think about it. The figures are daunting and they’re clear. Since we are going to look at women’s vulnerability, I want to say a few words about the vulnerability of women. Women are increasingly the infected and affected by the epidemic and they are more vulnerable than men. In the Asia region it seems the number of women infected and affected is increasing more rapidly than it did in the early years of Africa epidemic. In one study in India, for example, more than 90% of the HIV positive women were married, monogamous and ever had only one sexual partner. Another 99 study in Thailand found that 80% of HIV infected women were likely infected by their spouses.

About half of all people living with HIV/AIDS in the world are women. Women are especially at risk because they have fewer defenses. In Asian societies for example, but not special to only Asian society, society tends to frown on open discussion of matters of sexual and reproduction health, even between husbands and wives. Many women are kept ignorant and this is very common in Asian. Girls are married and they do not know even the basic facts about sex and reproduction. The result is that married women in Asia, particularly in India, are among the groups were infection is rising at the fastest rate. It’s now being said that marriage is hazardous to a women’s health. Many women and girls are vulnerable to HIV because of the high risk behavior of others.

This year’s worlds AIDS campaign with the tag line, “Have You Heard Me Today?” seeks to raise awareness about and help address the many different issues affecting women and girls around HIV and AIDS. Globally young women and girls are more susceptible to AIDS than men and boys with studies showing that they can be 2½ times more likely to be HIV infected as their male counterpart. Their vulnerability is primarily due to inadequate knowledge about HIV, insufficient access to HIV prevention services, inability to negotiate safe sex and a lack of female controlled HIV preventive methods, such as the female condom and microbicides.

My job as special enjoy for the Secretary General in Asia Specific AIDS is to make people wake up to this. So far the impact of HIV in Asia countries has been relatively light, but of course, silence, denial, stigma, discrimination are all very much prevalent in Asia as they were in the early years in Africa and still continues in many parts of the world. Today we have to work on many different fronts. For example, we need to address trafficking, violence, and child marriage. 13% of Asian adolescent girls are married by the age of 15 and 60% by the time they’re 18. For each of these things we talk about, trafficking, etc., there has to be really zero tolerance.

We also need to strengthen and provide long term support to women’s empowerment in society and their leadership role and to mobilize the strong existing women’s movement in many countries around the world as well as internationally. Everywhere that I travel, I meet a lot of women leaders, whether from government, civil society, people living with AIDS, local communities who know and understand these issues and are working in very hostile environments, consisting of false cultures and one-sided values. We have to find a way to relay their voices to insure that they are heard where they need to be heard. I think strong and courageous leadership is the key to defeating HIV/AIDS. I’m talking about political leaders, presidents, prime ministers, but leadership also at all levels of our society, parliamentarian, civil society, business people, religious leaders, authorities, teachers, scientists, people of standing in their communities, but also get the voices of ordinary people heard.

To lead our discussion today we have a very eminent keynote speaker, Mrs. Mary Robinson. She’s been a crusader for women’s rights, gender equality based on the rule of law, she always said that, and the universality of human rights. As a lawyer, activist, politician, head of state, High Commissioner for Human Rights, and now as the head of very important project called Realizing Rights, The Ethical Globalization Initiative. But she’s also a very strong member of the Global Coalition on Women Against AIDS. I won’t read her CV, it’s in your dossier. But her CV includes many things. Please join me in welcoming Mary Robinson, who’s going to give you the keynote speech.

Mary Robinson
Executive Director, Ethical Globalization Initiative
Former UN High Commissioner for Human Rights and President of Ireland

Good afternoon. Thank you very much both for setting the scene and the context of this very important lunch that is Mobilizing Women’s Leadership in the Fight Against AIDS, the particular reference to Asia. Thank you also for your kind words. I’m going to start by quoting you. We could have gone on listening to you. I want to quote at the start of what you said at one of the speeches you made at the Bangkok conference, it was very memorable, and it does relate to Asia. She said, first the HIV/AIDS pandemic is spreading this Asia/Pacific societies in the same way termites attack a house, invisible at first, catastrophic in the end. Second, that Asia/Pacific can control HIV/AIDS epidemic in the same way that householders control termites, by strict vigilance, early action and determined leadership. Lets bear that in mind.

It is a great pleasure to be back here in the Asia Society and to be invited to lead a discussion on this important issue of mobilizing women’s leadership. I personally believe that women’s leadership is absolutely vital and curiously is the missing link in current efforts to address this global crisis. There are definitely signs of progress, of greater recognition that women can do more by joining forces, to help other women infected and affected by HIV/AIDS. I’d like to reflect briefly on this. We begin by noting that we are at a critical point along the trajectory of HIV/AIDS, particularly in much of Asia. You have been laid out the statistics and I’m not going to repeat those, but in my view, a great deal of attention has been prayed to the spread of the disease in China. I know Mary Ann Leper, who has been in China recently, will speak about China. In South Asia, we know that the epidemic most pronounced in India, where as I understand it, between 2.2 million and 7.6 million people were infected nationally by the end of 2003. That’s according to UNAIDS. These trends may not yet be mirrored in neighboring countries, such as Bangladesh and Nepal, where national HIV prevalence has remained under 1%. But risky behavior in parts of the population is so extensive, that it could be just a matter of time before wider epidemics erupt.

Three Southeast Asian countries have already had to contend with serious nationwide epidemics: Cambodia, Miramar and Thailand. HIV prevalence in Thailand and Cambodia have remained stable in recent years, thanks to resident efforts, which we heard a lot about at the Bangkok conference, to hold the epidemic in check. Two breakthroughs spearheaded these achievements. Condom use in commercial sex increased and men sought the services of sex workers less frequently. Analysis suggests that HIV transmission between spouses has become a more prominent cause of new infections. Can I remind you of what she said? Marriage is hazardous to women’s health. That is a desperate thing to say. It rings home how difficult this situation is. I was actually pleased to hear that earlier this month Vietnam adopted a national strategy on the prevention of

HIV/AIDS that would hopefully draw from the experience of other countries in the region. If AIDS is to avoid the painful path, I would advise those working on HIV/AIDS in Asia, go quickly and talk to your friends in Sub-Saharan Africa, they’ve been there.

They are worried about what they’re hearing and it’s the same things that they heard, the underestimation and denial and everything else. Make that connection.

I also believe that if we’re to tackle AIDS effectively, we must begin by placing human rights at the center of the response. That’s not just because I’m associated with human rights. That’s practical and it’s very real. Non-discrimination, legal protection and equal access to services are critical. Constitutional and national protection of the rights of those infected and affected by HIV/AIDS is still lacking in most countries. States have a particular responsibility to meet that human rights commitment and we must never try to do things that take away the primary responsibility of states. We must remind states of the primary responsibility.

Over time we’ve realized that it’s also wrong to have discrimination on the basis of gender, race or religious beliefs. We’ve also learned that it’s wrong to discriminate on the basis of physical ability or sexual orientation and I think it’s time that we realize that discrimination based on health or HIV status has no place in our societies. Gender equality is at the core of the human rights approach to HIV/AIDS and it forms part of the work that we’re doing in the project that I’m leading, which we call Realizing Rights, The Ethical Globalization Initiative. My Irish friends tell me it’s a ridiculously long title for a very small initiative and they’re perfectly right. Realizing rights has a double meaning. Everyone in the world should realize they have human rights. We guaranteed it in 1948 with the Universal Declaration. We are free and equal in dignity and rights. And secondly, their rights should be realized, should be implemented. Therefore it’s the responsibility of states and other non-state actors, such as transnational corporations, etc.

We must have a gender response that’s sensitive to the needs and multiplies the impact through working with women’s groups and those working with those that are particularly vulnerable. There has been much talk recently about the feminization of the AIDS epidemic. Women make up a steadily increasing proposition of people infected by HIV. In Sub-Saharan Africa where our project is particularly focused, 57% of infected adults and 75% of infected young people are women and girls. This means that a woman in Sub-Saharan Africa is 3 times more likely to be HIV positive than a man. While women, young girls age 15 to 24 are 3.4 times more likely to be infected than their male peers. Women also bear the brunt of this epidemic’s impact. As traditional caregivers, women are more likely to assume care for an ill spouse or sick children or to take in orphans. Girls are more likely to leave school to take on domestic responsibility when their parents are ill or have died. Women’s lower social economic status and dependency on men also leaves them more vulnerable to the impact of HIV/AIDS, which is compounded in many places by discriminatory property and inheritance laws. Geeta Sodhi speaks eloquently about the importance of property and assets to change the dynamics.

Stigma discrimination is also harsher for women than for men. Many infected women have been blamed for spreading HIV, have been ostracized, thrown out by the families and communities and victimized for their HIV status. There has been less talk about the other type of feminization of AIDS. That’s what we’re talking about today. The fact that women are some of the greatest leaders in the response to this pandemic, in homes and communities around the world, women are already leading efforts through reverse spread of HIV and to care for those who are infected and affected. Don’t let us think we’re in the lead on this. Women in Asian countries on the ground are already leading, they carry the burden, what we can do is recognize that and use our leadership to link with that and to make a difference.

At the international level I would highlight several important women’s leadership initiatives. The newly formed Network of Women Health Ministers, which was launched in Geneva at the WHO assembly in May 2004, provides a platform for women’s health ministers from around the world to share ideas and experiences as they work to address the persistent inequalities in women’s access to basic health services, including HIV prevention and care services.

I want to say immediately, I was involved, wearing an invisible hat of being Chair of the Council of Women Who are Leaders. That was pretty awesome, but it was a body that I helped to form with another world power broker, that then woman president of Iceland, Vigdis Finnbogadóttír, who is a good friend. She was my role model when I was seeking election as President of Ireland and we combined with some other women leaders to form basically a club of visibility, of women who had been democratically elected as President or Prime Minister or who currently served or had served and there are 31 of us in the Council of Women World Leaders. We work with a ministerial assembly which Madame Albright chairs and it is a virtual assembly of women ministers in office and we’re linking them into networks. It’s a very active network of women ministers of the environment. The latest one that we formed is women ministers of health. I would be the first to say that not all women ministers of health are particularly good on this issue. I’ll say no more. But the importance of a network is its peer group pressure, it’s learning, it’s an intimate way of trying to encourage progress and together, women’s network can be very powerful. So it is very worthwhile.

I also want to point to another very strong leadership on HIV/AIDS. That’s the International Community of Women Living with HIV/AIDS. They were very visible in Bangkok. They were contributing at all of the discussions that we had. I have learned a great deal from a close association with the ICW, with women living with AIDS. They know and they bear the burden and their courage is unbelievable. They start with stories of terrible victimhood and discrimination and now knowing how to cope, because there are women who haven’t coped and they find within themselves, they dig terribly deep and suddenly they become powerful in their little circle. And their little circle becomes bigger and you find that these women are running something that involves thousands of women locally, out of nothing. Out of just the sheer capacity to cope with the situation they found themselves in.

Of course, at the other level, we’ve had recently the very important development of the Global Coalition on Women and AIDS, a number of us in this room, including myself, serve on the steering committee of that. What this Global Coalition of Women and AIDS established by UNAIDS and all the UN agencies is saying, we look to you, wider than UN to work with us but to be the motors of change. What we will do if this alliance in the Asian context works well, is link it very much with the UN Global Coalition on Women and AIDS. But it actually is also driving the ideas.

I want to take up something that’s been touched on, that is the youth of those infected, above all the youth of Asia. Half of all new HIV infections occur among 15 to 24 year olds. Which means that every minute, 5 young people worldwide become infected with HIV/AIDS. That’s more than 7,000 young lives per day. The heart of it are young women. Last year the UN found that roughly 7.3 million women, aged between 15 and 24 were HIV positive, compared with 4.5 million young men. In South Africa, 77% of infected youths were women. In many Africa countries, HIV prevalence is up to six times greater than young women among their male counterparts. One study in Kenya in 1998 found that 23% of young women were infected versus 3.5% of young men. 23% of young women who are going to be the mothers in Kenya. These are shocking statistics. We shouldn’t just take them as statistics, we should actually take a deep breath and understand what that means. What’s it like to be HIV positive at the age of 18 and wonder what happens when you become pregnant? Do you infect your child?

This gender disparity is in part driven by biological differences. But also by social norms and gender eccentricities that encourage sexual relationships between younger women and older men, which promote promiscuity and deter condom usage among men and leave young women economically dependent on men. In this context, many young women are unable to negotiate condom use or to refuse sex. Sex for food, education, shelter and it’s generation sex. It’s older men who think they’re entitled.

I’m particularly focused on Africa because that’s where I am focused, but I’m sure I’d be told it’s not much different in the detailed context in Asia. As UNICEF has said, the world’s 2 billion children and adolescents are at the center of the HIV/AIDS crisis and yet they are the ones that offer the greatest hope for defeating the epidemic. Young people are themselves, leading efforts around the world to prevent the spread of HIV through music, theater, video and other forms of creative expression. They find innovative ways to convey the key AIDS messages and I particularly wanted to say this here at the Asia Society, because I associate the Asia Society with a vibrant culture. Use your culture. Use the cultural means to influence the young. It’s your great strength. Young people don’t like to listen to political speeches, but they’re very influenced by good film, good theater, good drama, good comedy, whatever. I think during half time of a football game, at a church youth meeting, by hanging out on the street corner, they talk about sex, and they talk about relationships and how to stay safe in the world.

I do want to say a few words, also in the context of youth, and about the youth focused prevention efforts like all HIV/AIDS programs that it should rest solidly on a foundation of human rights. Human rights offer much more than principles to guide our response to HIV/AIDS. They also are among the most powerful tools to insure its success. A rights based approach to HIV/AIDS rests primarily on the fundamental right to health, based on the Universal Declaration on Human Rights and further enshrined in the International Covenant on Economic Social and Cultural Rights, in the Convention on the Rights of the Child, in numerous regional treaties, including the African Charter on Human People’s Rights, the additional protocol to the American Convention on Human Rights in and the area of economic, social and culture rights, the protocol of San Salvador and many constitutions. The interdependence and the visibility of rights means that the right to health is closely related to and dependent upon the realization of other human rights, including rights to food, to housing, to education, to human dignity, among others.

I will shorten what I could possibly say because we’ve got a great panel coming on stream. I want to tell you about a lesson I learned recently. Very personal lesson in context of not being a health expert or an AIDS expert in that sense, like some here. But rather somebody who is very interested in the way stigma and discrimination have been so devastating. I was sitting with a very small NGO in Clitia, the township outside Cape Town who are working on HIV/AIDS. They told me that they’re not happy at all with the way the AIDS issue is discussed at the international level. They said, what you hear is there needs to be access to testing and then quickly ARVs, why can’t we have antiretrovirals? This is shocking to us, because antiretrovirals are a very difficult, but necessary and rather poisonous prolonging at the end of a life after you’ve been diagnosed as HIV positive. And in between the whole band of time, it’s all about nutrition. Growing the right vegetables, using the right things that will prolong it. We don’t even think about this in our part of the world, because we have access to vitamin pills and right vegetation. But that is far more important than access to ARVs. Access to ARVs is also vital, I don’t want to let the drug companies off for one minute.

I’m just going to make one final remark and I’m not going to even talk about the Global Coalition on Women and AIDS, maybe somebody else will talk about that in the panel, but I do want to lead into what I hope Mary Ann Leper will talk a little bit about. She came to me a short time ago and asked me to join with her, and we’re doing it also under the Global Coalition on Women and AIDS and to actually bring the enormous energy, imagination, brain power, courage, determination and ruthlessness of top business women into this issue. I thought that was absolutely right. We need all of that combination. Particularly the ruthlessness. We have actually been very successful in starting and bringing together a steering committee, which will meet on Friday of this week, here in New York and we are working on two fronts. We are determined that the female condom will be recognized as the only effective current means of protection of women and Mary Ann, if you won’t mind me saying bluntly, it’s not very user friendly, it’s too expensive and it’s not very available. And she’s trying very hard on all three fronts, and she’ll tell you more about it. And microbicides. We have to completely change the dynamics in relation to microbicides. I’m in expert company on this. We need to make microbicides the new Viagra. They have to be as sexy to R&D, to really make change, as Viagra was. If we can’t do that, there’s something wrong. Because Viagra is for men’s pleasure. Microbicides save women’s lives.

That’s my message. Thank you.