ACTIONS, PAST AND PRESENT

PREVENTING HIV/AIDS

Situation Sexual behaviour is the most important determinant of the spread of HIV and surveys show that generally, men have more sexual partners than women.


As the prevalence of HIV infection increases in the general population, a higher number of people - particularly women - become infected. Often these women are married women whose husbands have had unprotected sexual relations outside marriage. This has been shown in Rwanda where an increasing proportion of women with HIV have their regular partner or husband as their only sexual contact.

The mainstream measures aimed at stopping the sexual transmission of HIV such as using condoms consistently and correctly, sexual abstinence, and access to appropriate treatment for STDs are not effective by themselves alone, especially in developing countries. These measures should be implemented in combination with empowerment of women so that women are able to control their lives, particularly decision making in reproductive and sexual matters. By the year 2000, for instance, more than 10.3 million young people were infected with HIV, of whom nearly two thirds were girls and young women.

When women with HIV get pregnant, the risk of a baby acquiring the virus from an infected mother ranges from 15 to 25 per cent in industrialised countries and from 25 to 45 per cent in developing countries. Mother-to-child transmission accounts for more than 90 per cent of all infections in infants and children.

When these children outlive their parents who die of AIDS, they become orphans. Over 8 million children under age 15, most of them in Sub-Saharan Africa, have lost a mother or both parents to AIDS since the beginning of the epidemic. The number of these 'AIDS orphans' is projected to double in the next two years and to reach 40 million by 2010.

'AIDS orphans', without parents to protect them, are more likely to die not only from AIDS but from other causes ranging from traumatic injuries to malnutrition and infectious diseases. If these children with HIV survive, they tend to drop out of schools more than others in their age groups. Further, they have to support themselves and take on adult responsibilities in the home, if they stay. Studies show that these orphans are more likely to leave home or lose their homes.

A large burden to supporting orphans will fall on grandparents and other family members. With family systems already under stress from the impact of the AIDS pandemic, one result is the growing numbers of street children.

Actions New goals were adopted during ICPD + 5 and again reiterated at the 2001 UN General Assembly Special Session on HIV/AIDS to:

• provide access to the means to prevent and control HIV/AIDS to least 90 per cent of young people aged 15 to 24 by the year 2005 and 95 per cent by the year 2010; and
• reduce HIV infection rates in persons 15 to 24 years of age by 25 per cent in the most affected countries by the year 2005 and globally by the year 2010.

To contribute to achieving these goals, UNFPA's overall thrust has been prevention of HIV/AIDS among young people. Thus, UNFPA's major strategies are directed towards empowering women, ensuring wide access to both male and female condoms, sensitising boys and men to share responsibility for protecting their own and their partners' health, and prevention of infection in mothers and transmission to children (PMTC).

Behaviour Change UNFPA has supported strategic information and communication campaigns designed to enable girls and boys, women and men to alter their sexual behaviour, such as avoiding unprotected sex, learning negotiation and decision-making skills to prevent unwanted sexual relationships, exploitation and violence.

In Cambodia, where HIV infection is rising, UNFPA, in collaboration with the European Commission, HIV/AIDS Alliance of London, and KHANA, a Cambodian NGO, use innovative means to reach out to young people. From a boat on the Mekong River, the organisers have staged plays which have been attracting large audiences of young people. During these plays, the organisers inform young people about HIV/AIDS and distribute free condoms and T-shirts.

Another creative project, this time using religious channels, is found in the Maldives. Every Friday, sermons are broadcast live on radio which are powerful channels for reproductive health advocacy.

One other initiative using the radio is an information programme on adolescent reproductive and sexual health that is being carried out by the Voice of Viet Nam, with technical assistance from the BBC and financial support from UNFPA. Broadcast every Sunday morning, the call-in programme involves a panel of experts who answer questions on reproductive health, sexuality, and related topics.

Peer educators in Albania reached more than 1,500 young men and women aged 15-24 as part of a UNFPA-supported project in 2000 that also sold 1.3 million condoms. Social marketing targeted young people and soldiers.

Men's Participation Boys and men play a critical role in preventing the transmission of HIV. Thus, UNFPA has been encouraging men to participate in programmes. Involving boys and men will not only help prevent HIV infection but will also help delay their first sexual intercourse, promote safe sexual behaviour including abstinence, and increase consistent and correct condom use. UNFPA has given its full support towards involving boys and men and it has done this through several innovative ways.

In the Arab States Region, Boy Scouts are learning how to prevent HIV infection, other STDs and pregnancy. Training in interpersonal and counselling skills and sensitivity to gender are an important part of the project. For boys attending the recent 19th World Jamboree in Chile, workshops were held to raise awareness of these issues and related topics such as adolescent health and development, marriage and family issues, ethics and values, and the roles of women and men.

Barbershops in the Dominican Republic provide an added service for clients: advice on how to prevent HIV infection, condoms for sale, and referrals to STD clinics. The barbers, who receive training in interpersonal communication and how to demonstrate correct condom use, have reached half a million men with their preventive messages.

In Ghana, workplace clubs for men are a source of information on reproductive and sexual health. Called Daddies' Clubs, they are focal points in a regional project of the Planned Parenthood Association of Ghana and the Ministry of Health. With the co-operation of company management, fieldworkers and nurses present weekly talks followed by group discussions and videos. Some club members have received training to promote and sell condoms to club members and others at work and in their communities.

The Ministry of Defence in Ukraine launched an education project in the year 2000 with support from UNFPA. Training in prevention of HIV and counselling were provided to 210 military psychologists who then reached 20,000 soldiers. Curricula were prepared for military educational institutions; booklets, and posters were produced; and condoms were distributed to soldiers and officers.

Empowering Women UNFPA recognises that improving women's status within the household and the community at large is critical to preventing the spread of HIV. In order to reduce the risks of unprotected sexual intercourse to young girls - which leads to adverse consequences such as HIV/AIDS and STDs and unwanted pregnancies, UNFPA supports initiatives to empower girls and women, inform them of their reproductive rights, and provide them with reproductive and sexual health services.

In the occupied Palestinian territories, UNFPA helped establish a women's centre in the Al Burey refugee camp in Gaza. The centre offers comprehensive reproductive health services and social assistance and counselling on women's rights, including reproductive rights.

Volunteers distributed information on HIV/AIDS and other STDs and contraceptives, including condoms, to 80,000 women of reproductive age in Kazakhstan. The results were striking: the abortion rate decreased; contraceptive use increased; and women gained knowledge about reproductive health. Declines in the rates of maternal and infant mortality in the project areas were also reported.