"Gender and HIV/AIDS: Reinforcing the National Response", Statement at the Fifth Regional Conference of African Women Ministers and Parliamentarians in Sal, Cape Verde

15 October 2002
Author: UNFPA

Good morning. It is a pleasure to be here in Cape Verde for the first time. I would like to personally thank the Government of Cape Verde for hosting this important, and timely, Conference. I would like to express my deep gratitude to the President of the Republic of Cape Verde, Mr. Pedro Pires, for opening this important meeting. His presence and his words demonstrate his commitment to the issues of gender empowerment and HIV/AIDS and move us to commit ourselves as well in this war against the deadly disease.

Certainly it is an honour to be here with African Women Ministers and Parliamentarians for their Fifth Regional Conference and my first time participation in this important gathering. I truly believe that women leaders have an indispensable role to play in effectively addressing the many challenges we face today, especially the issues of gender and HIV/AIDS. It is my hope that this Conference will prove useful in focusing the issues, in sharing experiences and success stories, identifying challenges, generating concrete recommendations and strategies, and providing the advocacy tools needed to move forward with energy and commitment.

I would like to extend a warm welcome and thank you to the Special Representative of the Secretary-General, Mr. Stephan Lewis, who has generated so much energy through his work and words. Thank you goes also to the African Union and the Economic Commission for Africa who have worked closely with us to ensure that HIV/AIDS has its visible position in New Partnership for African Development (NEPAD). I also welcome the regional directors of our sister organizations and The World Bank and other colleagues who are with us for the next few days. My special thanks goes to the United Nations Resident Coordinator, Mr. Joseph Byll-Cataria, who has been supportive, not only of this conference, but of UNFPA's work in Cape Verde. It is most encouraging that all of you chose to come to this Conference to discuss, and more importantly, to take action on this most important subject, "Gender and HIV/AIDS: Reinforcing the National Response".

HIV/AIDS and Gender in Africa

Before we can move forward, we must look at where we have been. Just 12 years ago, the number of women and men in sub-Saharan Africa infected with HIV was roughly equal-totalling about 3 million people. Today, the number of people living with HIV/AIDS in the region has increased nearly tenfold, to 28.5 million citizens, and women and girls are bearing a growing and disproportionate burden of the disease.

Sub-Saharan Africa is the only region in the world where more women than men are suffering from HIV infection and dying of AIDS. Six women now live with HIV for every four to five infected men. For teenagers, that risk is even higher. In some areas, young women account for 60 per cent of all new infections.

According to UNAIDS, one-third to one-half of new mothers in the worst affected countries could die of AIDS in the coming years.

Your Excellencies, ladies and gentlemen, I do not need to repeat what we all already know -- the human, social, economic, political, and demographic consequences of this pandemic are hard to imagine and have yet to be fully absorbed. And what makes matters even worse is that young women themselves, who are so vulnerable to HIV infection, know so little about HIV/AIDS, and oftentimes what they do know is nothing more than myth.

The stories we continue to hear demand an urgent response.

Stories of girls being raped in the belief that sex with a virgin cures AIDS.
Stories of women who feel they cannot ask their husbands to use a condom.
Stories of rape and deliberate HIV infection used as instruments of war.
Stories of young women forced into prostitution or marriages against their will.
Stories of teenage girls with "Sugar Daddies" who bear gifts and HIV infection.
Stories of wives who are infected by their husbands and fear they will be beaten and thrown out of their homes.
Stories of girls pulled out of school to care for sick relatives.
Stories of AIDS orphans forced out on the streets.
And stories of AIDS widows who are neglected and shunned.
The stories I have just recited are not inevitable. And I would like to stress that for every negative story, there are several positive ones that are homegrown on the African continent and that demonstrate courage and commitment to deal with HIV/AIDS. I would also like to stress that the greatest resource that Africa has to fight this disease is its people. From the highest level to the grassroots level, it is people who will turn this epidemic around. Working together in partnership with the international community, people can, and have, saved countless lives and stopped the disease from spreading. However, today, global prevention efforts reach fewer than 1 in 5 of those at risk.

We all know that the response to the HIV/AIDS pandemic has not been sufficient. We know this because the virus continues to spread. The threat presented by AIDS to Africa cannot be overstated. Life expectancy has fallen by between 18 and 23 years in the worst affected countries; malnutrition has risen; immunization rates have dropped; more than 14 million children have been orphaned by AIDS, 95 per cent of them in Africa, four million have died of AIDS since the epidemic began. The death of teachers and health workers from AIDS is wreaking havoc on social services that are crucial to welfare and development. And the growing famine across southern Africa, putting 14 million people in urgent need of food, is exacerbated by HIV/AIDS, which is causing agricultural productivity to decline, forcing children to drop out of school, and placing an extraordinary burden on families and health systems. It is safe to say that governments that fail to respond with comprehensive large-scale national programmes are not only facing the prospect of millions of sufferers, but of the very fabric of their societies coming unravelled.

Just as greater resources are needed from the international community, greater efforts are also needed at the national level. As Ministers and Parliamentarians, you have a vital role to play in stopping the spread of HIV/AIDS. You are close to your communities and you are close to the top leadership in your countries. If ever there was a challenge for the Network of African Women Ministers and Parliamentarians, this is surely it.

Now is the time for leadership. Greater leadership is needed to break the silence and stigma surrounding AIDS, to open up space for dialogue and discussion, to mobilize the resources and communities to respond to the crisis, and to scale up prevention activities so that information and services spread faster than the HIV virus itself spreads. The only way we are going to turn the tide is by scaling up programmes to reach all those at risk-in cities and in villages, and by actively addressing obstacles to prevention that must be overcome. These obstacles include poverty, cultural norms and practices, gender power imbalances, and violence against women and girls.

Just last week I was attending the World Faith Development Dialogue, an interfaith dialogue, that was sponsored by the President of The World Bank, Jim D. Wolfensohn, and the Archbishop of Canterbury, His Grace George L. Carey. The meeting was held to discuss ways in which faith-based institutions and development agencies can work together to scale up responses to the implementation of the Millennium Development Goals, which has poverty reduction as its heart, with a focus on decreasing maternal and child mortality as well as stopping the spread of HIV/AIDS.

A special session was held dealing with the responses of faith-based institutions and religious leaders to this devastating epidemic, especially on the African continent. It was very clear that these institutions are doing much to deal with this disease but we need to join hands, respecting each other's spaces for action yet linking to each other in a cohesive way. It is clear that no one group alone can stop and/or prevent this disease or provide care for those living with HIV/AIDS or support the orphaned children and the many family members who are taking care of them. Therefore, we all need to join hands, government officials at the highest level, you Mr. President, Your Excellencies the Ministers and Parliamentarians, civil society organizations, the private sector, and community and religious leaders. We need to work together in each country in such a way that our work reinforces each other and that we are able to generate maximum impact. We need to work together because the disease is faster than our action and does not care about our debates and differences. We need to find ways to overcome our differences; because, we are not engaging in a philosophical debate. It is our collective moral and national duty to ensure that the action on the ground, in each community, is part of a national strategy and action plan that allows us to form a formidable army to face the real enemy of the people. Only if we join hands can we scale up our actions and without scaling up our response, we will fail in our struggle against this enemy.

Without a cure, our first line of defence is prevention. Young people, pregnant women, and citizens caught in emergency or conflict situations must be urgently targeted for prevention and treatment.

Most women of childbearing age are highly vulnerable to HIV/AIDS because they lack the power and the means to protect themselves from infection. Today, women's lack of economic, social, legal and political equality seriously hinders HIV prevention efforts. In particular, gender inequality often makes it difficult for women to negotiate condom use and safer sex with their partners or leave abusive relationships. Women's social and economic disadvantages also make them less likely to obtain needed services, such as voluntary counselling and testing, reproductive health care and HIV prevention services. And gender inequalities also place a greater burden of the impact of AIDS on the shoulders of women and girls, who remain primary caregivers at a time when caregiving is in great demand.

Role of UNFPA

UNFPA is working tirelessly to provide support for preventive measures against the spread of the infection, and leadership and advocacy for effective, affordable treatment and care of affected people and their families. UNFPA supports efforts to ensure that every young person knows how to avoid infection and has access to services. We support programmes to help pregnant women protect against infection so they remain HIV-free and their babies do, too. And we are working to ensure that condoms are readily available and are used consistently and correctly.

In the past decade, our involvement in HIV prevention has risen dramatically. Today, we support HIV prevention projects in over 100 countries.

One of the exciting partnerships in which we are involved is the African Youth Alliance in Botswana, Ghana, Tanzania and Uganda. Our goal is to help these four countries reduce rates of HIV/AIDS, other sexually transmitted infections, and pregnancy among young people and to promote the delay of sexual activity, the use of condoms by youth who are already sexually active, and the elimination of harmful traditional practices and forced and coerced sex.

A cornerstone of UNFPA's HIV prevention efforts is condom programming, linked with gender-specific programmes to teach negotiation skills with a partner. One aspect of this is the introduction and promotion of female condoms. Since 1999 more than 19 million female condoms have been supplied to several countries in Africa, Asia and Latin America through joint efforts with UNAIDS, WHO and the Female Health Company.

UNFPA is also working to expand and integrate services to prevent HIV and sexually transmitted infections into existing primary health care facilities, and reproductive health centres including family planning and maternal-child health clinics in order to make these services available and accessible to more people.

We are also working with a broad range of partners to ensure that HIV prevention and reproductive health are integrated into humanitarian response and post-conflict operations. In war-shattered Sierra Leone, where HIV/AIDS is rapidly spreading, UNFPA and other UN agencies and NGO partners are working to provide HIV prevention information, services and skills to girls and women who were abducted and raped during the conflict, to war affected youth, and to UN peacekeepers and uniformed personnel.

Lessons Learned

Since the AIDS pandemic started two decades ago, many lessons have been learned. First, it is clear that effective HIV prevention programmes must be carefully tailored to the particular social and economic settings in which they are implemented and to the specific needs and values of the target population. It is important to involve members of the target group in the design and implementation of projects in order to ensure their cultural relevance and success.

Secondly, proven interventions should be supported with much greater efforts to reduce stigma and silence, encourage open discussion, reduce poverty, and promote gender equality and human rights, including reproductive rights.

Third, it is clear that multiple strategies must be developed simultaneously to reduce vulnerability to sexual coercion, and to increase social and economic power for women and girls. Strengthened income-generating activities such as micro-finance to promote economic autonomy, universal education for girls and incentives to keep girls in school, literacy training, and enactment and enforcement of laws to promote gender equality and prevent violence and other forms of abuse are necessary to reduce women's vulnerability to HIV infection.

Fourth, if we are to win the battle, all institutions at the national and community must work together to ensure maximum impact and scaling-up of the responses.

And fifth, we must empower those living with HIV and AIDS to be part of the struggle against this deadly disease, for they know what they need and how to go about it with sensitivity and effectiveness. We must hear their voices and their views and we must bring them into society and support them to remain active members. It is through inclusion, and not exclusion, that they will be strengthened to continue their various responsibilities and obligations. It is their right to remain active and productive members of their communities.

Also needed are parallel strategies for boys and men that are designed to alter the negative attitudes and behaviour towards women that they learn from some of the social practices and cultural values that discriminate against women. In many countries, prevailing gender relations are also placing men at greater risk of infection. Enabling boys and men to challenge negative masculine stereotypes supports them in resisting unwanted peer pressures and taking greater care of themselves and their partners. To put it in simple terms, we would have succeeded in changing the behaviour of boys and men when they ask themselves: is this the way I want my mother, my sister, or my daughter to be treated? It is the human right of girls and women to be free from coercion, violence, disease, and fear and boys and men need to learn this and to practice it in their daily lives.

It is also necessary to intensify HIV prevention technologies to ensure that they are easily available to women and men and, most importantly, to young people. Male and female condoms must reach those in need who are sexually active as part of the ABCs of prevention: Abstinence, Be Faithful and Condoms.

Together, we must scale up gender-sensitive efforts to reach communities that have been affected by conflict and disaster. Refugees and displaced persons are at increased risk of HIV/AIDS, other sexually transmitted infections and sexual violence, and they need services that meet their specific needs.

Future Strategies

Overall, as we look to the future, we should approach the prevention of HIV/AIDS not simply as a health issue but as a development challenge-a challenge to reduce poverty, reverse the spread of HIV and promote reproductive health and the empowerment and autonomy of girls and women. Programmes that identify and address the effects of gender-based disadvantages and promote employment and income-earning will make a difference and lead to assertiveness for self-care and protection from HIV/AIDS.

Special efforts must be made to reach and involve all young people, pregnant women and communities caught in crisis. Today the median age in Africa is 18 and 63 per cent of citizens, nearly two in three, are younger than 25. They are in desperate need of reliable and factual information and quality services.

Efforts aimed at reducing the number of sexual partners, delaying initiation of sexual activity, and encouraging condom use are essential. Although safer sex programmes often encourage young people to remain abstinent, research indicates that comprehensive services offering a full range of information and services are more effective in reducing HIV risk than programmes that only promote abstinence.

Working together, we must ensure compliance with international agreements such as the Convention on the Elimination of Discrimination against Women, the Programme of Action of the International Conference on Population and Development and the ICPD+5 Key Actions, and more recently the HIV/AIDS Declaration of Commitments. These agreements provide a rights-based framework for systematically addressing the gender dimensions of HIV/AIDS and they also provide benchmarks for monitoring progress.

Finally, we must ensure adequate funding for national HIV/AIDS programmes that cut across sectors. The Global Fund for AIDS, the African Union and its New Partnership for African Development, the UN system, donor governments, and programme country governments must work together with local communities and their leaders to ensure that the proper resources are not only mobilized to fight HIV/AIDS but also that they are properly spent to save human lives, meet human needs and promote human rights.

In conclusion, I would like to reassure all of you here today of the strong support of UNFPA and our commitment to work hand in hand with you to reverse the spread of HIV/AIDS and to ensure that the human rights of women, men and their families for a life free of want and free of fear are achieved.

Thank you.

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