Women and AIDS
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| Source: Mike Jay Browne/Photoshare |
Responding Globally
U.S. President’s Emergency Plan For AIDS Relief Launches New Initiative for Young Women - 10/29/07
Women and girls make up a growing proportion of those
infected by HIV/AIDS. At the end of 2004, UNAIDS
reported that women made up almost half of the 37.2 million
adults (aged 15 to 49) living with HIV/AIDS worldwide.
The hardest-hit regions are areas where heterosexual
contact is the primary mode of transmission. This is most
evident in sub-Saharan Africa, where close to 60% of adults living with HIV/AIDS are women.
The United Nations estimates that every day 6,000 young
people aged 15 to 24 become infected with HIV. A staggering
two-thirds of these new cases are adolescent women.
Economic, social, and cultural factors contribute to the disparity
of new HIV/AIDS cases between men and women.
As the lead U.S. government agency responsible for economic
assistance and humanitarian relief in the developing
world, the U.S. Agency for International Development
(USAID) is proud to be a partner in President Bush’s
Emergency Plan for AIDS Relief, announced in 2003.
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| Since the inception of its international HIV/AIDS program
in 1986, USAID has supported activities that address issues
facing women and HIV/AIDS. From almost 100 bilateral
programs to the President’s Emergency Plan for AIDS
Relief, USAID has worked consistently to help women and
girls gain control of their economic and social lives. |
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The Emergency Plan aims to support treatment for at least two million people living with HIV/AIDS, prevent seven million new infections, and support care for 10 million people infected with and affected by HIV, including orphans and vulnerable children.
A cornerstone of the President’s Emergency Plan is
accountability for results that achieve specific goals for prevention,
care, and treatment. USAID worked in collaboration
with other U.S. agencies to develop reporting indicators
that will count people receiving services, disaggregated
by sex. For example, these data will show the number of
women who participate in behavior change programs and
receive antiretroviral therapy and palliative care in each of
the 15 focus countries.
Prevention
USAID seeks to provide additional tools and a supportive
environment so women can protect themselves from HIV
infection. Gender norms contribute significantly to challenges
and needs women face with respect to HIV prevention.
For many women, “fear of sexual coercion and violence
often precludes the option of abstinence or holds
them hostage to their husband’s infidelity.”¹ Recognizing
that positive male involvement in HIV prevention efforts is
crucial for changing the course of the epidemic, USAID
continues to support programs such as the Men as Partners
(MAP) initiative. This program works to positively involve
men in maternal health, family planning, and HIV prevention
around the world. MAP encourages men to address
behaviors that conform to social norms about masculinity
but have potentially adverse effects on their own health and
the health of their partners (the idea, for example, that “real men don’t go to the doctor when they’re ill”). In
South Africa, men participate in MAP workshops where
they first link male social norms such as gender-based violence to HIV transmission and then work toward an understanding of how to shift gender norms on individual
and community levels toward healthier behaviors.
Prevention programs must also help young women develop
skills and have access to information and tools. In some
African settings, young women aged 15 to 19 have HIV
rates six times higher than young men the same age. In
contrast, older men tend to have much higher rates of HIV infection, suggesting that intergenerational sexual relationships
may contribute substantially to new infections in
many parts of the world. Poverty and vulnerability to sexual
exploitation and coercion put girls at risk, and economic
factors also influence girls to trade sex for money or other items of value and have relationships with older, more sexually
experienced men. USAID helps communities recognize
and address social norms that put young women’s
health in jeopardy. The Kenya Girl Guides Association
(KGGA) promotes HIV/AIDS prevention among girls
and young women through peer education, life skills
training, and outreach activities such as theater and awareness contests. The KGGA program has mobilized a
broad range of community leaders to support HIV/AIDS
programming for youth, especially for young girls who are
not yet sexually active.
See More:
Prevention of Mother-to-Child HIV Transmission (PMTCT)
In 2002, President Bush announced a new $500 million
International Mother and Child HIV Prevention Initiative
that seeks to prevent mother-to-child transmission of
HIV/AIDS (PMTCT) and to improve health care delivery
in Africa and the Caribbean. By improving care and drug
treatment and building health care delivery capacity, this
new effort is expected to reach up to one million women
annually and reduce transmission of HIV from mothers to
infants by 40% within five years or less in 12 African countries
and the Caribbean.
USAID has carried out PMTCT programs since 1999.
Primary interventions include improvement of antenatal
services; short-course antiretroviral prophylaxis for HIV-infected
pregnant women; support for safe infant feeding
practices; and strengthening of health, family planning, and
safe motherhood programs. USAID’s PMTCT programs also work with young men. Programs that encourage male
partners’ support of PMTCT offer an opportunity to
increase men’s involvement in maternal health, as well as in
the counseling and testing process and, as necessary, care
and treatment. USAID has PMTCT programs in 26 countries
in every region of the world. In 2004, one project
reached more than 220,000 women with PMTCT services,
providing 22,340 women with antiretroviral prophylaxis to
help prevent transmission of HIV to their children.
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As part of USAID’s “PMTCT Plus” programs, 2,868 women
at 12 sites in Africa and Thailand, and 764 adults and 1,908
children in their households, have been identified as eligible
for HIV care and/or treatment. Currently, 1,013 adults
(28%) and 129 children (7%) receive highly active antiretroviral
therapy (HAART), and the others are receiving care
and being monitored for HAART eligibility. |
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See More: Care
Women bear the greatest burden of HIV/AIDS care. Left
unmitigated, this burden threatens the sustainability of
communities and families. A study in the village of
Kagabiro in Tanzania demonstrated that in two-thirds of
the cases where a household included someone with AIDS,
two females were devoted to nursing duties and that on
average the total labor lost to the household was 43%.
These women and girls who shoulder the care burden often
do so with little training, material, or moral support.² In
two northern Zambia provinces, youth at community clubs received training in caring for people living with
HIV/AIDS. Male and female caregivers provided similar
kinds of services, not limited to expected gender roles.
Caregivers reported a decrease in perceived community
stigmatization of families affected by AIDS. Additionally,
caring for people living with HIV/AIDS had a positive
effect on the trained youth.
One of the tragic consequences of HIV/AIDS is the toll
on children. Globally, approximately 2.2 million children
under age 15 are living with HIV/AIDS. In 2003, more
than 15 million children under age 18 had lost one or both
parents to AIDS. Girls in affected families not only have to
deal with grief and abandonment, but often leave school to assume added burdens, such as nursing a dying parent,
raising younger siblings, running the household, or replacing
a breadwinner.
In response, USAID currently has 102 programs in 27
countries in support of orphans and vulnerable children.
Program activities include psychosocial support, educational
support, HIV prevention, income generation, and health
care. In the Dominican Republic, the Global Orphan Project/Promundo unites family and community groups to
assist children affected by HIV/AIDS, including HIV-positive
children. In 2004, pilot activities identified more than
1,000 vulnerable children and delivered 2,100 direct services
(medical, psychological, education, legal, food, clothing,
etc.). Today, program enrollment continues to increase by
10 to 20 vulnerable children a week. Pilot activities also test
techniques of family case management, microcredit, and microenterprise. An additional 1,000 families affected by
HIV/AIDS (including 2,000 children affected by
HIV/AIDS) benefited from microenterprise and microcredit
programs during 2004.
Women’s ability to care for themselves and their loved ones
can be strengthened through access to economic opportunities.
More than 800 million women worldwide are economically
active in agriculture, small and microenterprises,
and, increasingly, in the export processing industries that drive globalization. More than 70% of these women live in
the developing regions of Asia, Africa, and Latin America.
Women’s unemployment rates remain high relative to those
of men, and when employed, women receive less pay than
men for the same work. It is not surprising, then, that
women constitute 60% of the rural poor. In 2004, USAID
began funding Positive Partnership, a program in Bangkok,
Thailand, that gives small loans to teams of two people,
one of whom is HIV-positive and one HIV-negative. The
program aims to encourage entrepreneurship and reduce
the stigmatization of people living with HIV/AIDS by
associating them with successful businesses and incorporating
them into the community.
Ensuring equitable inheritance and property rights is a key
element to increasing women’s economic and social status
and mitigating some of the effects of the HIV/AIDS epidemic.
In Kenya, women account for 80% of the agricultural
labor force and generate 60% of farm income, yet own only 5% of the land. In 2004, USAID initiated “Women and Inheritance: A Framework for Action,” an
advocacy project with the goal of supporting policy
changes to promote and protect women’s inheritance and
ownership rights in Kenya. Today, the project is working
with local groups to help them develop a shared critical
analysis, a vision for change, and a strategy for action.
Treatment
Women often face limited access to services and treatment.
Key barriers include lack of control over decision making;
the need to have male permission to seek services; and
fears of the stigma and discrimination that communities
direct toward HIV-positive women. Further, as treatment becomes more available, both men and women may give
men the priority for access to medication.
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Of the 9,885 persons receiving clinical care through U.S.
government-funded treatment programs in Ghana, Kenya,
and Rwanda, 6,410 (65%) are women.
Of the 3,147 persons receiving antiretroviral therapy
through U.S. government-funded programs in Ghana,
Kenya, and Rwanda, 1,943 (62%) are women. |
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In partnership with the President’s Emergency Plan,
USAID seeks to ensure that as access to treatment increases,
potential inequities are avoided. Strategies to ensure
equitable access include community education to support
treatment for women; comprehensive workplace policies; costing schemes that account for economic constraints; and
involvement of women leaders and women living with
HIV/AIDS in developing treatment program designs and
protocols, delivery mechanisms, and evaluation and monitoring
activities.
Research
To complement current prevention, care, and treatment
interventions, emerging technologies and research must
address the specific needs of women.
USAID is supporting the development of chemical barriers
known as microbicides to stop HIV transmission. If effective
microbicides are developed, they could become important
female-controlled methods for preventing HIV infection.
Microbicides could also be an effective tool for HIV-discordant
monogamous couples, among whom condom
use is typically low with the woman often at risk. For more
than a decade, USAID has been essential in shaping the
strategic direction of this program and leveraging and coordinating
the intellectual, proprietary, and financial capital of
a host of contributors.
USAID is working with governmental and nongovernmental
partners, including the National Institutes for Health
and Centers for Disease Control and Prevention, to
advance the development of a vaccine against HIV.
USAID has funded the International AIDS Vaccine
Initiative (IAVI) since 2001, understanding that women’s
health needs must be part of research and development.
IAVI is taking key steps to integrate gender in AIDS vaccine
trials by forming a gender advisory board, developing
gender-sensitive guidelines and protocols, training trial
teams to be gender-sensitive, and establishing accountability
mechanisms.
Gender-Based Violence Encouraging education for both men and women is one
step toward curbing gender-based violence associated with
HIV/AIDS. In a USAID-funded study in Dar es Salaam,
Tanzania, more than one-fourth of female voluntary counseling
and testing (VCT) clients agreed with the statement “Violence is a major problem in my life.” HIV-positive
women were 2.68 times more likely than HIV-negative
women to have experienced violence from a current partner.
The study suggests that fear of physical violence was a
principal deterrent keeping women from accessing VCT
services and disclosing their status.
USAID seeks to address risks of partner violence by
developing and implementing counseling and treatment
initiatives. As counseling and testing sites are often integrated
with PMTCT services and antenatal clinics, women are
likely to be the first person in the relationship to learn their
HIV status and may face unfounded blame for bringing
HIV into the family. The AIDS Information Center of
Uganda has changed its timing of notifying couples of
their test results in order to address these dynamics.
Additionally, USAID-supported demographic and health
surveys in developing countries include questions on
domestic violence and women’s empowerment, allowing for
in-depth analyses of the consequences of gender relations
within households.
Leadership
Looking toward the future, women must continue to
emerge as community leaders to engender political support
for quality AIDS programs in their countries. In Tanzania,
USAID supported community activist Lediana Mafuru’s
efforts to work with a coalition of HIV/AIDS advocacy organizations to reduce HIV-related stigma and discrimination.
Recognizing Lediana’s other potential contributions to
the fight against HIV/AIDS, USAID sent her to a leadership
training program. Soon after completing the training,
Lediana won election to Tanzania’s National Parliament.
Today, she is an elected leader of the Tanzania
Parliamentarians AIDS Coalition, helping to ensure the
proper allocation and use of national resources.
In addition, women’s groups offer a forum to learn from
each other while building capacity and reducing stigma and
discrimination. In Rwanda, PRO-FEMMES, the national
women’s umbrella group, developed and implemented a
mass media campaign that reached more than 800,000 women and girls with messages addressing stigma, discrimination,
and empowerment of girls.
Using the models above and multifaceted strategies from all
around the world, USAID’s programs continue to help
women and girls build lives from the shadows of
HIV/AIDS. In 2005, USAID will publish a series of briefs
that will document these best practices.
¹ The President’s Emergency Plan for AIDS Relief, U.S. Five-Year Global HIV/AIDS Strategy, p. 27
² UNAIDS fact sheet
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